Early childhood development and nutrition in India

The Integrated Child Development Programme (ICDS) is one of the largest and most comprehensive family welfare programmes in the world, but it still faces a number of operational challenges. The World Bank is supporting initiatives to strengthen the quality and coverage of service offering under the programme – including the addition of crèche services to Anganwadi health/community centres (AWCs). We assisted the evaluation of the effectiveness of this innovation, through the design and implementation of baseline data collection on child development measures.

Our work included the design of a randomized controlled trial household survey incorporating an Ages and Stages questionnaire, and anthropometry and data collection in two districts in Madhya Pradesh. The project will provide the foundation for an evidence base on the effectiveness of the AWC-cum-crèche model and its potential scale-up across India.

Challenges

India’s Integrated Child Development Programme is one of the largest and most comprehensive family welfare programmes in the world. Operating on a national scale, it offers public health support - including immunization, nutrition and education services - to pre-school children and their mothers.

Despite its widespread coverage, operational gaps mean that service delivery is not of a consistent quality and quantity across the entire country. The Programme is being strengthened through initiatives that aim to address these gaps and support the more efficient allocation of resources. The introduction of the Anganwadi Centre (AWC)-cum-crèche model is one such initiative. Supported by the World Bank, this intervention will see the addition of expanded crèche services - including an additional worker – to Anganwadi community centres across the state.

One of the main aims of the initiative is to free up Anganwadi Workers (AWW) to focus on improving child nutritional outcomes. The success of this new model of service delivery will depend, to a large extent, on the training and supervision support provided during its implementation as well as the ease and efficiency of rolling it out on a national scale. This project was established to assess if and how this model improved the existing ICDS package of support and its objectives.

Our approach

We designed evaluation tools to assess whether the conversion of AWCs to AWC-cum-Crèches will support measurable improvements in child welfare.

The framework included a longitudinal survey based on a randomised control trial design to capture household-level data in two districts in Madhya Pradesh. Incorporating the latest Ages and Stages Questionnaire, we compared households in areas where the new model was piloted with ‘control’ households, which at that time didn't receive any additional ICDS services. The aim of the survey was to gather data that allowed for the measurement of the following variables:

• The cognitive development of children up to three years old
• Changes in child anthropometric measures over time
• The labour activities of Anganwadi workers including work outside of the day care facility
• Time and labour allocation of primary care givers.

We provided technical assistance in the following areas:

• Development of a baseline survey design including the adaptation of long-running tools such as Ages and Stages Questionnaire and CES-D Depression Scale
• Designing a sampling strategy based on a two stage randomization model to ensure representative coverage across the catchment areas
• Conducting fieldwork and data collection at household- and health worker-level

Outcomes

This study provided important insights into the potential impact of a more integrated model of service delivery on Early Childhood Care and Development (ECCD) and Nutrition in India.

By designing and implementing the baseline round, our work laid the foundation for gathering comparable evidence across a range of impact indicators. This evidence will help contribute to programme improvements, supporting the development of a higher quality model of service delivery capable of achieving its goal and objectives of improved child development.