For a better future

DEVELOPMENT: The child survival project shows the way.

Between intention and implementation of government schemes, there's usually a chasm. So it is with the government of India's Integrated Child Development Services (ICDS) scheme. And perhaps no state embodies the systemic problems of the ICDS better than Uttar Pradesh (UP).

But in the midst of the gloom, the success of World Vision India's Pragati Child Survival Project (PCSP) in 19 blocks of Balia, Moradabad and Lalitpur, touching the lives of 1.13 million children under age three, and 16,09,280 women of reproductive age, stands out as a beacon of hope.

Especially so because the PCSP works with the infrastructure existing in the villages "" anganwadi workers, rural-health officials and local NGOs "" helping them strengthen service-delivery mechanisms and build capacity.

In the four years since it was launched (it ends this September), PCSP has had encouraging results. As the third annual review of the project reported, "Indicators related to use of expanded programme on immunisation, family planning, nutrition behaviours and Vitamin A supplementation have generally shown increases from the previous year, with exceptions being iron-folic acid tablets consumption reported in previous pregnancy and exclusive breastfeeding up to six months of age. Use of contraceptives has also shown only moderate increases."

So how did PCSP work? Says Dr Beulah Jayakumar, national coordinator-child survival, "We decided that we would not look at food procurement, restricting ourselves to household level behaviour and the home-visit criterion of anganwadi workers."

Also, more than food, it is "inappropriate infant feeding and care practices, poor access to health services" that result in malnourishment, as the "Repositioning Nutrition" report of the World Bank notes.

This was where PCSP intervened, with its concepts of time-counselling and "red register", since made mandatory in all districts of UP. Earlier, anganwadi workers would time their visits to suit their convenience. Under PCSP, visits were timed to coincide with important milestones in pregnancy and early childhood.

Of course, it hasn't always been easy. Trouble with two competing anganwadi workers' unions forced WVI to stop working with the ICDS in Balia.

Also, many institutional problems, the rivalry between local health and ICDS workers for example, continues. But as the PCSP draws to a close, it can show the way to others who want to make a difference.