Crowd-out in school-based health interventions: Evidence from India’s midday meals program

Abstract

Governments often rely on schools to implement multiple programs targeting child outcomes. How to improve the implementation of these programs is an important, open question. As part of a randomized controlled trial in Odisha, India, we measured the impacts of a nutrition program and a monitoring intervention on the implementation of a pre-existing school-based nutrition program, specifically the Indian government’s iron and folic acid supplementation (IFA) program. The new nutrition intervention distributed a micronutrient mix (MNM) to be added to school meals while the monitoring intervention varied the intensity of monitoring activities. We find that high intensity monitoring improved implementation of the government’s IFA program, while the MNM intervention crowded it out. The net effect is that high intensity monitoring improved child health, while the MNM intervention did not. Both crowd-out of the IFA program and sensitivity to monitoring were predominantly found among schools that were resource or capacity constrained.