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Improving family planning, health, and nutrition in India: experience from some World Bank-assisted programs.
Washington, D.C., The World Bank, 1989. , 45 p. (World Bank Discussion Papers No. 59)This paper looks at the experience of 3 large-scale, World Bank- assisted, outreach programs in India, and attempts to distill some lessons for the design and management of the National Family Welfare and Integrated Child Development Services programs. The 3 programs reviewed are 1) the Tamil Nadu Integrated Nutrition Project, which has halved the rate of severe malnutrition in about 9000 villages in Tamil Nadu; 2) the training and visit system of agricultural extension, being implemented in most of the major states of India and in about 40 other countries; and 3) the health component of the Calcutta Urban Development Project, which has sharply increased immunization and contraceptive prevalence rates among slum dwellers in that city. In spite of these programs being in different sectors, they have a number of design and management features in common: 1) field workers focus on a manageable number of priority tasks; 2) the ratio of clients to workers is reasonable; 3) workers are trained to follow a defined daily routine concentrating on clients most in need of services; 4) workers receive regular, in-service training complemented by regular, supportive supervision; 5) 2 of the 3 programs recruit local workers; and 6) clients are involved in implementation. Design and management improvements could be made in 1) increasing field worker productivity by concentrating on priority tasks, 2) making services more responsive to community needs and therefore increasing demand, 3) developing a national-level family planning in- service training program, and 4) initiating operations research programs in service delivery.