The National Family Health Survey (NFHS) is a periodic survey conducted by the Ministry of Health and Family Welfare (MoHFW). It gathers data on many indicators related to health and nutrition. The last two such surveys were conducted in 2015-16 (NFHS 4) and 2019-21 (NFHS 5). Figure 1 shows how Durg has performed in these two surveys on select indicators that are relevant to the ICDS scheme.

• Durg saw a mixed trend, with both improvement and deterioration in nutritional indicators from NFHS-4 (2015-16) to NFHS-5 (2019-21).
• The district has recorded slight improvements under the wasting and underweight categories.
• However, there has been an observable deterioration under stunting and anaemia in children and women categories.

Figure 1: Performance of Durg in select nutritional indicators (%)

Figure 2 compares the nutritional status of Durg with that of Chhattisgarh based on data from NFHS 5.

• Durg has performed better than the state in indicators related to wasting, underweight children and anaemia in women and children.
• However, Chhattisgarh has performed better than Durg on stunting in children.

Figure 2: State and district’s comparison on nutritional performance (%)

There are two kinds of factors that can influence change in the status of nutrition among women, children and adolescent girls: socio-economic factors, and nutrition and health-related factors. Socio-economic factors include early marriage, early pregnancy, education levels of women and access to family planning. Nutrition and health-related factors include access to clean drinking water, sanitation facilities, adequate diet for children, prevalence of diarrhoea and acute respiratory infection (ARI), access to vitamin A for children and antenatal care for mothers.

Figure 3 shows how Durg has fared between two surveys on socio-economic factors that affect nutritional status.

Figure 3: Socio-economic factors affecting nutritional status of the district (%)

• There is an overall improvement in all socio-economic factors affecting the nutrition level of women and children in the district. Notably, there was an improvement of 12.6 percentage points in early marriage and 1.5 percentage points in early pregnancy.
• Family planning has improved in Durg. There has been a 14 percentage point increase in the current use of family planning methods by women of reproductive age and a 4.4 percentage points reduction in the total unmet needs for family planning in the district.

Figure 4 shows how Durg has fared between the two surveys on health and nutritional factors that affect nutritional status.

Figure 4: Nutrition and health related affecting nutritional status of the district (%)

• There was an overall improvement in all nutrition and health-related factors that could influence nutrition outcomes in a district.
• There was an improvement of 4.7 percentage points in adequate diet for children, 44.8 percentage points in access to sanitation, and a reduction in prevalence of ARI.
• The district also improved on the prevalence of diarrhoea, with cases falling from 6.8% to 2%.
• Access to Vitamin A increased from 72.5% to 82.3%, antenatal care from 59.9% to 69.9%, and access to drinking water from 98.3% to 98.5%.

Figure 5 shows the amount of funds received by the district treasury for implementation of ICDS, and how much was spent. Allocation between 2017-18 and 2020-21 saw volatility, with the highest increase in 2019-20 and the lowest allocation in 2018-19.  Expenditure of funds shows an inconsistent trend from 2017-18 to 2020-21. There was a dip of 52% in 2018-19 and 33% in 2020-21.

Figure 5: Allocation and expenditure of ICDS funds in Durg (Rs lakh)

As per the standing instructions issued in 2009 by the Directorate of Women and Child Development, every AWW must compile utilisation certificates (UCs) of the actual expenditure incurred. However, in the findings of the performance audit report by the CAG, it was found that the system of reporting actual expenditure incurred was not adhered to by field-level functionaries, i.e. AWWs. The absence of accurate reporting of expenditure incurred by AWWs makes it difficult to ascertain the designated purposes for which the funds were utilised.

Figure 6: Utilisation of ICDS funds in Durg (%)

Figure 7: Fiscal performance of Supplementary Nutrition Programme in Durg

Allocation for SNP in the district saw a hike for two consecutive years, 2018-19 and 2019-20. It declined thereafter in 2020-21. However, the expenditure in 2018-19 does not reflect the increase in allocation.

Reduction in beneficiaries under SNP: According to the Comptroller of Auditor General (CAG), the number of women and children enrolled in the scheme reduced from 2014 to 2019, mainly due to the distance between their homes and AWCs.

Non-distribution of supplementary nutrition: The CAG report states that 76 of the 240 test-checked AWCs did not distribute supplementary nutrition for at least 25 days for 16 to 31 months during the 2014-19 period. The main reason for this lacuna was delayed supply of food items/ready to eat foods by the SHGs and absence of AWWs.

Shortfall in Aadhaar authentication of beneficiaries: In Chhattisgarh, Aadhaar linking of only 43% of children and 97% of pregnant and lactating women had been done as of December 2019. It was observed that Aadhaar authentication of all beneficiaries, particularly children, could not be completed by the target date due to non-procurement of Aadhaar kits by the Department.

Referral of severely malnourished children to NRCs: During health check-ups and growth monitoring, sick and malnourished children were referred to Primary/Community Health Centres (PHC/CHC), while severely malnourished children were further referred to Nutrition Rehabilitation Centres (NRCs), in coordination with the Health Department. However, in the eight test-checked districts, of the total of 75,516 children identified as severely malnourished at CHCs/PHCs, only 12,306 (16%) were admitted to NRCs for intensive treatment during the 2016-19 period.

Availability of Anganwadi centre buildings and basic facilities in AWCs: The audit observed that as of October 2019, construction of 44,809 Anganwadi buildings was sanctioned. Of this, construction of 38,894 buildings (87%) was completed and construction of 5,915 buildings (13%) was not completed (including 2,138 buildings not yet taken up for construction as of October 2019).

Out of the 38,894 Anganwadis constructed, 37,407 buildings were utilised for functioning of AWCs. The remaining 1,487 buildings were not being used either due to their dilapidated condition or the long distance between habitations and the constructed building.

With regards to the availability of basic facilities in AWWs, it was observed that in eight test-checked districts, out of 14,646 AWCs operating from their own buildings, 2,209 AWCs (15.1%) did not have toilet facilities, 2,509 AWCs (17.1%) did not have a drinking water facility, 8,105 AWCs (55%) did not have a play area for children, and 9,268 AWCs (63%) were without electricity. The lack of availability of basic resources such as sanitation, safe drinking water and electricity can be possible factors for the poor nutrition levels in the state as well as its districts.

Shortfall in training: The success of any policy lies in the efficacy of the level of execution by the staff employed at the grassroots level. It was observed in the audit that during the 2014-19 period, the shortfall in fixation of targets was 42%-100% for CDPOs, 15%-85% for supervisors and 40%-65% for AWWs/AWHs for refresher training. Further, the targets fixed were also not achieved and the shortfall was 44%-90% for CDPO (Child Development Project Officers), 25%-51% for Supervisors, and 2%-100% for AWWs/AWHs. The training deficit of the ground staff may have affected the efficacy of the scheme, leading to a poor performance by the district on nutritional indicators, as can be seen above.

Given the importance of ICDS in providing nutrition and helping in the overall development of children, different data/information about the scheme should be readily available to and accessible by the common masses.

The following table shows a list of essential data points/information regarding ICDS that various stakeholders will find useful. The availability and accessibility of this information is critical to ensure the scheme’s success. The current level of information available has been evaluated for each of the indicators.

Transparency and Accountability Index

Availability

Is the data is available at the district level?

Fiscal (input) indicators: Yes, on the district treasury website. It is available for various ICDS components such as Supplementary Nutrition Programme. Data is available for allotment and expenditure under these components.

Outcome indicators: Yes. It is available online for nutrition-specific indicators such as stunting, wasting, anaemia among children, etc, from the National Family Health Survey.

Is the data available via online/offline mode?

Fiscal (input) indicators: Online

Outcome indicators: Online

Accessibility

Is the data available in an 'open access' format?

Fiscal (input) indicators: Yes

Outcome indicators: Yes

Is the data published in machine-readable formats, such as CSV, Excel etc., and is it easily reusable?

Fiscal (input) indicators: Yes. Data can be downloaded in Excel format.

Outcome indicators: Data is available in PDF format.

Is the data published in multiple languages?

Fiscal (input) indicators: No, English only

Outcome indicators: No, English only

Completeness/Comprehensiveness  

Is the data complete or partial?

Fiscal (input) indicators: Partial. Comprehensive data on the scheme is not available. Only component-wise information is available.

Outcome indicators: NFHS data has comprehensive district-wise information on health and nutrition indicators.

Timeliness of Data that is available

Is the data generated on a timely and regular basis?

Fiscal (input) indicators: Yes

Outcome indicators: Yes

How frequently is the data updated?

Fiscal (input) indicators: Annual

Outcome indicators: NFHS data is available at different intervals each time. The latest survey was conducted after an interval of three years.

Which year does the latest data cover?

Fiscal (input) indicators: 2022-23 (until December)

Outcome indicators: For NFHS, data is available up to 2019-20.

User-friendliness and relevance of data that is available 

Is the data easy to understand and comprehend and are the analytics published online? (Is it free of technical codes and difficult terminology?)

Fiscal (input) indicators: To download ICDS data from the treasury, knowledge of DDO/scheme codes is required.

Outcome indicators: Yes, analytics produced by NFHS are relevant and user friendly.

Public participation and accountability  

Is there space for people to participate in planning/budgeting/monitoring/evaluation/auditing of the scheme at the district/block/panchayat level?

No

Are people physically present and actively involved in the consultations/meetings in any of the above tiers of programme design and implementation?

No

If there is no possibility of physical participation, are there other 'means' of participation?

No

Is there any provision for a social audit of the scheme?

No

Are social audits conducted as per norms?

No

Are social audit reports publicly available?

No

Is there any grievance redressal mechanism for beneficiaries?

Toll free number 14408 (an initiative by the Central Government)

• The nutritional parameters covered under ICDS, which deals with better health outcomes for children, adolescent girls and pregnant women, showed a mixed trend in Durg over the years. The district has fared better than the overall state in reducing the share of children who are underweight, wasted and anaemic, but the state has performed better than the district in reducing stunting. The incidence of anaemia among adolescent girls and pregnant women also increased over time in the district.
• Although, by its very nature, ICDS has well-defined beneficiaries and unit cost, the extent of fund utilisation is always high because the fund allocation is known prior to spending. But in the case of Durg, fund utilisation was below 70% in each of the three years between 2018-19 and 2020-21, an area which needs to be focused on and taken into consideration. Further, the shortage of human resources across departments has huge implications on fund utilisation as well.
• Fund utilisation under the SNP component is only 40%-50% between 2017-18 and 2020-21. The key findings suggest a greater shortfall in trainings under different line departments of the scheme. The training deficit of the ground staff and tech-savvy staff may have affected the efficacy of the scheme, leading to the district’s poor performance on nutritional indicators and fiscal outcomes.