DISCUSSION PAPER: THE OPERATIONAL EVIDENCE BASE FOR DELIVERING DIRECT NUTRITION INTERVENTIONS IN INDIA

This Discussion Paper features results of a desk review (1) to document the extent to which national and civil society/NGO programs in India reflect current technical recommendations for nutrition and (2) assess the operational evidence base for implementing essential interventions for nutrition in the Indian context. A team from IFPRI reviewed the designs of two major national programs, Integrated Child Development Services (ICDS) and the National Rural Health Mission (NRHM) and then used Google Scholar to search the published literature from 2000 to 2012 for evidence of interventions addressing the inputs to improve child nutrition. The team also contacted 70 program stakeholders to identify the unpublished evidence on inputs in program models implemented by civil society/nongovernment organizations.

The team found that by design, the two national programs (ICDS and NRHM) together appear to incorporate all the essential inputs and use evidence-based interventions. There is an expectation by design that the frontline workers of ICDS and NRHM coordinate and collaborate to deliver the interventions. A review of 22 program models shows that a majority focused on improving breastfeeding and timely initiation of complementary feeding. However, only a few addressed the full spectrum of complementary feeding, vitamin A deficiency, pediatric anemia, and severe acute malnutrition. None addressed how to reduce intestinal parasitic burdens or prevent malaria. There is limited published literature on the effectiveness of the recommended interventions to deliver the essential inputs. There are few efficacy studies and even fewer effectiveness studies or program evaluations on delivering essential nutrition interventions in the Indian context.
Overall, a large gap persists in both the published and gray literature on how to promote interventions to address the essential inputs. Much more operational evidence is needed to ensure high-quality delivery of the evidence-based interventions that are already being implemented nationwide. Given the potential for the national programs to effectively deliver interventions to achieve maximum coverage and impact, and the government of India’s current interest in ICDS system strengthening, this is an opportune time to test some of the innovations using the ICDS and NRHM platforms.