Will Vimla Devi survive the burden of Millennium Development Goals?

Meet Vimla devi, a committed anganwadi worker (AWW) in a remote village in Uttar Pradesh, the most populated state of India. Anganwadi is a village level institution under Integrated Child Development Scheme (ICDS), one of the most talked about flagship program of Indian Government.

The children make up forty two percent of the total population of the country. But when it comes to the union budget for the year of 2010-11, they have got the share of only 4.63 percent.

As per Section 8.1 (BUDGETARY ALLOCATION) in GoI, ICDS website, alongside gradual expansion of the scheme, there has also been a significant increase in the budgetary allocation for ICDS scheme from Rs.10391.75 crore in 10th five year plan to Rs.44,400 crore in XI plan period. The details of budget allocation and expenditure for the year 2007-08 to 2009-10 in respect of ICDS (General) and supplementary nutrition are given as under:

S.No.	Year	Budget Allocation (Rs. In Lakh)	Funds released under ICDS(G)	Funds released under Supplementary Nutrition
1	2007-08	529300	310803.27	206231.05
2	2008-09	630000	401319.16	228131.33
3	2009-10	670500	177894.15	182001.76

Under 2010 – 11 budget, ICDS received Rs. 7, 932.71 crore against Rs. 6705 crore in 2009-10, nearly 18 percent increase. But even then it far below to universalize the ICDS scheme in all villages of India. The assessment made by CBGA says that the magnitude of funds required from the union budget 2010-11 to universalize ICDS would be in the range of Rs. 45,355 crore to Rs.75,055 crore depending on the number of anganwadi centers taken into consideration and the proportion of them that need construction of pucca building.

Government of India is spending about $1.7 billion/year on ICDS with around 75-80% utilization. But is this budget sufficient? Is it being spent on the appropriate heads to target the millennium development goals of reducing Infact Mortality Rate (IMR) and Maternal Mortality Rate (MMR).

Vimal Devi has to provide six services to the children and women in her Anganwadi, which intern are designed to reduce Infant Mortality rate (IMR), Maternal Mortality rate (MMR), to reduce hunger deaths among children and to prepare the children for elementary education. These targets are linked directly to at least four millennium development goals (MDGs 1,2,4 &5)

Each of these six services are quite demanding and designed assuming, various kind of skills in the anganwadi workers i.e community mobilization skills, technical skills, dealing with children, documentation and many others. Let’s spend a minute on each of these six services

· Supplementary Nutrition – There are four types of supplementary nutrition powders (called Panjeeri) targeted for four different kinds of beneficiaries - children (one group of 0.5-3 years and other of 3-6 years), pregnant and lactating women and for the adolescent girls to check different kinds of mal/under-nutrition among women and children. Different quantities of each of these powders should be measured and given to respective beneficiary and anganwadi worker has to maintain at least 7-8 registers to manage the procurement and distribution of these nutritional supplements. Apart from this they have to prepare hot cooked meal for the children of 3-6 years of age, with the help of the helper appointed in the anganwadi. Procurement of these “nutritional supplements”, ration for the meals and tracking the money for the meals is also their responsibility. This directly targets millennium development goals (MDG) 1, 4 &5, which commands a huge international attention but Vimal Devi is quite oblivious about the same!

· Immunization – Vimal Devi has to help the health workers (ASHA and ANM) in routine immunization of children and women and the village. She needs to mobilize the beneficiaries for the immunization and convince and educate the one’s who are refusing for the service. The developed world is quite concerned on the low % of immunization in India (Uttar Pradesh being at < 35%), in the fear of any chance of trans-border travel of these fatal diseases to their countries and they have left it on the shoulders of Vimal Devi. Here Vimla Devi is working unknowingly on millennium development goals (MDG) 4&5.

· Health check-up – Vimla Devi needs to assist the health workers (ASHA and ANM) to check and monitor the health of children and pregnant/lactating in the village and maintain all the data in separate registers.

· Referral services – All the children who are severe mal nourished, need to be referred to Nutritional Rehabilitation Center (NRC) to save their lives and here Vimla Devi directly work on to reduce IMR under millennium development goals (MDG) 4

· Nutrition & health education – Vimla Devi needs to spread the awareness of health, hygiene and other practices for the good health of women and child to the adolescent girls and other women’s group in the village

· Pre-school non-formal education – While doing all the above, Vimla Devi needs to engage 40-50 children in her anganwadi for 2-3 hours daily for pre-schooling education, to prepare the children for class 1 in the primary school. Needless to say that she needs to maintain some more registers for the same and the above five services hardly leaves any time and focus in her for this very important component.

So in total she maintains 20-25 different registers, procure food, cook the same and distribute it among the children, engage children in pre-schooling sessions, ensure immunization, mobilize the beneficiaries to avail these services, take care of all the pregnant and lactating women in the village and thus help Indian Government and International agencies to achieve their millennium development goals. And for all these she gets a salary of Rs 1500 per month ($35/month). Our kindhearted government made it Rs 3000 per month ($70/month) in the last budget, but even that is not realized in states like Uttar Pradesh and many others.

After running the ICDS for 35+ years, even today India’s IMR and MMR measures are abysmally poor and comparable only to Sub Saharan Africa and same is the case for % of malnourished children in the country. Infact ‘Eeshani Kandpal’ writes in her paper that budget allocation between states and villages also varies as per the voting pattern in that area. Ministry of ‘women and child welfare’ needs to have a hard look at the budget allocation to ICDS and/or reprioritizing the allocation of existing budget towards strengthening ICDS program at the ground level. Anganwadi workers should be empowered for the success of the ICDS scheme and for realizing the set targets of IMR and MMR.

But as of today, hope seems to be distant and the plight of Vimla Devi is endless. While performing these six mammoth responsibilities, she needs to regularly bribe her supervisors for not giving a negative report on her during their monitoring visits, the nutritional supplement is being sold in the open market before it reaches Vimla Devi and on any small irregularity on these 25+ registers and six services, she faces cuts in her salary or suspension from the job.

As of December 2010, Vimla Devi has more than 12.5 lacs fellow anganwadi workers in India, somehow surviving the burden of these four millennium development goals (MDGs) in Rs 1500/month.