When People Wake up the Anganwadi—Community Monitoring and Action in Maharashtra Is Making Child Nutrition Services Accountable and Effective

Abstract

Ensuring community accountability of social services is a major challenge in India, with few proven and effective models at scale. In this context, Community Based Monitoring and Planning (CBMP) of health services in Maharashtra, implemented with support from the National Rural Health Mission (NRHM) since 2007, has emerged as a large scale, effective model for the ‘reclaiming’ of public health services. Several organizations involved in CBMP in Maharashtra considered social determinants of health (SDH) as an important allied area, requiring similar community interventions, and child nutrition was a logical area in which to implement similar processes. Hence, Community Based Monitoring and Action (CBMA) to strengthen Integrated Child Development Services (ICDS) has been implemented on a pilot basis in six rural and urban areas of Maharashtra covering 114 habitations since mid-2013. Development of this process includes developing an operational framework based on an official mandate, capacity building of NGOs and field-level activists, formation of multistakeholder monitoring committees at various levels, periodic community monitoring of Anganwadi services using data collection tools, preparing public report cards, discussing issues identified in block-level public hearings, and ongoing facilitation at state level. Implementation of this process over nearly two years has yielded significant positive results. Analysis of data over successive rounds of monitoring shows substantial improvement in nutrition and health-related services provided by ICDS in CBMA areas. This paper is an attempt to describe and analyse the process of CBMA of ICDS services in Maharashtra, as a participatory approach to promote the accountability and improved delivery of ICDS services, exploring the positive impacts, as well as discussing challenges and lessons emerging from this process.