How do we harness the nutrition potential of social protection programs in India?

This blog by Kalyani Raghunathan, IFPRI  was previously posted on the POSHAN website.

The most recent data on India from the Rapid Survey of Children (2013-14) shows that there has been considerable improvement in undernutrition indicators in India in the 9 years that passed since the last round of available survey data, the 2005-06 National Family Health Survey (NFHS-3). However with almost 40% of children under the age of 5 still stunted, and almost 30% underweight, there is ample room for improvement. One of the ways in which this can be done is to use the vast array of social protection programs in India as platforms for delivery of nutrition-specific and sensitive interventions, as well as drivers of change in the underlying determinants of these indicators.

It was with the intention of discussing how best to improve the nutrition sensitivity of these programs, that over 100 researchers and practitioners gathered in New Delhi on October 16th for a seminar titled ‘Maximizing the nutrition potential of social protection programs in India: what will it take?”. The goal of the seminar was to outline the evidence on the successes and failures of the major initiatives undertaken by state and national governments – the PDS, the Midday Meal Schemes, conditional cash transfer schemes, among others – as well as ways in which they can be strengthened for the purpose of delivering nutrition interventions. This seminar was jointly hosted by Transform Nutrition and POSHAN (Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India), both initiatives led by the International Food Policy Research Institute (IFPRI).

A. Santhosh Mathew, Ministry of Rural Development, Government of India. The seminar began with a keynote speech by Dr. Harold Alderman from IFPRI on the worldwide experience in using social protection programs to achieve nutrition goals. Using data that predated the recent RSOC survey, he pointed out that even the full scaling up of ten proven effective nutrition specific interventions would only reduce stunting globally by twenty percent, thereby underscoring the need for renewed commitment to additional programs that would address the underlying determinants of malnutrition include nutrition sensitive social protection. Dr. Alderman said “If the poorest 40% of India were to have had the assets of the middle quintile, national malnutrition rates in 2006 would have only declined from 48% to 39%, though poverty would have been virtually eliminated. This reflects that fact that improved income addresses food security but does not have a rapid impact on care giving and knowledge, nor on health and sanitation.”

Dr. Alderman’s speech was followed by comments by Dr. A. Santhosh Mathew, Joint Secretary to the Ministry of Rural Development, and by Dr. Emmanuel Jimenez, Executive Director of the International Initiative for Impact Evaluation (3ie). “The great thing about nutrition… [is] that you cannot get nutrition outcomes unless an entire plethora of [governmental provisions] fall into place… therefore, what nutrition really provides us is a fantastic metric with which to measure the progress that our country is making”, said Dr. Mathew. However Dr. Jimenez pointed out that social safety nets often have multiple targets or objectives, within which nutrition is typically not prioritized, and that ultimately, the limits to implementation capacity dictate the success of these goals.

The second session of the morning presented evidence from studies both within and outside India on the use of cash transfers, and their efficacy vis-à-vis food transfers in improving dietary diversity and nutritional indicators. The session began with IFPRI’s current research in this area in Ecuador, Uganda, Niger and Yemen, as well as a comprehensive study in Bangladesh. The 4-country study showed that while cash transfers are often more effective in providing food security, food transfers have larger impacts on calorie intake. These presentations were followed by preliminary results from the Bihar Child Support Programme (BCSP) study conducted by Oxford Policy Management, from the Westat study of the MAMATA cash transfer scheme in Orissa, and from two studies being conducted by the Abdul Latif Jameel Poverty Action Lab (J-PAL) in Tamil Nadu and Bihar on the use of school platforms in providing weekly iron and folic acid supplementation and iron fortified salt respectively. Echoing Dr. Alderman’s observation that increases in income are necessary but not sufficient drivers of improvement, the main message from this second session was that the largest impacts of the cash and food transfers were observed when the transfer was accompanied by behaviour change communication or information about practices.

The next session presented evidence from the impact of midday meal schemes on calorie and nutrient intake, and from the introduction of pulses into the PDS. These scheme-specific presentations were followed by Sudha Narayanan, who urged researchers to be advocates of their own research and develop strategies to communicate the evidence they generate. In this specific political context, there is an unnecessary polarization of views and no middle ground, and thus when researchers want to advocate for social protection programs, the burden of proof rests on them.

The day ended with a panel discussion that brought together ‘consumers’, ‘producers’ and ‘disseminators’ of impact evaluation research, with a panel that consisted of Jyotsana Puri (3ie), Nel Druce (the Department for International Development, DFID), Akhtar Ahmed (IFPRI), and Jasmine Shah (J-PAL).

The overarching questions for this session were “How do we deliver research/evidence that make programs work? And how do we engage with governments in generating demand for evidence?” They talked about the various ways their organizations engage with state and national governments, and of the importance of having receptive dedicated government officials who appreciate the value of careful research and are willing to invest money in data collection.

A lingering theme from Dr. Mathew’s presentation in the morning session was discussed, namely the short political and bureaucratic cycles during which officials hold positions and are able to commit to issues. This prompted the observation that the research community needs to learn to take advantage of these windows of opportunity and increase communication between researchers and policy makers. Building deep partnerships with the government, and keeping them involved in the research process from the design phase onwards, creates a sense of ownership that facilitates high quality research.

It was a day filled with thoughtful presentations on the current state of research into improving India’s nutritional profile, and on the big questions practitioners and academics should focus on in the future. Though some of the statistics were discouraging, there is tremendous potential for turning these social protection programs into powerful drivers of change in nutritional indicators. This feeling was echoed by Dr. Emmanuel Jimenez in his closing speech, who said he was very optimistic about India’s ability to improve its nutritional status. “I’ve heard a lot about researchers being from Mars and policymakers from Venus. All I see in this room are really good researchers who want to make a policy impact with their evaluations.” he said. Let us hope that these dedicated researchers do just that.

Presentations

Making social protection more nutrition sensitive: A global overview
Harold Alderman (IFPRI)

Comparing food, cash and voucher programs in four countries
Purnima Menon (IFPRI)

Lessons from the Bihar Child Support Programme (BCSP), an initiative to deliver cash transfers via the Integrated Child Development Services in Bihar
Tom Newton-Lewis (Oxford Policy Management)

A framework of approaches to strengthen the nutrition-sensitivity of social protection programs in India
Suman Chakrabarti (IFPRI)

See images from the event on flickr

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