1. The need to reopen anganwadis: India must invest robustly in the world’s largest social programme on early childhood services

Context: Being closed since the April 2020-lockdown, anganwadis are slowly reopening. Those in Karnataka, Bihar and Tamil Nadu are opening or considering opening shortly.

 The Anganwadi system:

  • There are 14 lakh anganwadis, or centres provide basic healthcare and nutrition to mothers and children from low-income households.
  • As part of the Integrated Child Development Services (ICDS), anganwadis play a crucial role in supporting households, particularly from low-income families, by providing childcare, health and nutrition, education, supplementary nutrition, immunisation, health check-up and referral services.
    • The largest in the world, ICDS covers about 88 million children aged 0-6 years in India. Their closure significantly impacted service delivery and weakened an important social safety net.

 Importance of Anganwadi – Source of crucial support

  • Surveys by IDinsight across five States in November 2018 and November 2019 found that anganwadi workers were a primary source of nutrition information for families.
  • They serve as childcare centres. According to National Family Health Service (NFHS)-5 data, in 2019-20, less than 15% of five-year-olds attended any pre-primary school at all.
    • This frees up women’s time, including for economic activities.
    • A recent study estimates that the time women spend on unpaid work may have increased by 30% during the pandemic. In our COVID-19 rural household surveys across eight States, 58% of women cited home-schooling as the biggest contributor to increase in unpaid work.
  • Child Development: Early childhood, the period from birth to five years of age, is a crucial developmental window.
    • As platforms for early childhood education and nutrition support, anganwadis can play an important role for children to achieve their potential.
  • Crucial part of Education Policy: The National Education Policy, 2020, places anganwadis at the centre of the push to universalise access to early childhood care and education (ECCE).
    • Last week, the government proposed a phased rollout of ECCE programme across all anganwadis, covering one-fifth each year, starting from 2021-22.

Problems faced by the Anganwadi centres:

  • Anganwadi workers are overburdened with duties beyond their primary jobs, such as working for the census and other government schemes.
    • Administrative responsibilities take up significant time, and core services like pre-school education are deprioritised.
    • A typical worker spends an estimated 10% of their time — 28 minutes per day — on pre-school education, compared to the recommended daily 120 minutes.
  • Anganwadi workers can lack key knowledge – as found by studies from Delhi and Bihar. Surveys we conducted in 2018-19 found that among mothers listed with anganwadi workers, knowledge about key health behaviour such as complementary feeding and handwashing was low, at 54% and 49%.
    • Anganwadi workers often do not have the support or training to provide ECCE.
  • Anganwadis often lack adequate infrastructure: NITI Aayog found that only 59% of anganwadis had adequate seating for children and workers, and more than half were unhygienic.
  • Utilization of services is poor: These issues worsen in an urban context, with the utilisation of early childcare services at anganwadis at only 28%, compared to 42% for rural areas, according to NFHS-4 data.
  • Often paid less than minimum wage.

Way Forward – As anganwadis reopen, we must prioritise interventions with a demonstrated history of success, and evaluate new ones.

  • Home visits are important: Studies in Odisha and Andhra Pradesh (and globally) have found that home visits, where volunteers work with children and caregivers, significantly improved cognition, language, motor development and nutritional intake while also reducing stunting.
  • Recent initiatives around home-based newborn and young child care are promising, but they need to extend beyond the first few months of a child’s life, with seamless coordination with anganwadi workers.
  • Improve Career incentives for Workers: Many States will have to improve career incentives and remuneration for anganwadi workers. One way to ensure they have more time is to hire additional workers at anganwadis. A recent study in Tamil Nadu found that an additional worker devoted to pre-school education led to cost effective gains in both learning and nutrition.
  • Policymakers have tried linking anganwadis and primary schools to strengthen convergence, as well as expanding the duration of daycare at anganwadis.
  • Reaching out to beneficiaries:
    • Reaching out to women during pregnancy can increase the likelihood that their children use ICDS services – as tried in Tamil Nadu.
    • In order to boost coverage as they reopen, large scale enrolment drives, that worked in Gujarat, may help mobilise eligible children.

Conclusion: As the world’s largest provider of early childhood services, anganwadis perform a crucial role in contributing to life outcomes of children across India. To improve these outcomes, we need to invest more significantly in anganwadis, and roll out proven innovative interventions.


2. Boosters short: Availability, coverage, and scientific evidence should decide approval of booster shots

Context: The new Omicron variant, by bringing pandemic-related risks to the fore, has reminded us that the virus is yet to be defeated. 

Vaccination readiness for the Omicron:

  • No Scientific evidence on Booster Dose: On November 22, the Director-General, ICMR, said that there was no scientific evidence thus far to administer a booster vaccine dose to fully vaccinated people.
    • Even when there was growing clamour from a few States for booster doses once the new variant with higher transmissibility causing a huge surge in cases in South Africa became known, the Government has reiterated that any decision on booster doses will be based solely on scientific recommendations.
  • Better way is to Increase the number of fully vaccinated people: The priority instead was to increase the percentage of people who are vaccinated with two doses.
    • The Health Minister too said the priority was on fully vaccinating all adults than on booster shot immunisation though adequate vaccines were available.
  • Study on booster dose:  
    • On Delta Variant: One study found Covishield to be 85% protective against moderate or severe disease and 63% protective against symptomatic infection, While another found Covaxin to be 50% effective against symptomatic infection. Both studies were undertaken during the peak of the Delta variant-driven second wave.
    • On Omicron: The effectiveness of both vaccines against the Omicron variant is unknown. While this variant appears to be far more transmissible than the Delta variant, disease severity and the age groups most vulnerable to disease are not fully known.
  • Despite these uncertainties, it might still be prudent to approve booster doses for people older than 60 years and young adults who are immunocompromised or have comorbidities. 
  • Vaccination data: Over 1.26 billion doses have been administered as on December 4, with nearly 85% receiving one dose but only over 50% being fully vaccinated.

Global verdict regarding vaccination for Omicron:

  • In the US: Although over 65 million people in the U.S. are unvaccinated, on October 21, a booster shot was approved for all above 65 years and certain categories of young adults. It was later expanded to include all adults.
  • Many countries in Europe too have approved booster shots, having based their decision at least partially on vaccine effectiveness data.

However certain precautions are necessary in the case of booster dose too:

  • Not at the cost of first vaccination of a few: Administering booster doses cannot be at the cost of increased coverage of the first dose and full vaccination.
  • Also, the need to begin immunising adolescents cannot be ignored.
  • Door to door vaccination:  Though the door-to-door vaccination campaign held last month witnessed 11.7% increase in second dose coverage, there is still a sizeable percentage of the population in the priority groups who are not fully vaccinated.
  • Vaccinating healthcare workers: Over 8% of health-care workers, 30% of those above 60 years and over 33% of people aged 45-59 years are yet to be fully vaccinated.

Conclusion: The rapid global spread of the Omicron variant might also lead to increased vaccine uptake. While a sufficient supply of Covishield, which accounts for nearly 90% of vaccines administered, might be able to meet the demand, the priority should be to increase vaccine coverage and not boosters, particularly so as India will be under pressure to supply vaccines to the global South.




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