India Case Study ICDS and TINP

Context In the 1960s, the GOI initiated intervention measures to deal with food shortage and protein deficiency In the 1960s, the GOI initiated intervention measures to deal with food shortage and protein deficiency Structural adjustment programs and stabilization programs – World Bank/IMF Structural adjustment programs and stabilization programs – World Bank/IMF High inflation rates High inflation rates Large-scale subsidies discouraged Large-scale subsidies discouraged Better targeted subsidies on social welfare schemes beginning to receive stronger political and government attention Better targeted subsidies on social welfare schemes beginning to receive stronger political and government attention

ANDHRA PRADESH Population: 66.3 million Population: 66.3 million 73.2% living in rural areas 73.2% living in rural areas 14.9% Scheduled Castes and 5.9% Scheduled Tribes 14.9% Scheduled Castes and 5.9% Scheduled Tribes Literacy Rate: 37.4% (compared to 52.1% for entire country) Literacy Rate: 37.4% (compared to 52.1% for entire country) Female Literacy: 28.0% (39.4% - India) Female Literacy: 28.0% (39.4% - India) Male Literacy: 46.6% (63.9% - India) Male Literacy: 46.6% (63.9% - India) Agriculture – 36.2% of net domestic product Agriculture – 36.2% of net domestic product

TAMIL NADU Population: 55.6 million Population: 55.6 million 21 districts 21 districts 2/3 of population rural 2/3 of population rural Highly urbanised Highly urbanised Male Literacy Rate: 74.8% Male Literacy Rate: 74.8% Female Literacy Rate: 52.3% Female Literacy Rate: 52.3%

The Integrated Child Development Services Scheme (ICDS) Started in 1975, now reaches about 242 million people (28.7% of the total population) Started in 1975, now reaches about 242 million people (28.7% of the total population) Majority (92%) funded by the Government of India (GOI) Majority (92%) funded by the Government of India (GOI) Implemented through the Department of Women and Child Development in the Human Resources Development Ministry Implemented through the Department of Women and Child Development in the Human Resources Development Ministry Coverage in Andhra Pradesh: million 0-3 year olds, million 3-6 year olds, and million pregnant/lactating women Coverage in Andhra Pradesh: million 0-3 year olds, million 3-6 year olds, and million pregnant/lactating women Coverage in Tamil Nadu: million 0-3 year olds, million 3-6 year olds, and million pregnant/lactating women Coverage in Tamil Nadu: million 0-3 year olds, million 3-6 year olds, and million pregnant/lactating women The package of services includes supplementary nutrition, immunization, health check-ups, referral services, health and nutrition education, and pre-school education The package of services includes supplementary nutrition, immunization, health check-ups, referral services, health and nutrition education, and pre-school education

The Tamil Nadu Integrated Nutrition Program Started in 1980 Started in 1980 World Bank/IDA assisted health and nutrition intervention World Bank/IDA assisted health and nutrition intervention Reached approximately 16 million people Reached approximately 16 million people The major components were: nutrition services, health services, communications, and monitoring and evaluation The major components were: nutrition services, health services, communications, and monitoring and evaluation

ICDS ICDS TINP TINP <6-year olds <3-year olds + pregnant, lactating women Nutrition + health services + pre- school education Nutrition + health services +communication +monitoring and evaluation Enhance mother’s ability of child care Reduce pregnant and lactating women’s anemia 300-day supplementary food/per year Short-term supplementary food Minor differences in nutritional status in children of ICDS and non- ICDS areas Statistically significant improvement of nutritional status of beneficiaries

ICDS ICDS TINP TINP Selecting beneficiaries not through nutritional screening but individual perceptions + quotas (fixed) Poorest areas not covered by ICDS + “nutritional needy” group (<24 months) Lack of community participation, activities rarely conducted in women’s working groups Information-education- communication component, women’s working groups set up in 9000 villages Inadequacy in implementation, monitoring and supervision Well-designed monitoring and information system, attention to grassroots and supervisor workload Hard to assess; big impact variations Documented evidence of impact via improved “care” factors and access to health facilities

Outcomes Reached around 40% of rural India Reached around 40% of rural India Established an integrated package of health and nutrition services with potential for improving child nutrition and health Established an integrated package of health and nutrition services with potential for improving child nutrition and health 1/3 to 1/2 reduction in prevalence of severe malnutrition among 6-24 month olds 1/3 to 1/2 reduction in prevalence of severe malnutrition among 6-24 month olds Highlighted key characteristics needed for the success of a program Highlighted key characteristics needed for the success of a program ICDS TINP

Moving on to TINP-II Designed to cover 316 of the total 385 rural blocks in Tamil Nadu, with an estimated total population of 32.8 million Designed to cover 316 of the total 385 rural blocks in Tamil Nadu, with an estimated total population of 32.8 million Target group has been extended to cover children from birth to six years of age Target group has been extended to cover children from birth to six years of age A less strict selection criteria for supplementary feeding, weakening the success of TINP-I A less strict selection criteria for supplementary feeding, weakening the success of TINP-I More emphasis on communication and health service delivery More emphasis on communication and health service delivery Stronger coordination between health and nutrition service delivery Stronger coordination between health and nutrition service delivery

The future Improved targeting Improved targeting Enhanced training and supervision Enhanced training and supervision Better quality of services and impact Better quality of services and impact A reliable monitoring and evaluation system A reliable monitoring and evaluation system Community ownership and management of the program Community ownership and management of the program