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Analysis of positive deviance in ICDS . Educational Resource Unit Vimala Ramachandran 22 September 2004. Specific issues explored. Centre-related: Targeting of poor households and children under 3 years Services: location, regularity, activities Worker related:

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analysis of positive deviance in icds

Analysis of positive deviance in ICDS

Educational Resource Unit

Vimala Ramachandran

22 September 2004

specific issues explored
Specific issues explored
  • Centre-related:
    • Targeting of poor households and children under 3 years
    • Services: location, regularity, activities
  • Worker related:
    • AWW and AWH; Supervisory staff
  • Management factors:
    • State, district and Block, supply and logistics, monitoring and support, training
  • Community related:
    • Interface with community groups, PRI

Educational Resource Unit

slide3
Note!
  • Our aim was to understand the situation we encountered - positive and negative, analyse why something does or does not work in a given environment.
  • The findings of this qualitative study does not purport to be an evaluation of the ICDS programme in the two states.
  • Views expressed are those of the researchers and not W Bank or the 2 State Governments.

Educational Resource Unit

the findings
The findings
  • Strong, mild and negative processes and outcomes explored with reference to
    • Workers
    • Centres
    • Community
    • Management
    • Others

Educational Resource Unit

the human factor
The human factor
  • Primary objective as articulated by state leadership:
    • Emphasis on targeting of poor, SC/ST
    • Timely procurement and supply of SNP
    • Fixed health-day
    • Under-3s – take home rations (No demonstration to manage grade 3 / 4 malnourished)

Educational Resource Unit

targeting of poor
Targeting of poor
  • House-to-house surveys, weights (the only growth indicators being used) of 0-6 years, malnourished (grades 1 and 2andgrades 3 & 4) children (We did not find names!)
  • The following order adhered to:
    • BPL families
    • IRDP families
    • Landless labour or small marginal farmer
    • ST and SC families

Educational Resource Unit

the human factor 2
The human factor (2)
  • District and Block functionaries take the cue from the state leadership
  • Banswara (Raj) DPO proactive
    • Was PD in Rajasthan WDP – committed and pro-poor
    • Monthly health-day – closer coordination with health department,
    • Importance to supply logistics – committee constituted for tenders to supply up to AWC level
      • Average time-lag of supply after SNP received at Block level is 10 days

Educational Resource Unit

the human factor 3
The human factor (3)
  • Cluster level (Lady Supervisor) and AWC level crucial
    • Dynamic and motivated LS makes a big difference, LS who worked as Pracheta in WDP were cut above rest
    • Training of LS and AWW makes a difference
      • Garhi a model Block since inception of ICDS
    • Perceived status of AWW:
      • Bottom of the chain, low status, given FP and SHG targets, participates in campaigns and surveys
      • Outreach to under 3s limited to immunisation and health-day only

Educational Resource Unit

the human factor 4
The human factor (4)
  • Notwithstanding; positive deviance found:
    • Where LS had good rapport with workers, visited regularly
      • Residence of LS and AWW important
    • Where LS and AWW can access Panchayat resources – hand pump, repair and maintenance of centre, jaggery, synchronise timings with school
    • Highly motivated / committed LS can offset unresponsive / unmotivated CDPO

Educational Resource Unit

what is a good awc
What is a good AWC?
  • Where village survey completed, poor and malnourished children enrolled
  • PSE happens, health day once a month
  • Record keeping of acceptable level
  • Relationship between AWW and panchayat officials is good
  • SHG groups credits are arranged and utilised
  • Cooperation between Health and Education Departments in the block, panchayat, village;
  • AWW motivation higher than average.

Educational Resource Unit

operational procedures
Operational procedures
  • Lot to learn from Rajasthan – guidelines and operational procedures formulated and communicated, efforts made to iron out contradictions crept in over the years
    • Location and construction / maintenance
    • Streamlined SNP procurement, supply logistics
    • Selection of AWW & “retirement” age fixed at 58
    • Target beneficiaries fixed, age-group-wise
    • Weekly menu fixed, distribution 6 days a week
    • Regular payment of honorarium to bank account
    • Recognition for good work - awards

Educational Resource Unit

lessons
Lessons
  • Cohesive guidelines & operating procedures creates positive environment, minimises ambiguities and facilitates clarity of roles and responsibilities among functionaries.
  • When complemented by motivated and efficient leaders at state and district levels, it provides tremendous scope for positive deviance.

Educational Resource Unit

since snp is critical
Since SNP is critical…
  • Ensure adequate and uninterrupted supply
    • Minimise time-lag: receipt at block & supply to AWC
  • Cooked meal better than dry & ready to eat
    • Palatable food a must: link up with Panchayat to supply jaggery, spices, vegetables (where centralised procurement problematic) – good practice in Bellary
    • Arrangements for fuel, cooking space and water
  • Distribute SNP 2 times – 10.30 and 12.00 – facilitates better uptake / absorption by children and ensure children stay for 4 hours;

Educational Resource Unit

under 3s
Under 3s
  • Casual approach to nutrition education to mothers / care providers
  • Take-home rations the norm for under-3s, immunisation done, growth monitoring done but we could not tally data with real children!)
  • Evidence of referrals in Raj – good Block PHC, resident doctor couple

Educational Resource Unit

targeting mothers
Targeting mothers
  • SNP distributed to 10 pregnant & 8 lactating women and 2 adolescent girls in Raj
  • But AWW do not check if pregnant woman are registered with ANM for antenatal care
    • No nutrition education, few tips mentioned in passing
  • Rajasthan: AWW have FP targets, SHG targets. LS have targets to link SHGs to banks
    • Poorest women in village not part of SHG – AWW not interested in them. Focus more on one layer above – those who have some means to save.

Educational Resource Unit

growth monitoring gm
Growth Monitoring (GM)
  • Aggregate data given by LS / CDPO
    • This could not be verified in 60 percent of cases!
    • Weights and names given in registers, no age!
  • 0 to 3 weighed on health-day, same children not tracked from month-to-month
  • Data available – but has little meaning as it is not child specific
  • No connection between nutrition status and quantity of SNP, anyone who comes is fed

Educational Resource Unit

pre school education
Pre-school education
  • Rajasthan: recent efforts to give refresher training in PSE (ex-Shiksha Karmi Director made in-charge)
  • No evidence of play-way / child-centered processes, as yet

Educational Resource Unit

convergence
Convergence
  • ICDS does not stand alone:
    • Proactive Sathins and energised education system make people confident to accessgovernment programmes. When programme uptake goes up, pressure on worker to provide services increases.
    • Converse is also true:ICDS cannot shine by itself if the health system is dysfunctional, primary schools over-crowded, teachers indifferent, there is no independent forum for women to come together and governance is poor.

Educational Resource Unit

information flow and monitoring
Information flow and monitoring
  • 15 + registers maintained
    • AWWs burdened, many pay Rs 100/ a month to someone to help with record keeping
    • Most important information, i.e., children grade 2, 3 and 4 malnourished not available by name!
  • Most important channel is monthly meetings – data submitted
    • No systems for tracking malnourished children
    • Put a face to the numbers

Educational Resource Unit

community interface
Community interface
  • Can potentially make a big difference
    • Encountered active / interested SHG, Panchayat leaders
    • Did not come across effective mother’s committee, routine minutes, repetitive month after month, across AWCs
    • Women more aware in villages where Sathins were active (Raj)

Educational Resource Unit

what we saw in garhi block
What we saw in Garhi Block
  • Though not part of study sample, visited Garhi (Banswara) - told of “good practices”
    • AWW selected and trained pilot phase in mid-1970s
    • Close inter-flow between ICDS and WDP, LJP also working in this area (micro-planning), SHG also fairly active, functioning PHC, TLC was vibrant
    • CDPO proactive – used relief work to upgrade and maintain facilities
    • NGO Vihan providing continuous training inputs
    • Functioning AWC, food distributed twice, pre-school education interesting, workers energetic

Educational Resource Unit