Trial of Nodal Anganwadi Centre: Uddeepan Intervention Design
The ICDS programme in Bihar, reaching its beneficiaries through the Anganwadi centres (AWCs) at the village level, is one of the largest outreach programmes with over 80,000 AWCs spread over 38 districts and 8471 Gram Panchayats (GPs). While it is recognised and accepted that ICDS can play a very important role in achieving health and nutrition development objectives, it has also been a mixed bag of outcomes. Experience in Bihar and other states have shown that much more can be achieved in terms of quality and outreach when there is improved supervision, motivated and skilled field level functionaries and increased convergence.
Uddeepan: “Uddeepan” (the nodal AWC) has been conceptualised as a process of continuous interactive learning and skill development of AWWs using a cluster approach supported by one additional worker – a cluster coordinator. The approach aims to address the problem of capacity development and supportive supervision of AWCs. It is perceived that as an output, the project shall be able to strengthen the coverage of children less than two years of age. The Uddeepan project is supported by BTAST, which is managed by a consortium of CARE (UK), Options consulting and IPE Global and consists of national and international consultants to provide technical and managerial support to the state government.
The project has the following objectives:
- It aims to bridge the gap in supervision and monitoring arising out of staff shortage.
- It will facilitate peer group learning among AWWs and promote leadership qualities.
- It will facilitate collection and dissemination of information from and among AWWs, and improve timely reporting and progress review.
- It is designed to strengthen coordination with Department of Health & Family Welfare machineries at Sub Centre as well as PHC level.
The project is piloting the “Uddeepan” concept and assessing its viability for scaling up. The pilot uses a cluster approach for stimulating change, both amongst users and among those who deliver services, and for building ownership of processes within the community. New Concept is providing support in implementing the pilot so that nutrition and development needs of children under three years who are not reached by AWCs can be met adequately through improved delivery of services.
All implementation stakeholders under the SWASTH programme have an aim that the AWC of their village should:
- Be a community-friendly AWC where children and mothers not only receive quality services but also enjoy and visit (own) it
- Have child focused activities (growth and development, nutrition and pre-school) involving parents and community
- Strengthen systems and processes for quality delivery
There is both a significant need and a tremendous opportunity to improve effectiveness at the ground level. It is with this possibility in mind that the project aims to pilot the “Uddeepan” concept and assess its viability for scaling up.
The “Uddeepan” intervention design would add:
- Inclusion and tracking of all eligible/entitled beneficiaries using tools like social maps, mother and child card, etc.
- Nutrition and Health Days (NHD) and Take Home Ration (THR) to be organised periodically and effectively to ensure changes in nutritional, feeding, health and caring practices of families and communities towards children below two years.
- Prioritised home visits during critical periods of the life cycle (late pregnancy, first day, first week, first month, 1-5 months, 6-8 months, 9-11 months using AWW home visit planner).
- Participating and enabling sector/cluster meetings
- Focused supervision/monitoring of all critical interventions by sector, block and district leadership.
The design of the pilot is based on buy-in by various stakeholders, through consultations, participatory visioning at ground level (field level functionaries/ workers), and utilisation of existing capacities and social capital, enhancing it through systematic and sustainable capacity building.
Of the nine focal priority districts (Madhepura, Supaul, Araria, Sheohar, Madhubani, Kishanganj, Purnea, Jamui and Banka) identified by SWASTH on the basis of a vulnerability composite index, a baseline study focusing on implementation in two selected districts namely, Madhubani and Supaul with clear identified interventions and matched control areas for comparison has been carried out by New Concept.
The baseline study conducted by New Concept gathered information on key indicators by providing in-depth understanding of the project in the identified areas and baseline value for indicators for analysing change in these areas as a result of the project. The baseline study analysed information on both output and process level indicators.
New Concept is now continuing capacity building and handholding support in the pilot blocks. The inputs include:
- Interactive display materials
- Provision of interactive display materials, growth monitoring chart, ANC posters to AWCs
- Mats and colour pencils, paper sheets for children to draw and colour
- AWW handholding by demonstrating various interactive games and activities on how to engage with children
- Assisting AWWs in organising VHSND, Bachpan Diwas by using 1000 days messages visibility tool
- Holding of discussions and Q & A sessions with Pregnant & Lactating mothers
- Quality Growth monitoring of 0-2 yrs old children