TOWARDS A WORLD FIT FOR CHILDREN

UNICEF’S Role in West Bengal for ICDS

(version May 2005)

In order to ensure the rights and wellbeing of children and to develop ‘a world fit for children’, UNICEF's distinctive mission aims to empower families and communities with appropriate knowledge and skills to improve the care and protection of children, expand partnerships as a way to leverage resources for children and strengthen the evaluation and knowledge base of best practices on children to inform policy, support programme formulation and enhance monitoring capacity. 

UNICEF collaborates with WCD & SW in India as well as in all the States for ICDS which is  the largest integrated welfare programme for women and children of GOI. In West Bengal UNICEF works with the Government for quality improvement of ICDS specially focusing on “under 3” children for prevention and reduction of malnutrition, to improve  monitoring system of ICDS and also to bring about policy changes for sustainability and institutionalization of the process.

The challenges

The process of becoming malnourished starts very early – inadequate care of and discrimination against the young girl child, poor nutrition and health status of the adolescent girl, chronic energy deficiency and anaemia are some of the key impending factors. The situation in West Bengal is further aggravated by poor socio-economic conditions, early marriage, and early and frequent pregnancies. Together, these result in an unsatisfactory state of affairs: 23 per cent of children are born with low birth weight, 49 per cent of children under three years are underweight, 76 per cent of children under three suffer from some level of anaemia, and only 43 per cent of children are covered by vitamin – A supplementation. To compound this, 63 per cent of women suffer from different degrees of anaemia that get further aggravated during pregnancy. Coupled with early age at marriage, 62 per cent of girls get married below the age of 18 years, this brings us firmly back to the problem of low birth weight -- completing the classical life cycle of malnutrition.

The ICDS programme in the state initially suffered from two deficiencies: the absence of high quality nutritional status monitoring system and the absence of an effective methodology for reduction of existing malnutrition and its prevention among new entrants. These have been largely addressed through the initiative on strengthening the surveillance system and scaling up the Positive Deviance methodology creating capacity at state, district and project level for assessment analysis and informed multisectoral action for prevention and reduction of malnutrition (including micronutrient malnutrition) in children under three years.

	Results

 

Nutritional Status Analysis system

Earlier, ICDS data were routinely collected but these were rarely analysed in time, especially at the district and the project level. This hampered evidence based planning of activities and affected the quality of programme implementation. GOWB and Unicef have developed an IT supported, user friendly module for nutritional status data analysis for children under three years based on the routine Monthly Progress Report (MPR).This module was easily implemented at the district level throughout the state. This activity has lead to better focus within the programme and identified higher regions of malnutrition needing priority attention for intervention, thus launching of positive deviance programme.

Achievements so far

v      54,000 AWCs have been equipped with weighing scales and growth charts which helps in regular weighing of children for early detection of malnutrition.

v      Computers and user friendly data capturing system have been provided in all the districts and State ICDS cell.

v      350 ICDS personnel have already been trained (including State, District & Block level) out of 394 scheduled for training. The training commenced on April ’03, 141 persons have been trained in the year 2003, 219 persons have been trained in the year 2004.

v      Computerized MPR is being sent from the DPO-ICDS cell to the Directorate through e-mail regularly from November 2003.

v       Monthly analysis is now being carried out with the help of Charts and Maps to monitor the progress of the Nutritional Status.

More Results

 

Positive Deviance (PD):

Above analysis has led to introduction of an initiative for accelerated reduction and prevention of malnutrition among children in the 0-3 age group. This approach termed ‘Positive deviance’ (PD) is quite suitable in areas with high incidence of moderate and severe malnutrition. It is a strategy that reduces the burden of malnutrition in a short time and prevents it among younger children by enabling the community to adapt best local practices in child-care on a sustained basis. 

PD approach therefore acts as a quality improvement tool for ICDS by,

v      Improving weighing of all children under 3 years in the area.

v      Early detection and prevention of growth faltering

v      Making the community identify their own best practices.

v      Mothers of the malnourished children ‘learn by doing’ these practices.

v      There is more efficient utilisation of the food to severely malnourished children.

Other service Quality factors which show improvement are:

Immunization plus (Vitamin A), ANC services, Birth registration, Institutional deliveries, exclusive breast feeding upto six months, timely and quality complementary feeding.

This is further facilitated by use of various community monitoring tools like village resource mapping with various indicators, cohort registers (to track pregnant women to children upto 3 years), mother child protection card (home based record cards) and community growth charts in the concerned villages. All these monitoring tools are colour coded so that even if a person is illiterate malnutrition becomes visible easily.

Positive Deviance emphasizes on community involvement and participation, community contribution, behaviour change through practice.

Given the community involvement in this strategy, PRI representatives play a crucial role in it. They help mobilize the community based on the evidence of where it stands vis a vis neighboring areas. They help make issues of nutritional status visible and insist on convergence of different services in tackling the problem of malnutrition. Specific items like improvement in nutritional status seen through community growth charts, observation of fixed immunization days, conducting the nutritional counseling sessions (NCCS), adapting and sustaining improved child care practices and management of moderately and severely malnourished (grade II, III, IV), can be made issues of concern for the community by these representatives. This process makes the mothers and care-givers aware of infant feeding practices like exclusive breast feeding, timely introduction of complementary feeding, feeding during illness, important of complete immunization, hand washing practices etc.

Successful reduction of the moderate and severe malnutrition does then boost the confidence of the entire delivery system, provide ICDS with a strategy for a quantum jump in its performance and create environment for tackling even mild malnutrition. It releases the initiative of the individual ICDS functionaries bringing about an overall quality improvement in their functioning.

PD programme has now come of age with its scaling up in Dakshin Dinajpur (all 8 blocks), Murshidabad (10 blocks), Purulia (4 Blocks) and S-24 Parganas (2 blocks). The strategy is also being taken up in other states. It is time therefore to take stock of where we have reached so far.

Some Results