Satara Zilla Parishad , Satara

1. Community score card Satara Zilla Parishad , Satara Department of Integrated Child Development Scheme ( ICDS )

2. Community score card project of ICDS Department ZP Satara • With the background experience of CSC conducted jointly by ZP Satara, TISS and World bank in 14 villages • Zilla Parishad, Satara, decided to conduct similar exercise for ICDS services in 41 villages. • 18 villages of primary health center, Thoseghar located in hilly area. • 21 villages of primary health centre, Limb located in plain area.

3. Task group • A task group consisting of 62 employees and 21 officers participated in the training workshop followed by the field exercise. The participants included: • Medical officers, • Child development project officers, • Block development officers, • Block education officers, • Supervisory officers of health education Panchayat, agriculture and ICDS .

4. Services rendered under ICDS • Pre school Non formal Education • Medical Checkup of children & ANC. • Referral Services. • Immunization of children and ANC. • Supplementary food. • Health Education for children mothers and adolescent girls.

5. Important Issues Identified • Lack of public awareness and public participation. • Sensitization of the beneficiaries. • Improving Supply and Quality of Supplementary Diet. • Coordination between Health and ICDS staff. • Lack of infrastructure support.

6. Issue no1: Public Awareness and participation. Issue: Lack of Public Awareness Mass awareness campaigns launched. Public awareness campaign Launched

7. Public Awareness Campaign Regarding Malnutrition • IEC van. • Weighing all 0-6 children in presence of all villagers. • Medical Check up for pregnant women and breast feeding mothers. • Distribution of Ayurvedic medicines to all Gr.3&4 children through community contribution. • Adoption of Gr.3 & 4 children by prominent members of the community • Corpus fund raised through community contribution Rs.3 per month per child attending anganwadi for ICDS and Re.1 per member of family per year for general health services.

8. Women empowerment week observed. (14th Jan –21st Jan) Special focus on issues relating to health, nutrition, formation of Self help groups their linkage with banks etc. Public Awareness and Participation:

9. Women empowerment week observed. (14th Jan –21st Jan). • Special focus on issues relating to health, nutrition, formation of Self help groups their linkage with banks etc. • Kishori Melawas for adolescent girls to sensitize them regarding problems of adolescence, diet, small norm family, age at marriage, nutrition, general health problems etc. prominent women from different fields addressed the gatherings. • A film produced by ZP, Satara Divas tuze he phulayche, addressing the problems relating to growing up, menstruation, nutrition, age at marriage, sex determination, gender issues. • Community mobilisation and participation using micro planning done in 100 villages of Patan Taluka supported by European Commission sector investment program. Public Awareness and Participation:

10. Sensitization of the Beneficiaries: Community Growth Chart painted on Anganwadi floor in every village. Issue:Lack of public Awareness Normal • Community growth chart painted in all villages(Rs10 lacs from GP funds) Gr.1 Gr.2 Gr.3 Gr.4

11. Children standing on the community Growth chat

12. Sensitization of the Beneficiaries: Linking of child health and nutrition awareness campaign with pulse polio campaign ensuring 100% coverage. • Linking of child health and nutrition awareness campaign with pulse polio campaign ensuring 100% coverage.

13. Sensitization of the Beneficiaries: Linking of child health and nutrition awareness campaign with pulse polio campaign with following advantages: 100% turnout of children. Children accompanied by their parents which helps in counseling of parents. Weights taken in presence of the parents enabling the sensitization of parents. Administering of supplementary diet or medicines and ensuring its consumption becomes possible. Regular Follow-up of the child becomes possible if mother is sensitized.

14. Improving Quality of Supplementary Diet • Supplementary food through Self help Groups. • Coverage of all children and ANCs by covering Balwadis and private nurseries. • Demonstration of Recipes. • Competitions for preparation of good recipes with locally available food grains, cost effective and high calorie and nutritional content. • Encouraging kitchen garden in every household of the village for preventing anemia and malnourishment.

15. Coordination of Health and ICDS • Combined monthly meeting of Health and ICDS staff at PHC on 27th of each month presided by Medical Officer and attended by all Health supervisors, Multi purpose health workers, anganwadi workers and their supervisors. • Regular health check up of all 0to6 children every 3 months. Performance reviewed each month. • Special pediatric camps for gr.3, gr.4 and seriously ill children every 3 months. • A special project for production and supply of Ayurvedic tonic (Shatawari kalp) for malnourished children by health department conceptualized and budgeted by ZP.

16. Infrastructure Support • Construction of toilets through TSC (700) (35 lacs). • Construction of Anganwadis from MP, MLA LAD funds.(26 lacs) • Repairs of buildings from funds allotted from the 12th finance commission (15lacs). • Public contribution of Rs. 40 lacs for educational kits, toys ayurvedic medicines.

17. Results achieved • Percentage of normal grade children improved from56 to 69 percent in respect of Thosegar PHC from Oct o6 to Feb 07. • Percentage of normal grade children improved from 67 to 73 percent in respect of Limb PHC from Oct 06 to Feb 07. • Percentage of normal grade children improved from59to 66 percent in respect of Satara distict from april06 to feb 07 • Reduction in grade 3 & grade 4 children from 7 to 0 in both PHCs • Reduction in grade 3 grade 4 ( acute malnourished) children from 399 to 58 in respect of Satara district.

18. THE PERCENTAGE OF NORMAL CHILEN FROM APRIL TO FEBRUARY

19. Major outcomes of CSC • Starts with sharing Information and understanding the various services provided. • Introspection by the service provider as to what the basic objectives of the services provided are. • The service user or the community also gets to understand its entitlements and its obligations. • Becomes a catalyst to social mobilization. • Becomes a catalyst to managerial changes in administration. • Becomes a guide to the policy maker. • Generation of social demand with a sound understanding of the limitations of the govt. machinery. • Beginning of a adult to adult dialogue.

20. CSC: A Tool for measuring outcome against societal needs • Administrative machinery or the service providers tend to measure their success against their targets and what was planned to be achieved and not against the final projected outcome. Example: Distribution of iron tablets to pregnant women. The target is achieved in terms of the distributed number but is this is a worthless indicator of success if there is a general apathy to the consumption of these tablets and hence there may be no significant impact on incidence of Anemia. • CSC as a tool will be able to identify this gap in sensitization of women before making such provisions. Promotion precedes marketing.

21. CSC: A Tool for assessing non-quantifiable success. • Success of Health, Nutrition and Education programs measured only in quantifiable terms such as allocation made, schools or hospitals built, books distributed, immunization done, Pills distributed etc. • Thrust on quantity rather than quality because as it is said, what can be counted gets measured, what gets measured gets rewarded and what gets rewarded is really what counts.

22. CSC: A Tool for assessing non-quantifiable parameters. • Not all Health Education or Nutrition parameters can really be quantified. Hence the administrator or the service provider has a very impressionistic, subjective and a personalized view of the services provided. • A need has always been felt for a objective factual, impersonal tool for assessing the success with which the service provider has met.

23. CSC: A Tool for assessing non-quantifiable parameters. • Assessment of non quantifiable as well as quantifiable services provided. • Assessment is factual without loosing its essential personalized character. • Services provided are assessed vis-a-vis the needs of the community rather than fulfillment of the target of the administrative machinery.

24. CSC: A tool for general evaluation and monitoring • Community Score Card is an efficient tool for quick and random assessment of the need, status, quantity and quality of services being provided to the community. • Such random and quick assessment can prove more effective and efficient than routine inspections and visits which provide limited input to the administrator.

25. Proposal for Developing Community Ownership of Village plan through Micro-planning and Community Monitoring. • Main features: • Proposal for carrying out micro planning and CSC in 1508 GPs, 1717 villages, 25 lacs population of Satara district with the help of NGOs. • Health, Nutrition, Sanitation to be the focal points. • Micro planning and Community score card; both strategies to be integrated in order to achieve better results without duplication of work. • Convergence of IEC funds from various departments and various schemes like National Rural Health Mission, Jalswaraj, Watershed development program (Hariyali), Total Sanitation Program, Sarva Sikshya Abhiyan etc. About 1 crore to be made available from these sources. • Estimated cost 4.61 crores

26. BUDGET FROM ZILLA PARISHAD SATARA ….lacs HEALTH 20 TOTAL SANITATION CAMPAIGN 50 JALSWARAJ 15 ICDS 5 DRDA-HARIYALI 5 SUB TOTAL 95 EUROPIAN COMMISSION - SECTOR INVESTMENT PROGRAM 13 BUDGET AVAILABLE WITH Zilla Parishad, SATARA 1,08 SUPPORT REQUIRED FROM FUNDING AGENCY 3,53