A Qualitative Evaluation of the Micro-level Barriers to Better Delivery and Utilisation of Nutrition Services in Rural India

Abstract

Malnutrition remains one of the most rigid outcomes to be addressed by policies and interventions. Although the forms and predictors of malnutrition have been extensively studied, relatively less focus has been placed on the micro-realities of policy implementation that can explain the barriers to achieving better service utilisation outcomes. To fill this gap and gain insights into the socio-environmental barriers to the supplementary nutrition programme, a micro-level qualitative study was undertaken on the beneficiary experience from one of the largest nutrition services in the world, the Integrated Child Development Services (ICDS) in India. Combining qualitative phenomenological with a retrospective design, the study compared the service experience of current ICDS to its erstwhile regime called the ‘UNICEF-Dular’ using data from a 2018 study in Bihar. Thirty beneficiaries, including 12 mothers with children in both regimes, 10 front-line workers (FLW) and erstwhile second-line workers, and two Bihar-UNICEF officials, were included in the FGDs and interviews. The analysis revealed that strategic changes in the programme regarding downscaling personnel by removing second-line workers, selective coverage in supplementary nutrition, hazardous work conditions, the low capability of FLW, and social incoherence are barriers to service delivery in nutrition.