Innovations & Good Practices In ICDS: The West Bengal Experience

1. Innovations & Good Practices In ICDS:The West Bengal Experience 6th - 8th November, 2013 NIPCCD Regional Centre Bengaluru

2. Malnutrition : A Silent Emergency (0 -3 years)

3. Malnutrition : A silent emergency (0 -3 years) .. Contd. Nutritional status of children in WB Micronutrient s … the hidden hunger Percent Source: NFHS 3 2005-06

4. PACKAGE OF NUTRITION INTERVENTIONS • Maternal Nutrition: • ICDS • 1000 days’ window of opportunity • Piloting of IGMSY • Adolescent Nutrition: • WIFS & Piloting of RSEAG SABLA Child Nutrition: - ICDS - Community based management (PD) & Facility based management & care (NRC) - Micronutrient supplementation ( VAS & IFA bundled with de-worming)

5. Good Practices in ICDS/ State innovations Improving Service delivery of SN Creation of buffer stock zones at AWC level Improving Community awareness & participation • Heath & Nutrition Education • ECE

6. Improving Service delivery of Supplementary Nutrition

7. Critical Indicators: Maternal & Child nutrition Impact level: Reduction in prevalence of underweight <3 yrs. & <5 yrs. children • Moderate/ <-2SD ( target: 10% point) • Severe /<-3SD (target: 50% point) Process level: • Improve % of registered children 6-71 months who received Supplementary Nutrition for at least 21 days a month in last 3 months ( Target: 100%) • Improve % of registered P&L women who received Supplementary Nutrition for at least 21 days a month in last 3 months ( Target: 100%)

8. Strategy: Buffer Stock zone Objectives • Facilitate uninterrupted supply of food grains at AWCs through improved supply chain management • Comply with feeding norm of min. 300 days a year • Influence maternal and child nutrition outcomes positively

9. Implementation design • One AWC over a cluster of 25 AWCs to be identified in each GP of the project • The identified AWCs will stock the food grains /SNP items; and supply in case of requirement raised by other AWCs in the net

10. SALANPUR BARABONI Kulti (U) JAMURIA PANDAVESWAR Asansol (U) - II KETUGRAM-I KETUGRAM-II Jamuria (U) Asansol (U) - I FARIDPUR-DURGAPUR RANIGANJ Raniganj (U) KATWA- I ONDAL KATWA- I Durgapur (U) - I AUSGRAM-I KATWA- II MANGOLKOTE Durgapur (U) - II KANKSA PURBASTHALI - II AUSGRAM-II BHATAR MANTESHWAR PURBASTHALI -I GALSI-I GALSI-II BARDDHAMAN-I KALNA-I MEMARI-II Barddhaman (U) BARDDHAMAN-II KHANDAGHOSH KALNA-II MEMARI-I RAINA-I JAMALPUR RAINA-II Demonstration/learningphase • Pilot tested successfully by Burdwan district • Spread over 46 ICDS projects 9278 AWCs in the district

11. Monitoring • A user friendly monitoring tool had been in use for tracking the status of requirement & supply • No. of AWCs providing 21+ days of SNP increased in the district – from 95.95% in December 2011 to 99.21% in December 2012 (source: DMPR)

12. Expansion & way forward • Going by the success in improving feeding continuity, the state has asked all districts to identify AWCs to act as buffer stocks for supply of SNP in respective GPs • Currently NIC is supporting Deptt. in developing a web based solution for monitoring which would help in issuance of advisory to the projects regarding availability of stock, and therefore • Reduce leakage within the system • Streamline indenting procedure • Reduce data transmission time • Improve food supply chain for SNP • Improve data reliability • Improve quality and coverage of ICDS SNP

13. Improve Community awareness & participation Nutrition & Health Education

14. Critical Indicators: Child nutrition • Outcome level: Children aged 6-9 months receiving semi solid food along with breast milk(%) : 55.9% (NFHS-3) • Impact level: Reduction in prevalence of underweight <3 yrs. & <5 yrs. • Moderate/ <-2SD ( target: 10% point) • Severe /<-3SD (target: 50% point)

15. Strategy: Annaprashan Objective To improve infant and young child nutrition (initiation of age appropriate complementary feeding at 6 months)

16. Coverage HARISCHANDRAPUR - I CHANCHAL - I • Initiated in Malda - 17th amongst 19 dists. in HDI ranking ( WBHDR 2004) • Covers 26 projects, 5573 AWCs • To be intensified as part of District Integrated Nutrition intervention plan from next year HARISCHANDRAPUR - II CHANCHAL - II RATUA - I GAZOLE BAMANGOLA RATUA - II MANIKCHAK OLD MALDAH OLD MALDAH (M) HABIBPUR ENGLISH BAZAR ENGLISH BAZAR (M) KALIACHAK - II KALIACHAK - I KALIACHAK - III

17. Activities • Community level celebration and awareness camps • Demonstration of age appropriate complementary food • Initiation of Active Feeding • Counselling of mothers/ care givers • Financial support by district

18. Critical Indicators: Maternal Nutrition • Outcome level: Percentage of pregnant women who received 3 or more ANC check ups: (latest status 62.4% - NFHS-3, target : 80%) Percentage of pregnant women who consumed IFA for 90 days or more: 24.3% (latest status -NFHS-3, target : 80%) • Impact level: Reduction in prevalence of anemia in pregnant women (latest status : 62.6% - NFHS3, target: 20%)

19. Strategy : Sadhbhakshan Objective: To promote maternal nutrition during pregnancy

20. Coverage HARISCHANDRAPUR - I CHANCHAL - I • Initiated in Malda - 17th amongst 19 dists. in HDI ranking ( WBHDR 2004) • Covers 26 projects, 5573 AWCs • To be intensified as part of District Integrated Nutrition intervention plan from next year HARISCHANDRAPUR - II CHANCHAL - II RATUA - I GAZOLE BAMANGOLA RATUA - II MANIKCHAK OLD MALDAH OLD MALDAH (M) HABIBPUR ENGLISH BAZAR ENGLISH BAZAR (M) KALIACHAK - II KALIACHAK - I KALIACHAK - III

21. Activities • Community level awareness on importance of pregnancy care through • Community level celebration • Demonstration of food basket containing samples of all food groups • 100 IFA • IEC booklet on dos & don’ts on care during pregnancy, (also need for institutional delivery and essential new born care) • Counselling

22. Addressing Child Undernutrition through Improved Health & Nutrition Education in ICDS The Positive Deviance Approach

23. Concept of Positive Deviance (PD) in Nutrition • An important part of the nutrition gap is information gap • People can succeed nutritionally in low-income communities • The “positive deviants” utilize their resources effectively • beneficial practices amongst families of similar socio-economic status living under similar conditions are shared with mothers/ care givers of moderate and severely underweight children in the age group of 6-36 months • Emphasizes importance of behavioural change in nutrition

24. Goal Reduction of undernutrition among children < 3 years Objectives Identification of all undernourished children for reduction of undernutrition Rehabilitating them to higher nutrition status , i.e., Normal grade of nutrition Develop capacity of community for prevention of future incidence of malnutrition and birth of LBW babies Program Goal & Objectives

25. Phase I: Community Mobilization Use of community level child undernutrition monitoring tools Identification of child undernutrition prevalence and making it visible to the community Implementation Phases Identification of proper nutritional status of all children Use of undernutrition monitoring tools for community mobilization

26. Child Undernutrition Monitoring Tool • Community Growth Chart • Social Map • COHORT Register • Mother and Child protection card

27. Implementation Phases (contd.) Phase II: Nutritional Counselling and Child Care Sessions (NCCS) • Use of PD approach to identify local resources and beneficial child care practices • Demonstration, practice and active feeding at AWC with mothers/ Care givers of undernourished children apart from issue based counselling • Monitoring of weight gain of children till rehabilitation to Normal grade Practice of food hygiene and cleanliness Identification of community level child care practices through FGD / PDI Active child feeding practices at community set up Involvement of community in running NCCS

28. Package of services in NCCS • 12 day learning by doing technique to adopt correct feeding, hygiene, health and psychosocial practices • Package of services • Health check up by ANM, de-worming of children • Weighing of children to monitor weight gain • Active feeding of children • Theme based nutrition and health education for 12 days at AWCs • Use of self monitoring tool for mothers to monitor attendance & learning • Counseling of care givers on ten essential nutrition interventions • Referral of severely underweight with medical complications to health facility/ NRC • 18 days’ of continued practice at household till child shifts to normal grade of nutrition

29. Self Monitoring NHED Issues Self Monitoring Tool for mothers

30. Monitoring Individual: • Child wise tracking : NCCS report Community: • Anganwadi- wise : NCCS and GMP report • Sector - wise : NCCS and GMP report • Project-wise :NCCS and GMP report • District-wise: NCCS and GMP report • State: NCCS and GMP report

31. Farakka Samserganj Suti - II Raghunathganj - II Map Not to Scale Sagardighi MURSHIDABAD DISTRICTPD PROJECT BLOCKS Existing PD BlocksTrining on of PD Blocks Bharatpur-II Bhagawangola - I Kandi Noada Burwan Khargram Raghunathganj - I Suti - I Bhagawangola - II Nabagram Bharatpur - I Hariharpara Beldanga - II Berhampore Domkal Jalangi Raninagar - I Raninagar - II Lalgola Murshidabad - Jiaganj Beldanga - I Introduced by UNICEF in March, 2001 in collaboration with DWCD& SW as a pilot initiative for reduction of Infant & young child malnutrition CINI was commissioned as a facilitating agency for implementation Piloting was done in 2 blocks of Murshidabad – Beldanga- I and Berhampore; and in 2 blocks of South 24 parganas – Falta and Bishnupur- I Inception: The Pilot Phase of PD Murshidabad South 24 parganas Map Not to Scale

32. As the pilot initiative became successful, Positive Deviance was gradually introduced to Murshidabad, Purulia, DakshinDinajpur, South 24 Parganas from 2003 followed by phase-wise introduction in other districts Upscaling of Pilot experience Dakshin Dinajpur Murshidabad Purulia South 24 parganas Map Not to Scale

33. Positive Deviance Program in West Bengal ( as of Dec, 2012) Darjeeling Jalpaiguri Cooch Behar ** Total no. of ICDS projects ( pre- bifurcation number) Implementation by Deptt. of CD, GoWB, Financial support mainly from NRHM, Deptt. of H&FW and part from UNICEF, Technical support by UNICEF Uttar Dinajpur Dakshin Dinajpur Malda Murshidabad Birbhum Nadia Barddhaman Purulia Bankura Hooghly North24 Parganas Paschim Medinipur Kolkata Howrah South24 Parganas Purba Medinipur Map not to scale

34. Evaluation Evaluation by National Institute of Nutrition (NIN), Hyderabad in 2006: • Positive impact found in: • Young child care and feeding practices • Utilization of health & nutrition services, quality improvement of ICDS • Improved community participation in PD areas • Relatively better nutrition status of children in PD areas: • Better mean heights and weights of <3 yr children, • Lower prevalence of stunting • Increased weighing resulting in increased identification of child underweight • Improvement in child care practice • Reduction in child underweight

35. Impact : Evaluation Report by NIN Source: PD evaluation by NIN, 2006

36. Taken at sale as SnehaShivirby GOI To improve Counseling and Child care services of ICDS

37. Going beyond: Linkage with facility based care Identified malnourished children (6 m-3 yr) Severely malnourished Moderately malnourished With medical without medical complication complication Infection NRC/ MTC No improvement To NCCS Practice of health seeking behaviour at household / Focussed home visit & follow up at household level To be continued till the child(ren) attain normal level of nutrition

38. AWCs as Vibrant ECD Centre

39. Objectives • Prioritize ECE within the daily activities of AWC, in light of RtE Act 2009 • Review of Existing ECE curriculum and gap analysis with reference to National Level Documents • Development of a revised curriculum – with reference to National Policy and Curriculum Framework • Development and roll out of a capacity building plan for implementation of the newly developed ECE curriculum

40. Processes Adopted • August 2011: Formation of State Level Core Committee on ECE: Convergence between DWCD&SW, SSA, Unicef • March 2012 : 2 day Consultation -overview of national and international trends in ECE. Guiding principles finalized • May 2012 : 5 Day Curriculum Development Workshop in– 35 member Core group identified, Consensus on curriculum design, design of AWW’s handbook and implementation strategy • July 12: 5 Day Curriculum Finalization Workshop in - working group reviewed feasibility of draft curriculum and AWW handbook, National level RPs (including NCERT and NIPCCD) reviewed

41. Processes Adopted (contd.) • September 2012 : Curriculum finalized and Piloted as part of NIPCCD’s pilot study project in 16 states of India. Participation in Regional workshop at NIPCCD Guwahati • February 2013: field testing and data analysis workshop at 2 projects • May 2013: 2 days’ sharing workshop on ECE curriculum and capacity building strategy of West Bengal • July 2013: Field testing of training modules for AWWs at S-24 Parganas

42. Shifts in Curricular Approach • Domain based to activity based • Thematic Approach incorporated • New routine break up • Move away from 3Rs to School Readiness • Emphasis on Early Language Learning

43. Curriculum Design ACTIVITY BASED ECE CURRICULUM AGE APPROPRIATE – based on Early Learning Development Standards EMBEDDED THEME

44. Sample Routine

45. Pilot Process • Pilot - 100 centers (50 rural and 50 urban) for 8 weeks from Rural and Urban projects as per guidelines provided by NIPCCD Guwahati • Frequent monitoring and on-site support • Peer to peer support for AWWs • Monitoring visit by NIPCCD and CECED • Data Analysis workshop at project level after completion of Field Test

46. Pilot Findings • Impact of curriculum on AWW and children There is a specific, visible rhythm in the daily classroom process and a clear progress can thus be seen in children’s participation and learning • Use of Handbook by AWW’s Although it is designed for AWWs, handbook may prove to be a valuable resource for all levels of ICDS officials –a ready reckoner for what is appropriate for pre-school • Impact of shift from Domain Centered to Activity Centered Curriculum • Impact & Use of books in the Centre • Impact of suggested material display (4 corners)

47. Lessons Learnt • The inclusion of field knowledge of AWWs and Supervisors has made the curriculum and handbook more hands on and easy to implement • Structured routine with activities and materials aligning principles of • i. age appropriate, • Ii. thematic, and • Iii. activity based learning made children more enthusiastic and better tuned in towards the routine

48. Influencing Factors • Involvement of parents, local community to know about curricular shift • Mothers’ meeting by AWWs to convince the parents • AWWs should be enthusiastic and open to Activity based processes • Availability of space and time to conduct all suggested activities • Additional support for Student Teacher ratio – more than 30

49. Way forward • Revision of routine from 2.5 hours to 4.5 hours including SNP • Development of training manual and piloting of training design as per suggestions received from MWCD, NIPCCD and NCERT during sharing workshop (3rd- 4th May 2013) • Formation and Capacity building of State and District Resource Groups (400 individuals, selected from officials and functionaries of Deptt. of CD and WD &SW) – SRG 1 batch over, 1 going on, DRG planned

50. Community Participation in PSE