What are the micro-level barriers to better nutrition service delivery and utilization? Qualitative evaluation of the beneficiary experience from the Integrated Child Development Services in India

Malnutrition has remained one of the most pressing challenges to human development and a rigid outcome of underdevelopment to respond to policies and interventions. Although forms and predictors of malnutrition is extensively studied, relatively less focus have gone to the micro-realities of policy implementation that can explain the barriers to achieving better service utilization outcomes.

This study attempted to fill this gap by undertaking a micro-level qualitative analysis of the beneficiary experience from one of the largest nutrition services in the world i.e., the Integrated Child Development Services (ICDS) in India to gain insights on the social-environmental barriers to the supplementary nutrition program.

Combining qualitative phenomenological design with a retrospective design, the study compared experience of current ICDS services to the services of its erstwhile strategic regime called the ‘Dular’ using data from a 2018 study in Bihar. 30 beneficiary mothers including 12 mothers with children in both regimes, 10 front-line and erstwhile second-line workers and 2 UNICEF officials were included in focus group discussion and one-to-one interviews.

The analysis revealed that even if the ICDS budget allocation has increased, the strategic changes in the program downscaled in terms of service personnel by removing second line workers, this led to a deceleration in knowledge and practice gain among the beneficiaries. The current-ICDS was also challenged due to non-universal coverage in supplementary food delivery leading to exclusion of some children, the hazardous work condition of the FLWs, low FLW capability, and incoherence between the beneficiaries. Engagement of local governance was found to be an enabler.