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Malnourished Systems: Why India's Child Development Programme Is Getting Stunted

26/01/2017 1:08 PM IST | Updated 26/01/2017 1:22 PM IST
Stringer India / Reuters

Somewhere in Chhattisgarh, in the summer of 2015, an anganwadi worker lamented the hours spent maintaining countless registers: "Kagzi karyawahi me sara time chala jata hai, jiske karan Kendra ke mukhya kaam me dhyan nahi de pate (Paperwork and procedures take up all our time, and work suffers)." Around the same time, a district programme officer for the Integrated Child Development Services (ICDS) scheme in the state revealed that there is hardly any administrative emphasis from the "higher levels" on monitoring of anganwadis: "No one looks at the monitoring reports they prepare so strictly." It is this mismatch in administrative priorities and hierarchies which impacts the health and nutrition levels in India.

The mismatch in administrative priorities and hierarchies impacts the health and nutrition levels in India.

Nearly 40% of Indian children are stunted, while close to 30% are underweight. Our maternal healthcare system is not performing well either—the country's maternal mortality rate (MMR) of 174 deaths per 100,000 live births is still very high when compared to countries such as China (27) and Sri Lanka (30)2. The ICDS, which is one of India's largest and longest standing government programmes, seeks to fill these gaps through its provision of food, preschool education and primary healthcare to children under 6 years of age, as well as its delivery of nutritional services for adolescent girls and young mothers.

To ensure continued effectiveness in the scheme's implementation, a transparent and well-maintained monitoring system is critical. Though the government has instituted management information systems (MIS) to enable this, these fall short of the required level of rigour. Accessibility to this data is important so citizens can hold their government accountable—money collected from the Indian public must be used efficiently to provide us with the goods and services we require.

It can also be very hard to track money when linkages are established across schemes—what the government refers to as "convergence". Some of the ICDS programmes for example, are run by the Department of Health and Family Welfare. Following the path of the money for these, however, is extremely difficult as they change hands a lot and the channels of exchange are extremely cluttered. To add to the confusion, information on funds in transit is not available. Ironically, the argument for convergence is that it's a more "efficient" use of funds. In our experience, however, the absence of coordination and clearly defined roles and responsibilities yields more confusion than productivity.

To support the movement towards better data, efforts such as those by Accountability Initiative (AI) are being made from various quarters to pressurise the government to be more transparent. Many a time, however, roadblocks are faced. For instance, the ICDS's flow of funds from the union to the local level of government is extremely difficult to track. Accessing state share data in order to track releases has proved impossible, as has knowing what is being spent as part of the scheme at the local level. On occasion, when the government is contacted or an RTI is filed, the response received is that the data does not exist, which is extremely worrying in any scenario—both if the government does not know how to access it, as or if they're trying to hide it.

Citizen-led engagement can be crucial in addressing data opaqueness and building accountability that stems from the bottom up.

Despite these difficulties, in order to overcome issues of data availability, citizen-led engagement can be crucial in addressing data opaqueness and building accountability that stems from the bottom up. In 2015 for instance, AI undertook a survey of 300 anganwadi centres (AWCs) spread across 10 districts in five Indian states (Bihar, Madhya Pradesh, Rajasthan, Maharashtra and Himachal Pradesh). The survey, which tracked fund flows to anganwadi centres, led to a number of crucial findings:

  • The annual grant to which each AWC is entitled had reached only 42% of the centres surveyed in December 2015. Moreover, only 57% of those that received the grant had spent it at the time of the survey.
  • Though nearly 80% of anganwadi workers (AWWs) and 81% of anganwadi helpers (AWHs) received their honorarium on time in FY 2015-16, 8% of AWWs and 7% of AWHs reported a delay of more than four months in receiving it.
  • Shortfall and delays in grains (cash and kind) were also high in FY 2015-16. 14% of the AWCs surveyed reported shortfalls in grains in December 2015, while 38 per cent Self Help Groups reported delays in receipt of grains.
  • The uniforms (or a corresponding allowance) mandated in the ICDS had reached only 64% AWWs and 62% AWHs by December 2015.
What gets lost is how hard it is for the government to know the situation on the ground... and that is where citizen-led accountability comes in.

Data, thus, is available at the local level. The anganwadi centres have sufficiently consolidated information on attendance, fund flows, infrastructure facilities and so on. When this data is collected and presented to government officials, they are often surprised by the situation on the ground. In a recent presentation of our findings to a district magistrate in Himachal Pradesh, for example, the officials present expressed concern over the fact that a high proportion of anganwadis were being run from rental accommodations and issued an immediate directive to shift the functioning of such centres to empty school rooms.

There are multiple stories like this which illustrate that the government when provided with reliable data does want to take action. What gets lost on the outside is how hard it is for the government to know the situation on the ground. Though it can be argued that it is their job to know, the complexity of government structures renders this extremely difficult—and that is where citizen-led accountability comes in.

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