2005年-世界发展银行全球_Improving_Child_Nutrition_Outcomes_in_India___Can_the_Integrated_Child_Development_Services_Program_Be_More_Effective__27页_427kb

Summary of "Improving Child Nutrition Outcomes in India: Can the Integrated Child Development Services Program Be More Effective?"

Core Content

This paper evaluates the effectiveness of the Integrated Child Development Services (ICDS) program in India, which aims to improve child nutrition through supplementary feeding, health services, and pre-school education. Despite significant economic growth and substantial public spending, child malnutrition levels in India declined only modestly during the 1990s. The study uses NFHS data from 1992 and 1998 to analyze program placement and its impact on child nutrition outcomes.

Main Findings

1. Program Placement is Regressive Across States

• Poor Northern states (Bihar, Uttar Pradesh, Orissa, Madhya Pradesh, Rajasthan) have the highest levels of child malnutrition but the lowest ICDS coverage and funding.
• These states account for over 40% of India’s population and contribute a high proportion of malnourished children.
• Kerala and northeastern states have the lowest levels of child malnutrition and high ICDS coverage.
• The central government allocates much less funding per malnourished child to poor Northern states compared to richer states like Punjab.
• Budgetary allocation in poor Northern states is insufficient relative to their needs, and only 65-76% of allocated funds are spent in these states, unlike other states where full utilization is observed.

2. Program Placement is More Progressive Within States

• Poorer and larger villages have a higher probability of having an ICDS center.
• Villages with other development programs or community associations are more likely to be covered by ICDS.
• However, the overall trend from 1992 to 1998 shows a greater regressive distribution in program placement across villages.

3. Little Evidence of Program Impact on Child Nutrition

• The study finds limited evidence that the presence of ICDS centers improves child anthropometric outcomes.
• Implementation issues are identified as a major barrier to effectiveness, including:
  • Inadequate training, supervision, and support for anganwadi workers (AWWs).
  • Erratic supply provision and leakage in food procurement.
  • Poor targeting of food supplementation, which reaches children past the optimal growth window (4–6 years old).
• Program design issues include:
  • Lack of community participation.
  • Top-down implementation, leading to lack of accountability.
  • Neglect of more cost-effective interventions, such as improving environmental hygiene and domestic health practices.

4. Trends in Child Malnutrition

• Underweight and stunting are widespread in India, even among wealthier households.
• Lower socio-economic groups show sharper declines in nutritional status compared to higher groups.
• Girls are more disadvantaged than boys in all socio-economic groups, with higher rates of stunting and underweight.
• Discrimination against girls appears to have increased in lower socio-economic groups, likely due to son preference and reduced access to sex-selective abortion.

Key Variables and Methodology

• Economic Status Index: Constructed using principal components analysis on household assets (e.g., electricity, TV, refrigerator, etc.).
• Child Nutrition Indicators:
  • Height-for-age z-score (HAZ) and Weight-for-age z-score (WAZ).
  • These indices are used to measure chronic and acute malnutrition.
• Data Sources:
  • NFHS-1 (1992–93) and NFHS-2 (1998–99).
  • Data is collected at the village level, with no direct information on household or child-level participation.

Implications

• Program placement is a crucial determinant of effectiveness.
• Nutritional supplementation programs require careful targeting and effective implementation to yield meaningful results.
• The study suggests that evaluations of intervention programs in India and elsewhere must consider both program placement and implementation.
• Improving community participation and targeting interventions more effectively could enhance the program's impact on child nutrition.

Conclusion

The ICDS program, while large in scale and budget, has limited impact on child nutrition due to regressive distribution, implementation challenges, and poor targeting. The findings highlight the need for reforms in program design and placement to ensure that the most vulnerable children receive the necessary support.