India - Integrated Child Development Services Project

Document of The World Bank FOR OFF1CIAL USE ONLY sLA 32 C3' IAI C,a7 Rep o No P-5309-IN MEMORANDUM AND RECOMMENDATION OF THE PRESIDENT OF THE INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT AND THE INTERNATIONAL DEVELOPMENT ASSOCIATION TO THE EXECUTIVE DIRECTORS ON A PROPOSED LOAN OF US$10 MILLION EQUIVALENT AND A PROPOSED CREDIT OF SDR 73.6 MILLION (US$96 MILLION EQUIVALENT) TO INDIA FOR THE INTEGRATED CHILD DEVELOPMENT SERVICES PROJECT AUGUST 7, 1990 This docunnt has a resticted dtibution and may be uwed by recpients only In the performance of their offici dutie ts contents may not otherwise be discosed wihout World Bank autorization.  CURRENCY EQUIVALENTS Currency Unit - Indian Rupee (Rs) US$ 1.00 - Rs 17 Rs 1.00 - US$ 0.059 WEIGHTS AND MEASURES Metric System FISCAL YEAR April 1 - March 31 ABBREVIATIONS AND ACRONYMS GOI Government of India ICDS Integrated Child Development Services MDM - Mid-day Meals Program SNP G Special Nutrition Program TINP - Tamil Nadu Integrated Nutrition Project  FOR OFFICIAL USE ONLY INDIA INTEGRATED CHILD DEVELOPMENT SERVICES PROJECT Loan/Credit and Project Summary Borrower: India, acting by its President Beneficiarv: Governments of Andhra Pradesh and Orissa Amount: IBRD: US$10 million equivalent IDA: SDR 73.6 million (US$96 million equivalent) Terms: IBRD: 20 years, including 5 years' grace, at standard variable interest rate IDA: Standard, with 35 years' maturity Onlending Terms: Government of India to Andhra Pradesh aitd Orissa: In accordance with standard arrangements for development assistance to States on terms and conditions applicable at the time Financing Plan: Local Foreign Total -US$ million----- IBRD/IDA 96.8 9.2 106.0 GOI 40.4 - 40.4 Andhra Pradesh 5.5 - 5.5 Orissa 5.6 - 9,6 Total Project Cost* 148.3 9.2 157.5 *Including duties and taxes of US$4.0 million. Economic Rate of Return: Not applicable Staff ADRraisal Report: Report No. 8568-IN, dated June 1, 1990 This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed withoun World Bank authorization.  MEMORANDUM AND RECOMMENDATION OF THE PRESIDENT OF THE INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT AND THE INTERNATIONAL DEVELOPMENT ASSOCIATION TO THE EXECUTIVE DIRECTORS ON A PROPOSED LOAN AND A PROPOSED CREDIT TO INDIA FOR AN INTEGRATED CHILD DEVELOPMENT SERVICES PROJECT 1. The following memorandum and recommendation on a proposed loan and a proposed credit to India is submitted for approval. The loan would be for US$10 million equivalent and would have a term of 20 years, including 5 years of grace at the Bank's standard variable interest rate. The credit, for SDR 73.6 million (US$96 million equivalent) would be on standard IDA terms with 35 years' maturity. The loan and credit would help finance an Integrated Child Development Services project in tribal and otherwise disadvantaged areas of the states of Andhra Pradesh and Orissa. A statement on Country Strategy is attached as Schedule E. 2. Background. India's development priorities emphasize poverty alleviation. Human resource development programs focussed on child and maternal health and nutrition as well as education are an important component of efforts to raise the living standards of the poor. Moreover, the National Policy for Children mandates nutrition and health improvements as primary government duties. India has achieved considerable success in improving child survival, but an estimated one-third of India's pre-school children have some form of serious growth deficit from malnutrition. The extent of malnutrition among scheduled tribes and castes is higher than averages in most places. Severe malnutrition (<60 percent of weight for age) is declining but exists among all classes. Recent survey results from the pioposed project areas of Andhra Pradesh show that more than a third of the children 0-6 years suffer from moderate or severe malnutrition. Preliminary Orissa data suggest that nearly 40 percent of children age 0-6 years suffer from moderate or severe malnutrition. This proportion rises sharply to 55 percent for children in the age group 6-36 months. A higher level of malnutrition among younger children is generally found in all rural, urban and tribal areas. 3. The Government of India (GOI) has sought to address nutrition issues in a variety of ways. In addition to income generation, these efforts include the Applied Nutrition Program, the Mid-day Meals Program (MDM), which provides supplementary food to around 17 million primary school children, and the Special Nutrition Program (SNP), which provides nutrition supplementation to an estimated 6 million pre-school children and pregnant and nursing women, primarily from tribal and backward areas and urban slums. However, enrollment of children below 3 years of age, the most vulnerable group, is low. A public distribution system of "fair price shops", run by the Ministry of Civil Supplies provides low-cost staples to poor households against ration cards. A substantial share of the program operates in urban areas. 4. India's nutrition policy and strategy are reflected in its programs rather than explicit statements or plans. Nutrition accounts for around 1% of Central and state plan outlays combined, or around 0.16% of GDP in 1986/87. The Government has focussed its nutrition resources on four types of programs:  - 2 - ICDS, provision of vitamin A and iror Jlements, food subsidies and feeding programs. All supplementary feeding p..,:ams combined cover an estimated 11 million of India's 38 million pre-schoolers. 5. India's most important national child nutrition intervention is the Integrated ,hild Development Services (ICDS) scheme, which is large, com- prehensive and imaginative. ICDS has four objectives: (a) to improve the health and nutrition status of children 0-6 years; (b) to promote child psych- ological and social development through early stimulation and education; (c) to enhance maternal ability to provide proper child care through health and nutrition education; and (d) to achieve effective coordination of policy and implementation among the various concerned agencies. ICDS delivers a package of services comprising supplementary nutrition, immunization, health check- ups, referral services, and health and nutrition education to children under 6 years of age, pregnant and nursing women, and pre-school education to children between 3 and 6 years of age. Initiated in 1975 on an experimental basis in 33 blocks, ICDS now covers around 2,200 out of India's total of 5,500 rural blocks. (Blocks have an average population of 110,000.) 6. ICDS is centrally sporsored but administered by the state governments. The GOI and the states also share ICDS costs. The GOI provides training and operating costs estimated at US$53,000 per block-year. State governments meet the costs of supplementary food, currently estimated at around US$100,000 per block-year. States themselves also have set up an addi- tional 188 ICDS projects for which they pay all the expenses. GOI's annual outThys for ICDS, which constitutes the bulk of India's nutrition spending. run around $US220 million, a tiny fraction of total GOT social sector expendi- tures. 7. ICDS coverage doubled in the Seventh Plan (1985-90) and further expansion is likely in the forthcoming Eighth Plan. ICDS expansion has been based on two kinds of targetting: first, to -he most disadvantaged areas and, second, within them to vulnerable pre-school children and pregnant and nursing women. The initial geographic focus was on tribal, drought-prone areas and blocks with a significant proportion of scheduled caste population. The program is also targeted towards malnourished children. In practice, however, selection criteria for supplementary feeding generally reflect a combination of individual workers' perceptions of which are the poorest households and overall quotas which the Central and individual state governments set for supplementation, rather than nutritional screening. 8. The most striking aspect of the findings of numerous ICDS evalua- tions is the wide variation in ICDS impact by component, region, age and caste status of households. Monitoring data from the ICDS Central Technical Committee show that the prevalence of severe malnutrition declined faster in ICDS than in non-ICDS blocks and that IMR was 20 percent lower in ICDS areas, even though ICDS blocks were judged to be poorer than non-ICDS blocks. How- ever, other studies indicate no significant changes or only marginal improve- ments. According to one national ICDS study, about 30 percent of the children taking part in ICDS continue to remain moderately or severely malnourished. 9. The Tamil Nadu Integrated Nutrition Project (TINP) is the only IDA- assisted nutrition project in India, covering over 10 million population in  3 - 173 of the state's 373 rural blocks. It is estimated to have contributed to a reduction of a third to a half in severe malnutrition among 6-24 month olds, and a reduction of about 50X in severe malnutrition among 6-60 month olds. The program also reduced inequalities in the incidence of malnutrition among different districts and demonstrates that it is possible to reach a high proportion of younger children who are nutritionally the most vulnerable. While it did not achieve all of its goals, the project has an unusual number of lessons for the design and implementation of outreach programs, particularly in the area of training, supervision and monitoring. 10. The proposed project builds on lessons from ICDS's own rich experience, augmented by lessons from TINP and elsewhere, by: (a) emphasis on in-service field-based training, supportive supervisory practices and simple monitoring systems to ensure high levels of service quality and coverage; (b) community-based growth monitoring and intensive nutrition education; (c) community mobilization, particularly of women's groups; (d) increased attention to promotion of behavioral change, and (e) operational research in alternative modes of therapeutic supplementation to arrive at the most efficacious approach. 11. Rationale for Bank Involvement. The proposed project is part of Bank Group assistance for human resource development. Assistance to ICDS also can help overcome some of the more disastrous consequences of poverty as a brake on human capital formation. The Bank's human resource development intentions include assisting India to reduce excess fertility, mortality and morbidity, and increase and maintain higher levels of school enrollment. Improved nutrition, particularly of younger pre-school children and their mothers, can contribute directly to improved health and education outcomes and indirectly to lower fertility rates. 12. Project Objectives. The project would focus on 301 tribal or other- wise disadvantaged blocks in Andra Andhra Pradesh and Orissa. Specific nutri- tion and health impact objectives for project areas are to reduce severe mal- nutrition by 5U. among children 6-36 months, increase the proportion of children 6-36 months in normal or only mild malnourishment status, and to contribute to reductions in infant mortality and the incidence of low bir-h weight. 13. Project Description. The project would consist of four components: service delivery, communications, community mobilization and project management and evaluation. Service delivery would finance construction, furnishing and equipping of village child development centers and block offices; increased training for ICDS and health workers and supervisors; incremental drugs and medicines; vehicles for supervision, and incremental salary and other operating costs. Communications would finance production and distribution of audio-visual materials, local consultancies for message design and development, training, surveys and incremental salary and other operating costs. Community mobilization would finance support to village women's organizations and special educational programs for women and adolescent girls, including incremental worker honoraria and other operating costs. Project management and evaluation would finance furnishing and equipping of a project management office in each state, its operating costs, local consultancies, surveys (baseline, monitoring and for mid-term and final evaluation) and oper-  - 4 - ations research, including the costs of therapeutic nutrition supplements under optional delivery arrangements for growth-faltering, moderately and severely malnourished children under three years of age. 14. Total project costs are estimated at US$157.5 million. The proposed Bank loan of US$10 million and proposed IDA credit of SDR 73.5 million (US$96 million equivalent) would finance 70Z of project costs net of duties and taxes, including all foreign exchange costs and around 65% of local costs. The GOI would finance US$40.4 million and Andhra Pradesh and Orissa would finance US$5.5 million and US$5.6 million, respectively. A b-eakdown of costs and the financing plan appear in Schedule A. Retroactive financing of up to US$2 million would be provided for eligible expenditures made after September 30, 1989. Amounts and methods of procurement and disbursements and the disbursement schedule appear in Schedule B. A timetable of key processing events and the status of Bank Group operations in India appear in Schedules C and D, respectively. The Staff Appraisal Report, No.8568-IN of June 1, 1990 is being distributed separately. 15. Agreed Actions. GOI and the states agr ,d: (a) in project areas to maintain beneficiary selection criteria and procedures for ICDS nutrition supplementation satisfactory to the Bank Group; (b) that under terms of refer- ence satisfactory to the Bank Group, Andhra Pradesh and Orissa would Ii) by September 30, 1991, carry out operations research on nutrition and health staff work routines at and below the block level and discuss the results with the Bank Group by April 1, 1992, and (ii) by September 30, 1994, complete and discuss with the Bank Group the findings of operations research on alternate approaches to provision of therapeutic supplementary nutrition; (c) esrablish by January 1, 1991, in each project state a project management unit w':h a key staffing plan satisfactory to the Bank Group, and (d) under terms ot eference satisfactory to and in consultation with the Bank Group, carry out id-term review and final evaluation of the project by December 31, 1993, ant .eptember 30, 1997, respectively. 16. Benefits. The project would substantially accelerate nutrition and health status improvement of young children and would contribute to a faster reduction in infant and child mortality in poor areas of Andhra Pradesh and Orissa. Around an estimated five million relatively disadvantaged children 0- 6 years of age and three million pregnant and nursing women would directly benefit from project services. Through the project, several health technologies--acute respiratory infection management, oral rehydration therapy, deworming, and vitamin A and iron supplementation--would become more widely available. By increasing family and community competence to avert and treat malnutrition, the project would help bring about a reduced need over time for therapeutic supplementation. In the new project blocks to be developed, an estimated 45,600 women would obtain training and employment as workers and supervisors. New women's groups with a total membership of about 600,000 would be formed, trained both in basic health and nutritional care and in how to pass on their knowledge to other women in the community. Around 5,600 women's groups would participate in income generation activities; over 150,000 adolescent girls would receive apprenticeship training in health and nutrition. A more significant and long term indirect benefit is the project's likely impact on ICDS. Testing of innovative ways of therapeutic supplementation and nutritional rehabilitation would lead to more effective  - 5 nutrition services. The software systems--training, supervision, communication, community mobilization, and monitoring and evaluation-- developed under the project, if successful, would lend themselves to w_.der replication, thereby increasing the pace of improvement in child nutrition and reduction in infant and child mortality. 17. Risks. There are two main risks. First is inadequate implementation capacity, which may result in lower than desired service coverage and quality. The second is constraints to replacing worker- determined socio-economic criteria with verifiable nutrition criteria as the basis for supplementary child feeding. Three project actions would reduce the first risk. First, organization at block, district and state levels would be strengthened and staff would receive necessary training. Second, the new modes and content of service delivery would be tested and refined in pilot blocks and evaluated as the basis for wider replication. Third, the results of a mid-term evaluation after two years of project operation would be discussed with the Bank Group and would guide both refinements of project content and the subsequent implementation pace. The latter risk would be reduced by assurances that initially-agreed ICDS supplementary feeding criteria and any modifications to them would have to be mutually satisfactory. Moreover, the weight of accumulating evidence that a targeted approach is more effective and efficient than near-universal feeding in promoting child development and growth will also foster the adoption of more objective sup- plementation criteria. 18. Recommendation. I am satisfied that the proposed loan and credit will comply with the Articles of Agreement of the Bank and Association, and recommend that the Executive Directors approve the proposed loan and credit. Barber B. Conable President Attachments August 7, 1990 Washington, D.C.  -6 Schedule A INDXA INTEGRATED CHILD DEVELOPENTSEVIxE PPE]z LL_WSLEE Estimated Costs and Financing Plan Estimated Costs: Local Foreign Total - US$ millions ------- A. Service Delivery 1. Nutrition 97.3 5.5 102.8 2. Health 10.1 2.1 12.2 3. Training 14.9 0.7 15.6 Subtotal 122.3 8.3 130.6 B. Communications 9.4 0.5 9.9 C. Community Mobilizatior 10.8 0.2 11.0 D. Project Management 1. Project Organization 4.6 0.2 4.8 2. Monitoring and Evaluation 1.2 0.0 1.2 Subtor.l 5.8 0.2 6.0 Total Prolect Cost 148.3 9.2 157.5 *The total cost net of Duties and Taxes (US$4.0 million) is US$153.5 million. Financing Plan Local Foreig Total ------ US$ million ------- IBRD/IDA 96.8 9.2 106.0 GOI 40.4 - 40.4 Andhra Pradesh 5.5 - 5.5 Orissa 5 5.6 Total Project Cost 148.3 9.2 157.5  - 7 - Schedule B Page 1 of 2 INDIA INTEGRATED CHILD DEVELOPMENT SERVICES PROJECT Procurement Method and Disbursements Procurement Method !CB LCB Other N/A Total Cost Project Element --------- US$ million --------------- Civil Works 0.0 2.1 17.7 0.0 19.8 (0.0) (0.0) (17.5) (0.0) (17.5) Equipment and Materials 0.0 6.9 2.0 0.0 8.9 (0.0) (5.3) (1.6) (0.0) (6.9) Medicines and Drugs 4.4 1.0 3.0 0.0 8.4 (4.4) (0.8) (2.7) (0.0) (7.9) Vehicles 0.0 0.0 4.2 0.0 4.2 (0.0) (0.0) (3.3) (0.0) (3.3) Training, Consultant 0.0 0.0 23.7 0.0 23.7 Services, Studies and Research (0.0) (0.0) (23.3) (0.0) (23.3) Furniture 0.0 0.0 0.9 0.0 0.9 (0.0) (0.0) (0.6) (0.0) (0.6) Grants to TWomen's Groups 0.0 0.0 0.0 7.4 7.4 (0.0) (0.0) (0.0) (0.0) (0.0) Incremental Therapeutic 0.0 0.0 3.7 0.0 3.7 Nutrition Supplementation (0.0) (0.0) (2.1) (0.0) (2.1) Other Incremental 0.0 0.0 0.0 80.5 80.5 Operating Costs (0.0) (0.0) (0.0) (44.4) (44.4) Total 4.4 10.0 55.2 87.9 157.5 (4.4) (6.1) 51.1) (44.4) (106.0) Figures in parentheses are amounts to be financed by Bank Group.  -8- Schec.jl"f Page 2 of 2 Disbursements Categ-ory Disbursement Z of expenditures amount to be disbursed (US$ millon) Training, Consultant Services 23.3 100l Civil Works 17.5 90X Medicines, Drugs, Equipment, 18.7 100l of CIF, ex- Vehicles and Furniture factory or 80X of goods purchased otherwise Incremental Therapeutic 2.1 60X Nutrition Supplements Incremental Operating Costs 37.3 60X Unallocated _ 7.1 Total 106.0 Estimated Disbursements: FY91 FY92 FY93 FY94 FY95 FY96 FY97 FY98 Annual 5.0 5.5 14.2 19.3 20.6 18.6 17.0 5.8 Cumulative 5.0 10.5 24.7 44.0 64.6 83.2 100.2 106.0  Schedule C INTEGRATED CHILD DEVELOPMENT SERVICES PROJECT Timetable of Key Projec Processing Events (a) Timetable to Prepare 18 months (b) Prepared by Government of India, State Governments of Andhra Pradesh and Orissa (c) First Bank/IDA mission June 1988 (d) Appraisal Mission Departure January 18, 1990 (e) Negotiations May 1990 (f) Planned Date of Effectiveness October 1990 (g) Relevant PCR India: PCR on Tamil Nadu Integrated Nutrition Project (Credit 1003-IN)  - 10 - SCHEDtUE 0 PAOE 1 of 4 TM TAIS T OF OMI OM PETIN IN INA A. STATff OF SAW LOA AND IDA CREITS (A. of Marc 81, 100) USJ M ilion (net of cancelltlis.o) Loan or Fical YTer Credit No. of Approval Purpose no IDA 1/ Undlbured 2/ 72 Lons/ 4300.1 - 160 Creits fully disbursed - 10587.2 1172-IN 1902 Ko-' 'her"eI Power 1 - 400.0 29.73 1177-iN 12 I Pradb major Irrigation - 220.0 71.73 1178-1N 1002 We"ngal Social Forestry - 29.0 6.00 2070-IN 1062 R u m ral Power U 260.0 - 23.56 1280-IN 1908 CuJrt atr Supply - 72.0 88.68 1266IN 1068 Ja/Khir and Haryana Social Foreetry - 38.0 6.27 1190-1N 106i Haryana Irrigation U1 160.0 41.97 1332-iN 1o8" U.P. Public Tubewelle 1I - 101.0 14.98 1356-ZN 168o Upper Indravati Hydeo Poer - 170.0 55.97 2270-ZN 1906 Upper Indravati Hydro Power 168.4 - 156.01 1369-1N 1068 Calcutta Urban Developent III - 147.0 91.62 2268-IN 1908 Central Powr Trnomiseion 250.7 - 178.09 2205IN 108 - Himlyas Watershed Managnt 40.2 - 16.21 1388-N 106 Maharashtra Water Utilization - 32.0 6.56 2820-1N 1i63 MAhy Pradesh Urban 16.1 - 7.27 1424-ZN 1904 Ratned Aire Watershed Dev. - 31.0 30.69 1426-iN 1964 Population III - 70.0 29.02 1432-IN 1904 Karnatako Social Fortery - 27.0 11.27 2387-IN 1904 Nbove Sheva Port 250.0 - 27.00 289J-IN 1904 Dudhichus Coal 109.0 - 29.07 2403-IN 1i64 Cawbay Basin Petroleum 21J.6 - 75.96 2415-IN 1904 Madhyo Pradesh Fertil ser 203.6 - 44.19 1454-IN 1984 Tamil Nadu Water Supply - 36.5 21.99 SF-12-IN 1904 Tamil Nae aOter Supply - 86.5 43.64 1468-IN 1904 Porlyar Veigal i IrriTgOtion - 17.6 0.44 SF-16-IN 1904 Perlyar Vaogal II Irrigation - 17.5 13.59 1483-IN 1964 Upper Ganga Irrigation - 125.0 106.7C 1496-IN 1964 Gujarat Medium Irrigation - 172.0 110.64 2416-IN 1964 Indira Sarover Hydroeloctric 17.4 - 12.60 SF-20-IN 1904 Indira Sarovar Hydroe:ectric - 13.6 16.16 1613-IN 1065 Indira Sarover Hydroelectric - 13.2 16.03 2417-IN 1904 Railways Electrification 279.2 - 89.54 2442-IN 1964 Farakka II Therml Power 300.8 - 203.62 2452-IN 1964 Fourth Troabay Thermal Power 135.4 - 16.49 1502-IN 1904 National Cooperative Development Corporstios III - 220.0 153.33 1614-IN 1965 Kerala Social Forestry - 31.6 20.70 1523-IN 19865 Ntional Agric. Extension I - 39.1 38.83 1544-IN 1965 Bombay Urban Developmnt - 1l8.0 120.79 o/ Final disbursements being processed.  - 110- SCHEDULE D PAGE 2 of 4 USU Million (net of coniellotions) Loan or Floe l Year Creit No. of Approvl Purpse IDA 1/ Undlebursd 2/ - a - - ~~ ae------ --- 2497-IN 196 Nmrda (Guj arat) Des and Por 200.0 - 200.00 152-IN 19s6 Nrmnade (Gu, rst) Dow and Po r - 100.0 83.71 156-IN 196N Nrinade (GuJ, *rt) Canal 160.0 152.09 15-IN 19t6 Second National Agricultural Ext. - 49.0 37.9- lll-IN 1985 National Social Forestry - '.06 2498-IN 1906 Jberla Coking Coat 57.7 - 12.06 2606-IN 1986 Maherehtra Petrochemicals 800.0 - 20.63 25J4-IN 19865 Second National NHghwoy 200.0 _ 151.67 2544-IN 196 Chandrapur Thermal Power 800.0 - 178.94 2555-1N 19t6 Rihand Powor Transmission 260.0 - 84.90 2502-IN 1986 Karla Poer 176.0 - 152.60 1619-IN 1960 West BengpI Minor Irrigation - 99.0 120.71 1621-IN 1966 Mahra htrV Compo_lie Irrigation - 160.0 186.93 1622-IN 1986 Kerala Water Supply and Sanitation - 41.0 41.96 1628-IN 19W6 West Bengal Population - C.0 39.13 1631-IN 1986 National Agercultural Research II - 72.1 70.73 2629-IN 1966 Industrial Export Dev. Finance 90.0 - 48.71 2630-IN 1966 ICICI-Indue. Exp. Dew. Finance 160.0 - 79.11 104t-IN 1966 GuJart Urban - 62.0 49.67 26J3-IN 196 NHOARD I $76.0 - 0.60 266O-tN 1986 Cemont Industry 165.0 - 94.22 2661-IN 1986 ICICI - Cment Industry 35.0 - 25.29 1665-IN 1966 Andhra Prades t Irrigation - 140.0 150.37 2662-IN 1986 Andhra Pradesh It Irrigation 131.0 - 181.00 2674-IN 1966 Combined Cycle Power 48C.0 - 141.06 2729-IN 1966 Cooperative FertilIzor 150.2 - 6.95 2730-IN 1906 Cooperative Fertil zer 145.0 - 56.55 1787-IN 1967 Bihar Tub eslls - 66.0 66.64 2769-IN 1987 Bombay Water Supply A Sewerage III 40.0 - 40.00 1750-IN 196? Bombay Wator Supply A Sewerae III - 145.0 117.71 1754-IN 1967 National Agri