Performance Index for Assessing Government Funded Nutritional Programme in India

Research Article

Austin J Nutri Food Sci. 2017; 5(2): 1092.

Performance Index for Assessing Government Funded Nutritional Programme in India

Ramamoorthy T¹, Patil RR²* and Joseph A²

¹Division of Biostatistics, School of Public Health, SRM University, India

²Division of Epidemiology, School of Public Health, SRM University, India

*Corresponding author: Rajan R Pati, Sr. Epidemiologist School of Public Health, SRM University, Chennai, India

Received: November 13, 2017; Accepted: December 12, 2017; Published: December 19, 2017

Editorial

Introduction: An index is a composite of indicators that produces a single calculation which can then be ranked. An indicator is a quantitative or a qualitative measure derived from a series of observations that can reveal relative positions. An Index can summarize complex, multi-dimensional realities with a view to supporting decision makers. It is easier to interpret than a battery of many separate indicators and it reduces the visible size of indicators without dropping the underlying information base. Integrated Child Development services (ICDS) Scheme is the largest nationwide programme for the promotion of mother and child health. The scheme services are rendered essentially through Anganwadi Centres (AWC), which plays a vital role in child health nutrition and maternal health. It becomes essential to assess these anganwadi centres based on its functions and this study attempted to develop an index for assessing the performance of Anganwadi centres across Tamil Nadu to facilitate inter and intra district comparison. The main objectives of the Performance index development are 1) to find complex inter-relationships between various dimensions of ICDS programme in Tamil Nadu and their current levels of outcomes. 2) To classify the Anganwadi Centers based on their performance 3) To rank the Districts based on the performance of the AWCS.

Methodology: The dimensions and the indicators for the index has been finalized by the experts which captures all the facets of AWC functioning and performance in terms of input, process and output. The theoretical framework aimed to capture an interrelated set of factors that represent the primary elements which combine to produce ICDS progress and performance. Data was being collected from 1600 AWC’s across 32 districts in Tamil Nadu during April to September 2014 as part of independent evaluation of ICDS programme commissioned by Government of Tamilnadu and carried out by School of Public Health, SRM University. This study was an academic component of the survey carried out by the authors after taking due permission from state authorities. The number of sample AWCs in each district was proportional to the total AWCs in each district. The collected data is then normalized using Max – Min method of normalisation which resulted in a score ranging from 0 to 1, to preserve the comparability of the dimensions. To reflect the relative importance of indicators and dimensions, the dimension weights and indicator weights were allotted through multivariate technique called factor analysis. Weights were constructed using the matrix of factor loadings, given that the square of factor loadings represents the proportion of the total unit variance of the indicator which is explained by the factor. Finally, simple aggregation technique was used to arrive at the overall performance index score. Anganwadi centres with a score greater or equal to 75 were classified as “Good” performing centre, 60 – 74.99 as “Average” and less than 60 as “poor” performing centres. Also the districts were ranked based on the average (simple average scores of the centres in that district) dimension / index score with higher score indicating better performance of the district. IBM SPSS version 22.0 was used for the analysis.

Results: The ICDS performance index score resulted from the weighted sum of 35 indicators (chosen from 55 indicators) representing 7 dimensions of ICDS namely Infrastructure, Nutrition, Preschool Education, Health, Immunization, Referral services and Nutrition and Health Education. Dimension scores along with the overall index score has been calculated for each and every anganwadi centre. The districts were ranked based on the mean score obtained by the AWCs on each of the components and overall dimension score. The scores of individual districts ranged from 0.918 to 0.790. The best performing districts were Chennai, Dharmapuri, and Madurai. The least performing districts were Tiruvannamalai, Villupuram, Nagapattinam. The average ICDS Performance score for Tamil Nadu state was 0.863. About 17 districts were above state average and 15 districts were below the state average. Overall efficiency of AWCs in providing ICDS Services was excellent across all AWCs in Tamil Nadu state. It was found that overwhelming majority of 95 per cent of AWCs in Tamil Nadu were classified under Good category, while only about 4 per cent were categorized as Average. It was noteworthy only 1 percent of the sample AWC could be classified as poor.

Conclusion: ICDS Performance Index is the first ever index developed to assess AWCs, to the best of our knowledge. The ICDS performance index which objectively assesses the Anganwadi centres based on its core functions provided a holistic, objective, transparent, outcome-based measure of ICDS performance right at the level of AWC. ICDS Index facilitated the comparison of AWCs and districts on different facets of Input, Process and Output indicators allowing the identification of specific areas of strength or weakness of AWCs. It also allows AWCs to benchmark themselves against other AWCs in same districts as well across the Tamil Nadu state. The index, when transformed into a self-assessment tool will help to understand the parameters on which each and every anganwadi center is performing well and also help identify focus areas for improvement. This performance Index can be easily customised to other states, so that rational Inter and Intra state comparison can be made on IDCS performance.

Keywords: Index; Anganwadi; ICDS; Evaluation

Introduction

An index is a composite of indicators that produces a single calculation which can then be ranked. An indicator is a quantitative or a qualitative measure derived from a series of observations that can reveal relative positions. An Index can summarize complex, multidimensional realities with a view to supporting decision makers. It is easier to interpret than a battery of many separate indicators and it reduces the visible size of indicators without dropping the underlying information base.

Integrated Child Development Services (ICDS) in India is the largest nationwide programme launched in the year 1975, for the promotion of mother and child health. The beneficiaries of the scheme includes children below six years, pregnant and lactating women, adolescent girls in the age group of 14 – 18 years and women in the age group of 15 to 44 years [1,2]. The program provides an integrated approach for converging all the basic services for improved childcare, early stimulation and learning, health and nutrition, water and environmental sanitation aimed at the young children, expectant and lactating mothers, other women and adolescent girls in a community. The scheme services are rendered essentially through the Anganwadi Worker (AWW) at a village centre called “Anganwadi”. Anganwadi Centres (AWC) plays a vital role in child health nutrition and maternal health.

Researchers have evaluated various aspects of ICDS program like infrastructure of AWCs, characteristics of Anganwadi workers, utilization of services and coverage of various ICDS services provided [3-7] and found the program gaps in each of these aspects. It was found that none of these studies attempted to study all the functions of ICDS. It becomes essential to assess these anganwadi centres based on its functions and this study attempted to develop an index for assessing the performance of Anganwadi centres across Tamil Nadu based on input, process and output indicators to facilitate inter and intra district comparison.

The main objectives of the index development were 1) to find complex inter-relationships between various dimensions of ICDS programme in Tamil Nadu and their current levels of outcomes. 2) To classify the Anganwadi Centers based on the performance 3) to rank the Districts based on the performance of the AWCS.

Methodology

Index development involved intense data mining of ICDS-SRM survey data to interpret composite indicators until they proved useful in benchmarking AWC at center level and district performance on core ICDS functions and services. Data was being collected from 1280 AWC’s across 32 districts in Tamil Nadu. A sample of 40 AWCs was chosen from each district proportionately stratifying on rural, urban and tribal status of AWC. Data collection was done during April 2014 – June 2014. Pre designed pre tested questionnaire were used for the study. The input, process and output indicators of various functions were being collected from the Anganwadi workers and from the community. IBM SPSS version 22.0 was used for the analysis.

Following steps were followed in developing ICDS performance Index. It begins from the development of a theoretical framework to the presentation and dissemination of an Index results. Each step is extremely important, but coherence in the whole process is equally vital. Choices made in one step can have important implications for others: therefore, the Index building process has not only to make the most appropriate methodological choices in each step, but also to identify whether they fit together well.

Developing a theoretical framework - Selection of dimensions

The ICDS Performance Index framework aims to capture the level of ICDS Anganwadi centers performance within a given area. The Index is composed of seven dimensions, which are based on the functions and services of ICDS. The indicators within the dimensions are combination of input, process and output variables of the corresponding dimension. Together, this framework aims to capture an interrelated set of factors that represent the primary elements which combine to produce ICDS progress and performance. The ICDS performance Index methodology allows measurement of each dimension, and yields an overall score and ranking. The structure of framework has been illustrated in Figure 1.