(P24-029-24) Strengthening Delivery Platforms of National Nutrition Programs in Subnational Geographies in India Improved Coverage of Interventions and Child Growth

Objectives: Between 2016 and 2020, novel system strengthening mechanisms were implemented in 63.9% (N=409) of India’s districts by the government in collaboration with multiple partners to enhance the delivery of essential nutrition interventions for women and children during the critical first 1,000 days. We evaluated the influence of these mechanisms on the coverage of interventions and child growth outcomes.

Methods: We merged mother-child pair data from the 2016 (N=185,101) and 2020 (N=172,426) rounds of the National Family Health Survey with a district-level support mechanism dataset. The 11 district support mechanisms, which included a combination of capacity building, additional human resources, finance, infrastructural support, community mobilization, and performance-based incentives, were classified into two groups distinguishable on these features, human resource intensive (HRI) and human resource and finance (HRF), using the k-means clustering algorithm. Districts received only HRI (N=73), only HRF (N=99), both (overlap) (N=237), or no support (N=231). We employed a difference-in-differences (DiD) design with heterogeneous treatments to estimate the effect of district-level support on coverage and child growth.

Results: Compared to districts that received no support, coverage in districts receiving any support had significantly faster progress. DiD coefficients for coverage on the only HRF and overlap arms were similar (4.0 to 13.7 percentage points) and larger compared to those on the only HRI arm (2.0 to 5.9 percentage points). There were significant additional gains in height-for-age z-score in only HRF and overlap districts (0.16-0.19 standard deviations) compared to districts with no support. Only in the case of districts receiving an overlap of support, significant differential trends (0.11 standard deviations) in weight-for-age z-score were observed.

Conclusions: The implementation of system strengthening mechanisms in a wide array of subnational contexts across India was associated with significantly faster improvements in the coverage of nutrition interventions and child growth. The findings suggest that financial support can complement human resource improvements to enhance the delivery of national programs in subnational geographies with limited-service delivery capacity.

Funding Sources: Multiple funding sources