POSHAN Delivering for Nutrition 2016: Session on Self-Help Groups and Rural Livelihood Programs

Women’s self-help groups (SHG) are fast emerging as an ideal platform to effect change in health and nutrition behaviors. The unique design of group-based interventions presents opportunities to simultaneously tackle multiple basic, underlying and immediate causes of malnutrition laid out in the UNICEF Conceptual Framework of Malnutrition. As forums of adult women, they directly reach target populations of pregnant and lactating women, as well as other women within the household who might play an instrumental role in decision making, e.g. mothers-in-law and grandmothers.  In addition, these platforms are often specifically aimed at the poor and marginal households within rural communities who are at the greatest risk. Finally, through the activities that SHGs engage in– savings and credit, agriculture and livelihoods, support for women– they are already building social capital working towards the economic, social and political empowerment of women. Interventions focused on health and nutrition are now layered on to the vast network of existing SHGs and include BCC and counseling, information on coordination with FLWs and service delivery.

Research on SHGs as platforms for health and nutrition interventions is ongoing and the final session of the IR conference featured 3 such programs at different stages of implementation and evaluation. The similarities in the observations and modalities across these three presentations was quite striking.

The first of these presentations, by Dr. Malavika Subramanyam (IIT Gandhinagar) discussed baseline results from an evaluation of Gram Varta, a large scale health intervention layered onto the existing JEEViKA SHG platform in 68 gram panchayats in Madhepura district in Bihar. Under this intervention, a trained facilitator is tasked with conducting PLA sessions on health, nutrition, and WASH with existing SHG members, frontline workers and other members of the community. The evaluation is designed as a randomized controlled trial with three waves of data collection. Some interesting societal barriers to adoption of health and nutrition behaviors were already apparent from the baseline completed in 2015, especially with regard to adolescent girls. In particular, food-related norms, lack of awareness around contraception, and conformity to societal norms around early marriage could affect the impact of these interventions.

Dr. Niranjan Saggurti of the Population Council then presented results of an evaluation of the Health Integration Intervention project, also using the JEEViKA platform in 41 blocks of 8 districts in Bihar. This project involves the integration of structured health BCC modules targeted at SHG members, as well as structural level resources and activities including establishing committees and systems, discussions with key stakeholders and so on. The baseline, midline and endline surveys for this evaluation have been completed, and preliminary results were shared at the conference. Most interestingly, Dr. Saggurti highlighted the importance of group cohesion. While there was a small impact of the intervention on practices such as the consumption of IFA tablets, bathing after 72 hours, and exclusive breastfeeding in all groups, the improvement in newborn health behavior was significantly better in those SHGs which had high degrees of collectivization. For many SHG-related interventions that attempt to layer on multiple additional interventions onto young or heterogeneous groups, this is an important lesson to bear in mind.

In the last presentation of the session, Dr. Kalyani Raghunathan presented study designs and some preliminary findings from two impact evaluations being done by IFPRI. The first evaluation employs a randomized controlled trial design to evaluate the addition of health and nutrition BCC to the existing Jeevika platform in Saharsa district in Bihar, along with an increased emphasis on convergence and coordination across service providers. The second is the quasi-experimental evaluation of an agriculture-nutrition intervention using the PRADAN platform in 8 districts spread over 5 states in northern and eastern India. In this study, the intervention involves both the provision of health and nutrition BCC, as well as tailoring existing PRADAN efforts in agriculture, gender and entitlements to health and nutrition-related goals. Both of these evaluations are underway, with the baseline surveys completed.

The chairs of the session presented the audience with some key takeaways at the end of an engaging discussion and two major concerns. In targeting women, they urged implementers to be cognizant of the limits on women’s time and ability, and of the fact that social change cannot be effected by only one member alone. They also stressed the need to ensure the sustainability of projects without external support. Dr. Bhagwat questioned whether a large nation-wide program such as the National Rural Livelihood Mission (NRLM) could support these changes without access to additional resources, and whether the impacts continue once donors withdrew.

The presentations indicated that there is a serious effort towards evidence generation through rigorous, well-designed evaluations in this area. In all three studies, care was taken to supplement results with insightful process-related quantitative and qualitative data. In coming years researchers can look forward to a body of documentation on impacts, processes and survey tools, one that we can all benefit from. Finally, there is recognition of the limitations of the use of this platform, as well as an acknowledgement of its strengths, which will hopefully result in even better designed interventions that truly improve maternal and child health and nutrition.

Written by Kalyani Raghunathan and Samyuktha Kannan, IFPRI

Related resources:

Blog: Improving Nutrition in India: Taking Flight with WINGS