Improving the implementation of the Take Home Ration Programme Under ICDS

Executive Summary

Adequate nutrition during early life stages is a critical input for lifelong health outcomes, physical growth, cognitive development, and even earning potential. Despite India’s substantial progress in the last two decades, 40.6 million children remain stunted – accounting for one-third of the global burden of stunting.¹ Preliminary results from the fifth National Family Health Survey (NFHS-5) indicate that some dimensions of nutrition have worsened recently: 13 of 22 states report an increase in childhood stunting in the last five years. Under India’s National Nutrition Mission (NNM), also called POSHAN Abhiyaan, the country has set targets to reduce stunting, undernutrition, anaemia, and low birth weight in children by 2022.

An intervention critical to achieving those goals is the Supplementary Nutrition Program (SNP), under the Integrated Child Development Services (ICDS) scheme. This program is one of the oldest and largest nutrition-focused interventions in India. Under SNP, all pregnant and lactating women, as well as children aged six months to 3 years, are entitled to receive Take Home Ration (THR) from their local Anganwadi Centers, while children aged 3 to 6 years old are eligible to receive Hot Cooked Meals.

Evidence continues to support the use of supplementary food to improve child growth outcomes in food-insecure settings,² but effective program implementation is critical; supplementary foods must first reach and be eaten by intended beneficiaries to have their intended effect. The THR program is implemented at the state-level, with states determining the composition of foods, the sourcing and supply chain, and the production and distribution model based on local availability, diet norms, and feasibility. Both Rajasthan and Jharkhand recently altered their THR production and distribution models. Rajasthan moved towards a more centralized model in March 2020, and Jharkhand towards a more decentralized approach in November 2019.

Rates of access to and use of THR by women and children vary between states as well. In two previous state- and district-representative quantitative surveys that IDinsight conducted in 12 districts across Rajasthan and Jharkhand, we found that access to Take Home Ration was much lower in Rajasthan than in Jharkhand. In Rajasthan, only about one-third of eligible beneficiaries reported receiving THR in the month of January 2020, compared to about two-thirds of eligible beneficiaries in Jharkhand for the same period.³ We also found that access to THR decreased in both states between January and May 2020, as the COVID-19 pandemic disrupted food supply chains and freedom of movement.⁴

Given the lack of existing evidence on the functioning of the newly introduced THR production models in each state, as well as the trend of reduced THR access identified in our previous quantitative surveys and concerns that THR programming may have experienced further challenges during the COVID-19 pandemic, we conducted a qualitative study to map the processes behind the newly introduced production models, uncover and diagnose challenges in implementation and to identify opportunities for improvement. Our study’s concurrence with the COVID-19 pandemic allowed us to provide Indian government officials with rapid reporting and insights on the functionality of these systems and the experiences of women and children in the first few months of the COVID-19 pandemic.

We conducted a total of 114 semi-structured qualitative interviews (54 in Rajasthan and 60 in Jharkhand) with supply and demand-side actors in August 2020. On the demand side, we spoke with pregnant women, lactating mothers, and mothers of children aged 6 to 36 months old – women eligible to receive THR either for themselves or their child. On the supply-side, we spoke with Anganwadi workers (AWWs), and in Jharkhand, we also spoke with self-help group (SHG) members. Due to safety and security concerns related to the pandemic, all interviews were conducted remotely via phone call. Interviews were recorded with participants’ consent, transcribed into Hindi and English, and analyzed via theme-coding to uncover emerging patterns. Our work was funded by the Children’s Investment Fund Foundation (CIFF) and supported by input from NITI Aayog. IDinsight’s internal research ethics committee approved our methodology and consent procedures, and NITI Aayog provided a letter of support to authorize our data collection in specified districts of Rajasthan and Jharkhand.