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.