The International Food Policy Research Institute (IFPRI) has released a study based on an in-depth analysis of the access to the world’s largest nutrition programme, the Integrated Child Development Services (ICDS) in India, at the individual and household level. It specifically assesses the inequity in terms of the expansion of programme usage, while focusing upon the complex factors underlying these aspects. Part 1 of the article provides an overview of the outcomes of the study. This article outlines in some detail the context of the study and highlights the factors shaping the inequities in the uptake of ICDS.
In 2013, certain nutrition-specific interventions were reviewed and it was estimated that scaling-up the effective ones would result in a 20% reduction to stunting levels and 15% reduction in child mortality. While these accounted for progress vis-à-vis goals related to economic growth and sustainable development, a mismatch prevailed, between the coverage and efficacy of these interventions.
The ICDS was launched in India in 1975 and by 2000, all states were brought under its ambit. In 2006, the Supreme Court ruled that the programme was to be offered universally. This resulted in an expansion of the availability of the programme, with a goal of establishing 1.4 million programme centres across the country.
Subsequent studies on the impact of the reforms to ICDS have focused upon the performance and implementation at the state-level. However, there has been limited investigation at the individual and household level, vis-à-vis uptake of the programme. Thus, IFPRI’s study has assessed equity gaps and other factors impacting this aspect, based on data from the Indian National Family Health Surveys of 2005-06 and 2015-16.
According to the trends discussed in the report, the poorest people in India have been excluded from the ICDS, especially in states like Uttar Pradesh and Bihar that are in any case weak performers and suffer from a high malnutrition burden. This indicates a relation between massive exclusions and poor performance in high-poverty states.
Multiple factors could contribute to the exclusion and inequitable patterns of usage of the ICDS programme. These include challenges related to traversing difficult terrains in certain geographical areas, compliance with the conditionalities of the programme, entry-level barriers, variations in education levels, caste and tribe-based discrimination etc.
In 2006, the coverage of supplementary food during pregnancy and lactation was less than 25% in most states, except Jharkhand, Tamil Nadu, Chhattisgarh and Odisha. By 2016, the situation improved in almost all states. State-wise coverage of supplementary food during childhood also increased to more than 50% in most central and southern states.
However, targeted efforts have been made in states like Odisha, Chhattisgarh and Maharashtra to address some of these challenges, as part of the state nutrition missions. Interestingly, despite the hypothesis that girls are discriminated against in health service use in India, the study found no evidence of preferential treatment towards the sons, over daughters, in terms of using the programme. Instead, the likelihood of receiving services was marginally better for female children.
According to the study, people with health insurance coverage were about twice as likely to use the programme’s services in 2016, even though insurance plays no direct role in gaining access, since the services are free. This trend may simply reflect self-selection i.e. households that take up government health and nutrition services are also more likely to be enrolled in the national health insurance. Under the Rashtriya Swasthya Bima Yojana, health insurance coverage improved 10-fold between 2006 and 2016.
Thus, while the child development services in India have become more inclusive between 2006 and 2016, especially amongst the historically disadvantaged tribes and castes, there has been an inadvertent exclusion of certain social groups. Women with poor education and households with the poorest incomes are still not adequately served.
India Outbound
March 14, 2019
source https://indiaoutbound.org/efficacy-of-the-icds-in-india/
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