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Shared Commitment Initiating Early Complementary Feeding and Increasing Community Participation in Banswara, Rajasthan Foreword For over two decades World Food Programme (WFP) has been supporting, primarily through the provision of the supplementary nutrition component, India’s premier initiative for child development—the Integrated Child Development Services (ICDS). Bridging the gap between food availability and food requirement, the supplementary nutrition component of ICDS is available to pregnant, nursing mothers and children under six years of age belonging to the economically underprivileged section, the most vulnerable section in society. Several mechanisms have been established to monitor and evaluate the progress of the supplementary nutrition component of ICDS. However, it is the recognition that the provision of nutritional supplements, though necessary, is not sufficient to improve the health and nutritional status of the population, that spurred WFP to adopt a more comprehensive approach towards strengthening ICDS. These initiatives have been set in motion through the utilisation of funds generated from WFP’s forestry and irrigation projects, and through collaboration with other donor agencies to strengthen the convergence of services towards the objective of increasing chances of child survival. The action research undertaken in 1990-92 in four districts of Rajasthan only helped to strengthen our conviction at WFP, that the agenda has to be broadened to include all aspects of ICDS. The summation of our experiences has been documented in the form of a booklet entitled “Starting Right”. Continuing the efforts, WFP, in close collaboration with the Government of India and the Government of Rajasthan, initiated the second phase of the project in 1994. This had the twin objective of the early initiation of complementary feeding and increasing community participation in ICDS. Conducted as a campaign, this project has once again reinforced our conviction that catalysing all social developmental activities at the village level is a necessity. Convergence of services at the village level, training and communication to enhance the capacities of both the service provider and care provider to change their lives, have emerged as problems needing solutions. “Shared Commitment” presents our experience in the district of Banswara in Rajasthan. We do hope that this will contribute to strengthening the chances of child survival in India. The synergy in thought and action that developed between the Department of Women and Child Development (DWCD), WFP and the team of professionals from New Concept Information Systems (NCIS), was one of the main propellants of these projects. Entering its sixth year, an enduring relationship has been achieved between these agencies and the commitment we share is now slowly but surely finding its echo amongst the service providers of ICDS in Banswara. It is this achievement that energises us as we enter into the third phase of the project—Improving Child Survival through ICDS: A District Initiative.
Angela Van Rynbach, Country Director World Food Programme India Acknowledgement The project, ‘Initiating Early Complementary Feeding and Increasing Community Participation, in Banswara, Rajasthan’, was a mutual learning experience for us as facilitators, and for the supervisors, anganwadi workers (AWWs), sathins, prachetas and the health workers with whom we worked closely. These service providers responded enthusiastically to the new methods of training and work and were open to criticism and self-reflection. They made efforts to understand each other’s strengths and shortcomings and to work out ways and means to overcome the barriers to communication that existed within their own departments and between ICDS and WDP. The service providers began to understand the importance of building trust and friendship among themselves and between them and the women in the community. The implementation of the concept of shared commitment would not have been possible without their participation. We thank each one of them for their time, effort and understanding. The CDPOs and the RDD, Mr. J.K. Upadhyay, on their part, provided supportive supervision and much encouragement. WDP Project Director, Ms. Razia Zabin, immersed herself in the project straight from the word ‘go’ and lent her time and skills to ensure that collaboration between the prachetas, sathins and the supervisors and AWWs, in thought and action, was made a reality. We express our appreciation to her for almost becoming a member of the facilitating team. The Collector, Dr. B. Shekhar, played his role effectively in integrating the efforts of the Total Literacy Campaign (TLC) and Halma (Community Based Convergence of Services), and that of the ICDS functionaries, to take the messages crucial for child survival to the people. The support of the health department at the district level, was another factor which assisted in moving towards the achievement of the project goals. At the state level, the Minister for Women and Child Development, Ms.
Narender Kanwar, showed keen interest and responded enthusiastically to
our invitation to participate in meetings related to the project. We were
encouraged by her support and critical comments. The Directors of DWCD,
Mr. Sanjay Dixit, Mr. J.C. Mohanty, Mr. J.K. Sachdeva and Ms. Seema Bahuguna,
deserve our special thanks and appreciation. The valuable inputs provided
by Dr. D.K. Aggarwal and Dr. S.L. Sharma proved to be very useful. Special
mention of Additional Director, DWCD, Ms. Pramila Surana for her suggestions
and comments is also due.
We have no words to record our appreciation for the unstinting effort put in by the other facilitating team members, especially that of Dr. Brijender Pradhan and Ms. Rina Tagore. While there were many others who provided their assistance, it has not been possible to name every one of them. We express our gratitude to them. Our thanks are also due to the Department of Women and Child Development, Government of India, for its support. We also thank the editing and designing team of NCIS for the care with which they have developed this document. Last but not the least, the village women of Banswara, who contributed their part to make this truly a shared commitment.
Purnima Kashyap, World Food Programme (WFP), India
Vimala Ramakrishnan, NCIS, India Abbreviations and Glossary
ICDS: some home truths The Integrated Child Development Services (ICDS) scheme was formulated by the Government of India as a comprehensive child survival and development scheme, drawing on the resources of the Centre, states, voluntary organisations and the communities. This ambitious plan, launched in 1975, aims to bring about improvement in the health and nutritional status of children below six years. Reduction in mortality, morbidity and malnutrition, reduction in school drop-out rates, and enhancement of mothers’ capability to look after the health and nutritional needs of their children are the other objectives of ICDS. It has expanded from the initial 33 projects to 5417 projects now, within a span of 22 years. ICDS cares for children below six years of age. ICDS also cares for pregnant women and nursing mothers residing in socially backward villages and urban slums. The scheme provides:
The ICDS team includes the anganwadi workers (AWWs), who are the frontliners; supervisors and child development project officers (CDPOs), who support and supervise anganwadi workers; the medical officers, the lady health visitors, the Auxiliary Nurse Midwife (ANM) and the female health workers of the Primary Health Centre. In Rajasthan, as elsewhere, the system of supervision and management of the programme has been weak. Malnutrition and other health-relevant data regarding the mother and child is merely reported upwards within the system. The supervision is geared to reporting rather than providing guidance. Interactions with the community are minimal and women are merely given instructions on the ways to bring up their children. Very little effort has been made to stimulate a dialogue with the care providers.
Rajasthan Rajasthan, formerly known as Rajputana, came into being in 1958. It comprises the erstwhile states of Jaipur, Jodhpur, Bharatpur, Mewar, among others. Rajasthan accounts for 10.43% of the total area (3,42,239 sq. km.) of the country and ranks ninth in terms of population with 5.2% (44 million, 1991 census) of the national population. The state of Rajasthan is now divided into 32 districts, which are further sub-divided into 213 tehsils and 237 development blocks. The per capita income is Rs. 5,035 (1992-93) compared to the all-India figure of Rs. 6,249. The infant mortality rate (IMR) in the state stands at 82 with the figures for rural and urban areas being 87 and 56 respectively. The sex ratio is 910 compared to 929 for the country. While there have been improvements in the literacy levels between 1951 and 1991, the overall literacy rate still remains at a modest 38.55% and wide male/female and rural/urban disparities persist. The ICDS was started in Rajasthan in 1975 in Garhi block in Banswara district, and has since expanded to cover 170 of the 237 community development blocks of the state and 11 urban slums. This is implemented in cooperation with WFP, UNICEF and CARE. In the last decade or so, both WFP and CARE have focused on strengthening the quality of services delivered from the AWC, manpower development and in improving nutrition, health, education and community participation. The WDP, DWCRA and the Health Department also provide the necessary supportive environment, to enhance women’s capability to take care of their children, families and themselves. In Banswara itself, under WDP, there are five prachetas and 83 sathins; under the Health Department there are 73 medical officers, 50 LHVs, and 375 ANMs; under ICDS there are eight CDPOs, 64 lady supervisors and 1230 anganwadi workers; under DRDA (District Rural Development Agency) there are eight mukhya sevikas and 19 gram sevikas, who are working towards improving women’s health and child-care. There are still ‘promises to keep’, and as the State Plan of Action states: “the impact of poverty is felt most acutely by children and women. Children, in particular, cannot wait till poverty is reduced or eradicated, and urgently require actions and programmes that seek to improve their health, nutrition and education”. [Source: Promises to Keep, State Plan of Action for Children, Department of Women and Child Development, Government of Rajasthan, 1995] Banswara 
The Genesis of a Commitment Having started with a research project on infant health and child-care practices in four southern districts of Rajasthan in 1990, and having implemented a project in campaign mode, to initiate early complementary feeding and increase community participation, the two organisations, World Food Programme (WFP) and New Concept Information Systems (NCIS), are currently working in close collaboration with the Government of Rajasthan on 'Improving Child Survival' in the district of Banswara. All the three phases of this project were undertaken to strengthen the Integrated Child Development Services (ICDS). The ICDS scheme was introduced 22 years ago with the laudable objective of providing a comprehensive package of services for child development. It was envisaged even at the time of its conception, that the people—the care providers—must be actively involved in deciding the types of services, and how these services should be managed. In practice, however, the participation of women and children, who were the target group in the ICDS, began to slowly decrease. The activities at the anganwadi centres (AWCs) were perceived to be a ‘government programme’ and not as the people’s own programme. The AWCs were viewed as ‘food distribution centres’ and not as centres where child survival was the key issue. Study after study only helped to bring home the point that the ICDS
needed strengthening. The key to strengthening ICDS lay in increasing the
participation of the care providers, i.e., the women of Rajasthan. In this
case, however, the reasons for the low participation rate needed to be
studied thoroughly.
Towards this end, WFP and NCIS conducted, in consultation with the Central Government and the State Government of Rajasthan, a research project (1990-92). The research activities were designed to understand and analyse the existing perceptions, knowledge, practices and beliefs in relation to infant feeding and child-rearing. They were also designed to study the interface between the service providers (AWWs and other ICDS personnel) and the care providers, i.e., mothers and family members. In order to assist the anganwadi workers in strengthening the bond at the village level, their supervisors required orientation and training. They needed to understand and appreciate the odds against which the anganwadi workers were functioning. Their task was not restricted to collecting and despatching reports. They had to adapt themselves to their new role as supportive supervisors. This meant that the anganwadi workers (AWWs) were to have an understanding of the inherent needs of the villages from where they operated. They needed to have a deep understanding of the prevalent knowledge, attitudes, beliefs, practices of the villagers and the behavioural changes. And if the supervisors were to function effectively, they required total support from their superiors, the Child Development Project Officers (CDPOs) and the Regional Deputy Director (RDD). Therefore, there arose a need to strengthen commitment at all levels. This is precisely why the project initiated in 1994, entitled ‘Initiating early complementary feeding and increasing community participation in women and child development programmes, in district Banswara, Rajasthan’, focused on improving the activities at the village level and the supervision of the anganwadi worker, in particular, in addition to supervision and support at all levels.
Efforts were made to communicate through dialogue and discussions, which led to an increased awareness about colostrum feeding and early initiation of complementary feeding. The workers and the women in the village felt a strong conviction that changes could take place. This conviction and the visible changes in perceptions and practices, carry within them tremendous possibilities for the success of this shared commitment. This was our experience with the women in Rajasthan and it is this that fuels our spirit when we march on towards improving child survival. Cultivating Trust and Faith
Such a process requires facilitators who must practice what they preach. It can begin only by the dedicated efforts of the facilitators to tear down the veils of suspicion that separates them from the people. The NCIS team and WFP were the facilitators, providing interventions during the stages of reflection, analysis and planning. The monitoring and support were provided by the district team, comprising the RDD, CDPO, PD (Project Director) of WDP and APO (Assistant Project Director) of DWCRA. Any intervention strategy for effecting change in any system and more so a strategy for social transformation, must necessarily accept the truth that all systems are constantly in a state of motion and action. The intervention strategy designed for this project can be best described as a double helix—a symbol of all in constant motion and change—linking the forward and the backward, the top as well as the bottom of the ICDS, as well as the other related departments like health, nutrition, and women’s development activities of GOR in general, and Banswara district in particular. The most vital link in this cyclical motion is the community. The interventions developed always kept this vital goal of effecting concrete changes in the minds and hearts of the mothers of Rajasthan, in prime focus. There certainly exists enormous potential and capacity within the system and the community, which needs to be harnessed and developed. The facilitators were convinced that these can be achieved through knowledge, skill improvement and change in attitudes and approaches. Their challenge was to get the functionaries to actively think about the village situation, understand what needs to be done, develop feasible plans, and provide the required support for action. All these and more were sought to be achieved through a system of workshops, which were carried out at different levels—at the state, district, block, sector and village. Workshops, as the name suggests, are meant to be goal oriented. They are expected to produce tangible results. It is this concept that motivated the facilitators to opt for this method for the transformation of the knowledge, attitude and practices prevailing amongst the women of Banswara. This they did in spite of the criticisms levelled against the workshop methodology. Accepting that these criticisms did contain an element of truth, the facilitators set out determinedly towards realising their definition of a workshop. The workshops encouraged the supervisors of ICDS to reflect on the prevailing situations, analyse them, think about possible alternatives, plan for suitable and appropriate action and, more importantly, grasp the necessity and urgency for change. The project designers also made sure that the project was not thrust upon the district level officials and functionaries. It would have been easier to undertake the project in the traditional top-down approach. The path chosen was more difficult and needed greater commitment and patience. Flexibility was an important aspect of the plans and no rigid deadlines
or targets were specified, so as to realise and utilise the full potential
of the functionaries.
The facilitators spared no efforts in sensitising the district level officials and functionaries and inculcating in them a sense of responsibility towards both, the project goals and the people. The facilitators were delegated with the powers to plan the project themselves, by trying to understand the problems related to the women of Banswara, their needs and the overall question of child survival. They evolved a concrete methodology to work towards the project objectives. It is only by these efforts that trust and faith can grow and flourish, enabling people to feel as a part of the system. It is this sense of ownership that can motivate them to become successful catalysts in the process of social change, to stop feeling helpless and hopeless, and to contribute positively and constructively towards their own progress and development. But if these efforts are tardy and lackadaisical then a project is destined to fail. The entire process was a cumulative experience as the content and outcome
of the previous workshop formed the basis—the point of take off—for the
next.
Numerous multifaceted workshops were conducted in this period, from May’94 to January’96. They were designed to accommodate and facilitate the fullest and most conscious participation of the people—the service providers at all levels and the care providers at the ground level. The workshops aimed to build the commitment of all towards the strategic objective of child survival, while the reduction of maternal, neonatal and infant mortality were the short-term objectives. The project’s most immediate objectives were to tackle the problems of low priority to child-care, late introduction of complementary feeding and indifference in the face of these problems, leading to passivity in demanding health and nutritional care provided by the system. Workshops were organised to motivate the service providers at the state
and district levels towards opening up and facilitating the process of
informing, educating and energising the service providers in the front-line,
namely the anganwadi workers, and the mothers. They were designed to impart
knowledge, develop skills in planning, logistics, facilitate self-monitoring
and evaluate progress and introduce the implementors to the grim reality
that faces all those who work for social change. Above all, these workshops
were for free and frank discussions, and breaking down walls that exist
between people. This was seen as a necessary precondition for developing
the much needed communication skills in all the participants involved in
this great endeavour.
While constantly strengthening interpersonal communications at, and between, all levels, the participants were also trained to develop communication strategies such as campaigns and appropriate communication material for planning, raising awareness for moni-toring, as well as for evaluating their work. The immediate need was for creating a quick and comprehensive understanding about the timely initiation of complementary feeding. An intensive drive for consciousness-raising, on a campaign mode, was seen as an immediate necessity. To facilitate the process of providing the mothers with supplementary nutrition as well as knowledge about better child-care practices, it was necessary to increase the participation and involvement of women in the ICDS scheme, a scheme designed to achieve precisely that. This required that the faith in the women and the anganwadi workers be affirmed, their latent potential tapped and their capacities strengthened. It required that the bonds that tie the village women and the anganwadi workers be strengthened in order that they enter into a partnership to understand the ramifications of all the problems related to child-care and nutrition, and together seek solutions and take action for better care of their children and themselves. The link between the anganwadi worker and the powers above her was yet another interface requiring attention. The supervisor of today had to be transformed into a friend, philosopher and guide of the anganwadi workers. This was by no means an easy task, considering the attitudinal problems developed over the years of practising supervision as a control system rather than as a supportive mechanism. To build the momentum amongst women to organise to change their lives required the activation of all the women in mahila mandals. The anganwadi workers had to mobilise her other comrades in the common cause—the auxiliary nurse midwives, the sathins, the prachetas and the gram sevikas—into a vital organizing force to bring about convergence of all the efforts unleashed at the village level through numerous schemes into one trained force for child survival.
The programme implementors at the district level faced numerous problems leading to disaffection and scepticism. It was no wonder that questions such as these were raised at the workshop: “What is this project about? What has been decided and what is left for us to decide? Can we have a say in the planning? Have the higher authorities decided that we should all collaborate at the field level? Will there not be contradictions, when it comes to particular tasks?” Further, they asked, “Will the higher authorities support us?” Who will coordinate all the departments? There should be more say at the district level and below. Yes, we can and must work together; but it will not be all that easy.” Hence, the facilitators, with long years of experience in the field, approached the programme planners and implementors with sympathy, patience and humility. An enabling environment was created by clarifying, at the very outset,
that the people best suited to develop solutions are the frontline workers
themselves. It is they, and not the ‘people above’ who can be the ideal
planners for this project. The role of WFP and NCIS—as mere facilitators—was
emphasised.
Group work, role-play and simulation exercises using realistic questions, helped to provoke thought. This method energised the participants in developing concrete action plans for project implementation. Many issues that need to be tackled, emerged after a free and frank exchange of views. After discussions on the main idea and focus of the project—to improve complementary feeding practices, and reduce infant mortality and morbidity—the participants arrived at a consensus that concrete and realistic steps need to be taken in order to achieve this. Careful planning and increased involvement of mothers and women in general, it was realised, would bring about change in the condition of children and women in the villages. As the next step the participants embarked on the task of identifying the blocks for initiating the project, using the following criteria. They were:
Functionaries of three programmes selected two blocks, Kushalgarh and Pipalkhunt, out of the eight in Banswara, to initiate activities. This method was in itself a major break from the traditional way of handing down decisions. This proved to the functionaries that the facilitators meant what they said. It assisted in uprooting deep-seated scepticism and built the way for a more lasting and constructive partnership between the facilitators and the service deliverers.
The participants in this planning exercise went through a situation analysis. They analysed their work and assessed the strengths and weaknesses of the delivery of services through a series of mapping, prioritising and other exercises. For the first time, the functionaries objectively analysed and assessed their own work and made their own plans. This gave them a sense of satisfaction. At the end of this workshop, the participants enthusiastically planned for the next step. The fact that the supervisors suggested the inclusion of sathins, anganwadi workers and prachetas, showed that a thinking process had been triggered in them. The next step, therefore, was to focus on the indicators and develop key messages pertaining to the timely initiation of complementary feeding and proper child-care. This focused training of the frontline workers (AWW and sathins) began in August ’94. It was conducted in two batches, as a residential programme. The health functionaries at the village level were unable to attend due to an outbreak of an epidemic of diarrhoea. The objectives of the training programme were:
Flexibility was the keyword as the workshop sessions were modified to suit
the needs of the participants.
The participants went through a series of reflection and analysis sessions. They recalled what they had learnt through role-plays, mapping and other group exercises in the earlier workshop. In the course of this workshop it became clear that weighing, growth monitoring and utilising the growth chart, were the two very weak links in the service delivery. Addressing this need, a new growth chart was developed. Role-play and other exercises were used to strengthen the communication skills of the frontline workers. That children could be fed complementary food as early as 4-6 months was demonstrated by feeding the workers’ own children. Releasing immense creativity, the participants developed numerous new messages. The supervisors reviewed the previous action plans, reallocated tasks, and fine tuned the strategies, to reach the community with important messages. An important decision to concentrate on a few AWCs first, and then using the experience to scale up the project to other AWCs, was taken. The participants expressed their satisfaction at the end of the workshops. The supervisors repeatedly said, “We wish we could have brought all our workers, it would have been very useful. Even though we participate in other training programmes, here things are explained in a very different manner.” The AWWs said, “This has not been yet another class, we have enjoyed it and learnt many things. Yes, we can also do it.” The sathins felt “stronger and could work together with the AWW as a team”. No sooner had the block level initiatives begun, the necessity to rejuvenate district centred activities pressed itself for solution. Addressing this concern, a workshop was organised at the district level, in October 1994. The Minister for Women and Child Development inaugurated the workshop. The state department was represented by the Director, DWCD, and the Additional Director, while the RDD, CDPOs and PD (WDP) participated. The Director pointed out that India can and must achieve child survival, as other developing countries whose Gross National Product (GNP) was less than India’s, already had. ICDS should become a community programme rather than a programme imposed from above. The State Nutrition Policy and the State Plan of Action for the Child would go a long way in helping to achieve this objective. The Additional Director stressed the need to combat, in all seriousness, the problems of malnutrition, high maternal mortality rate and infant mortality rate. She reiterated the need to enhance community participation and awareness and that it was possible to make women take positive action regarding child-care and rearing. The Minister stressed that the workers needed motivation and support and that this should be provided by the CDPOs. People and women needed leadership and they should be provided effective and proper leadership in order to ensure a healthy population. Following this, the participants had a detailed discussion, and a consensus was reached on the problems identified and as well as the indicators to be used for measuring progress. Minor modifications on the measurable indicators were made. Recognising the need for greater support from the district level, this
workshop, attended by the upper echelons of the service providers and policy
makers, gave birth to the core facilitating team (CFT), as a means to keeping
alive the flames of the project at the district level. It was agreed by
the participants that the CFT would comprise the CMHO (Chief Medical and Health Officer)
or a nominee from the health department; the Regional Deputy Director and
CDPO, ICDS; Project Director, WDP; and Assistant Project Officer, DWCRA.
It was also decided to scale up the project to cover four out of
the eight blocks of Banswara district. These were Kushalgarh, Pipalkhunt,
Ghatole and Bagidora.
The end of October saw the facilitators visiting a few centres in the Pipalkhunt and Kushalgarh blocks to familiarise themselves with the ground reality. These visits revealed that in many of the sectors, especially in Pipalkhunt, anganwadi workers had taken pains to strengthen home visits and to conduct meetings with women. Feedback from the supervisors of these blocks indicated that some activities had been initiated, such as, frequent home visits, organising meetings and explaining the importance of colostrum and celebrating nutrition week with special emphasis on the campaign issues. The supervisors expressed that the anganwadi workers had begun to understand the need and importance of growth monitoring. However, the problem of non-functional weighing scales remained. The visit also showed that the supervisors, some anganwadi workers, sathins, prachetas and lady health visitors had arrived at a critical understanding of the area. They were assessing their own work and had initiated some activities to further the campaign for child survival. The facilitators encouraged the workers and the supervisors to monitor five to six families in each of the villages where intensive efforts were being made. The change in practice in these families, it was felt, would act as examples for the rest of the women in those villages. Initiating the scaling up of the project to include two more blocks, the supervisors of these new blocks were mobilised and assisted in developing plans of operation for their areas. Effecting improved communication at and between all levels of the system is the key link for any project designed for changing social behavioural patterns. While this was kept in mind, the urgent need to focus on the particular communication needs emanating from the task of scaling up of the project, prompted the facilitators to organise a workshop devoted to communications at the state level in December 1994. The newly formed CFT had to be equipped with a comprehensive understanding of the campaign, its strategy, the messages, the target audience and expected behavioural changes. At first, the supervisors were familiarised with the concept and principles of communication. They then worked out the matrices, identified the target audience, the expected beha-viour outcome and the key messages. Each of these were thoroughly analysed for respective strengths and weaknesses. Following this, the supervisors developed strategies for implementing the campaign. With the help of the workers, these strategies were further refined. From each block, one supervisor was identified to become the workshop coordinator for conducting the session with the anganwadi workers. The supervisors repeated with clarity, the steps they had gone through when they were trained. The entire exercise only confirmed that if the supervisors are trained properly, they can master participatory methods and become trainers themselves. By the end of the workshop, five strategies for initiating campaign activities were developed, which were explained through maps, actual plotting of sectors and the movement and approach of the campaign. The teams were encouraged to implement their strategies with vigour, after they had gone through a similar exercise in detail in each of the sectors. The teams had to specify the media and methods they would adopt for the achievement of their plans.
By January 1995, the project was ready for a mid-term review. The facilitators were acutely aware of the fact that even though eight months had elapsed since the inception of the project, it was still at its infantile stage. The frontline workers, having been motivated systematically, had only
a couple of months for initiating the field level operations. The process of evaluation evokes mixed and fearful emotions in the best of programme implementors. Fearing that an evaluation in the traditional sense might mitigate the enthusiasm already generated, and keeping in mind that participation in project planning and implementation has to be extended into the monitoring and evaluation realm as well, a thoroughly service provider-friendly, mid-term review was designed. The mid-term review provided the project with the opportunity to strengthen the functioning of the CFT. In six villages, mapping exercises, focus group discussions and home
visits were conducted. The village visits were planned in such a manner
as to provide ample time at the AWC, to gather information as well as to
observe the functioning of the centre. As the project sought to bring
about a fundamental attitudinal and behavioural change in women, both in
the fertile group and the elderly, the target group for both, the mapping
and focus group discussions, became the women with under two-year-old children,
expectant mothers and elderly women. In all the six villages visited (in
three blocks), all the AWWs had selected five families for intensive
interaction. This generated awareness among the women and they were able
to recall many of the campaign issues—feeding of colostrum, initiating
complementary feeding at the age of 4-6 months, increased intake of food
during pregnancy, correct practices during delivery.
The necessity for combining all the skills, resources and abilities of all the catalysts at the village, that would effect the convergence of all services—education health, women’s development, agriculture, Icds—along with the formation of an action oriented women’s group to coalesce all existing women’s groups, were the two profound directional conclusions that emerged at the end of one year of project implementation. It is no wonder that these two problems assumed the centre-stage in all the four subsequent workshops held in 1995. It was at this juncture that the Collector of Banswara intervened and opened up the prospects for a relatively trouble-free integration of all the forces under his command. In May 1995, a meeting was convened by the Collector of all the heads of departments, such as agriculture, education, health, public works, forestry, women’s development et al, to discuss the possibilities for coordination. This meeting took place at a time when the district officials were already grappling with the concept of Halma. Halma is the resultant wisdom which has emerged from the experience gathered from the implementation of the campaign to achieve total literacy or Total Literacy Campaign (TLC) as it is popularly called. Fortuitously, for the children of Rajasthan ‘child survival’ came to be placed at the centre-stage of the concerns of the district. Further, the significance of the meeting in May, lay in the fact that it gave official sanction to the concept of one unified women’s group to spearhead the child survival objective in the community. While discussions continued at the district level, the campaign in the four blocks broke new grounds. To maintain the momentum, workshops were organised for participants from Bagidora, Kushalgarh, Pipalkhunt and Ghatole towards the end of May 1995. The facilitators assessed the district and block level workshops positively for having achieved the objectives that were set. Assessing the meeting at the collectorate, it was noted that the convergence that had started to take place at the district, had far-reaching and profound implications for the campaign for child survival. This prospect of unity amongst the departments was seen as a necessary harbinger for this mammoth exercise and for social change. It was further noted that while the Kushalgarh and Bagidora groups had started out somewhat lethargically at the first block level workshop, during the course of the proceedings, a strong emotional response was elicited from the participants. Through the workshop the participants had been compelled to become more aware of the precise status of their target groups. This was achieved by teaching them to process and assimilate the routine data and information they collected. At the workshop held in Ghatole, the Pipalkhunt and Ghatole personnel showed interest from the very beginning. The participants were quite knowledgeable about their areas. They were motivated to further their efforts to make a difference in the health and nutrition status of their target groups. They worked well with the sathins and the health workers and were receptive to the idea of convergence of services and the formation of one women’s group. It was an immensely energised facilitator group that went to the second meeting at the collectorate in August 1995. The priority focus was on how to integrate the campaign for child survival into the ongoing campaign to achieve total literacy. The presentations at the meeting drove home the concept of Halma, the philosophy of convergence, as distinct from programmes such as ICDS, WDP, DWCRA, Sanitation Water and Community Health (SWACH) and TLC, which work for people’s development. Converging and approaching the people as one group, in the service of the people, it was stressed, would assist vastly in enhancing the scope of all development activities. Keeping this perspective in mind, the participants, working in groups, came up with action plans on how they could integrate the early complementary feeding concept into the various services that were being provided. By September 1995, four new blocks were oriented towards project goals and objectives. The project that began 16 months ago in two blocks, now covered the whole district and was poised for growth. The functionaries were assisted to develop a methodology for working
intensively with five families in their village.
The experiences in the field only confirmed that if the barriers between the frontline workers reporting to numerous departments are removed, then a forceful group of prime movers and catalysts for change emerge. Learning from each other, pooling their knowledge, compensating for each other’s lacunae—these activists had unlimited potential as a group. But this group needs sustenance and unmitigated support from the powers at the district level. The district of Banswara has barely woken up to its responsibilities. The immediate objective of increasing the chances of child survival through the early initiation of complementary foods itself, was still to be achieved. The long-term objective of healthy babies’ remains a distant prospect. However, an exciting beginning had been made. Its ripples were gathering momentum. It was at this stage that the project was drawing to a close and needed an evaluation.
Deepening the Commitment It was strongly felt that a rigorous but sensitive evaluation was required to provide the necessary insight into a project of such magnitude, which, through its findings and recommendations, can and must become the curtain-raiser for the third phase of the project, entitled ‘Improving Child Survival through ICDS: A District Initiative, Banswara’. These considerations and more were the underpinnings of the decision to compose an evaluation team consisting of two representatives from ICDS (selected from amongst the participating supervisor), two from NCIS and one from WFP. To maintain objectivity, two completely independent consultants with a health and medical background were inducted into the team. In keeping with the participatory principles of the project, the methodology was designed for a maximum interaction with all levels of functionaries and the village women. The tools and checklists were developed on the basis of specific objectives. Alongwith the field visits, reports and documents related to the project, were reviewed. Four blocks out of eight, two from the initial phase and two from the latter phase, were taken for evaluation. From these blocks, eight villages were chosen. The entire process was of random selection. The tools used by the team included a village profile, anganwadi centre
profile, interviews with anganwadi workers, record of the five families
chosen for intensive interaction, discussion and semi-structured interviews
with village women, focus group discussions with supervisors, the CDPO
and RDD and meetings with the district and block officials, such as the
collector, representatives of the health department, DWCRA and WDP.
However due to the non-availability of the people concerned and lack of time, all the individuals, especially at the district level, could not be met. Following a thorough briefing on the project approach and philosophy, activities carried out, the purpose of the evaluation, and discussion on the tools and checklists, the team set out for the field visits. The members of the evaluation team divided themselves into two groups
to cover two villages in each block, over a period of four days. The WFP
representative alternated between the two teams each day. Each team was
headed by an independent consultant.
Not only did all the supervisors display a clear understanding of all the campaign issues, they also displayed a great degree of confidence in themselves and their abilities. The effect was evident in the level of awareness noticed among the anganwadi workers. The anganwadi worker in turn had initiated several activities to spread the message among the mothers. The centres were slowly but surely being transformed from mere feeding centres into centres where the growth of the child was being monitored, and where the mothers were being taught how to prepare a balanced feed from the food available in their homes. The messages that infants can and must be fed the colostrum immediately after birth, and that soft, mashed foods must be fed alongwith breast milk, as early as between their 4-6 months, was being imparted persuasively. The strategy of selecting five families for an intensive follow-up too, was yielding good dividends. The mothers and the other older women in these families were becoming carriers of the vital messages of child-care amongst their peers. This has the potential for a geometric progression in the awareness level of the communities in question. The campaign activities initiated in many villages, displayed the skills in planning and implementation that had been acquired by the functionaries. The workshops to enhance skills in planning and communication had been
absorbed to such a degree that the supervisors were practising what they
had been trained in—the participatory method of planning and implementation.
While hurdles such as lack of inter-departmental communication and understanding, conflicting priority-setting, etc. remained to be crossed, a great beginning had been made at the village level. The sathins, gram sevikas, prachetas, ANMs and LHVs were working closely with the anganwadi workers and supervisors to initiate campaign activities, showing the immense potential that exists to actualise the idea of one women’s group in a block. The volunteers of TLC too had, in right earnest, put the issue of child survival at the centre of their activities. While these efforts were few and far between, they still carried in them the prospect of a brighter future for effecting Halma. True to its objectives, the evaluation, highlighted all the weaknesses that still persist. The highest on the list was the lacunae noted in the abilities of the anganwadi worker to monitor the growth of the child. This was further compounded by the fact that many centres remained without weighing scales or with malfunctioning weighing scales. The project showed clearly that it is indeed possible to educate illiterate workers on growth monitoring through patience and simplicity. However, this area remained one needing maximum attention in any future training. While the anganwadi booklet had been welcomed, the campaign activities were still being hampered by the lack of knowledge on correct practices of child-rearing amongst the frontline functionaries. The need for a simple tell-all booklet to guide the workers and an awareness-raising exercise regarding all available communication material already developed, was all to apparent. Administrative problems such as lack of time for field visits, frequent transfers, with supervisors holding charge for more than one sector, non-availability of supplementary food leading to reduced activity at the anganwadi centre, etc. continue to hamper the overall functioning of the programme. These and the need for a regular inbuilt supportive monitoring of activities, remain the other areas which need strengthening. The idea that monitoring is not control but support has to become an issue for all future sensitising efforts. The concept that the data the frontline workers collect is vital to their work has not yet been sufficiently understood. It still remains a duty to be performed to keep the powers above happy. Making the monitoring and information system a dynamic one, is a challenge that any new project needs to address. Innovative training that is area and need specific, whether it is refresher training, training to enhance skills, training to educate on the use of data collected, training to build the capacity of frontline workers as community mobilisers—has emerged as a vital ongoing activity to assist in mitigating the problems that ail the system. The campaign to initiate early complementary feeding and to increase community participation in ICDS in Banswara district had gained momentum. Of all the changes that had taken place, the one that deeply touched the facilitators was the change in the attitude of the people involved in the project. While in the beginning many had started sceptically and lethargically, the whole proceedings and the results on the ground after twenty months of work, helped to reinforce the faith that it is possible to achieve child survival. The women of Banswara were starting to shed their apathy, hopelessness and helplessness that had become inherent in them at the occurance or prospect of their Children’s death. These were slowly being replaced by a righteous anger, a sense of responsibility and courage to demand from the system what was rightfully theirs. The energy of an angry responsible, courageous mother is the energy that can transform life. It is this energy that needs to be nurtured and directed towards the goal of hajo soru or healthy child. The anganwadi worker, the supervisors, cdpos, rdds, Collector and the
facilitators themselves had emerged as a group imbued with great optimism
for the future. It is this group that became the planning group to lay
the foundation for the third phase of the project “Improving Child Survival
through ICDS: A District Initiative, Banswara, Rajasthan.”
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This
phase of intervention, stretching over a period of 20 months (1994-96),
resulted in perceptible changes in the attitude of the anganwadi workers
and in the functioning of the anganwadi centres. The supervisors became
better at planning, supportive in their supervision and most importantly,
began to view their workers with a new-found respect and understanding.
The workers too, on their part, began to treat their co-workers
allies rather than competitors.
To
bring about the conviction that child survival is indeed realisable, in
the face of a reality in which infant and maternal deaths are commonplace,
is by no means a small task. The processes that need to be set in motion
and the changes that have to be effected are numerous and complex. They
should allow for the most conscious participation of both the service providers
and care providers alike who must be made to identify themselves with the
project objectives. This mobilisation towards ownership of the project
should be in letter and spirit. With this objective in mind, this project
was meticulously designed to facilitate maximum participation from both,
the service providers within the system, and care providers, especially
women.
July
saw enthusiastic initiatives at the block level to plan and implement a
strategy for revitalising health and child-care activities at the anganwadi
centres.
As the levels of awareness and practices of people living in different
centres vary, the teams were encouraged to work out specific plans, tailored
to suit their different requirements.
The
walls of the AWC in Talwara block were plastered with local reproductions
of pages from the anganwadi booklet which had been pre-tested. The messages
on ANC (Antenatal Care) and timely initiation of complementary feeding
came through in vivid colours. We found out that the AWW had done it all
by herself, supported by and encouraged by her supervisor and the CDPO.
This entire incident was soul-stirring. This was just one example of how
the immense potential that is there at the functionary level can be used
effectively. The discussion on the concept of the healthy child or ‘Hajo
Soru’ began to take shape.