Special articles

Universalisation with Quality

ICDS in a Rights Perspective
India has some of the worst indicators of child well-being. About half of all Indian children are undernourished, more than half suffer from anaemia, and a similar proportion escape full immunisation. There is therefore an urgent need to re-examine what India is doing for the survival, well-being and rights of children under the age of six years. Ultimately, this involves addressing the structural roots of child deprivation. However, there is also an immediate need to protect this age group by integrating it in an effective system of child development services that leaves no child behind. In this context, this paper, along with the collection of articles published in this issue, examines the role of the Integrated Child Development Services programme in protecting the rights of children under six.
JEAN DRZE
magine what would happen if a gardener were to grow flowers by depriving them of sunshine and water for a few weeks, allowing anyone to trample on them, and then catching up with heavy doses of fertiliser. No doubt he or she would be considered fit for the asylum. Something like this, however, is being done to Indian children. Most of them are left to their own devices until the age of six years, when they are finally herded into school for crash indoctrination. Yet the first six years of life (and especially the first two years) have a decisive and lasting influence on a childs health, well-being, aptitudes and opportunities. Some time ago I attended a conference held in a village of Kerala. The conference was a little boring, and as a diversion, I visited the nearest anganwadi (childcare centre). It was located in a tidy and spacious building, well furnished with toys, charts, cooking utensils, a medical kit, a ceiling fan, and even a smokeless chulha. The children, I was told, were given a glass of milk on arrival in the morning, a full meal at noon, and some uppama before they leave around 3 pm. There were also well-rehearsed routines for immunisation, deworming, growth monitoring, micronutrient supplementation and health check-ups. Details of the age, weight, height and immunisation status of every child in the neighbourhood were neatly posted on the walls. The registers, including detailed minutes of monthly meetings with the childrens mothers, were in good order. When I asked the anganwadi worker how many anganwadis there were in the gram panchayat, she casually replied 25.1 She said that about 90 per cent of the children below six years of age were enrolled in these anganwadis. It is perhaps not an accident that Kerala has the best indicators of child well-being among all Indian states, by a long margin. In other states, early childcare and development services (hereafter child development services) are grossly neglected, and the consequences are staring us in the face. About half of all Indian children are undernourished, more than half suffer from

anaemia, and a similar proportion escape full immunisation (Table 1). Few countries have such disastrous indicators of child well-being. According to the latest UNDP Human Development Report 2005, India has the highest proportion of undernourished children in the world, along with Bangladesh, Ethiopia and Nepal.2 In fact, in terms of the general situation of children, even Bangladesh now seems to be doing better than India, as Table 2 illustrates. This contrast is all the more striking as Bangladesh is poorer much poorer than India. Against this background, there is an urgent need to re-examine what India is doing for the survival, well-being and rights of children under the age of six years (hereafter children under six). Ultimately, this involves addressing the structural roots of child deprivation, including mass poverty, social discrimination, lack of education, and gender inequality. However, there is also an immediate need to protect children under six, by integrating them in an effective system of child development services that leaves no child behind. This immediate task is the focus of this collection of articles on Indias Integrated Child Development Services (ICDS).

Focus on Children under Six

The articles published in the special section on ICDS in this issue of the journal were initially presented at a workshop on Universalisation with Quality: An Agenda for ICDS, held in Mussoorie in November 2004. The Mussoorie workshop was part of a wider process of action-oriented dialogue among scholars and activists concerned with ICDS from the point of view of childrens rights. This dialogue has informed various interventions for the universalisation of ICDS, notably in the Supreme Court, the National Advisory Council, the Planning Commission and Parliament. The recent convention on childrens right to food, held in Hyderabad on April 7-9, 2006, was a continuation of this process.3 This article builds not only on the Mussoorie workshop but also on these wider deliberations.

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The Mussoorie workshop was also an opportunity to discuss the preliminary findings of a recent field survey of ICDS, known as the Focus On Children Under Six (FOCUS) survey. This survey was conducted in May-June 2004 in six states: Chhattisgarh, Himachal Pradesh, Maharashtra, Rajasthan, Tamil Nadu and Uttar Pradesh. It involved unannounced visits in a random sample of about 200 anganwadis as well as detailed interviews with about 500 mothers of children under six. This introduction also draws on the FOCUS survey. In spite of differences on specific issues, the papers in this collection share a common perspective on ICDS. In this perspective, ICDS is not just a welfare scheme, but a means of protecting the rights of children under six including their right to nutrition, health and joyful learning. Following on this, the contributors share the view that all children under six should have access to ICDS, and also that the quality of ICDS services needs radical improvement. This shared commitment is expressed in the title universalisation with quality. A more complete expression would be universalisation with quality and equity. This stresses the need to give priority to underprivileged groups (e g, Dalit and adivasi communities) in the process of universalisation, as well as to eradicate social discrimination of any kind in the implementation of ICDS.

agenda, and to forge new social norms on these issues. To illustrate, the recent recognition of elementary education as a fundamental right of every child has helped to dispel the resilient notion that education is unnecessary for some sections of society. A similar consensus needs to be built regarding the rights and entitlements of children under six. Aside from its political value, the rights perspective has practical implications for public policy on child development services. First, this perspective is the main foundation of the demand for universal child development services. Indeed, one implication of the rights approach is that all children are entitled to certain opportunities and facilities (as the Constitution puts it) that do not have to be justified on a case-by-case basis, let alone submitted to cost-benefit tests. The main role of ICDS is to act as an institutional medium for the provision of these facilities. Second, the rights perspective points to the need for strong monitoring and redressal mechanisms, so that people are able to claim their entitlements. As discussed below, there are few redressal mechanisms in the present scheme of things. In some states, for instance, nutrition programmes under ICDS have been interrupted for months at a time without any action being taken. One reason for this apathy is that these services are regarded as a form of state largesse, rather than as enforceable entitlements.
Table 1: The State of Indias Children
Proportion (per cent) of young children with the following characteristics: Undernourished a Acutely undernourished b Not fully vaccinatedc Not vaccinated at all c Birth was not preceded by any antenatal check-up Suffer from moderate or severe anaemia Had fever during the last two weeks Had diarrhoea during the last two weeks Had symptoms of acute respiratory infection during the last two weeks

ICDS in a Rights Perspective

The value of a rights approach to social development has been well demonstrated in recent years.4 Wider acknowledgement of elementary education as a fundamental right (recently expressed in the 86th constitutional amendment) has contributed to the rapid expansion of school education in the 1990s, evident in age-specific literacy data from the 1991 and 2001 Censuses. The Right to Information Act 2005 has lifted the veil of secrecy from government documents, a major step towards restoring accountability in public life. Supreme Court orders on the right to food have forced the government to take major initiatives in this field, such as the provision of cooked mid-day meals in primary schools.5 Similarly, the National Rural Employment Guarantee Act has empowered rural labourers and reversed the long-standing neglect of rural employment in public policy. In the light of these experiences, there is a case for more active use of the rights approach in the context of childrens issues, including the survival and well-being of children under six. Childrens rights are not, of course, a new idea. The idea is conveyed in the Constitution, notably Article 39(f), which directs the state to ensure that children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity. This Article belongs to the Directive Principles, and should be read along with Article 37, which states that these principles are fundamental to the governance of the country, and that it shall be the duty of the state to apply these principles in making laws. As Article 39(f) illustrates, the Directive Principles (largely due to Ambedkar) include a visionary emphasis on positive freedoms. The governments formal commitment to child rights and positive freedoms was further affirmed in the international Convention on the Rights of the Child. In practice, however, little has been done to protect and promote the positive freedoms of children as a matter of right. The primary role of the rights approach is to change public perceptions of what is due to Indian children. In particular, the rights approach can help to put childrens issues on the political

47 16 58 14 34 51 30 19 19

Notes : a : Based on weight-for-age data (below 2 SD of the median of the reference population). b: Based on weight-for-height data (below 2 SD of the median of the reference population). c: Age 12-23 months. Source : National Family Health Survey 1998-99 (International Institute for Population Sciences, 2000, pp 209, 219, 270, 272, 283). Unless stated otherwise, the reference group consists of children aged below three years (excluding children aged below six months if appropriate).

Table 2: India and Bangladesh: Childrens Well-being and Related Indicators, 2003
India Infant mortality rate (per 1,000 live births) Proportion (per cent) of one year olds immunised BCG Measles Proportion (per cent) of undernourished children, 1995-2003 a Based on weight-for-age Based on height-for-age Estimated maternal mortality rate, 2000 (per 100,000 live births) Net primary enrolment ratio (female) (per cent) GDP per capita (PPP US$) 63 81 67 Bangladesh 46 95 77

47 46 540 85 2,892

48 45 380 86 1,770

Note : a: Data refer to the most recent year for which estimates are available during this period. Source : Human Development Report 2005 . Unless stated otherwise, the reference year is 2003.

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Last but not least, the rights perspective highlights the possibility of putting in place legal safeguards for childrens rights. Many Indian laws, of course, deal with childrens rights in one way or another. But these legislative provisions tend to be of a negative kind, in the sense that they are aimed at protecting children from various evils (such as child labour or child marriage), rather than at guaranteeing the positive opportunities and facilities mentioned in Article 39(f). The proposed Right to Education Bill, flawed as it may be, is an example of the sort of legislation required to guarantee positive freedoms to Indian children. More can be done in this respect, including similar legislation for children under the age of six years. Needless to say, the protection of childrens rights involves much more than better laws and policies relating to child development services. It also calls for far-reaching action in fields such as elementary education, gender relations and even property rights. Nevertheless, the universalisation of ICDS has a crucial role to play in this context.

Universalisation with Quality

In concrete terms, what does universalisation with quality mean? It essentially means that (1) every settlement should have a functional anganwadi, (2) ICDS should be extended to all children under the age of six years (and all eligible women), and (3) the scope and quality of these services should be radically enhanced.6 ICDS is the only major national programme that addresses the needs of children under six. It seeks to provide young children with an integrated package of services relating to nutrition, health and pre-school education. Because the needs of a child cannot be addressed in isolation from those of his or her mother, the programme also extends to pregnant women, nursing mothers and adolescent girls.7 Basic ICDS services include supplementary nutrition, growth monitoring, nutrition counselling, health education, immunisation, healthcare, referral services and pre-school education. These services are provided through a vast network of ICDS centres, better known as anganwadis. Each anganwadi is managed by an anganwadi worker, assisted by an anganwadi helper. An
Table 3: FOCUS Survey: Perceptions of ICDS among Sample Mothers
Six Sample States a Proportion (per cent) of sample mothers who reported that: The local Anganwadi opens regularly 94 Supplementary nutrition is provided at the Anganwadi 94 Their child attends regularlyb 63 Their child is regularly weighed at the Anganwadi 64 Immunisation services are available at the Anganwadi 60 c Pre-school education activities are taking place at the Anganwadib 47 The Anganwadi worker has a kind attitude towards the children 79 ICDS is important for their childs welfare 72 Tamil Nadu

100 93 87 87 63 c 89 84 96

Notes : a : Chhattisgarh, Himachal Pradesh, Maharashtra, Rajasthan, Tamil Nadu and Uttar Pradesh. b: Among mothers with at least one child in the age group of three-six years (the reference group for this question). c: These figures are likely to be underestimates (see below in the text). Source : FOCUS Survey 2004. The figures are based on a random sample of women with at least one child under the age of six years, enrolled at the local Anganwadi.

anganwadi is supposed to cover a population of about 1,000 persons roughly 200 families.8 The coverage of ICDS has steadily expanded since its inception in 1975. Today, the programme is operational in almost every block, and the country has more than seven lakh anganwadis. However, the effective coverage of ICDS remains quite limited: barely one-fourth of all children under six are covered under the supplementary nutrition component. As mentioned earlier, the basic premise of the demand for universalisation of ICDS is that all children have a right to nutrition, health, pre-school education and related opportunities. The anganwadi is an institutional medium to protect these rights, or at least to bring them within the realm of possibility. There are at least four other arguments in favour of universalisation: a legal argument, a political argument, an economic argument and an equity argument. The legal argument is that, like mid-day meals in primary schools, the universalisation of ICDS is mandatory under Supreme Court orders. On November 28, 2001, the court directed the government to ensure that every settlement has a functional anganwadi, and that ICDS is extended to all children under six, all pregnant or lactating women, and all adolescent girls. This order was reiterated and extended on April 29 and October 7, 2004, along with further directions on ICDS.9 The political argument is that the universalisation of ICDS is one of the core commitments of the common minimum programme (CMP) of the UPA government. The CMP clearly states: The UPA will also universalise the Integrated Child Development Services scheme to provide a functional anganwadi in every settlement and ensure full coverage for all children. Thus, aside from being important in is own right, the universalisation of ICDS can be seen as an aspect of the need to hold the government accountable to its promises. It is in this spirit that the National Advisory Council formulated detailed recommendations on ICDS, in line with the commitments of the CMP [National Advisory Council 2004, 2005]. The economic argument is that providing health and nutrition services to children is a good investment, so to speak. Many recent studies indicate that the returns to child nutrition programmes are quite high, or at least, can be quite high.10 The methods underlying these estimates of economic returns have serious limitations, and the results are at best indicative. Further, one should guard against allowing economic criteria to become the arbiter of public policy in this field. Nevertheless, these studies strengthen the case for a major expansion of child development services in India. Last but not least, there is an equity argument for universalisation. Indeed, the universalisation of ICDS would curb the intergenerational perpetuation of social inequality, by creating more equal opportunities for growth and development in early childhood. It would also foster social equity by creating a space where children eat, play and learn together irrespective of class, caste and gender. This socialisation role of ICDS is very important in a country where social divisions are so resilient. Having said this, equity is often invoked as an argument for targeted (as opposed to universal) entitlements more on this below. Taken together, these arguments add up to a fairly strong case for the universalisation of ICDS. Two counter-arguments should be briefly addressed. One is that ICDS does not and cannot work. It is easy to provide superficial support for this claim by citing

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horror stories of idle anganwadis or financial embezzlement. These horror stories, however, are a poor reflection of the general condition of ICDS. Indeed, recent evidence suggests that ICDS is actually performing crucial functions in many states, and that there is much scope for consolidating these achievements. To illustrate, Table 3 conveys the perceptions of ICDS among mothers of children enrolled at the local anganwadi, based on the FOCUS survey mentioned earlier. It is encouraging to note that, according to a large majority of them, the anganwadi opens regularly. This is, in fact, consistent with direct observation: nearly 80 per cent of the sample anganwadis were open at the time of the investigators unannounced visit. Similarly, 94 per cent of the sample mothers stated that supplementary nutrition was being provided at the anganwadi. Even pre-school education, the weakest component of ICDS, was happening in about half of the sample anganwadis. This is not to deny that the quality of ICDS services is quite low in many states, and needs urgent improvement we shall return to this. But there is no basis for the claim that ICDS is a non-functional programme. Aside from debunking this myth, the FOCUS survey draws attention to the enormous potential of ICDS. As Table 3 illustrates, this potential is well demonstrated in states such as Tamil Nadu (not to speak of Kerala), where ICDS is a political priority. The sensible way to go is to make better use of this potential, given that the foundations of ICDS are already in place throughout the country. To put it another way, opposing the universalisation of ICDS on the grounds that there are serious quality issues in some states would be like saying that primary schools should be closed because schools are not working very well in Bihar or Kalahandi. Another counter-argument is that universalisation is unnecessary and even wasteful: instead, public provision of child development services should be targeted to disadvantaged children. This advice is based on the familiar case for targeting social services: targeted interventions are more cost-effective and also help to reduce inequality. This is not the place to review the numerous arguments that have been made for and against targeting in various contexts. As far as ICDS is concerned, suffice it to note that there is no reliable way of targeting children who are vulnerable to malnutrition or ill-health. Indeed, undernourished children are found in all socio-economic groups. Even among relatively privileged households, a substantial proportion of children are undernourished.11 To look at this from another angle, the causes of malnutrition and ill-health are very diverse and these deprivations have no obvious, measurable correlates that could be used for targeting purposes.12 Thus, any targeted system is bound to leave large numbers of children exposed to malnutrition and ill-health. It would effectively convert ICDS into a hit and miss programme. This is incompatible with the notion that nutrition, health and pre-school education are fundamental rights of all Indian children.13

do they belong to families that have little voice in the political system, they also have no voice within the family. This political invisibility of childrens rights is the main theme of Shantha Sinhas opening contribution to the ICDS collection in this issue of the journal. As Shantha Sinha notes, childrens health seldom finds space in contemporary political discourse in India. Childrens issues, for instance, receive little attention in parliamentary debates, political manifestoes, or the mainstream media.14 For this and other reasons, the assertion of childrens rights is a constant challenge to the established order. Shantha Sinha also draws attention to the need for a normative framework that supports the well-being of women and children, and to the possibility of using democratic space to build new social norms on childrens issues. In particular, she argues that childrens rights have to find expression in legal entitlements enforceable in court. Mirai Chatterjees paper is an important contribution to building the sort of normative framework advocated by Shantha Sinha. It gives a beautiful glimpse of childcare services as we would see them if we were to recognise their wide-ranging personal and social roles. As the author points out, childcare services are not just about averting infant mortality or preparing children for school. Public involvement with childcare also serves many other goals: the wholesome growth of every child as a human being; the removal of poverty and deprivation; the healthy socialisation of children; the realisation of the right to education and other fundamental rights; the elimination of social discrimination; the growth of collective solidarity; and so on. In many ways, socialised childcare also contributes to the liberation of women: it lightens the burden of looking after young children, provides a potential source of remunerated employment for women, and gives them an opportunity to build womens organisations. SEWAs experience in Gujarat, briefly discussed by Mirai Chatterjee, illustrates the value of putting childcare in this broad perspective. It is in the light of these rich contributions of childcare to social progress that ICDS deserves far greater attention in public policy and democratic politics.

ICDS and Child Nutrition

Several papers in this collection focus on the role of ICDS in protecting children from hunger and malnutrition. At the outset, it should be recalled that ICDS is not just a nutrition programme. It is meant to be a package of integrated services that include, but go beyond, nutrition services. Further, nutrition services are not restricted to supplementary nutrition. They are also supposed to include other interventions such as nutrition counselling, micronutrient supplementation, and antenatal care for pregnant women. In practice, however, the supplementary nutrition programme (SNP) has come to dominate ICDS. Further, the main focus of SNP has been on children in the age group of threesix years. Younger children have been comparatively neglected, if not excluded. This resilient bias (overemphasis on feeding of older children) is flagged in the title of Shanti Ghoshs paper: ICDS: Food Dole or Health, Nutrition and Development Programme? The author argues for reviving the original vision of ICDS as a child health, nutrition and development programme in which the department of women and child development and the ministry of health were active partners. Following on this, she points out that universalisation with quality must encompass every aspect of ICDS and not just SNP.

Politics of Childrens Rights

The state of Indian children ultimately reflects a deep lack of political commitment to childrens rights. At one level this is just another example of the fact that the concerns of poor people count for very little in Indian politics. But the well-being and rights of poor children are particularly neglected, because these children are twice removed from the centre of attention: not only

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Shanti Ghosh makes two related points that have a crucial bearing on the revival of ICDS. First, she stresses the need to pay much greater attention to children under the age of three years. This is the critical period in the development of the child, when his or her capabilities (health, nutrition, learning abilities, etc) are largely determined. For instance, this is the time when 90 per cent of the brain develops. Further, as the author points out, it is between the age of six months and two years that the nutritional status of Indian children deteriorates in an irreversible way. If we are serious about preventing malnutrition, she says, we have to focus on the age group of 6 months to 2 years. The second point is that, during this period, much can be done through better feeding practices at home. For instance, it is well known that faulty weaning plays a major role in the onset of child malnutrition. Better knowledge and practice of appropriate feeding at home can go a long way in addressing this problem, even without additional economic resources. This requires interventions such as home visits and nutrition counselling. As Shanti Ghosh reiterates, these interventions were part of the original vision of ICDS, but have not been taken seriously. Arun Guptas paper on infant and young child feeding (IYCF) echoes many of these arguments, with special focus on breastfeeding and related matters. The author presents specific prescriptions on IYCF: exclusive breastfeeding for the first six months (starting within one hour of birth) and continued breastfeeding for two years or beyond, along with adequate and appropriate complementary feeding beginning after six months. This prescription, described as optimal IYCF, reflects a unique global consensus on issues related to optimal infant and young child feeding. Arun Gupta summarises the scientific evidence on the benefits of optimal IYCF, and makes a strong case for nutrition counselling as a critical means of promoting better feeding practices at home. The effectiveness of this approach has already been established in various contexts, including a recent experiment conducted by the Breastfeeding Promotion Network of India (BPNI) in Gujarat.15 The case for paying greater attention to children under three is compelling enough. However, further work is required on the specifics of this challenging task. There have been useful attempts, in some states, to reach out to children under three through take-home rations and other means. But effective services for this age group actually require the appointment of an additional anganwadi worker, in charge of home visits, nutrition counselling, and so on. The success of these activities, in turn, depends on innovative communication techniques (such as repeated demonstrations), adequate training, effective supervision, community support, and related inputs. This is a critical area of further exploration for ICDS. Needless to say, the wake-up call for children under three should not be read as an argument for discontinuing feeding programmes for older children, or for rationalising (read downsizing) other ICDS services.16 Nor should the extension of ICDS to children under three come at the expense of timely universalisation. Rather, it needs to be seen as an integral part of the task of universalisation with quality.

micronutrient deficiencies, such as inadequate intake of iron, calcium, iodine or Vitamin A. Unlike overt hunger (the pangs of an empty stomach), hidden hunger is not felt, recognised or voiced by the child or her parents, as the author points out. Yet micronutrient deficiencies are widespread: all members of lowincome (and even middle-income) families are likely to be deficient in vitamins and minerals. Further, the deficiencies are large, in relation to the current recommendations of expert bodies such as the Indian Council of Medical Research. For instance, in the age group of four-six years, the ratio of average intake to recommended daily allowance is only 16 per cent for Vitamin A, 35 per cent for iron and 45 per cent for calcium. Following on this, Tara Gopaldas argues for various forms of micronutrient supplementation, such as the inclusion of iron and Vitamin A supplements in school meals, and the integration of ICDS with national micronutrient programmes (e g, the National Nutritional Anaemia Control Programme). She points out that micronutrient supplements are very cheap, and that there is scientific evidence of their effectiveness in many cases. She also sees this as an essential dimension of the universalisation of ICDS: the ICDS programme should take responsibility for the procurement, delivery and coverage of all inputs in the mother-child dyad. This would include micronutrients. This being noted, attention must also be paid to the claim that unnecessary or even harmful micronutrient supplements are often pushed by commercial interests. There is much passion on both sides, and the recent debate on micronutrient supplementation (e g, salt iodisation) has often generated more heat than light. Perhaps the terms of the debate are a little misleading. Instead of asking for or against micronutrient supplementation? with daggers drawn, it would be more productive to unpack the real issues. There is no doubt that some micronutrient deficiencies, such as iron and Vitamin A, cause massive damage and can be addressed quite effectively through low-cost supplementation programmes. Nor is it a mystery that commercial interests loom large in this field.17 Further clarity requires scientific evidence on a range of questions: What are the critical micronutrient deficiencies? Are these deficiencies better addressed through supplementation than through dietary improvements or nutrition counselling? If supplementation is required, what is the best means of achieving it? Should supplementation be universal or selective? What about cost-effectiveness, cultural acceptability, side effects, and so on? There is much scope here for further research and debate. Meanwhile it is important to note that, in spite of a major difference of emphasis, there is no tension (let alone contradiction) between the contributions of Shanti Ghosh and Tara Gopaldas in this collection. Shanti Ghoshs thesis does not obviate the need to pay attention to micronutrient deficiencies. Tara Gopaldas, for her part, explicitly supports nutrition counselling and related interventions. The two papers complement each other and point to the need for an integrated approach, involving various types of intervention: feeding programmes, micronutrient supplementation and nutrition counselling, among others. That, indeed, was the spirit of ICDS from the beginning.

Hidden Hunger
While the Ghosh thesis is fairly uncontroversial, Tara Gopaldas navigates troubled waters in her paper on hidden hunger and possible interventions. Hidden hunger essentially refers to

Health and Pre-School Education

As things stand, health services under ICDS are quite patchy. The main activity is child immunisation, and in this respect, the programme does seem to play a useful role. In the FOCUS survey,

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about 60 per of the mothers stated that immunisation services were being provided at the local anganwadi, and 84 per cent of the anganwadi workers reported that immunisation sessions had taken place during the preceding 30 days. While the last figure may be exaggerated, the former is likely to be on the low side, because immunisation sessions are not always conducted at the anganwadi itself, even when they are convened by the anganwadi worker.18 For instance, in Himachal Pradesh 84 per cent of the children enrolled under ICDS had an immunisation card, and 76 per cent were fully immunised. This was achieved through joint efforts of the anganwadi worker and the health department, with anganwadi workers taking children to the nearest health centre for immunisation. However, only half of the mothers in Himachal Pradesh said that immunisation services were available at the local anganwadi, because in their perception immunisation is happening elsewhere (at the health centre). Bearing this in mind, the survey responses suggest that immunisation services are in place, even though their effectiveness varies a great deal between different states.19 As immunisation services illustrate, one of the key issues in the provision of health services through ICDS is smooth cooperation between the anganwadi worker and health workers such as the Auxiliary Nurse Midwife (ANM). As Sundararaman argues in his contribution to this collection, there is a strong case for integrating ICDS with community health volunteer programmes. The proposed appointment of an Accredited Social Health Activist (ASHA) in every village, under the National Rural Health Mission, is a crucial opportunity in this respect.20 Aside from this, direct provision of basic health services at the anganwadi needs to be revived. For instance, many anganwadi workers interviewed in the FOCUS survey said that the supply of medical kits had been discontinued. This was a disappointment for them, as the provision of basic medicines at the anganwadi used to be quite popular, and enhanced their social status. Health check-ups at the anganwadi are also far from regular: while 59 per cent of the anganwadi workers stated that health check-ups had taken place during the preceding 30 days, only 38 per cent of the mothers were aware of such services. There are major gaps here that are waiting to be filled. Pre-school education (PSE) is another neglected aspect of ICDS. In the FOCUS survey, Tamil Nadu was the only state with a really effective PSE programme. In Tamil Nadu, 89 per cent of the mothers said that PSE activities were taking place at the anganwadi, and among those, 91 per cent felt that these activities were useful. In the sample as a whole, however, the corresponding proportions were only 47 per cent and 64 per cent, respectively.21 This gap is all the more unfortunate as PSE has much potential as a selling point for ICDS. Mothers interviewed in the FOCUS survey frequently expressed a strong desire to see their child learn something at the anganwadi, so that he or she would be better prepared to enter primary school. Among those whose children were not enrolled at the local anganwadi, more than 70 per cent said that they would like their children to be enrolled. When they were asked why they thought this would be useful, PSE emerged as their prime aspiration. Unfortunately, PSE is also a neglected issue in this collection of papers. The authors (and editor!), like ICDS itself, seem to have over-concentrated on food matters at the expense of other issues. However, Mirai Chatterjees paper presents some insightful

observations on this topic. For instance, she argues that locating anganwadis in the same premises as primary schools would help to facilitate PSE activities: Whenever we have had crches in the school premises, it has benefited all. The young children come in with their older siblings, they get used to the idea of school and their older siblings come in and play with the little ones during the school breaks. There is a general atmosphere of learning and education, with the young children quickly learning from the older ones already at school. The FOCUS survey also suggests that locating anganwadis near school premises is a good idea, provided that the primary school is relatively close to childrens houses an important qualification. Of course, reviving PSE activities in ICDS requires more than just relocating the anganwadis. For instance, it also requires extensive training programmes for anganwadi workers, better facilities (including space), and effective monitoring arrangements. The first step, however, is to recognise the problem and to learn from states that already have lively PSE programmes, such as Kerala and Tamil Nadu. Universalisation with quality is not just about expanding the coverage of ICDS, or quality improvements. It also means extending the scope of ICDS services, and in particular, placing healthcare and pre-school education at the centre of the programme.

Implementation and Accountability

In ICDS as with other development programmes, there is a wide gap between policy and implementation. In their paper, Nandini Nayak and N C Saxena scrutinise this problem with reference to Bihar and Jharkhand. These two states are known for dismal standards of governance, and this may be regarded as a worst-case scenario. It illustrates some of the implementation problems associated with ICDS, without claiming to give a representative picture of the situation in India as a whole. The most striking pattern emerging from this case study is that the effectiveness of ICDS is constantly being held up due to sheer neglect. Because children have no voice in the system,
Table 4: FOCUS Survey: Selected Regional Contrasts
Tamil Maha- North Indian Uttar Nadu rashtra States a Pradesh Proportion (per cent) of Anganwadis where:b Overall functioning is rated as poor or very poor by the survey team 13 Supplementary food was not being provided at the time of the survey 0 Effectiveness of child immunisation is low or very low 12 Proportion (per cent) of villages where:b The motivation of mothers to send their children to the AWC appears to be high or very high 60 Mothers look at the Anganwadi worker as a person who can help them in the event of health or nutrition problems in the family 5 2

32 9 0

41 13 35

42 25 44

55

29

23

60

16

10

Notes : a : Chhattisgarh, Himachal Pradesh, Rajasthan and Uttar Pradesh. b: Proportion of valid observations, i e, of Anganwadis/villages for which the relevant assessment could be made by the survey team. Source : Drze and Sen (2004), based on the FOCUS Survey. All figures are based on the overall assessment of the survey team, after an unannounced visit to the Anganwadi and a series of interviews with mothers. In the last column, Uttar Pradesh has been singled out as the state with the poorest ICDS services among the six sample states, on most counts.

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there is no self-correction mechanism whereby implementation failures lead to outspoken protest and timely redressal. As a result, problems that could be solved relatively easily are often left unaddressed. A telling example is the lack of supervision in ICDS. This is an acute problem in Bihar and Jharkhand, to the extent that the authors speak of supervision in absentia. In Bihar, 85 per cent of the supervisor posts are vacant, and 18 per cent of the ICDS projects do not have a single supervisor.22 In Jharkhand, even the post of child development project officer (CDPO, the project in-charge) is vacant in about half of the projects. It is hard to
Table 5: Quality Variations in ICDS: Supplementary Nutrition Programme (SNP)
Tamil Maha- North Indian Uttar Nadu rashtra States Pradesh Proportion (per cent) of mothers who report that:a SNP is provided at the local Anganwadi 9 3 Food distribution is regular 96 Children get a full meal at the Anganwadi 98 Proportion (per cent) of respondents who feel that the quality of food is poor: Mothers 8 Anganwadi workers 0 Proportion (per cent) of respondents who feel that the quantity of food is inadequate: Mothers 2 Anganwadi workers 3 95 94 79 94 73 45 94 51 23

19 6

33 15

57 34

13 6

47 27

69 35

Note : a: Based on assessment of field investigators. Source: FOCUS Survey 2004 (see also Table 4).

Table 6: Tamil Nadu Is Different

Tamil Nadu Northern States a Proportion (per cent) of Anganwadis that have: Own building 88 18 Kitchen 85 30 Storage facilities 88 58 Medicine kit 81 22 Toilet 44 17 Average opening hours of the Anganwadi (according to the mothers) 6 hours a day 3 hours a day Proportion (per cent) of children who attend regularly b Age 0-3 59 20 Age 3-6 87 56 Proportion (per cent) of mothers who report that: Pre-school education activities are taking place at the Anganwadi 89 48 The motivation of the Anganwadi worker is high 6 7 39 The Anganwadi worker ever visited them at home 5 8 22 Proportion (per cent) of women who had at least one prenatal health check-up before their last pregnancy c 100 55 Proportion (per cent) of children who are fully immunisedd 71 41 Average number of months that have passed since Anganwadi worker attended a training programme 6 30 Proportion (per cent) of Anganwadi workers who have not been paid during the last 3 months 0 22 Notes : a : Chhattisgarh, Himachal Pradesh, Rajasthan and Uttar Pradesh. b: Among those enrolled at the local Anganwadi; responses from mothers. c: Among those who delivered a baby during the preceding 12 months. d: Based on assessment of investigators (they were trained for this purpose). Source : FOCUS Survey, 2004. See also Table 1, on mothers perceptions of ICDS.

see how anganwadis can be expected to provide quality services without any supervision. Another shocking example is the disruption of food distribution in anganwadis. In Bihar and Jharkhand, the SNP has been interrupted for months at a time in recent years, bringing ICDS to a standstill as children stopped attending. The reason for failing to address the problem is not that it is difficult to do. As recent experience with mid-day meals in primary schools has shown, it is well within the administrative capability of every state government to provide cooked meals in schools or anganwadis. Unlike ICDS, however, the mid-day meal scheme has received sustained attention due to Supreme Court orders, public pressure, and (following on that) political interest in this scheme. ICDS, by contrast, remains out of focus. Indeed, what is so startling about these SNP interruptions is not that they happened, but that no one took much notice for months on end. There are many other illustrations of this pattern in Nayak and Saxenas paper: under-utilisation of financial assistance from the central government, failure to operationalise sanctioned projects, appointment of anganwadi workers without any training, long delays in salary payments, lack of essential infrastructure, to name a few. In all these respects, much can be done with relatively little effort, yet it does not happen, because ICDS is not a priority. This is not to say that every implementation problem in ICDS can be resolved just by getting on with it. There are also difficult issues to address, notably in relation to nutrition counselling and pre-school education. And of course, larger much larger financial allocations are required. Yet it is important to recognise that radical improvements in the quality of the ICDS are well within reach. This fact is also reflected in another striking feature of the implementation of ICDS: sharp contrasts between different states. The point is illustrated in Table 4, and also in Table 5 with specific reference to the supplementary nutrition programme. As Table 5 shows, this component of ICDS is in place almost everywhere, but there are major quality variations between different states. In Uttar Pradesh, SNP interruptions are common. When food is available, it is just panjiri, a ready-to-eat mixture with a short shelf life, often stale by the time it is distributed. In Rajasthan, there is more regularity, but again no variety: murmura every day for all children regardless of age. By contrast, there are three items on the menu in Himachal Pradesh (khichri, dalia and chana), served on different days of the week, and the supply is quite regular in spite of the difficult terrain. The diversity and nutritional value of the food are even higher in Tamil Nadu, where two types of food are provided: (1) a hot lunch of rice, dal and vegetables cooked with oil and condiments (with occasional variants such as a weekly egg) for children in the three-six age group, and (2) a fortified, pre-cooked health powder (to be mixed with boiling water or milk) for younger children. Further, SNP disruptions in Tamil Nadu are rare. Similar inter-state contrasts apply to other ICDS services such as healthcare and pre-school education. These contrasts are all the more remarkable as the basic framework of ICDS is essentially the same everywhere. The operational guidelines are similar in different states, yet the results vary a great deal depending on the social and political context. For instance, in Rajasthan and Uttar Pradesh, the interests of private contractors often loom larger than those of hungry children, and this is an important reason why substandard ready-to-eat items

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continue to be provided in anganwadis, instead of nutritious cooked food. The politics of ICDS are very different in Tamil Nadu, as discussed in the next section.

Tamil Nadu Is Different

The relatively high standards of ICDS in Tamil Nadu has already been noted on several occasions (see also Tables 3, 4 and 5). Further evidence on this is presented in Table 6. Whether we look at the infrastructure, or child attendance rates, or the quality of pre-school education, or immunisation rates, or mothers perceptions, Tamil Nadu shines in comparison with other FOCUS states, especially the northern states. Perhaps the best sign of real achievement is the fact that 96 per cent of the sample mothers in Tamil Nadu considered ICDS to be important for their childs well-being, and half of them considered it to be very important.23 The central feature of Tamil Nadus experience is initiative and innovation. Unlike states like Bihar and Jharkhand, which have passively implemented the central guidelines on ICDS, Tamil Nadu has owned ICDS and invested major financial, human and political resources in it. For instance, anganwadis in Tamil Nadu are typically open for more than six hours a day, compared with an average of barely three hours a day in the northern states. Similarly, high child attendance rates in the age group of 0-3 years show that many anganwadis in Tamil Nadu include crche facilities for small children (Table 6). Tamil Nadu has also developed sophisticated training programmes, involving the formation of active training teams at the block level, joint trainings of ICDS and health department staff, regular refresher courses for anganwadi workers, inter-district exposure tours for ICDS functionaries, and more. The question arises as to why Tamil Nadu has done so well in this field, and indeed also in related fields such as mid-day meals and even health services.24 Anuradha Rajivans paper attributes this success to a combination of political initiative and public pressure (each reinforcing each other). On the one hand, combating child hunger and malnutrition became political priorities in Tamil Nadu well before judicial intervention triggered responses at the centre. On the other, Tamil Nadus relatively informed, articulate and vocal public kept the government on its toes, making it difficult, for instance, for an anganwadi to remain closed without immediate enquiry. Womens agency also played a crucial role in this success story, in several ways. First, ICDS in Tamil Nadu is managed almost entirely by women, not only at the anganwadi level but also at higher levels.25 Second, women have helped to hold the system accountable. The pressure from below, as Rajivan calls it, comes largely from women women who value the ICDS and are able to voice their demands. Third, women have also helped to make health and nutrition political issues. For instance, womens votes in Tamil Nadu matter a great deal, and this forces political leaders to respond to their aspirations, including those relating to child development. It is perhaps no accident that the only north Indian state where ICDS is doing relatively well, namely, Himachal Pradesh, has much in common with Tamil Nadu in terms of gender relations and the role of women of society. Tamil Nadu is an outstanding example of effective implementation of ICDS. It is important to note, however, that positive experiences are not confined to Tamil Nadu (or for that matter

Kerala). The FOCUS survey suggests that Maharashtra is rapidly catching up with Tamil Nadu, and making strides towards universalisation with quality, as Tables 4 and 5 illustrate. There were also many positive findings in Himachal Pradesh, such as a relatively good integration of ICDS with health services, reflected inter alia in high immunisation rates (as noted earlier). Even in the other northern states, there were many inspiring cases of lively anganwadis as well as some signs of general improvement over time.26 In laggard states such as Uttar Pradesh, ICDS essentially emerges from the FOCUS survey as a missed opportunity. The programme has great potential and is of critical importance for the future children under six, but this potential has been wasted because the well-being of children has little political value. This situation, however, is not immutable.

Action for ICDS

One of the sobering findings of the FOCUS survey is that community involvement in ICDS is low, almost everywhere. Village communities, or for that matter gram panchayats, are rarely involved in the management or supervision of the local anganwadi.27 There are, however, positive experiences of public action and community involvement in ICDS. The papers by Dipa Sinha and Samir Garg discuss two recent initiatives of this kind, located in Andhra Pradesh and Chhattisgarh respectively. In Andhra Pradesh, child rights issues were taken up in a setting where reasonably functional community institutions (mainly, the gram panchayats) were in place. The first task of the MV Foundation was to create a new social environment for child rights, as Dipa Sinha puts it. The central feature of this new social environment is that the survival, well-being and rights of children become social issues, of interest to the whole community and not just to the mothers or families of the children concerned. For instance, MV Foundation tried to ensure that the birth or death of a child is seen as a community event. When a child is born, the panchayat issues a birth certificate and the community celebrates. When a child dies, there is an enquiry and a public discussion of how the death could have been prevented. As Dipa Sinha puts it: To change norms, the entire community has to be mobilised to protect the rights of women and children. In this new social environment, a range of practical interventions are possible. For instance, monthly meetings are convened by the gram panchayat with the anganwadi worker, the ANM, the school headmaster and others to review the situation of children: births and deaths, the progress of immunisation, the functioning of the local anganwadi, and so on. A new rapport also develops between the anganwadi worker and the community, whereby the latter helps to address the concerns of the anganwadi worker but also holds her accountable.28 The Koriya experience in Chhattisgarh, discussed by Samir Garg, has many features in common with the CRPFs work in Andhra Pradesh. In particular, it began with an elaborate process of awareness building and grassroot mobilisation. This process was greatly facilitated by the presence of a community health volunteer, known as Mitanin, in each hamlet (the Mitanin programme is discussed in Sundararamans paper). For instance, the Mitanins did an initial survey of malnutrition in the area, which helped not only to collect useful data but also to initiate collective discussions of child nutrition issues. The Mitanins also took the lead in forming nutrition monitoring committees (dekh rekh

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samitis) in each hamlet, consisting mainly of dalit and adivasi women. These monitoring committees, together with the Mitanins, conducted a joint campaign to restore accountability in the ICDS programme and expand its coverage. This involved both collaborative activities (such as the anganwadi revival campaign, jointly implemented by the Mitanins, ICDS staff and the health department) and adversarial action (such as exposing corruption). A special feature of the Koriya experience is the emphasis on nutrition counselling at home. This is an integral part of the Mitanin programme, and according to Samir Garg, it had an unprecedented effect on the feeding practices. It is not surprising that the success of nutrition counselling is closely linked with community participation in health and nutrition programmes, partly due to the influence of social norms in nutrition behaviour. There is a crucial lesson here, given the importance of reviving nutrition counselling as an integral part of ICDS. It may be asked whether initiatives of this sort can really have a large-scale impact. In this connection, it is worth noting that the MV Foundations related work on child labour does seem to have made a major difference in Andhra Pradesh. Indeed, according to recent census data, there has been a remarkable decline in child labour in Andhra Pradesh in the 1990s, and this achievement can be plausibly related to the MV Foundations work in various ways, including its impact on social norms and public policy [Burra 2006]. In Chhattisgarh, too, there are indications that the Mitanin programme is having a significant impact. As mentioned in Sundararamans paper, there has been a major reduction of infant mortality in Chhattisgarh (more precisely, rural Chhattisgarh) during the last few years: the infant mortality rate dropped from 85 per 1,000 to 61 per 1,000 within two years of the inception of the Mitanin programme (i e, between 2002 and 2004). As Sundararaman discusses, it would be nave to jump to the conclusion that the Mitanin programme is the driving force behind this rapid decline, but nevertheless, trends are certainly encouraging. Further initiatives of this kind are needed, not only to foster community participation in ICDS but also to transform the politics of child development services.

of the core commitments of the CMP is a major opportunity. The real breakthrough will happen when ICDS becomes a focus of competition between political parties, as has happened with mid-day meals and the Employment Guarantee Act. The vicious circle of political apathy, poor services, and low demand can also be broken. If ICDS delivers quality services that people value, the demand for these services is likely to increase. If political leaders respond to this popular demand, services will further improve. This could set off a virtuous circle of public pressure and state initiative, each reinforcing the other (much as in Tamil Nadu). It is also worth reiterating that legal safeguards can play an important role in this context. As discussed earlier, the premise of the demand for universalisation with quality is that all Indian children have a right to basic nutrition, health and pre-school education services. It would be naive to think that these rights can be fully translated into legal entitlements. But legal safeguards can certainly help to give them a cutting edge. The demand for universalisation with quality has farreaching political significance, going much beyond the wellbeing of children. It is also an integral part of the larger battle to defend central ideas of the Indian Constitution: wide-ranging economic and social rights for all citizens, state responsibility for the realisation of these rights, and the socialisation of essential public services, among others. These ideas have come under heavy fire in recent years, and the demand for universalisation with quality is an opportunity to reaffirm them. It is also a crucial test of the ability of Indian democracy to focus on the needs and rights of disadvantaged citizens. EPW Email: dreze@econdsc.org

Notes
[I am grateful to all the participants of the Mussoorie workshop (discussed in the text) for enlightening discussions. I have also learnt a great deal from related consultations, especially the Convention on Childrens Right to Food (Hyderabad, April 7-9, 2006), and collaborative work with Citizens Initiative for the Rights of Children Under Six. Special thanks are due to Reetika Khera and Shonali Sen for help with data analysis, and to the Lal Bahadur Shastri National Academy of Administration for hosting the Mussoorie workshop under the able leadership of Arti Ahuja.] 1 The panchayat has a population of about 22,000. These anganwadis are public facilities, and no fees are charged. However, in relatively urbanised settlements of Kerala, many parents send their children to private nursery schools. 2 Human Development Report 2005, Table 7, based on weight-for-age data. 3 The proceedings of this convention are available at www.righttofoodindia.org. The concluding statement, which reflects a broad consensus among the participants, presents detailed recommendations on ICDS. 4 For further thoughts on this, see Drze (2004). 5 For the full text of these orders, see www.righttofoodindia.org. For a summary, with explanatory notes, see Right to Food Campaign Secretariat (2005). 6 ICDS services are not restricted to children. Some of them (e g, antenatal care) are addressed to pregnant or nursing women and adolescent girls. These services are very important, but the main focus of this article is on services aimed at children under six. 7 For a more detailed introduction to ICDS, see e g, Right to Food Campaign Secretariat (2006) or http://wcd.nic.in. For recent reviews and assessments of ICDS, see Haldar (2004), HAQ (2005b), Drze and Sen (2004), Mander (2005), Prasad (2005), Ramachandran (2005),

Concluding Remarks
By now it should be clear that the main challenge of universalisation with quality is to make ICDS (and, beyond that, childrens rights) a lively political issue. This may sound like a tall order, if not wishful thinking. But the same would have been said 15 years ago of the right to education, 10 years ago of the right to information, five years ago of the right to food, and three years ago of the right to employment. There are, no doubt, important obstacles to contend with, including fiscal conservatism, the privatisation mania, corporate interference in the social sector, and the general mood of state abdication from its social responsibilities.29 However, there are also favourable developments. As parents (especially mothers) become more educated and articulate, they are likely to play a more active role in demanding quality services from ICDS. The Supreme Court has thrown its considerable weight behind the demand for universalisation with quality. And most importantly, the child rights movement in India is gaining strength. On this issue as on many others, political parties have been lagging behind public initiatives. However, this too can change. In this respect, the fact that the universalisation of ICDS is one

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9 10 11 12

13

14 15 16 17

18

19

20 21 22 23

24 25

26 27

28

Gragnolati et al (2006), Saxena and Mander (2005, 2006), among others. These population norms are in the process of being revised [Government of India 2006a]. Unfortunately, the proposed new norms are inadequate, and in some respects they represent a step backward; see Saxena and Mander (2006) and Right to Food Campaign Secretariat (2006). For further details, see www.righttofoodindia.org. For reviews, see Alderman (2004) and Behrman et al (2004). See, e g, International Institute for Population Sciences (2000) and Tarozzi (2005). Restricting ICDS to households that have a BPL (below poverty line) card, as used to be done in some states, is a particularly objectionable approach, not only because the BPL Census is highly unreliable (and conceptually flawed) but also because malnutrition is widespread even among non-BPL households. These basic facts do not prevent a recent World Bank report on ICDS [Gragnolati et al 2005] from making the startling suggestion that future efforts to combat malnutrition could be targeted to a relatively small number of districts/villages on the grounds that a mere 10 per cent of Indias villages and districts account for 27-28 per cent of all underweight children. In this and other ways, the World Bank report is at variance with the rights perspective on ICDS. For an enlightening analysis of parliamentary debates on childrens issues, see HAQ (2005a). On media coverage, see e g, Drze and Sen (2002). Other positive experiences with nutrition counselling are mentioned in the papers by Samir Garg and Shanti Ghosh. The World Bank report mentioned earlier includes disquieting recommendations along those lines. To illustrate, according to a personal communication from Michael Lipton (University of Sussex): CIMMYT wasted millions of dollars in researching lysine-enriched maize, though hardly any human maize-eaters are proteinconstrained, let alone lysine-constrained, if they have sufficient calories. It won CIMMYT the World Food Prize, presumably for economising on chicken production costs turning this award into a bad international joke. Note also that the 60 per cent figure is based on an open-ended question where mothers are asked to describe the services available at the local anganwadi. The responses need not be exhaustive. Among the six FOCUS states, Rajasthan and Uttar Pradesh had the worst immunisation programmes. The proportion of children who had never been immunised (among those enrolled in ICDS) was as high as 36 per cent in Rajasthan and 15 per cent in Uttar Pradesh, compared with 7 per cent in Chhattisgarh, 4 per cent in Tamil Nadu, 3 per cent in Himachal Pradesh and 1 per cent in Maharashtra. The Health Mission, however, is expected to be restricted to 18 states [Government of India 2006b]. These are percentages of mothers with at least one child (in the age group of 3-6 years) enrolled at the local anganwadi. See Table 3 in the paper by Nayak and Saxena. The project is the basic unit of implementation for ICDS, and usually coincides with a block. The best anganwadis in Tamil Nadu were not very different from the model anganwadi described at the beginning of this article. For an enlightening case study (due to Vivek S), see Right to Food Campaign Secretariat (2006). For various interpretations, see Visaria (2000), Drze and Sen (2002), Drze (2003), Rajivan (2004), among others. Here again, the contrast between Tamil Nadu and the northern states is very sharp. In Rajasthan, for instance, most of the ICDS functionaries above the anganwadi level, including almost all trainers, are men. From the CDPO level upward, most of them are on deputation from other departments, and have no special competence or motivation to manage ICDS (personal communication, CDPO Barmer). On positive deviance of ICDS in Rajasthan and Uttar Pradesh, see also Ramachandran (2004). To illustrate, the average number of months that had lapsed since the sarpanch last visited the anganwadi was above 12 in every sample state, except Maharashtra (11 months) and Tamil Nadu (5 months). In Maharashtra and Tamil Nadu, there were some interesting signs of community involvement, such as voluntary contributions for extra toys or wall painting at the anganwadi. Judging from the FOCUS survey, major concerns of anganwadi workers include a heavy workload, low salaries, delays in salary

payments, inadequate infrastructure, lack of training, and low community support. The survey data substantiate many of these concerns. However, the findings also point to serious accountability problems in many anganwadis. 29 The pernicious influence of private interests in ICDS, and especially of contractors, is discussed in the Commissioners Reports to the Supreme Court [see Saxena and Mander 2005].

References
Alderman, Harold (2004): Linkages between Poverty Reduction Strategies and Child Nutrition: An Asian Perspective, mimeo, World Bank, Washington DC. Behrman, J R, H Alderman and J Hoddinott (2004): Hunger and Malnutrition in B Lomborg (ed), Global Crises, Global Solutions, Cambridge University Press, Cambridge. Burra, Neera (2006): Born Unfree: Child Labour, Education and the State, mimeo, New Delhi. Drze, Jean (2003): Where Welfare Works: Plus Points of the TN Model, Times of India, May 21. (2004): Democracy and the Right to Food, Economic and Political Weekly, April 24. Drze, Jean and Amartya Sen (2002): India: Development and Participation, Oxford University Press, New Delhi. Drze, Jean and Shonali Sen (2004): Universalisation with Quality: An Agenda for ICDS, report prepared for the National Advisory Council; available at www.righttofoodindia.org Government of India (2006a): Report of the Inter-Minsterial Task Force Set up to Review the Population Norms for Setting up of an Anganwadi Centre under the ICDS Scheme, mimeo, Ministry of Women and Child Development, New Delhi. (2006b): National Rural Health Mission: Framework for Implementation 2005-2012, mimeo, Ministry of Health and Family Welfare, New Delhi. Gragnolati, M et al (2005): Indias Undernourished Children: A Call for Reform and Action, HNP Discussion Paper, World Bank, Washington DC. HAQ: Centre for Child Rights (2005a): Says a Child... Who Speaks for My Rights? Parliament in Budget Session, 2005, HAQ, New Delhi. (2005b): Status of Children in India Inc, HAQ, New Delhi. Haldar, Antara (2004): Literature Survey on the ICDS, mimeo, Centre for Equity Studies, New Delhi. International Institute for Population Sciences (2000): National Family Health Survey (NFHS-2) 1998-99: India, IIPS, Mumbai. Mander, Harsh (2005): Promises to Keep: ICDS at Crossroads, mimeo, Centre for Equity Studies, New Delhi. National Advisory Council (2004): Recommendations on ICDS, available at www.nac.nic.in. (2005): Follow-up Recommendations on ICDS, available at www.righttofoodindia.org. Prasad, Vandana (2005): The State of Preventive Health and Nutritional Services for Children in L Gangolli, R Duggal and A Shukla (eds), Review of Healthcare in India, CEHAT, Mumbai. Rajivan, A K (2004): Towards a Malnutrition Free Tamil Nadu: A Case Study in M S Swaminathan and P Medrano (eds), Towards a Hunger Free India, East West Books, Madras. Ramachandran, Vimala (2004): Analysis of Positive Deviance in the ICDS Programme in Rajasthan and Uttar Pradesh, mimeo, Educational Resource Unit, New Delhi. (2005): Reflections on the ICDS Programme, Seminar, No 546. Right to Food Campaign Secretariat (2005): Supreme Court Orders on the Right to Food: A Tool for Action, Secretariat of the Right to Food Campaign, New Delhi, also available at www.righttofoodindia.org. (2006): Universalisation with Quality: Action for ICDS, Secretariat of the Right to Food Campaign, New Delhi, also available at www.righttofoodindia.org. Saxena, N C and H Mander (2005): Sixth Report of the Commissioners, report to the Supreme Court of India; available at www.righttofoodindia.org. (2006): Update on the Universalisation of ICDS: Clarifications and Recommendations, report to the Supreme Court, July; available at www.righttofoodindia.org. Tarozzi, Alessandro (2005): On the Nutritional Status of Indian Children, mimeo, Department of Economics, Duke University. Visaria, Leela (2000): Innovations in Tamil Nadu, Seminar, 489.

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