Can district level support enhance coverage and equity? Evidence from India’s nutrition program

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cg.authorship.typesCGIAR multi-centreen
cg.authorship.typesCGIAR and developing country instituteen
cg.contributor.affiliationCGIARen
cg.contributor.affiliationInternational Food Policy Research Instituteen
cg.contributor.affiliationInternational Institute for Population Sciencesen
cg.contributor.affiliationCentre for Policy Researchen
cg.contributor.donorBill & Melinda Gates Foundationen
cg.contributor.initiativeNational Policies and Strategies
cg.coverage.countryIndia
cg.coverage.iso3166-alpha2IN
cg.coverage.regionAsia
cg.creator.identifierSoyra Gune: 0000-0002-2327-4018en
cg.creator.identifierHarold Alderman: 0000-0001-8019-6397en
cg.creator.identifierRasmi Avula: 0000-0003-0066-6964en
cg.creator.identifierPhuong H Nguyen: 0000-0003-3418-1674en
cg.creator.identifierPurnima Menon: 0000-0001-5988-2894en
cg.creator.identifierSuman Chakrabarti: 0000-0002-5078-2173en
cg.howPublishedGrey Literatureen
cg.identifier.doihttps://doi.org/10.2139/ssrn.5109736en
cg.identifier.projectIFPRI - Nutrition, Diets, and Health Uniten
cg.identifier.projectIFPRI - Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India (POSHAN)en
cg.identifier.publicationRankNot rankeden
cg.reviewStatusInternal Reviewen
cg.subject.impactAreaNutrition, health and food security
dc.contributor.authorGune, Soyraen
dc.contributor.authorAlderman, Harolden
dc.contributor.authorAvula, Rasmien
dc.contributor.authorNguyen, Phuong Hongen
dc.contributor.authorDwivedi, Laxmikanten
dc.contributor.authorKapur, Avanien
dc.contributor.authorShukla, Ritwiken
dc.contributor.authorPedgaonkar, Sarangen
dc.contributor.authorSingh, Shri Kanten
dc.contributor.authorMenon, Purnimaen
dc.contributor.authorChakrabarti, Sumanen
dc.date.accessioned2025-02-11T15:28:43Zen
dc.date.available2025-02-11T15:28:43Zen
dc.identifier.urihttps://hdl.handle.net/10568/172955
dc.titleCan district level support enhance coverage and equity? Evidence from India’s nutrition programen
dcterms.abstractImportance: India’s Integrated Child Development Services (ICDS) program is among the world’s largest nutrition and health programs that offers services to pregnant, lactating mothers, and young children. To support national investments towards universalization of ICDS interventions, between 2016 and 2020, the Indian government in collaboration with multiple partners, introduced system strengthening mechanisms at the district (subnational administrative unit) level in 64% of India’s districts. Objectives: To examine national-level trends in coverage and equity of ICDS interventions and the role of district-level support mechanisms in improving equitable coverage. Design, Setting, and Participants: This quasi-experimental assessment used data (N=393,097 mother-child pairs) from three rounds of nationally representative surveys in 2006, 2016, and 2020. We used inequity indices and regression models to assess changes in equity by wealth, caste, and residence. We applied difference-in-differences (DID) models to investigate changes in coverage due to district support mechanisms between 2016 and 2020. Intervention: The district support mechanisms were introduced between 2016 and 2020 and included a combination of input features such as capacity building of frontline workers, additional human resources, financial, infrastructural, and technological support, among others. Main Outcomes and Measures: Our primary outcomes were the receipt of thirteen ICDS services during pregnancy, lactation, and early childhood. District support mechanisms were grouped into three treatment arms for DID analyses using an intention-to-treat approach with heterogeneous treatments. Results: ICDS utilization continued to increase from 2016 to 2020, with the most improvement observed in health and nutrition education (20-21pp). Unlike 2006-2016, there were large improvements in coverage equity between 2016-2020. DID models show, on average, that districts receiving any programmatic support had significant and faster improvements in coverage (2.2-14.7pp). Pooled effects sizes were larger, on average, for districts that received financial support in addition to human resources (8.9pp, 95% CI 7.3-10.74) compared to districts that only received human resource support (4.5pp, 95% CI 3.4-5.7). Conclusions: India’s programmatic efforts to further strengthen the ICDS were successful in increasing coverage of ICDS program at the national-level and reducing coverage inequities that persisted earlier. Focused district support mechanisms enabled faster progress in coverage and equity.en
dcterms.accessRightsOpen Access
dcterms.audienceCGIARen
dcterms.bibliographicCitationGune, Soyra; Alderman, Harold; Avula, Rasmi; Nguyen, Phuong Hong; Dwivedi, Laxmikant; Kapur, Avani; Shukla, Ritwik; Pedgaonkar, Sarang; et al. 2025. Can district level support enhance coverage and equity? Evidence from India’s nutrition program. SSRN Preprint. Available February 7, 2025. https://doi.org/10.2139/ssrn.5109736en
dcterms.extent47 p.en
dcterms.issued2025-02-07en
dcterms.languageen
dcterms.licenseOther
dcterms.publisherSSRNen
dcterms.subjectequityen
dcterms.subjectnutritionen
dcterms.subjectwomenen
dcterms.subjectchildrenen
dcterms.subjectchild developmenten
dcterms.typePreprint

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