Little boys and girls, sitting on the cement floor, unanimously repeat after their teacher, ”A for Apple” and on. But while the children go through their alphabet association exercise, water drips through the cracks in the window and the ceiling, and loud thunderstorms drown out the teacher’s voice.
Later their teacher, Mamta Shukla, confided in me “Attendance is very poor and the kids are distracted. Cleanliness in the center is often a problem too.” She talks as she picks up a bucket and places it under the crack to collect the water. I watch the kids play in the rain-water that has made its way through the cracks.
This is the story of N-15 Shambazaar Basti’s Anganwadi center in Muzaffarpur district in Bihar. According to the National Family Health Survey-4, 42 percent children below the age of six are underweight in Bihar. But malnourishment is not just limited to Bihar. In 14 other states in India, average malnutrition levels hover around 35 percent.
In 1975, the Indian government launched a welfare program called the Integrated Child Development Scheme (ICDS) with the aim of providing pre-school education, immunization, supplementary nutrition and health referrals to nursing mothers and children through a low-cost delivery model involving village centers called Anganwadi that is run by locally recruited female community worker. While well intentioned, ICDS has failed to deliver on its promise of reducing malnutrition levels to below 10%, despite its four decades of existence.
It’s not hard to figure out why.
The program is designed around the community (or Anganwadi) worker, a woman aged between 18-35 years with high-school level qualifications, from the local community. In addition to providing services to beneficiaries, by relying on local workers, the program is intended to support community mobilization for the young children, girls and women for a minimal honorarium. And so, Mamta, a resident of the Muzaffarpur district with three children of her own, is one of the two million Anganwadi workers who serve as India’s link between 70 million women and children and the formal healthcare system. After being voted-in by the committee of government officers and community heads, she was inducted after she completed a month long training.
However, since then, she is assumed to have attained super powers. She lists her tasks and the list goes on and on: teaching nursery children, providing immunization and referrals to walk-ins, advising pregnant and nursing women on their nutrition supplements, managing the kitchen as well as supplies in the center, doing book-keeping, conducting outreach in the village and more. For all of this, she received a monthly honorarium of $45.
Even if Mamta were the most passionate, hardest working Anganwadi worker, it wouldn’t be enough to overcome her lack of training to work on all the responsibility the program has charged her and her colleagues with—from training in basic nutrition, educating children, managing the center to providing basic health care!
The ICDS’s fundamental flaw has been the lack of preparation and regular training that it provides to the critical links in making the project work. For this, it is not only important for Ministry of Women and Child Development to acknowledge the impossibility of the tasks they have assigned women like Mamta but also to free up its budget to research and investigate the gaps in training strategy. At the same time, the ICDS has at best rudimentary monitoring of its 1.3 million centers to allow the Ministry to identify and address the challenges workers face. And this will just be the start, because the ministry will need to quickly move from barriers such as poor infrastructure and hygiene in the center that inhibit workers from performing their tasks to keeping them motivated and rewarding their efforts.
Considering that poor nutrition directly affects the quality of the Indian workforce, continued neglect for the end-of-the-line healthcare worker directly in contact with these crucial populations is not only a serious design flaw of the scheme but simply, a waste of money. Yet even with these weaknesses in the program, the education and healthcare the program provides is a critical safety net for India’s poor. According to estimates, every year 7% of India’s population is pushed below the poverty line due to the poor healthcare system. Imagine how much good it could do if these flaws of improper training and monitoring were addressed?
In 2016, the Modi government attempted to address the program’s flaws and criticisms of its effectiveness not by improving it but by imposing a budget cut of $220 million from the overall spending for child intervention. This cut, the second consecutive one, will push the excluded further into the malnutrition trap without allowing the Ministry of Women and Child Development to investigate and fix the flaws.
Budget cuts will not improve spending efficiency. Instead they will completely destroy the link between semi-formal (or any) healthcare to the rural women and children. What is needed instead is political will and support to increase funding and to direct it to the critical areas of training and monitoring. Without it, even reducing the funding means that public funds are being wasted—less of them yes, but wasted—in a project that even with all its flaws has shown some shades of success in improving the chances of Indian youth and women.
The walls of the Anganwadi center at N-15 Shambazaar Basti in Muzaffarpur will continue to leak as kids play in the filth that accumulates. And the scene is likely to be the same in 1.3 million other centers in the country, unless the Modi government shows political will to fix these leaks.