*z1 South Asia Education Sector Technical Working Paper No. I 21761 'RAHN OUT TO THE CHILb' WORKSHOP ON CHILD bEVELOPMENT A REPORT NEW DELHI OFFICE Report No. 1 June 30, 2000 Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized
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*z1 South Asia Education SectorTechnical Working Paper No. I
21761
'RAHN OUT TO THE CHILb'WORKSHOP ON CHILD bEVELOPMENT
A REPORT
NEW DELHI OFFICEReport No. 1June 30, 2000
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Note
The Technical Working Paper Series is to provide a reference system for
informal working papers generated during operational activities by South Asia
Education Sector staff and others.
These papers have been reviewed by the Education Team Leaders but have
not been peer-reviewed. The views expressed are those of the authors and
should not be attributed to the World Bank.
ii
TASK TEAMS
SOUTH ASIA EDUCATION SECTOR TEAM MEMBERS
Venita Kaul, Senior Education Specialist, World Bank - Task LeaderKalpana Seethepalli, Operations Analyst, (SASED), World Bank - Co-Task LeaderWard Heneveld, Sector Team Leader for India, World BankSusan Hirshberg, Education Specialist, World BankAnjali Manglik, Team Assistant, World BankSudesh Ponnappa, Program Assistant, World BankRenu Gupta, Team Assistant, World Bank
SOUTH ASIA HEALTH, NUTRITION & POPULATION SECTOR TEAMMEMBERS
Peter Heywood, Principal Health Specialist, World BankMeera Priyadarshi, Nutrition Specialist, World BankSuneeta Singh, Public Health Specialist, World BankAgnelo Gomes, Team Assistant, World Bank
CONSULTANTMukulika Dadhich, Consultant, South Asia Education Sector
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Contents
Task Teams.iii
Foreword. v
Executive Summary ............................................................... vi
1. Introduction. 1
2. Context. 1
3. The Workshop .................................................................... 23.1 Objectives ................................................................ 2
3.2 The Workshop Design ....................................................... 23.3 Highlights of discussions ....................... ............................ 3
4. Issues on which there was consensus ................................................ 7
5. Issues on which there was debate ................................................... 8
6. Questions that emerged from the workshop ....................................... 8- Indicators. 9- Role of Community .............................................................. 9- Institutional mechanisms ....................................................... 9- Policy/Public private partnerships ............................................ 9- Cost effectiveness ............................................................... 10
Conclusion ................................................................. 10
Annex 1. Stage-wise expected developmental outcomes and indicators ......... 11
Annex 2. Reaching out to the Child ..................................................... 141. Introduction ............................................................... 142. Conceptual Framework .......................................... ........... 14
Conceptual Framework - diagrammatic representation ......... 153. The Indian Context ............................................................ 18
3.1 Are all our Children Ready for Primary School? ................ 183.2 Are the Schools Ready for our Children? ....................... 193.3 To what extent is the Community Supportive of their
Children's Needs and Rights? .................................... 203.4 What are the Existing Policies and Programs to
Address Needs of Child ............................................ 213.5 The Current Situation .............................................. 22
Annex 3. Workshop Schedule ........................................................... 24Annex 4. List of Invitees ............................................................... 26
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Foreword
The future of our country rests with the young children of today. The best investment wecan therefore make in our county's future is to ensure that every Indian child grows up inan environment that is enabling foi her/his optimal development. While India has, overthe last few decades, made considerable progress in ensuring child survival and basiceducation, a lot still remains to be done. There is also a growing realization amongstakeholders that all efforts towards realizing our vision for child development need totake on a more holistic and multi-sectoral path, which focuses not on schemes for thechild per se, but on the 'child' herself.
In this context, we were happy to participate in the multi-sectoral workshop titled'Reaching Out To the Child' organized by the World Bank on February 29-23, 2000, andinteract with our colleagues and experts from different sectors on this very importantissue. We are glad that the deliberations of the workshop have been well documented inthe form of this report. Tnis will facilitate wider sharing of the wealth of ideas andsucgestions that inforrned the proceedings of the workshop. We look forward to furthercollaboration with all stakeholders, including the World Bank, on addressing many of theissues that have emered E=rom the workshop.
Sumit Bose RekLha BbaYgava Gautam BasuJoint Secretary Joint Secreiarv Joint SecretarvDept. of Elementary Education Dept. of Wom'nen & Dept. of Family& Adult Literacy Child Develament WelfareNHRD MHRD MEW
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Executive Summary
A multi-sectoral workshop entitled 'Reaching Out to the Child' was organizedcollaboratively by the Education and Health, Nutrition & Population teams of the WorldBank, New Delhi on February 21 and 22, 2000.
The objective of the workshop was to initiate multi sectoral discussions across thegovernment and non-govermment sectors as a first step towards establishing aconstituency for the development of an integrated, comprehensive and convergentapproach to child development. This involved (a) developing a shared vision of holisticchild development addressing the child both across the education, health and nutritionsectors as well as along the entire child development continuum from the prenatal stageto the age of 11+ years; (b) identifying critical outcome indicators and correspondinginputs of optimal child development for each sub-stage of the development continuum,leading up to successful completion of primary education as a development indicator; and(c) broadly reviewing existing programs and services for children to assess the extent towhich they meet the identified needs of children in an integrated and holistic manner.
The workshop contributed significantly to identification of certain areas of understandingof current child development needs and provisions in the Indian context. It also helped toidentify certain areas on which there was consensus and others where differences ofopinion were voiced and which would require further study and analysis. Some issuesthat found acceptance among most participants pertained to the need to capture thesynergistic effects of the health, nutrition and psychosocial aspects for the child's overalldevelopment; recognizing and promoting the significant role of the family and thecommunity in child development; and the importance of decentralization, policy reformand improved planning & management for better service delivery. In addition, there wasconsensus on the "vision" of what the child should be at the end of the primary schoolcycle, i.e., at around 11 + years, which would serve as the point of reference for planningchild development interventions within each of the identified sub-stages. Among theissues of debate were whether the upper limit of the child development continuum beretained at 11+ years or be extended to 14 years; whether the responsibility of pre-schooleducation should rest with school education or continue to remain with the ICDS; and therole of the private sector and its partnership with the public sector in service delivery.
The workshop pointed to the need for different sectors/partners to come together in aconvergent mode and work towards achieving the holistic development of the child. Tothis end, the need for joint initiatives in terms of planning, training, monitoring andsupervision was emphasized.
Analysis of the issues and concems raised in the workshop has led to their beingtranslated into questions around four topics: indicators, institutional mechanisms, policyissues and cost-effectiveness. Answers to these questions are expected to develop a morecomprehensive understanding of the issues and thus provide direction for the way ahead.The questions are proposed to form the basis of a comprehensive sector work to beundertaken in the coming years in consultation between the Bank and the governmentdepartments and other stakeholders and professionals working in this area.
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Reaching Out to the ChildA Report
1. Introduction
While it is universally acknowledged that the all-round development of the child requiresa holistic and multi-sectoral perspective, provisions on the ground do not necessanrlyreflect this in practice. As a result, even relatively large investments do not guaranteereaching out to the child in a manner that ensures achievement of the desireddevelopmental outcomes. It was in response to this concern that a multi-sectoralworkshop entitled 'Reaching Out to the Child' was organized collaboratively by theEducation and Health, Nutrition & Population teams of the World Bank, New Delhi onFebruary 21 and 22, 2000.
This report presents the outcomes of the consultations that were held during theworkshop. It begins by outlining the context of this multi-sectoral dialogue and proceedsto discuss the objectives, design and highlights of the workshop. It then goes on tosummarize the various issues of consensus and issues of debate emerging from theproceedings. The report concludes by articulating a few significant questions that needfurther attention.
The annexes appended with the report include a matrix giving the identified outcomesand indicators for each sub stage of development, the concept paper presented at theworkshop, the program schedule and the list of participants.
2. The Context1
Over the last two decades India has made considerable progress in ensuring child survivaland basic education. However, despite some major initiatives in the sectors of education,health, nutrition and child development, success of these has been limited and is, by andlarge, not commensurate with the investments made. One of the significant reasons fortheir limited impact is perhaps the tendency to compartmentalize services and programsfor children in terms of (a) human development sectors, i.e., health, nutrition or educationand/or (b) the developmental stages, with a focus on any one stage exclusively at theexpense of others. This tendency counters the very basic premise that a child'sdevelopment takes place holistically and incrementally and not in a piecemeal manner.Interventions for child development therefore need to focus, not on the scheme orprogram per se, but on the chief beneficiary of the program i.e. the 'whole child' andshould therefore synergistically address the health, nutritional and psycho-social/educational needs of the child.
Another constraint in effectively promoting child development through public servicescould be the absence of tangible indicators, particularly with respect to psycho-socialdevelopment, which has precluded effective monitoring of interventions. A possible wayout in this context is to consider successful completion of primary education as asignificant milestone in the development continuum as well as a concrete indicator ofoverall optimal child development. This would be in accordance with the rationalediscussed above that the development of a child is holistic, continuous and cumulative innature. It would also be justifiable on empirical grounds which indicate that not only are
See Annex 2: Concept Note titled 'Reaching out to the child' for a detailed analysis of the context of thechild development approach discussed in this section.
economic returns highest for primary education but primary education, particularly forwomen, leads to better family health, lower fertility and a better quality of life for thefamily. This would necessarily imply redefining the expected outcomes of primaryeducation more holistically and analyzing its implications for quality and mode ofdelivery.
The definition of 'successful completion of primary education', in this context, wouldthen not be limited to completion of primary grades and acquisition of literacy andnumeracy skills alone, but include a more holistic vision of developmental/educationaloutcomes such as demonstration of active learning capacity, positive self esteem, goodhealth/nutrition and good habits/values in the child. These outcomes are not determinedmerely by educational inputs, but also relate in an integrated and synergistic manner tohealth, nutritional and psycho-social aspects of development along the entire childdevelopment continuum. This would imply that any intervention for holistic childdevelopment and basic education would need to be addressed (a) multi-sectorally; and (b)along the entire development continuum from prenatal-I lyears. If this concept of holisticchild development is accepted, there is a need to reappraise the investments andinitiatives for children in India against this parameter. This concern essentially framed theagenda for the workshop.
3. The Workshop
3.1 Objectives
The objectives of the workshop were as follows:
to develop in the Indian context, a shared vision regarding a holistic approach to childdevelopment which specifically addresses the child both across sectors and along theentire child development continuum from the prenatal stage to the completion ofprimary education;
* to identify critical outcome indicators and corresponding inputs of optimal childdevelopment for each sub-stage of the development continuum, leading up tosuccessful completion of primary education as a development indicator at the stage of11+ and to consider their relative priority, in terms of cost effectiveness, within andacross each sub-stage;
* to broadly review existing programs and services for children to assess the extent towhich they are meeting the identified needs of children in an integrated and holisticmanner;
* to identify some critical areas for further research with a view to derive a morecomprehensive picture of the existing scenario of provisions and programs for theIndian child.
3.2 The Workshop Design
The workshop participants represented diverse groups of senior professionals from boththe governnent and non-government sectors working in areas related to early childhooddevelopment from the education, health, nutrition and child development sectors. These
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included education and nutrition specialists, medical personnel, NGO professionals,policy makers and implementers of projects and programs across the country.
In accordance with the objectives specified above, the workshop was organized tofacilitate discussion along the following lines:
* the concept of holistic child development;
* identification of critical outcomes ("what the child should be") by sub-stages;
* identification of critical outputs ("how do we know the child is what s/he should be")and related inputs ("what the child needs");
* review of programs and services vis-a-vis the outputs and inputs, and options forimprovement;
* suggestions for future strategies related to service delivery, legal provision,community mobilization, capacity building, policy and legal framework, andresearch.
The above themes were discussed in a participatory mode, in groups as well as in plenarysessions. In the final session on future strategies, the VIPP technique2 was employedwhich additionally ensured that each participant got an opportunity to express his/hersuggestion on each of the specified themes. The chairpersons of the various sessions inthe workshop were Dr. Shanti Ghosh, eminent pediatrician; Erma Manoncourt, DeputyDirector, UNICEF; and Ward Heneveld and Peter Heywood, Team Leaders, Educationand Health, Nutrition & Population respectively at the World Bank.
3.3 Highlights of discussions
The discussions in the course of the plenary and group sessions endorsed the need for amore holistic treatment of child development and suggested that this may also encompasswidening the scope of intervention to include children under 3 years as well as adolescentgirls, provide adequate maternity benefits and address the needs of working mothers. Inthis context, the significant role of the family and the community, the need for contextspecificity, decentralization, increased accountability and communication for behavioralchange were some of the themes articulated forcefully and these tended to dominate thediscussions.
The chairpersons consistently drew attention of the participants to the need to keep thechild as the focus of planning and implementation as opposed to the schemes orprograms. Ward Heneveld stressed the need to capture the synergistic effects of thehealth, nutrition and psychosocial aspects for the child's overall development andarticulated the need to review existing provisions for children from this perspective. Inthis context, Peter Heywood emphasized prioritization of the critical inputs for childdevelopment in terms of their cost effectiveness to ensure optimal utilization of thelimited resources available with the country. Dr. Shanti Ghosh reiterated the need forconsidering child development in a more holistic perspective. She also laid stress onfocusing on the needs of 0-3 year olds, adolescent girls as well as working mothers inprograms for child development. In addition, she drew attention to the absence of a
2 The VIPP technique involves eliciting individual participants' views on an issue(s) on cards which arethen thematically categorized and displayed. This visual representation of individual views also provides aclear sense of the range of group opinions/perceptions on an issues(s).
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psycho-social development component in the training of medical and health personneland suggested its inclusion in professional training. Erma Manoncourt emphasized thechild's right to protection and participation and to growing up in an inclusiveenvironment free from discrinination and abuse on the grounds of gender, caste, anddisabilities. In addition, some of the other issues/themes that emerged as important fromthe deliberations in the plenary as well as the group sessions included the following:
* Recognizing and promoting the significant role of the family and the community* Decentralization* Policy, planning & management for improving service delivery* Research priorities
Recognizing and promoting the significant role of the family and the community
There was general consensus on the crucial role of the family and community ininfluencing positive child care practices. The participants discussed the state ofpreparedness of the communities for the development of the "whole child". They were ofthe view that there is a need for enabling and sensitizing communities to effectivelynurture the child's overall development. Orienting the communities to recognize theimportance of health care during pregnancy and birth as well as educating mothers onchild development milestones was considered essential particularly from the point ofview of early detection and prevention of growth faltering. It was felt that improvinghome-based infant feeding practices such as timely initiation of complementary feedingin conjunction with a warm and caring caregiver-infant interaction was a priority. Childhealth care to ensure complete immunization, adequate micro-nutrient status, de-wormingand providing for sanitation and a safe environment also needed to be acknowledged bycommunities as crucial. The discussion also focused on the need for a stimulating andcongenial environment right from infancy for the child's psycho-social development.Equitable opportunities for leaming, both at home and in school, as well as activitybased, contextual teaching were considered as significant for contributing to achievingthe objective of enabling the child to successfully complete primary education. Thiswould also require addressing issues like reducing the burden of sibling care on theyoung girl child, attitudinal and behavioral changes with respect to gender equity, femalefeticide and child labor.
Educating and sensitizing the community, particularly women, to the developmentalneeds of children as well as to the available resources would enable the community toprocure and influence basic health care, nutrition and education services in line with the"community needs approach" based on local needs. Some participants were of the viewthat the media, which was currently under-utilized, could be used extensively as apowerful vehicle for communication with the community.
Decentralization
In the light of the 73rd and 7 4th constitutional amendments directing local governancethrough Panchayati Raj Institutions (PRIs) along with other community structures, theparticipants articulated the need for providing autonomy while also fixing accountabilityat levels close to the community. In addition, the possible benefits of involving the PRIsin deciding the nature of provisions based on local needs and monitoring their qualitywere also discussed. The potential of ensuring cross-sectoral linkages and integrated
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service delivery through empowering PRIs was particularly highlighted. In order to do so,it was emphasized that space be created for local initiatives and PRIs be involved in allstages of program implementation to ensure community ownership.
One of the policy options suggested to ensure better service delivery in a decentralizedcontext was provision of block grants to levels closer to the community. This wouldallow local issues/problems to get addressed through flexible and need-basedinterventions as opposed to standardized solutions implemented across the board as isevident in several centralized schemes. The possibilities of public-private partnerships tooptimize utilization and convergence of resources and improve the quality of service ofservice delivery were also discussed.
In this context, the discussion brought forth the need for capacity building at thecommunity level to facilitate proactive involvement in all aspects of programmanagement including micro-planning, making informed choices of services andresource utilization. This would require intensive and continuous training of the PRIs andorientation of the larger community in terms of information, transparency and theirrespective roles and responsibilities.
Policy, planning & management for improving service delivery
The need for improvement in the quality of programs related to children in the health,nutrition and education sectors consistently emerged as a major concern. Participantsemphasized the need for better collaboration and coordination between differentgovernmental and non-governmental programs across sectors to reach out to the child ina cost-effective manner. A concern was expressed regarding the mushrooming of privateprovisions of the education and health services even in the rural areas without adequatequality control. It was however acknowledged that with mechanisms in place formonitoring, regulation and accountability, the involvement/encouragement of the privatesector could improve the coverage and quality of service delivery.
A related concern raised was to do with the extent to which the existing provisionstargeted the most in need. In this connection, it was felt that more and better provisionsbe made for focus groups like tribal and rural children.
Contextual, need-based and continuous training is known to have a significant impact onthe quality of service delivery. Participants were of the view that it was important totrain/sensitize all cadres of functionaries, including those belonging to the government,NGO, and private sectors associated with services and programs related to childdevelopment as well as care-givers, i.e., parents, teachers, AWWs, ANMs etc. It waspointed out that joint training programs could be organized so as to address childdevelopment holistically and capture the synergistic interactions between various sectors.It was further suggested that the curriculum for all levels of training be made moreholistic, encompassing all aspects of child development.
A concern was expressed that several cadres at the grass-roots level such as teachers andAWWs were overburdened with responsibilities other than program implementation. Forinstance, conducting surveys for different departments, maintenance of records and otherrelated assignments reduce time spent on their primary responsibilities. Rationalization ofthese responsibilities was flagged as a priority and a suggestion was made in the context
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of ICDS to provide a second AWW with well defined job requirements. The need for theDepartment of Education to take on more responsibility for ECD was also raised.
As discussed above, it was felt that issues relating to the child's welfare and developmentcould not be addressed in isolation from those dealing with the woman's role and statusin society. In this context, attention was drawn to the need to strengthen the legal andpolicy framework to promote women's empowerment, universalize maternity benefits,prevent female infanticide etc. Administrative provisions in the form ofjoint directivesby different sectors were also considered necessary in the context of shared responsibilityof village functionaries to improve convergence and coordination. Attention was alsodrawn for the need to provide for better financial management and mechanisms forsmooth fund flow.
Research
To enable a more comprehensive understanding of the priorities for holistic childdevelopment, the participants suggested the need for research in the following areas:
* cost-benefit study of existing programs for prioritizing inputs critical for the expecteddevelopmental outcomes;
• impact evaluation of large scale child development and educational programs;* qualitative research on perceptions, needs, community knowledge attitudes and
practices, household decisions and priorities for improving the lives of children toassess local needs as well as ensuring implementability and community ownership ofvarious schemes;
* action research on convergence across sectors;* study of the impact of the synergistic relationship between psychosocial development,
health and nutrition on the child's overall development;* role of the private sector in meeting educational and health related needs of children;* reasons for school drop-out and non-enrollment.
A panel discussion was organized in the concluding session of the workshop. Thepanelists for this session included the Secretary and Joint Secretary, GOI, Ministry ofHealth & Family Welfare, Joint Secretaries, GOI, Departments of Education and Women& Child Development, Ministry of Human Resource Development, and the India CountryDirector of the World Bank.
The panelists reacted to and endorsed the outcomes of the workshop that were presentedto them. In addition, they also shared the initiatives of their respective departments,particularly under the DPEP and ICDS programs, in the context of the workshop's themeof reaching out to the child. Secretary, Health & Family Welfare talked about theNational Population Policy 2000 proposed by the GOI. The main focus of this policy is towork towards vertical and horizontal integration of interventions aimed at comprehensivedevelopment through a decentralized and multi-sectoral mode. The World Bank CountryDirector appreciated the fact that the Bank had begun to work across sectors on childdevelopment. He also thanked the participants for their contributions that had furtherencouraged the Bank to continue to work in this area.
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4. Issues on which there was consensus
Participation in the debates generated by the workshop was enthusiastic. This sectionbriefly articulates the issues that found support from most participants.
* The first session of the workshop was devoted to the discussion of the concept ofholistic child development and to outlining the "vision" of "what the child should be"at the various sub-stages of development. There was an overall consensus on theproposal that reaching out to the child in a holistic manner requires a multi-sectoraland longitudinal approach. In this context, participants agreed on the need for clearlydefined and accepted indicators.
* There was a common consensus on the "vision" for the child at the end of the primarygrades. It was agreed that by the end of the continuum at 11+ years, the child should,among other things, have developed adequate literacy and numeracy skills, activelearning capacity, good health and nutrition, good habits and values, positiveself image, coping skills and social competencies. This would define successfulcompletion of primary education. In addition, there was agreement that across thecontinuum, the child should be healthy, well nourished, secure, active, playful,responsive and not subject to discrimination.
* The concept note suggested that the child development continuum for the purposes ofintervention, range from the pre-natal stage to 11 years of age. The successfulcompletion of primary education would then be considered a significant indicator ofoptimal development. This concept provoked considerable discussion and finally ledto a consensus that the critical continuum for holistic child development should bepre-natal to the age of 11+ years. However, there was a rich debate on the upper limitof the continuum which is recorded below in the section on "Issues on which therewas debate".
* The discussion further identified critical sub-stages of the child developmentcontinuum. The group agreed on the following as the critical sub-stages forintervention/focus:
* pre-natal-] year* 1-3 years* 3-6years* 6-8 years,* 8-11 years* 11+ years
* The expected outcome for each sub-stage and corresponding inputs were identified(see Annex 1) but the exercise could not be completed due to the complexity ofarticulating the details of a holistic model of child development. There was howeveroverall agreement on the outcomes as defined by the groups during the workshop.
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5. Issues on which there was debate
* As mentioned in the previous section, there was considerable debate on the "endpoint" of the child development continuum. While there was overall consensus thatthe continuum should span the period from the pre-natal stage to 11+ years, opinionson this upper limit ranged from up to 14 years to about 18 years. The rationale formaking 14 years the upper limit was that this would cover the elementary educationstage, which is a constitutional commitment in India. Conversely, continuing supportto this vulnerable age group would be essential to realize this commitment. Theargument for the upper limit to be around 18 years was that this would includeadolescents, particularly girls, in the development continuum. It was consideredimportant to specifically address the needs of the adolescent girl from the perspectiveof the life-cycle approach.
* There was a debate over the role and responsibilities of the private sector. The widerange of views expressed were (i) allowing total participation of the private sector ineducation, health and nutrition service delivery; (ii) exploring public-privatepartnerships through, for instance, provision of block grants to private agencieswithin the framework of autonomy and accountability; and (iii) limiting privateinroads and instead improving quality of public systems as a priority.
* The current responsibility for the pre-school age group, i.e., 3-6 years, rests with theDepartment for Women & Child Development through the ICDS and related grants-in-aids schemes. As a critique of this provision, some participants were of the viewthat pre-school facilities be integrated with the primary school. This would help betterprepare children as well as facilitate their bonding with the school. This has also beencorroborated by the DPEP experience. However, some participants were of the viewthat this would be contradictory to the holistic approach for the age group 3-6 years,which could be better served within the ICDS framework.
6. Questions that emerged from the workshop
As stated above, the vision of the child at the end of the primary education cycle at 11years of age is that s/he should, among other things, have developed adequate literacy andnumeracy skills, active leaming capacity, good health and nutrition, good habits andvalues, positive self image, coping skills and social competencies. Given that childdevelopment is holistic, continuous and cumulative, the achievement of this finaloutcome can only be facilitated by providing the child with an enabling environment thatis conducive to the child's all-round development. This in turn would necessitateprovision of sectorat as well as cross-sectoral inputs in a timely and synergistic mannerthrough the child's pre-natal, infancy and childhood stages. The broad overarchingquestions that emerge in this context are (a) what enabling environment needs to beprovided to a child so that s/he attains the envisioned developmental outcome at the endof 11 years of age and (b) what would be the most cost-effective manner to provide thisenvironment, given the conditions in which many Indian children live. An analysis of thedeliberations of the workshop, while providing some direction, indicate the need for moreinformation to be able to arrive at a more comprehensive understanding of the needs andprovisions. Some specific questions that emerge are categorized as follows:
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Indicators
1. Given the expected outcomes at the end ofprimary grades, what set of indicatorswould best describe and monitor the outcomes expected at each of the sub-stages ofdevelopment that were identified in the workshop?
2. What would be the synergistic inputs required to achieve the identified outputs ateach of these sub-stages?
3. What is the status of the children in the country vis-a-vis these indicators, at thenational and state levels. Is data available by gender, caste etc. ? How reliable is thedata? How can data quality be improved?
4. What is the gap between the existing and the desired indicators for monitoringprogress of both program quality as well as child development outcomes?
Community perspectives
5. What are the community 's perceptions and priorities for children in diversecommunity settings? To what extent are these consistent with global knowledge?What role does the community see for itself in ensuring responsive care andparentingfor children? What is the support they require?
6. Given the identified child development objectives what is the current role of thecommunity in facilitating them? WVhat gaps exist between the community's currentrole and what is desired?
Institutional mechanisms
7. How well are the existing institutional mechanisms for delivery of interventionsfunctioning (given the answer to above as the preferred mode)? Which interventionsare effective and to what extent?
8. WVhat is the extent of convergence between the different sectoral programs andprovisions on the ground?
9. What would be potentially the more effective mode/s - centralized or decentralizedplanning and management, provision of grants for standardized designs or flexiblebock grants?
10. What is the gap between what exists and what is desired in terms of the institutionalmechanisms?
Policy/Public private partnerships
1]. In the past 25 years, what have been the trends, both sectorally (education, health,nutrition) and across sectors (child development) in:
* Government policy* Public finances
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e Success of government provisions and programs as well as ofprivate initiatives
How have government policy and public finances effected the success ofprogramimplementation both in the public as well as private sectors.
12. What is the extent ofprivate sector involvement in child development in the threesectors of education, health and nutrition? What would be optimal mix ofpublic andprivate initiatives for program design and implementation?
13. Given the identified child development objectives as well as the current provisions toattain them, what is the gap between what exists and what is desired in terms of thepublic/private partnerships?
Cost effectiveness
14. Given the fiscal pressure under which most states function, which interventionsemerge as the most cost effective and sustainable that would enable the achievementof holistic child development?
15. Given the limitation of available resources could these be prioritized in terms of costeffectiveness vis-i-vis the expected outputs?
Conclusion
The workshop made a significant contribution to the identification of certain areas ofunderstanding of current child development needs and provisions across sectors in theIndian context. It also helped to identify areas on which there was consensus as wellothers on which there were differences of opinion, and which would require further studyand analysis. Some of these issues are translated into the questions listed above, answersto which are expected to help develop a more comprehensive understanding of the issuesand thus provide direction for the way ahead. These questions will require to beaddressed through a thorough review of available research, study of relateddocumentation and field studies to address knowledge gaps. The questions are thereforeproposed to form the basis of a comprehensive sector work to be undertaken in thecoming years in consultation between the Bank and the government departments andother stakeholders and professionals working in this area.
Overall, the workshop highlighted the need for further and more intensive multi-sectoraldiscussion across the govermment and non government sectors involving, among otheraspects, a thorough review of the design and outcomes of the existing independent,sectoral programs and services from the singular viewpoint of their common beneficiary,i.e. the child. This is expected to pave the way towards establishing a proactiveconstituency for the development of the much-needed integrated, comprehensive andconvergent approach to child development that transcends, but includes the existing arrayof efforts on behalf of children in India.
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Annex 1
Stage-wise expected developmental outcomes and indicators 3
Sub- What the child should be How do we know the child is like that What the child needsstages ___
What Who i Where HowHealthy, well nourished, safe, secure, Appropriate birth weight, adheres to Supportive care for the Family at home, Support from family
Prenatal to trusting, happy, active, playful, responsive. weighUage standards and to normal woman during pregnancy Govt. at AWC, PHC e.g., joint family,lyear developmental milestones, indulges in including immunization, etc., NGO, providing
exploratory play, demonstrates sense of medical advice & follow neighborhood and informationattachment, free from frequent illnesses, up and adequate nutrition. community, TBAs. and socialresponds to stimuli. For the infant, complete awareness, creating
primary immunization, awareness/hygienic and multi- sensitivity to thesensoral stimulating needs of theenvironment, infant pregnant woman, togames, appropriate infant gender issues suchfeeding practices (e.g. as female feticidecomplementary feeding), etc., preventive,adequate feeding during promotive andillness, a close and curative programs.consistent interaction withcare-giver.
In addition to above, food secure, free from Begins walking, demonstrates gross Good and timely nutrition In addition to Parent education,1-3 years disease and micro-nutrient deficiencies, motor coordination, speaks simple and health care, a above, creches/day quality training for
especially anemia, confident, exploring/ sentences, continues to adhere to congenial, stimulating and care centres. care givers,curious, interacts with environment and weighUage standards, indulges in active safe environment, convergence ofcommunicates basic needs, toilet trained, play, begins experimenting with the opportunities for play and field-level programsable to handle separation anxiety. environment. language skills, for health, nutrition
demonstration of love, and family support._________________________ _toilet trained. _
3 These indicators em-lerged from the discussions in the workshop and should be therefore he tTeated as indicative rather than exhaustive.
1 1
In addition to above, has a positive self Is inquisitive and asks questions, In addition to above, In addition to the In addition to the3-6 Years image, is able to express him/herself interacts with peer groups, parents and opportunity for interaction above, pre-school above, making
clearly, forms concepts related to the adults, expresses him/herself with other children, programs. available theenvironment, develops pre-writing/ pre- confidently, communicates with ease and opportunities for opportunities andreading/ and pre-number skills, in sequence, asks many questions, reasoning and problem space for play.demonstrates interest in reading and comes to goes to pre-school/school solving and use oflearning, is full of curiosity, has good willingly, participates actively in group cognitive skills, playnutritional and health status, likes to activities and games, demonstrates based and joyful learning,experiment and can solve simple cooperation and concern for others. occasions to interact withproblems, is sociable, enjoys cooperative environment, balancedand group play (both indoors and diet.outdoors), shows signs of independentthinking, has a clear gender identity, seeksappreciation and physical touch forreassurance, begins to imbibe basicv _ alues. _
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In addition to above, can take care of Is able to read, write with enjoyment, can In addition to above, Home, school Emphasize school6-8 Years personal hygiene, is healthy and well communicate easily, makes adequate equitable opportunity for NFE Centre, education, focus on
nourished, free from worm infections, progress in heighVweight corresponding learning, activity based Camps, out of schooldeficiencies and disease, develops basic to age, has sustained interest and contextual teaching community. children, parentliteracy and numeracy skills, can reason concentration, demonstrates the ability to learning environment at education PRINECout logically and solve simple problems, take care of personal hygiene. home/school, appropriate training,can use language more creatively, enjoys stimulation from home/community/doing small tasks independently and can environment that is free school linkages,be responsible for them, develop a sense from discrimination. teacher training andof morality and of what is "right" and contextual"wrong", can empathize with others and curriculum, ensuringshow concern and respect for others needs utilization of health/and rights, can "feel good" about nutrition
.__ _ nhim/herself. interventions.Has adequate literacy & numeracy skills, Successfully4 completes primary Provision of primary As above As above
8-11+ active leaming capacity & ability to solve education. schooling with goodYears problems, good health, nutrition and micro- learning environment,
nutrient status, good habits & values, a health care and foodpositive self image, demonstrates security, opportunity foremotional maturity & balance, shows peer group interaction,empathy and compassion, has social opportunities forcompetencies, is curious, demonstrates participation and decisioncoping skills & basic life skills, making,progressively gets more independent in protection from child laborthought and action, and demonstrates a and other forms ofsense of responsibility. discrimination/
exploitation.
4 "Successful" completion of primary education is interpreted here as graduating from primary school with appropriate bodily growth and development, free frominfectious diseases and other medical conditions as well as otlher psychosocial characteristics listed in the corresponding column 1.
13
Annex 2Reaching Out To the Child
1. Introduction
Education is a very significant component of any long term strategy directed towardsnational human resource development that seeks to achieve sustained economic growth,poverty alleviation and a strong and equitable democracy. It also contributes to thedevelopment of human potential and fulfillment of human rights, including those of childrenand women, leading to an improved quality of life. Research across the globe indicates thatin developing countries, economic returns to education are highest for primary education andthese tend to decline with rising levels of education. Primary education, particularly forwomen, leads to better family health, lower fertility and thus slower population growth. Ithelps workers take advantage of technological change which raises their productivity andearnings. From the human development perspective as well, early childhood and primaryeducation are critical inputs, along with health and nutrition, which serve as the foundationfor life-long learning and development.
Since a child's development is continuous, cumulative and holistic in nature, a child'ssuccessful completion of primary education can be considered a significant milestone in, andan indicator of, the optimal child development trajectory. In this context, the definition ofprimary education outcomes would not be limited to literacy and numeracy skills alone, butinclude a more holistic vision of development of active learning capacity, positive selfesteem, good health/nutrition and good habits/values. These outcomes are not determinedmerely by educational inputs along the developmental continuum, but also relate in anintegrated and synergistic manner to health, nutritional and psycho-social aspects ofdevelopment. Any intervention.for holistic child development would therefore need to beaddressed (a) multi-sectorally and (b) along the entire development continuum from prenatal-1 l years.
This paper draws attention to the need to reappraise investments and initiatives for childrenin India, in accordance with this concept of holistic child development. The paper begins byelaborating on the conceptual framework for a holistic approach towards child development.It moves on to discuss (a) the status of readiness for schooling in children who are potentialschool entrants (b) the extent to which schools are responding to the needs of these childrenwho are coming into the schools (c) the resulting status of school age children, and (d) thepolicies and programs in place to address their needs. It concludes with a brief analysis ofemerging issues.
2. Conceptual Framework
Over the last two decades India has made considerable progress in ensuring child survivaland basic education. However, despite some major initiatives in the sectors of education,health and women and child development, success of these has been limited and is, by andlarge, not commensurate with the investments made. One of the significant reasons for theirlimited impact is perhaps the tendency to compartmentalize services and
1 14
THE CONCEPTUAL FRAMEWORK
Health (mother and child) Nutrition (mother and child)
Mother's sense of well beingBIRTH - 3 YEARS
Health Nutrition
Psychosocial stimulation3 - 6 YEARS
(3-4 years, 4-6 years)Psychosocial stimulation Health
Nutrition6- 11 YEARS
(6-8 years, 8-11I years)Psychosocial stimulation and academic learning
Health Nutrition11 YEARS
A child who has successfully completed primary education with:
Adequate literacy & numeracy skills Good health & nutritionActive learning capacity Good habits & values
A positive self image
15
programs for children in terms of (a) human development sectors, i.e., health, nutrition oreducation and/or (b) the developmental stages, with a focus on any one stage exclusively atthe expense of others. This tendency counters the very basic premise that a child'sdevelopment takes place holistically and incrementally and not in a piecemeal manner.Interventions for child development therefore need to focus, not on the scheme, but on the'whole child'.
In the 9-month period from conception to birth, the developing fetus responds to theprofound influences of genetic capital and maternal environment within which she lives andgrows. This period represents the period of fastest growth in a lifetime, as the individualgrows from a cell to a 3 kilo neonate. It also represents one of the most critical periods forenabling optimal development. New evidence from the field of neuroscience is now alsocoming through strongly that the period from conception to six years, particularly the firstthree years, is very significant for brain development. These years include critical periods forthe development of important functions such as binocular vision, emotional control, habitualways of responding, language and literacy, symbols and relative quality all of which impactschool/lifelong learning and achievement (Mustard et al, 1999). Many of these criticalperiods of development occur before the child enters school i.e. by six years of age. Oncethese critical periods are passed, it is difficult to achieve the brain's full potential, although itmay be possible, in cases where the child has not undergone extreme neglect, to develop itscapacity to some extent. During these critical periods a child must be exposed todevelopmentally appropriate interactions and experiences for optimal development of thesefunctions. Further along, according to the Indian cultural tradition as well, the first five yearsof life are very significant for a child's development, particularly for inculcating in childrenthe traditional sanskaras or values
In addition to psychosocial stimulation, health and nutritional status also has an impact on thechild's active learning capacity. For example, the capacity for processing, structuring andclassifying information, ability to ask and answer appropriate questions, short term memory,levels of alertness, attention and concentration are some of the capacities which are crucialfor success in school as well as for life long learning. These are known to be adverselyaffected by nutritional and health deficits, thus limiting the ability of the child to benefit fromclassroom instruction or later learning opportunities (Levinger, 1994; Del Rosso and Marek,1996). Indian researchers have also observed the negative impact of malnutrition on thecognitive and physical capacities of children, particularly in the first two years of life(Ghai,1975; Natesan and Devadas, 1981; Anandalakshmi,1982; Bhattacharya, 1981).
Nutritional problems such as protein energy malnutrition (PEM), deficiencies of micro-nutrients, particularly iodine, Vitamin A and iron have negative effects on the physical andpsychological development of the child. Malnutrition, even in its milder form, can dullmotivation and curiosity, reduce child's play and exploratory activities and interaction withthe caregivers and the environment. This adversely affects the process of early activelearning by the young child. The child's health problems relate to the genetic assets that hewas endowed with at conception, the effects of various nutritional deficiencies he might faceand the consequences from infectious agents that insinuate themselves into his environmentduring or after gestation. While the effects of genetic aberrations are usually sporadic and
16
relatively infrequent, nutritional deficiency and infectious disease have a significant andfrequent presence in a child's experience. Infectious diseases in childhood appear in greatestfrequency as the child's contact with the -external world increases. The changing pattern ofcultural responses to childbirth and socialization then, has great impact on the nature andtype of infectious agents that the child encounters at different stages of his early life. Thecircular relationship between infectious disease, nutritional status and psychosocialstimulation is well documented and their cumulative impact on a child's well being is known.Apart from the health effects of specific deficiencies, malnutrition has been found to beassociated with over 50 percent of all childhood morbidity (WHO, 1999). Some diseases ofchildhood have significant outcomes, such as the hearing and sight loss that are frequentlyencountered after measles, brain damage due to meningitis and cardiac damage secondary torheumatic fever. These have specific impact on the ability of individual children to attaintheir full potential.
Research also indicates that the nature and extent of the impact of nutritional deficiencydepends on the timing of the deficiency. For instance, most growth retardation occurs in thefirst two years of life; and iodine deficiency in utero has permanent effects on braindevelopment. It is therefore important to prioritize child development interventions so as tomap them with specific needs at specific sub-stages of the childhood continuum. Along thechildhood continuum the following four sub-stages could possibly be recognised from thepoint of view of planning, for which specific developmental/outcome indicators need to beidentified.
Pre-natal -3 years: This period is most critical for brain development. Therefore, this sub-stage calls for ensuring adequate nutritional intake of the mother during the period ofgestation, as of the growing child after birth. The incidence of significant childhood illnessesmakes immunization of mother and child in addition to immunization against comnmunicablediseases and proper sanitation, an imperative. It is also important to complement theseprovisions with developmentally appropriate adult-infant interaction, all of which takentogether, have a synergistic influence on the child's overall development.
The 3 to 6 year age group: While this period continues to be significant from the point ofview of brain development, the priority shifts from emphasis on nutritional and health needsto psycho-social development. This entails enabling the child to graduate to higher levels ofplanned cognitive and creative activity, developing motor skills, forming good habits relatedto health and hygiene and opportunities for social interaction -- all of which can be inculcatedusing play as the medium for learning. Specifically, in the Indian context, the child in the 4-6age group would also need some specific school readiness experiences which would preparethe child for the expectations of the primary school curriculum including psychomotor andcognitive activities for reading, writing and number readiness. . With the increased exposureof the child to the external environment as also other children in preschool, the chances oftransmission of infectious diseases increase. Also, the increasing activity levels and highlevels of growth, require that appropriate nutritional inputs continue
The 6-8 vears age group: The period from 6-11 years i.e. the primary school stage may beconsidered developmentally in terms of two sub stages, i.e., from 6-8 years and 8-11 years.
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The 6-8 years period is developmentally an extension of the early childhood stage whereinplay continues to be a dominant need as well as an effective medium for learning. In terms ofcognitive development too the child is likely to be in a stage of transition towards morelogical and analytical thinking and reasoning. Minor infective diseases become increasinglyevident as exposure to the general environment continues to grow. Specific nutritionaldeficiencies appear as growth demands are high and these have an impact on the learningcapacity of children.
The 8-11 year age group: Further along the continuum, the 8-11 year age group tends todemonstrate greater capacity for logical thinking, and more structured and formal learning.The child also has a longer attention span and demonstrates greater capacity to persevere on agiven learning task. Nutritional and health needs continue to be significant through this substage.
To sum up, the child's level of development at school entry is influenced to a large extent bythe physical and psycho-social experiences that the child brings with himlher to school. Thesecond five years in a child's life, i.e., the school-going stage then become crucial formaintaining and continuing the gains of the early experiences. To quote Brazelton, (1994) "Achild's experiences in the first months and years of life determine whether he or she willenter school eager to learn or not. By school age family and caregivers have alreadyprepared the child for success or failure. The community has already helped or hindered thefamily's capacity to nurture the child's development". It therefore becomes significant forthis discussion to move on to assessing the extent to which children at the preschool stage inlour country are ready for primary school and to what extent the school and community are, inturn, responsive to the needs of these children.
3. The Indian Context
3.1 Are All Our Children Ready for Primary School?
In the last fifty years, India has made significant progress in fulfillment of her children's rightto survival and development. There has been a sharp decline in childhood mortality and inthe incidence of vaccine-preventable diseases, most notably in neonatal tetanus and polio.Massive expansion of the Integrated Child Development Services (ICDS), has improvedaccess to early childhood care and education for children in the 3-6 year age group. There hasalso been marked progress in provisions for universalizing access to primary education andsignificant initiatives have been taken to improve the quality of the content and process ofteaching and learning.
As per the 1991 Census, India has around 150 million children below the age of 6 years,constituting 17.5% of its population. However, a large number of children continue to "livein economic and social environments which impede their physical and mental development.These conditions include poverty, poor environmental sanitation, disease, infection,inadequate access to primary health care, inappropriate child car.ig and feedingpractices."(Annual Report 1998-99, DWCD Government of India). More than 50 percent ofIndia's children under four are still moderately or severely malnourished and 30 per cent of
18
the newborns are significantly underweight. PEM is the most widely prevalent form ofmalnutrition among children with 53 percent of under fours demonstrating severe ormoderate forns (IIPS, 1995). In addition,-iron deficiency anemia is rampant among children,adolescent girls and women, especially pregnant women. VitaminA and iodine deficiencydiseases are also serious problems, albeit in concentrated areas. Infectious diseases rangingfrom wortn infestations to measles continue to take a toll on young children and are found inevery part of the country. Acute respiratory infections and diarrhea continue to be the mostcommon causes of morbidity amongst this age group.
In terms of psycho-social development one indicator could be the readiness level of childrenat the stage of entry to primary schools. A recent study conducted in four regions of thecountry on a sample of 1495 school entrants found most children to be deficient in conceptsand skills (such as sound discrimination, sequential thinking) related to readiness for reading,writing and mathematics (NCERT, 1999). This result has also been validated by studiesinvestigating the socioeconomic and cultural differential and its impact on the developmentof children. Further, interaction with primary teachers endorses the view that children notexposed to an organized preschool program find it difficult to adjust at the age of six years tothe school situation.
3.2 Are the Schools Ready for Our Children?
With more and more children now not only surviving into the school age but also beingmotivated to come into school, most tend to be first generation leamers who do not comefrom a home environment which is supportive of school learning. The school structure andcurriculum however does not take this into account and fails to respond to their differentsocial backgrounds and entry levels. The curriculum followed tends. to be rigid and inflexiblewith high and uniform expectations for the early grades. Inflexible and long school timings,uninteresting and information loaded curricula and assessment driven classroom practice,which gives priority to rote memorization at the cost of higher mental abilities, and lowmotivation of teachers all further compound the problem for most children. Recent NSSOdata (52nd round) reports that about 47 percent of the children who drop out of schoolindicate the predominant reason to be an inability to cope with academic failure and lack ofinterest in studies. Factors like gender, caste and poverty also continue to make children feelexcluded from the mainstream and adversely influence their level of participation andlearning in school. In addition, most schools are not able to cope with children with evenmild physical and mental disabilities.
Nutritional deficiencies and poor health in primary school children are also frequent causesof poor enrollment, absenteeism and early dropout. Conditions like worm infections,deficiency of iodine and iron tend to be very coinmon at this stage and adversely impact onchildren's cognitive abilities and general well being, leading to lower levels of motivationand achievement. In terms of health status, children continue to demonstrate significantlevels of morbidity. There is considerable direct and indirect evidence also of a highermorbidity among girls as compared to boys. These factors are also likely to lead to lowerutilization of available educational services. When children's health and nutrition are poor,
19
efforts to improve quality of teaching learning are rendered inefficient since children areunable to take full advantage of the educational stimuli that schools offer.
The primary school could serve as an effective entry point for child and community healthinterventions through a sound school health program which embodies the child -to- childapproach, basic health education etc. The School Health Program continues to posechallenges related to operationalization. Health education, while being a distinct curriculararea, is rarely taught in schools. The Nutrition Meal Scheme is being implemented in somestates as a centrally sponsored scheme, but its evaluation indicates it is more of an enrolmentscheme with little value to its nutritional impact.
3.3 To what extent is the Community Supportive of their Children's Needsand Rights?
Surveys across the country indicate that parents are interested in the education anddevelopment of their children. However, while there is a keenness to educate the child, thereis evidently little information in the larger community, particularly the new generation ofparents who often do not have access to extended family support systems, regarding thedevelopmental needs of the child at the different sub-stages and the significance ofresponsive parenting and child care, including the value of play for the child. One example isthe 'miseducation' (with emphasis on formal teaching of the 3R's), being practised at theearly childhood stage across the country due to ill-informed parental pressures. Many of themore traditional child care practices like massage, breast feeding and infant games which hada great deal of developmental significance are gradually disappearing from regular child-care practice. Studies indicate a dearth of spontaneous parent - child interaction at the level ofthe farnily, particularly in the socioeconomically disadvantaged and nuclear families, whichis acknowledged as a significant factor influencing learning and development. At the level ofthe larger community too, there is little evidence of social concern or discourse, except withsome NGOs, concerning issues/situations related to for example the rights of a child todevelopment and protection eg. working children, destitute children etc.
The situation of the child is also very closely linked to the situation of women in thecommunity. Unfavourable cultural biases towards girls and women along with their burdenof household and sibling care responsibilities often tend to keep the girl child out of school.Restraints on women's freedom and unequal access to basic social services also place younggirls and women at a disadvantage. This manifests itself in the form of widespread anemiaand malnutrition among adolescent girls and women and, in the case of pregnancy, affectsthe new born child. Women and young girls also carry a heavy burden of domestic work,spending long hours collecting water, gathering fodder and picking fuel in most parts of thecountry. Taken together then, this social reality results in poor health and nutritional statuswhich in turn contributes to poor fetal growth in pregnancy, with one third of all births in thecountry being below the minimum acceptable birth weight. Adding to this poor start in achild's life, inadequate or inappropriate feeding practices, repeated episodes of acuteinfections, poor access to health care and general neglect cause a substantial proportion ofchildren to become moderately or severely malnourished by the age of 6-18 months.
20
While there are isolated examples of the community's contribution in child related programs,involvement and sense of ownership, in planning and implementing child developmentservices/ programs is generally absent, since these are seen as 'government's responsibility'.With varying definitions of quality among stakeholders and inadequate understanding ofcommunity's role and involvement in ensuring quality, the efforts to mobilise thecommunity, despite good initiatives, become difficult to sustain. With the constitutionaldirective towards decentralised planning and management through Panchayti Raj Institutions(PRI s) at varying stages of implementation across the states, the potential for convergenceand coordination of interventions and closer monitoring of quality could be certainlyenhanced.
3.4 What are the Existing Policies and Programs to Address Needs ofChildren?
The Indian Constitution (1950) formulated after Independence, made a commitment toprovide opportunities for education to children 'up to fourteen years of age' (Article 45).Since then the government has tried to address issues relating to children through policiessuch as the National Policy for Children (1974), the National Policy on Education (1986/92)and more recently through ratification of the Convention on the Rights of the Child (1992).Consistent with the Eighth Plan's acknowledgement of malnutrition as a multifacetedproblem requiring an intersectoral approach to child development, the National NutritionPolicy was formulated in 1993 and a National Plan of Action was initiated in 1995. Thecurrent Ninth Plan has placed emphasis on food and nutrition security and on reachingchildren before two years of age and as a strategy, proposed instituting a National Charter forChildren which would ensure that " no child remains illiterate, hungry or lacks medical care"by the end of this plan period.
In pursuance of this policy framework, several centrally sponsored schemes and statesponsored programs are already on ground. Prominent among these are the ICDS and otherECE programs, the Mid-Day Meal Scheme, School Health Program, and the formal and non-formal primary education programs. Evaluation of these programs indicate some positiveimpact of ICDS on the incidence of severe malnutrition in children, of ECCE programs onenrollment and retention. The Noon Meal Scheme, while minimally influencing thenutritional status of primary grade children, has contributed more to higher enrollments.Interventions with the expectant mother and the infant have yielded significant results in thepast, but these are now beginning to stagnate. In 1977, the Ministry of Health and FamilyWelfare, initiated the Reproductive and Child Health Program which aimed to address theconcerns raised at the Cairo Conference and provide fresh impetus to work addressing thechief causes of maternal and childhood mortality and morbidity.
However, evaluation of many of these schemes point to wide gaps between theconceptualization and actual implementation of programs, including lack of holistic planningand convergence between sectors which tend to limit the impact of the programs. Forexample, a decision has been taken to address the issue of girls' participation in primaryeducation by synchronizing the timings of the ICDS centers to synchronize with the schoolsto provide alternative sibling care facility for the 3-6 year olds. Additional honorarium is paid
21
to the worker for spending longer hours with the children. This decision disregards the factthat the more acute problem for girls is the care of the 0-3 year olds, which does not getaddressed at all. Also by involving the worker for longer hours with the children her otherresponsibilities related to home visits and contact with the lactating mothers get neglected.Another example is the noon meal program which operates in several states as a centrallysponsored scheme, but has no coordination with the ICDS operating in the same areas,although both have a nutritional component. This leads to duplication of work and oftendouble enrollments. As yet another example, Health Education (HE) is a specified curriculararea which is expected to be taught in the primary school. Even if in the same school the midday meal scheme is being implemented the possibilities of treating the meal program as aneducational program for reinforcing linked messages of the HE curriculum are not evenconsidered, since it is seen as a separate scheme.
Some concems with planning and implementation of programs, across the board, relate moregenerically thus to the need to* target the child holistically across the development continuum using stage specific,
multi-sectoral development indicatorse prioritize interventions with a view to
-maximize child development and learning outcomes and- optimize resource utilization
* converge action to reach the child through- integrated approach to child survival, growth, development and learning
- clearly delineated shared responsibilities by different government departments- child centered as opposed to scheme centered implementation- structured mechanisms for convergence in place
* ensure quality by- defining quality in terms of child related outcomes- ascertaining a quality Vs quantity balance- addressing equity concerns- making monitoring and supervision provisions
* decentralize to the level of local management involving a process of- empowerment of PRIs with built-in accountability- capacity building for context specific solutions- consultation with and involvement of community.
3.5 The Current Situation
If we consider the status of primary education as an indicator of the impact of the existingprograms and services, the situation seems still very dismal. While the gross enrollment ratesin primary schools have shot up over the years, the retention and completion rates are still acause for concem with almost 30 percent of children who enroll dropping out of schoolbefore completing primary education. The high rate of drop-outs also leads to a wastage andinefficiency in the use of public resources. Among those who do survive the primaryeducation cycle, achievement levels remain deplorably low. The health and nutrition status ofchildren is also far from satisfactory, as already mentioned earlier. Therefore, while the
22
transition rates from primary grades to upper primary stage are very high, there is the moreserious issue of helping children survive the lower primary grades and emerge, havingcompleted the cycle, as well educated and healthy children.
Given the complexity of child development, on the one hand, and the range of programscurrently in place with little coordination between them, on the other, there is a need toreview the situation afresh and consider the way ahead. To be able to do this more effectivelyfrom the viewpoint of the child, there is a need to identify the more critical outcomes, outputand input indicators related to optimal development within each of the distinct substagesalong the development continuum, prioritize these in terms of cost effectiveness anddevelopmental significance and link these to a coherent, coordinated network of services forthe young child.
23
Annex 3
Workshop Schedule
February 21, 2000
9.15-9.30 Coffee/Tea9.30-10.30* Introductory Addresses
Ward Heneveld & Peter Heywood* Presentation of the concept note
Venita Kaul (Plenary)
10.30- 12.30* Discussion on concept of holistic child development* Identification of critical outcomes by sub-stages
Chair. Dr. Shanti GhoshFacilitator: Suneeta Singh
12.30 -13.00 Introduction to the group task: Matrix 1 (Plenary)Meera Priyadarshi
13.00-14.00 Lunch
14.00-15.45* Identification of critical output indicators and inputs by sub-stages: Matrix 1
Facilitators: Meera Priyadarshi & Kalpana Seethepalli (Group work)
15.45-16.00 Tea Break
16.00-17.30* Presentation of group work: Matrix 1 (Plenary)* Discussion
Chair: Ward HeneveldFacilitator: Susan Hirshberg
February 22, 2000
9.00-9.15 Coffee/Tea9.15-9.45* Overview of programs and services (Plenary)* Introduction to the group task: Matrix 2
Suneeta Singh
24
9.45-11.15* Review of service delivery systems and options for improvement: Matrix 2
Facilitators: Suneeta Singh & Kalpana Seethepalli (Group Work)
11.15-11.30 Tea Break
11.30-13.00* Presentation of group work: Matrix 2* Discussion (Plenary)
Chair. Erma ManoncourtFacilitator: Meera Priyadarshi
13.00-14. 00 Lunch
14.00-16:00* Future strategies for holistic child development: Open discussion (Plenary)
Chair: Peter HeywoodFacilitator: Deepika Shrivastava
16.00-16.15 Tea Break
16.15-1 7.30* Concluding session (Plenary)
Concluding session - Panel discussion
16.15-1 7.30
* Welcome address to panelistsPeter Heywood
* Brief presentation on workshop outcomesVenita Kaul & Meera Priyadarshi
* Panel discussionChair: Ward HeneveldPanelists: Edwin Lim, India Country Director, The World Bank
Secretary to GOI, Department of EducationSecretary to GOI, Department of Woman and Child DevelopmentSecretary to GOI, Ministry of Health & Family Welfare.
25
Annex 4
List of Invitees for the Early Childhood Development Workshop on February21st - 22nd, 2000
Education
1. Anita Kaul, Education Secretary, Primary & Secondary Education, Govt. of Kamataka,Bangalore - 560001; Fax: 080 - 2253756
2. Sumit Bose, Joint Secretary (EE1), Dept. of Education, Ministry of Human Resource, Govt. ofIndia, New Delhi
3. Amarjeet Sinha, Director (EE), Dept. of Education, Ministry of Human Resource, Govt. of India,New Delhi
4. Shalini Prasad, Director (DPEP), Dept. of Education, Ministry of Human Resource, Govt. ofIndia, New Delhi
5. Vrinda Sarup, State Project Director, ,UP Education for All Project, State Project Office,Nishatganj, Lucknow-226004
6. Rukmini Bannerji, " Pratham" ,Y.B. Chavan Center, Yashwant Rao Chavan Pratishthan, 4tFloor Near Sachivalaya Gymkhana, Nariman Point, Mumbai-400 021
7. Dr. Lakshmi, Andhra Mahila Sabha, Osmania University Campus, Hyderabad (040-672793)8. Sharda Jain, Director "Sandhan" Jaipur E-MAIL: Ressan4aipl .dot.net.in 0141-622549
R: 363487/ FAX: 6247419. Anuradha Joshi, Society for Integrated Development of Himalays, Hazelwood Cottage, PO. Box
19, Landour Cantt. Mussorie- 248179, TEL: 0135-632904/630338 FAX; 0135-631304;[email protected] .net.in
10. Yogendra, Director, Bodh Shiksha Samiti,AAI, Anita Colony, Bajaj Nagar, Jaipur -302015.Telefax: 0141-554315
11. Ms. Carla Barbiero, Director, Office of Social Development, USAID, American Embassy,Shantipath, Chanakyapuri, New Delhi - 110021. Fax: 4198454; Tel: 4198519
12. Divya Lata, Project Manager, (Education), Aga Khan Foundation, 6, Bhagwandas Road, NewDelhi -110001
13. Suzanne Allman, Chief Education Section, India Country Office, UNICEF House, 73, LodiEstate, New Delhi - 110003
14. 0. M. Sankaran, Pedagogy In-charge, State Project Office, Office of the PEDSK, 4" FloorCorporation Office Complex, Vikas Bhawan, P.O. Trivandrum - 695014
15. S. Nayan Tara, Indian Institute of Management, Bannerghatta Road, Bangalore- 560076. TEL:080-6582450; 6584050 E-MAIL [email protected]
16. Dr. G.C. Upadhya, Reader, Dept. of Pre-School & Elementary Education, NCERT, New Delhi -110016
17. Ward Heneveld, Education Sector Team Leader for India, The World Bank, 70, Lodi Estate,New Delhi - 110003
18. Venita Kaul, Education Specialist, The World Bank, 70, Lodi Estate, New Delhi - 11000319. Susan Hirshberg, Education Specialist, The World Bank, Washington D.C.20. Kalpana Seethepalli, Operations Analyst, The World Bank, 70, Lodi Estate, New Delhi - 110003
26
Child Development
1. Rekha Bhargava, Joint Secretary, DWCD, # 615, 'A' Wing, Shastri Bhawan, New Delhi - 1100012. Gopal Krishna, Project Director (WB), DWCD, # 645, "A" Wing, Shastri Bhawan,
New Delhi - 11 60013. S. K. Muttoo, Director, National Institute of Public Cooperation & Child Development, 5, Sin'
Fort Institutional Area, Hauz Khas, New Delhi - 110016, TEL: 6963002/6963204/6969010;FAX: 6851349
4. Dr. M.K. Bhan, Pediatric Department, All India Institute of Medical Sciences, New Delhi5. Ramji, Dept. of Paediatrics (Neo Natology), D-II/322, Pandara Road, New Delhi. Tel: 3381912
®, 3232400/3400 ext. 4245.6. Suresh Reddy, Program Associate, Girls' Education Unit CARE India, 27, Hauz Khas Village,
New Delhi -1100167. Geeta Menon, Sector Director,, Girls' Education Unit CARE India, 27, Hauz Khas Village, New
Delhi -1100168. Adarsh Sharma, National Institute of Public Cooperation & Child Development, 5, Siri Fort
Institutional Area, Hauz Khas, New Delhi - 110016, TEL: 6963002/6963204/69690 10; FAX:6851349® 91-387118
9. Minne Mathew, Training & Information Specialist, World Food Programme, 53, Jorbagh,New Delhi- 110003. Tel: 4694183
10. Neela Satyanarayanan, Secretary, Dept. of Women and Child Development, Govt. ofMaharashtra, Secretariat, Mumbai. Tel: 022-2027050; Fax: 022-2828281
11. Indu Balgopal, Child To Child South India, 14 Third Seaward Road, Valmiki Nagar,Thiruvanimiyur, Chennai - 600041. Tel: ® 044-4418164; (o) 4915996; 4454249Fax: 044-4915996
12. Kumkum Srivastava, Director, VIHAAN, 262, Muktananda Nagar, Opposite Amarnath Hospital,Gopalpura Mor, Jaipur. Telefax: 0 141-549676
13. Prema Mohite Dept. of Human Dev. And Family Studies, M.S. University, Vadodra14. Preeti Joshi, C/o Dr. P. L. Desai, 14/B, Hindu Colony, Stadium Road, Navrangpura,
Ahmedabad- 380 009 Tel: 079-6568338/644180515. 0. P. Rawat, Conmmissioner, Dept. of Women & Child Development, Govt. of Madhya
Pradesh, Block 2, 4t Floor, Pariyawas Bhawan, Jail Road, Bhopal - 462011.Fax: 0755-553705
16. Frances Sinha, EDA Rural Systems, E-9/7, DLF Phase I, Gurgaon. Tel: 91-350835, 35669217. Deepika Srivastava, India Country Office, UNICEF House, 73, Lodi Estate, New Delhi - 11000318. Patrice Engle, India Country Office, UNICEF House, 73, Lodi Estate, New Delhi - 11000319. Peter Heywood, Principal Health Specialist, The World Bank, 70, Lodi Estate, New Delhi -
11000320. Meera Priyadarshi, Nutrition Specialist, The World Bank, 70, Lodi Estate, New Delhi - 110003
Health
1. Minaxi Shukla, Deputy Director, CHETNA, Lilawati Ben Lal Bhai Bungalow, Civil Camp Road,Shahi Bagh, Ahmedabad - 380004. Tel: 079-2866695; Fax: 079-2866513
2. Anu Bhardwaj, F-13, Munirka Marg, Vasant Vihar, New Delhi - 1000573. Indira Murali, Professor & Head of Epidemiology, National Institute of Health & Family
Welfare, Munirka, New Delhi- 1100674. Sudhansh Malhotra, Assistant Conmnissioner (Training), Ministry of Health and Family Welfare,
405 "D" Wing, Nirman Bhawan, New Delhi - 110001. Telefax: 30199935. Shanti Ghosh,, 5, Sri Aurobindo Marg, New Delhi - 110016. Tel: 6851088; Fax: 65695266. Mala Ramachandran, Procurement Unit Head, Public Utility Building, 12th Floor, MG
Road, Bangalore-560001. Fax: 080-5598264; 080-5598263
1 27
7. Ravindra Prasad, Director, Regional Centre for Urban & Environmental Studies,Osmania University, Hyderabad. Telefax: 040-7019321
8. Samir Chaudhuri, Director, Child In-Need Institute, Village Daulatpur, PO Cailan, viaJoka, South 24 Parganas -743512. Fax: 033-4670241; e-mail: [email protected].
9. Gautam Basu, Joint Secretary, Ministry of Health and Family Welfare, 525-A, NirmanBhawan, New Delhi - 110001
10. Erma Manoncourt Deputy Director (Program) India Country Office, UNICEF House, 73,11. Lodi Estate, New Delhi - 11000312. Prema Ramachandran, Advisor (Health), Planning Commission, Yojana Bhawan, Sansad
Marg, New Delhi - 11000113. Suneeta Singh, Public Health Specialist, The World Bank, 70, Lodi Estate, New Delhi - 110003
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