Transforming the Anganwadi Ecosystem Next Generation Early Childhood Development Interventions in India

Transforming the Anganwadi ecosystem Next generation early childhood development interventions in India

March 2019

KPMG.com/in Narayanan Ramaswamy Partner & Leader Infrastructure Government Healthcare - Social KPMG in India Table of contents

1. Overview of early childhood development in India 1 1.1 Early childhood landscape in India 1 1.2 Regulatory framework around ECD in India 3 2. Anganwadis: Delivering ECD in India 5 2.1 ICDS – Government’s flagship programme for ECD 5 2.2 Service delivery model of Anganwadis 6 2.3 Challenges involved in ICDS 6 3. Next generation early childhood development interventions in India 7 3.1 New government interventions for transforming the existing landscape 7 3.2 Evolving synergies between the government and private sector: A game changer for ECD in India 8 4. Way forward for smart Anganwadis: Transforming the future of India 12 © 2019 KPMG, an Indian Registered Partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Foreword

Early Childhood Development is interventions in early childhood A transformed model of ICDS delivery perhaps the most important facet of development, and the same is system is absolutely critical to the social development for a country, more reflected in its flagship programme, the timely achievement of the Sustainable so for India, which as of 2011, was home Integrated Child Development Services Development Goals (SDG) 2, 3 and 4 to more than 159 million children in the (ICDS), ICDS is delivered through directly, and other SDGs indirectly as age group zero to six. approximately 1.3 million Anganwadi well. workers and 1.2 million Anganwadi Various studies have shown that early helpers to more than 80 million children childhood development has a long- term under six years of age. impact on a person’s income ability, health and emotional well-being. It is Today, the imperative is to reimagine therefore, imperative that the quality how Anganwadi services are delivered, and type of interventions are significant and in this publication, we take a look at determinants of overall development of some pioneering interventions which a child and shaping their overall growth. demonstrate the potential of technology and innovation in transforming early Government of India rolled-out the childhood development. While some of National Policy on Education in 1968, the showcased interventions are driven Nilachal Mishra which, along with the National Policy by the government, a few examples Partner, on Children 2013, has repeatedly also illustrate the large role the private Government Advisory emphasised on the need for holistic sector can play in the space. KPMG in India

© 2019 KPMG, an Indian Registered Partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. 1

Overview of early childhood 1. development in India

1.1 Early childhood landscape in India The first six years of development in solving ability, learning capacity, years, constituting 13.12 per cent of the a child’s life are critical to their overall etc. thereby limiting their long-term total population4, it becomes imperative development and well-being. According development. to ensure holistic development of these to a report, globally 7.6 million children children for them to achieve their full Evidence suggests that early childhood under the age of five years die each potential. India is also committed to development has an impact on a year and while more than 200 million achieving the Sustainable Development person’s income, health, and emotional children survive, they do not reach Goals (SDGs), which encompass well-being, thereby enabling them their full potential due to various socio- various targets on child well-being to achieve their full potential. The economic factors including families’ including quality of early childhood quality and type of interventions are income levels, ethnicity, disability, development, care and pre-primary determinants of the way a child’s brain religion or sexual orientation, etc1. education, elimination of all forms of develops and shapes their cognitive, malnutrition, and ending preventable Early childhood development (ECD) social and emotional growth. It deaths of newborns and children under encompasses an interlinked gamut of enables successful transition to school, five years of age, amongst others. elements critical for a child’s cognitive, which thereby helps in achieving social and emotional development. better learning outcomes, education, The government has adopted a rights These comprise learning, health, employment and health2. A recent based approach for addressing nutrition, play and care, in an enabling study from Andhra Pradesh suggested challenges in the area of child and protective environment. The that early life nutrition has positive development. While the country has absence of these interventions can effects on schooling and labour market witnessed significant reduction in have adverse effects on the child’s outcomes3. U5MR and stunting, the statistics intelligence levels, personality, mentioned are below the global average. India is home to approximately 159 behavioral aspects such as problem million children in the age group of 0-6

1. UNICEF, accessed March 2019 2. Australian Early Development Census, accessed March 2019 3. Early-Life Nutrition Is Associated Positively with Schooling and Labor Market Outcomes and Negatively with Marriage Rates at Age 20–25 Years: Evidence from the Andhra Pradesh Children and Parents Study (APCAPS) in India, Arindam Nandi, Jere R Behrman, Sanjay Kinra, Ramanan Laxminarayan, January 2018, accessed March 2019 4. Census of India, 2011, accessed March 2019

Table 1: Comparison of key statistics on Childhood Development5

Statistics World (2017) India

Under Five Mortality Rate 39.1(per thousand) 39 (per thousand) Stunted 22.2% 38% Wasted 7.5% 21%

5. The World Bank, Global prevalence of wasting, weight for height, (% of children under 5); Global prevalence of stunting (height for age), accessed March 2019

1.2 Regulatory framework direct states to provide preschool As part of the ECCE policy, a National around ECD in India education for children above three years Early Childhood Care and Education of age. Curriculum Framework has been The Constitution of India guarantees developed to promote excellence fundamental rights of all children in The new National Policy for Children in early childhood education. The the country and empowers the state 20138 was adopted to ’reiterate the framework provides guidelines on to make special provisions for all commitment to rights based approach childcare and early learning practices children. Article 45 (amended) of the for children’ and directs states to take and approaches to ensure optimal Indian Constitution directs that ’The appropriate measures to ensure Early learning and development of children. State shall endeavour to provide Early Childhood Care and Education (ECCE) It also sets out standards to ensure Childhood Care and Education (ECCE) to all children below six years of age, to adherence to quality and standardisation for all children until they complete ensure holistic development. The policy in the provision of ECCE services across the age of six years’6. The country also emphasised on maternal health states. developed its first National Policy on including antenatal care, safe delivery, Education in 19687 , a reflection of postnatal care and nutrition support. In 2016, the National Plan of Action India’s commitment to its children as for Children was launched as a road In 2013, the government also adopted the nation’s ’supremely important asset’. map for realising policy objectives the National Early Childhood Care India also ratified various international focused on improving the well-being and Education Policy to ’promote conventions and treaties including of children. The plan aims to synergise inclusive, equitable and contextualised the Declaration of the Rights of the efforts of various stakeholders working opportunities for promoting optimal Child, Universal Declaration of Human to advance the rights of children, and development and active learning Rights and its Covenants, Convention also strengthen the implementation and capacity for all children below six years on the Rights of the Child and its town monitoring of national and international of age’9. The policy was framed taking Optional Protocols, etc. to reinforce its commitments surrounding child into consideration the interlinkage of commitment for advancing and securing development. education, health, nutrition, cognitive, the rights of children. and emotional needs of a child and The Right of Children to Free and acknowledging the importance of a Compulsory Education (RTE) Act child’s early years in building a solid 2010 was introduced to ensure that foundation for the overall development children attain quality elementary and survival. education. Although ECE is not formally mandated under the RTE, the Act does

6. Ministry of Women and Child Development, Government of India, ECCE Policy, December 27th, 2013, 8. Ministry of Women and Child Development, Government of India, National Policy for Children, May 2013, accessed March 2019 accessed March 2019 7. Ministry of Human Resource Development, Government of India, National Policy on Education, 1968, 9. Ministry of Women and Child Development, Government of India, ECCE Policy, October 2013, Accessed accessed March 2019 March 2019

Anganwadis: Delivering 2. ECD in India

2.1 ICDS – Government’s flagship program for ECD The Integrated Child Development referral services. These are provided convergence plays a central role in the Services (ICDS) is one of the world’s through a network of 1.4 million implementation of ICDS as it involves largest government-led programme Anganwadis run by approximately 1.3 delivery of inter-linked services for for provision of early childhood million Anganwadi workers and 1.2 development of children in the early development in India. Launched million Anganwadi helpers catering to years. The government encourages in 1975, ICDS provides a range of approximately 80 million children under regulatory, operational and financial services across ECCE and maternal six years of age1. convergence between schemes, and child health including preschool policies and programmes related to ICDS is a centrally sponsored scheme non-formal education, supplementary child well-being for maximised impact implemented by the Ministry of Women nutrition, health-related awareness, through optimal utilisation of resources. and Child Development. However, immunisation, health check-up and

The objectives of the scheme include2

Improvement of Laying the foundation Effective coordination of nutritional and for proper psychological, policy and implementation health status of physical and social amongst the various children aged 0-6 development of departments to promote years the child child development

Enhance capacity of mother to ensure normal health Reduction in incidence of and nutritional needs of the child through proper mortality, morbidity, and nutrition and health education school dropout

1. Ministry of Women and Child Development, Government of India, accessed March 2019 2. Ministry of Women and Child Development, Government of India, accessed March 2019

2.2 Service delivery model of Anganwadis3 ICDS is implemented on-ground by including cluster level supervisor, the establishment of Village Health field level functionaries – Anganwadi Child Development Project Officer Sanitation and Nutrition Committees worker and Anganwadi helper – who (CDPO) at the block level and District (VHSNC). are trained to provide the various Magistrate/Collector at the district level. The delivery framework of services education, nutrition and health In addition to administrative monitoring, under ICDS is illustrated in the figure services in a standardised manner. The community-based monitoring below. service delivery is monitored through mechanism is also promoted under a three-tier governance mechanism ICDS to ensure accountability through

Services Target Group Service Provider Children below 6 years Supplementary Nutrition AWW and AWS (MWCD) Pregnant and Lactating Mothers (P&LM) Pre School Education Children 3-6 years AWW (MWCD) AWW/ ANM/ MO Nutrition and Health Education Women (15-45 years) (Health System, MHFW & MWCD)

Immunisation ANM/ MO Health Check-Up Children below 6 years (Health System, MHFW) Pregnant and Lactating Mothers (P&LM) ANM/ MO/ AWW Referral Services (Health System, MHFW, MWCD)

2.3 Challenges involved in ICDS With a range of interlinked services strong ECCE policy and framework, • Monitoring and evaluation of being delivered through these centres, systems are not yet in place to provide ECD activities is weak and needs various challenges arise in ensuring high adequate training, monitoring and strengthening to ensure timely enrolment of children, standardised technical assistance necessary for monitoring of a child’s progress in delivery and quality assurance, due improving quality of programming. Key order to introduce course corrections, to differing demographic and socio- issues include: inform decisions and improve overall economic patterns, awareness • Inadequate skills of field level service delivery. around importance of early childhood functionaries to provide learning • Many Anganwadis lack basic facilities development, capabilities of field level according to the ages and stages of such as drinking water and toilets4, functionaries, etc. Although coverage child development which are essential for providing a of ECD through ICDS has expanded, • Community engagement has not healthy environment for children in the quality of service provisioning and been effectively leveraged to build their early years. resultant outcomes across states ownership of the Anganwadis 3. Ministry of Women and Child Development, Government of India, remain uneven. Although there is a accessed March 2019 amongst the community 4. CPR India, Budget Brief 2018-19: Integrated Child Development Services (ICDS), February 2018, accessed March 2019

Next generation early childhood 3.development interventions in India

3.1. New government interventions for transforming the existing landscape ICDS – Common Application POSHAN Abhiyan - National • Prevent and reduce under-nutrition in Software (ICDS-CAS)1 Nutrition Mission children (0-6 years) at 2 per cent per annum In 2016, the Ministry of Women and Nutrition plays a paramount role in Child Development launched the the overall development of a child. • Reduce low birth weight at 2 per cent ICDS-CAS, an ICT-enabled real time India’s commitment to eradication of per annum monitoring system for strengthening malnutrition by 2030 is reflected in • Reduce prevalence of anaemia service delivery of AWCs across the launch of the National Nutrition amongst young children (6 – 59 the country. The ICDS-CAS aims to Mission, which strives to reduce the months) at 3 per cent per annum transform the collection of high-quality levels of stunting, under-nutrition, data on growth and nutrition status anemia and low birth weight babies. The of children; as well as to reduce the programme will be implemented in a burden on AWWs who were previously phased manner to cover all 36 states/ recording data on multiple registers. UTs through the use of technology, This monitoring mechanism is a convergence and behaviour change game-changer in identifying factors to create sustainable impact. The underlying progress in early childhood objectives of the mission include2: development and aiding timely • Prevent and reduce stunting in redressal. children (0-6 years) at 2 per cent per annum

1. Press Information Bureau, 25-May-2016, accessed March 2019 2. Press Information Bureau, Cabinet approves setting up of National Nutrition Mission, December 1st, accessed March 2019

3.2. Evolving synergies between the government and private sector: A game changer for ECD in India ISO certified Anganwadis in Integrating technology for divided into three categories – red, Aurangabad monitoring nutrition of Anganwadi yellow and green – indicating the children in Vadodara4 progress report of the children. The real Aurangabad is the only district in time availability of this information helps Maharashtra with approximately 300 The Vadodara Municipal Corporation AWW to identify serious cases and Anganwadi centres3 obtaining ISO initiated the SMART Anganwadi continuously follow up to improve the certification and furthermore in the project to improve the functioning child’s well-being. process of achieving the gold standard. and management of AWCs by way of ISO certification is a reflection of the digitising the monitoring mechanism. high quality and standardised delivery of services at AWCs across the district. The key driver of achieving the standard of services has been community participation. The community took ownership of the Anganwadi and donated in cash and kind (including furniture, uniforms, books, TVs, water filters, etc.) amounting to INR10 crore. The funds were utilised for up gradation of AWCs and also introducing additional facilities including 100 per cent institutional deliveries, mother VMC launched an Android-based care centre, etc. Moreover, one of the mobile application which monitors the AWCs in the village Bharadi in Sillod height and weight of children, health Taluqa became the first high-tech AWC status, delivery and consumption of in Maharashtra. The Anganwadi is milk and fruit, etc. making it available equipped with biometric attendance to the AWWs on their mobile phones system, air conditioner, internet facility for evaluating progress and identifying and hi-tech devices in addition to the issues. The details of AW children basic services including mid-day meals (name, age, height, weight, etc.) are and pre-school education. registered along with their photograph to an allocated zone. As per the Government of India, the zoning is

3. Integrated child development service: a tool for 4. Mobiles for Social and Behaviour Change, accessed March empowerment of women and its working in Aurangabad 2019 district in Maharashtra, Pratibha R. Girbane, 2014, accessed March 2019

The project is active in eight AWCs incorporates innovative strategies such kitchen gardens across all AWCs initially of the selected 87 high priority as showcasing educational videos in in six districts. The kitchen gardens are Anganwadis in the city of Vadodara and Augmented Reality, colourful and child- envisaged to aid improved nutrition for is targeted to be rolled out to 303 AWCs friendly environment, role-play activities children and mothers at AWCs, imbibe of Vadodara Mahanagar Sevasadan. on ‘Swachh Bharat’, road safety, etc. the importance of nutrition in children as well as inculcate an interest in Integrated Smart Early Education The AWWs in these centres will also farming, and promote the replication of (i-SEE) Anganwadi in Ahmedabad5 be equipped with smartphones/tablets these kitchen gardens amongst village for record keeping and monitoring the With innovation at the core of this households to guarantee year round development of every child. initiative, i-SEE has been pioneered nutrition for the family. by Ahmedabad Municipal Corporation The project was developed as a demonstration and training centre for rest of the Anganwadis in the blocks. Reliance Foundation is responsible for providing technical support by way of orientations/workshops, training and handholding.

as part of the ‘Smart City’ initiative. Government of Maharashtra – A public-private partnership, the Reliance Foundation partnership for building and set-up costs have been developing kitchen gardens at AWC6 contributed by corporates while the With the vision of reducing malnutrition management and operations is the and improving health and well-being responsibility of Ahmedabad Municipal of children and women in the state, Corporation (AMC). The concept is the government has collaborated with built around ‘learning through play’ and Reliance Foundation for developing

5. The Indian Express, May 16th, 2018 , Accessed March 2019 6. Department of Women and Child Development, Government of Maharashtra, Memorandum of Understanding between The Department of Women & Child Development, Government of Maharashtra, Rajmata Jijau Mother Child Health & Nutrition Mission and Reliance Foundation, November 24th, 2015, accessed March 2019

Ministry of Women and Child infrastructure and innovative solutions reputed partners for providing e-learning Development and Vedanta for delivering ECD. Nand Ghars are through television, pre-cooked nutrition, Foundation – Project Nand Ghar – constructed in 40 days using pre- smart kits and AD boards as new age Integrated Service Delivery approach fabricated technology, and are fitted learning tools, and a strong capacity with solar panels, drinking water building model for enabling AWWs to The Ministry of Women and Child supply and sanitation facilities and deliver high-quality services. The Nand Development, Government of have incorporated the Building as Ghars are currently operational across India has entered into an MoU with Learning Aid (BaLA) component. Nand Rajasthan, Uttar Pradesh and Madhya Vedanta Foundation for building 4000 Ghars are pioneering the revolution in Pradesh, impacting more than 6,600 Nand Ghars, which are modernised delivering ECD by collaborating with children and over 7,500 women. Anganwadis equipped with upgraded

NAND GHAR

Infrastructure Resource centre

• Solar panels Early Childhood • Training on new agriculture • Inverter and battery Education innovations by tie up with • Water purifier KVKs • Television • English speaking classes Core for boys • A D Boards Maternal and Skill and Child Health services Learning • Information exchange • Furniture center for farmers • Swings and slides

Nutrition

Digital Governance through mobile based application

This initiative is unique in the way that it not only looks at next generation infrastructure for Anganwadi centres, it is also providing cutting edge services to children and pregnant and lactating mothers. Further, the initiative is also utilising these centres as a ‘Village Resource Center’, wherein primary healthcare services for the community, skilling services for women as core offerings and other value added services such as farmer trainings, English speaking classes, etc. are also provisioned. It is also leveraging advanced digital monitoring tools, enabled through mobile applications to track and monitor actual on-ground operations and therefore initiating corrective measures, where required, in near-real time.

Way forward for smart Anganwadis: 4.Transforming the future of India

Smart Anganwadis are the need of the the requisite physical, social, cognitive standardisation and impact creation at hour as early childhood development is and emotional capabilities. Various the national level. emerging as a significant development innovations in this sector have proved KPMG in India’s experience points to driver in the Indian context. Reduction in to be successful in strengthening the following components as anchors of malnutrition and improvement in school the delivery of ECD in India, and it next generation Anganwadis in India: learning outcomes require interventions is important to institutionalise and from the early years of a child to develop scale up such practices to ensure

Leveraging mobile Introducing key ages technology for monitoring and stages tools as well progress of beneficiaries and as modern pedagogy enabling trend analysis to and learning tools for understand the overarching enhancing the learning factors influencing progress experience of children

Capacity building of field Sustained capacity building level functionaries to adopt of field level functionaries modern pedagogy and with modern teaching curriculum for enhancing methodologies as well as the learning experience of digital monitoring tools children

Acknowledgements

We are sincerely grateful to the following people for extending their knowledge and insights to prepare this report.

1. Ritu Jhingon, CEO, Project Nand Ghar, Vedanta Foundation 2. Officials of the Ministry of Women and Child Development, Government of India 3. Officials of the Government of Maharashtra

Authors • Abhinav Akhilesh • Aarti Harbhajanka • Aditi Sharma

Research and analysis support • Navin Godse • Pratyush Poddar • Priyanka Aggarwal • Rishiraj Shukla

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