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Human Development SectorSouth Asia Region September 2004

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Report No. 29695

THE WORLD BANK

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This report was prepared by a multi-sectoral team led by Venita Kaul which included MeeraPriyadarshi, (co-task leader), Peter Heywood, Suneeta Singh, Vandana Sipahimalani-Rao, DeepaSankar and G.N.V. Ramana. The team would like to acknowledge the efforts put in by Kamal Gaurwho provided academic support, S.A.A.Alvi who read through the final script meticulously andsuggested improvements and Sudesh Ponnappa and Karthika Nair who provided excellentadministrative support throughout, and more particularly in production of the final version of thereport. The team appreciates the valuable feedback received from Michelle Riboud, Michael F. Carterand Shantayanan Devarajan, which helped in the improvement of the report. Gratefulacknowledgement is also made of the contribution of Ward Heneveld for his continual guidance andsupport and of Mary Eming Young and Harold Alderman for their constructive contributions as peerreviewers.

The report draws on the following studies commissioned for this research – A Conceptual Approach toIntegrated Child Development by New Concept Information Systems; Empirical Analysis of the ConceptualFramework for Integrated Child Development by Indicus Analytics; Snakes and Ladders: Factors thatFacilitate or Impede Successful Primary School Completion by Vimala Ramachandran and her team; Study ofExisting Policies and Related Provisions and Schemes for Children and Public Spending on Child Developmentby D.B. Gupta. The team would like to place on record its appreciation of the cooperation received fromthe researchers in terms of not only timely completion of the studies but also their receptivity to feedback.

The research benefited greatly from regular consultations with a Technical Committee of Indianprofessionals from Health, Education, Nutrition and Child Development sectors, particularly indeveloping the conceptual framework. The committee also included representatives from UNICEF andfrom the three concerned departments of Ministry of Human Resource Development, Government ofIndia-Department of Elementary Education, Department of Health and Family Welfare and Departmentof Women and Child Development and some representatives from the states. The names of the membersof the committee are annexed. The team would also like to express its gratitude especially to Dr. R.V.V.Ayyar and Mr. S.C. Tripathi, Secretaries of Department of Women and Child Development andDepartment of Elementary Education and Literacy and Dr. S. Anandalakshmy, Child DevelopmentConsultant for their participation and ideas shared in the seminar organized in this context in April 2003and to Mr. Sumit Bose and Ms. Rekha Bhargava, Joint Secretaries for their contributions in all seminarsheld during the course of the research.

The report has been shared with Government of India, but does not necessarily bear approval for all itscontents, especially where the Bank has stated its judgements, opinions and conclusions.

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ANM Auxiliary Nurse MidwifeARI Acute Respiratory InfectionAWPB Annual Work Plan and BudgetAS Alternative SchoolsAWC Anganwadi CentersAWW Anganwadi WorkerCDI Child Development IndexCSS Centrally Sponsored SchemeCSSM Child Survival and Safe MotherhoodDIET District Institute of Education

and TrainingDOE Department of EducationDPEP District Primary Education Program DPT Diphtheria, Pertussis and TetanusDWCD Department of Women and

Child DevelopmentECCE Early Childhood Care and EducationECD Early Childhood DevelopmentECE Early Childhood EducationEFA Education for AllEGS Education Guarantee SchemeEGS&AIE Education Guarantee Scheme

and Alternative Innovative EducationEMIS Education Monitoring and

Information SystemsGDP Gross Domestic ProductICD Integrated Child DevelopmentICDS Integrated Child Development

ServicesIEC Information, Education,

CommunicationIMR Infant Mortality RateLBW Low Birth WeightMCH Maternal and Child Health

MDG Millennium Development GoalsMIS Monitoring and Information SystemMMR Maternal Mortality RateMMS Mid-day Meal SchemeMHRD Ministry of Human

Resource DevelopmentNCERT National Council for Educational

Research and TrainingNFE Non-Formal EducationNFHS National Family Health SurveyNGO Non-Governmental OrganizationNIEPA National Institute of Educational

Planning and AdministrationNIPCCD National Institute of Public

Cooperation and Child DevelopmentNSSO National Sample Survey OrganizationOB Operation BlackboardORG Operations Research GroupORT Oral Rehydration TherapyPHC Primary Health CenterPMGY Pradhan Mantri Gramodaya YojanaPRI Panchayati Raj Institution RCH Reproductive and Child HealthSERP Society for Elimination of

Rural PovertySC Scheduled CasteSNP Supplementary Nutrition ProvisionSSA Sarva Shiksha AbhiyanST Scheduled TribeTN Tamil NaduUEE Universal Elementary EducationUIP Universal Immunization ProgramVEC Village Education CommitteeVPD Vaccine Preventable Disease

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Acknowledgements ii

Contents iv

Preface vii

Executive Summary xi

Introduction – Development for a Lifetime 1Poor Children's Lives: Snakes and Ladders 3Shifting the Focus to People 4When do we Begin Developing Human Capability? 4Wanted: A Concrete Indicator of Successful Child Development 4The Indian Context: An Overview of Policies, Programs and the Current Situation 6

The Conceptual Framework – Towards an Integrated Approach 13The Whole Child: The Empirical Basis 15A Conceptual Framework for the Indian Child's Holistic Development 16Two-way Traffic: Determinants, Outcomes and Indicators 18The Concentric Interaction within the Framework Mosaic 24

The Real Picture – The Status of the Indian Child 27The Real Pictures, Frame by Frame 29Tracing the Child's Current Situation along the Continuum 30Across the Stages: The Burden of being Different 45A Summary of Conclusions: How has the Indian Child been doing over the Past Decade? 49

Existing Interventions – Are they Reaching the Child? 55Policies for the Child: An Overview 57Acting on the Child's Behalf: A Review of some Major Programs 63Before Getting to Primary School – ECD Programs: 65Reaching out to School Entrants and Ensuring Successful Completion: 78Paving the Way for Change – Analyzing the Poor Impact of Existing Interventions 84

Underwriting the Child's Development – Public Spending on the Child 87Trends in Allocations to the Social Sector: The Background of the Nineties 89Recent Patterns of Expenditure on the Child 90A Closer Look: Spending on Select Child-Related Programs 91Taking the Resources to the Child 96Making Changes: The Future of Public Spending on Children 99

The Way Ahead – Major Concerns and Recommendations 101Getting Ready for Action: The Background of Priorities 103Moving Ahead: Changing the Policy Paradigm 103

Appendix: Members of the Technical Committee and Core Committee 125

Bibliography 127

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List of TablesTables Description Page

1.1 Major Programs for Children from Conception to 11+ Years 7

1.2 Comparative Indicators for India, Developed and Developing Countries, 2002 8

3.1 Urban and Rural Sex Ratios in some Relatively Prosperous States, 2001 33

3.2 Economic Disparities in Outcome Indicators 46

4.1 Major Program Services for Early Childhood Development, Prenatal-6 Years 63

4.2 Some Major Program Services at the Primary School Level, 6-11+ Years 64

4.3 The Impact of Immunization, 1987-1999 (Number of Cases) 71

4.4 Coverage under Various ECCE Schemes, 1996-97 73

List of BoxesBoxes Description Page

1.1 Rationale for the Proxy Indicator 5

1.2 A Global Commitment, a National Commitment 6

1.3 The Rights-based Approach of the Tenth Five Year Plan 10

2.1 Readiness for School, Readiness for Life 21

3.1 Malnutrition: Causes and Pattern of Prevalence 37

3.2 Arriving at CDI 50

4.1 Why Choose an Integrated Approach? 58

4.2 The Case of ICDS 67

4.3 How much can that One Worker do? 75

4.4 Some Tried and Tested Models 77

List of FiguresFigures Description Page

1 An Indian Conceptual Framework for Integrated Child Development xvii

2 Village Plans for Children: A Possible Structure xxi

1.1 Past Trend and Future Progress Required to Achieve the MDG Goals 9

2.1 Critical Periods for some Aspects of Brain Development and Function 16

2.2 An Indian Conceptual Framework for Integrated Child Development 17

2.3 The Child Development Continuum – Sub-stage Priorities 18

2.4 Prenatal to One month 19

2.5 One month to Three Years 20

2.6 Three to Six Years 21

2.7 Six to Eight Years 22

2.8 Eight to Eleven Years 23

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Figures Description Page

2.9 A Reciprocal, Dynamic and Integrated Framework 25

3.1 Proportion of Anemic Mothers – Variations Across Rural and Urban Areas by State 32

3.2 Proportion of Children Weighing more than 2500g at Birth 33

3.3 Proportion of One-Year-old Children Fully Immunized Across States 35

3.4 Proportion of Two-Year-olds Given Vitamin A Supplement 36

3.5 Percentage of Three to Six-Year-olds Attending Pre-school 39

3.6 Age-Specific Attendance Rate, 6-10 Year-olds 41

3.7 Ten to Twelve-Year-olds Finishing Primary School 44

3.8 Outcome Indicators: Differentials Across Caste Groups 46

3.9 Child Development Index 51

3.10 Snakes and Ladders: Factors that Affect going to School and Staying there 53

5.1 Sectoral Spending on Children in the Union Budget 91

5.2 ICDS Expenditure per Beneficiary Child 92

5.3 A Resource Gaps between Demand and Supply 93

5.3 B A Vicious Cycle of Poor Development – Low CDI Outcomes 94

5.4 Percentage Share of Elementary Education in Education Expenditure 94

5.5 Trends in the Expenditure on Elementary Education in the 1990s 95

5.6 Underutilization of Central Government Funds for Child Development 96

5.7 Comparative per Child Expenditure on Children Below 6 Years and 6-14 Years 97

6.1 Village Plans for Children: A Possible Structure 111

6.2 Proportion of Underweight Children Across SC, ST and General Groups 114

6.3 Age-Specific Enrollment in Primary School, 6-11 Year-olds 114

6.4 Critical Period in Brain Development – Financing Gap 120

6.5 Per Child Expenditure under ICDS, 2001-2002 122