Quantitative Baseline Assessment of Child Nutritional Status and Performance of ICDS Supplementary Nutrition Programme in Bihar
Child malnutrition and leakage of funds from public service delivery programs are endemic throughout South Asia. In India, 43.5% of children are malnourished, a level twice as high as the sub‐Saharan African average (World Bank, 2012). The state of Bihar, with a population of 104 million people, has an even worse child malnutrition prevalence of 56.1%. The Bihar Government devotes US$200 million annually to address child malnutrition through its Supplementary Nutrition Programme (SNP), run by the Integrated Child Development Services (ICDS) Directorate of the Department of Social Welfare. The Supplementary Nutrition Programme disburses funds to village-level anganwadi (pre-school) workers to buy, cook and serve food to children of three to six years at anganwadi centres. The Programme also provides monthly “take‐home rations” to children aged 6 months to 3 years, and pregnant and lactating mothers. However, the government estimates that approximately 50% of spending is diverted, meals are only provided 60% of days, and the meals that are served lack the nutritional content stipulated by the government (BTAST, 2011). In order to decrease leakage and improve delivery of nutritional supplements, Bihar’s Department of Social Welfare is considering three interventions to improve the Supplementary Nutrition Programme. The first intervention is to use the well‐established JEEViKA women’s self-help groups (SHGs) as an intermediary to deliver cooked meals to the anganwadi centre. The SHGs will procure the food, hire a cook, and oversee operations to ensure their children receive daily meals. The second intervention equips supervisors with mobile phones with GPS and cameras to record anganwadi worker attendance, child attendance, and information on the provision of meals. The third intervention is to buy subsidised grains from the State Food Corporation of Bihar and to distribute the grains directly to the village-level, thereby potentially decreasing the ability of officials at various levels to pilfer funds. Although the three interventions are designed to reduce leakage and improve nutrition delivery, it is possible that they have no effect or could even worsen these problems. Moreover, each programme has unique cost implications to consider before scaling up. Therefore, the Social Welfare Department has commissioned rigorous impact evaluations of the three interventions as compared to the status quo to determine which intervention(s) will most cost-effectively reduce leakage and improve nutrition delivery. Bihar’s top social welfare officials are committed to using the evidence to decide which interventions to scale state-wide. Furthermore, the proposed impact evaluations will shed light on questions of broader relevance to other Indian state governments and the wider international development community, particularly on the potential role for community organisations and technology-based monitoring in improving delivery of government programmes. The present study is a quantitative baseline assessment of child nutritional status and performance of the ICDS Supplementary Nutrition Programme in Bihar. It is the first phase of a larger impact evaluation of three interventions aimed at improving the Supplementary Nutrition Programme.