This study uses a cluster-randomized design with cross-sectional baseline and endline
surveys to generate a proof-of-concept around an implementation model that aims to
strengthen systems for delivery of individual interventions and to strengthen convergence
of multiple interventions on the same households/families. The primary objectives of the
study are to answer the following questions:
To what extent and through which pathways can overall system strengthening
approaches improve quality of delivery of health and ICDS services?
To what extent and through which pathways do system strengthening approaches and
focused local efforts to engage multiple sectors improve coverage of individual
interventions and co-coverage of multiple interventions in the first 1,000-days?
Can efforts to improve the nutritional value and palatability of take-home rations
within the ICDS increase acceptability and use?
This study will also measure a range of secondary outcomes, for each research question as
well as outcomes that pertain to the pathways of impact of the five intervention
components. These include
MIYCN capacity building
Strengthening Supportive Supervision (SS) of the ICDS & Health Supervisory Cadre
Strategic Use of Data (SUD) & Convergent Action Plan
Involving Panchayati Raj Members (PRIs) for improved Co-Coverage of nutrition
services
THR offering refinement
Prior to the baseline survey, 13 out of 26 blocks from three districts randomly allocated
to receive interventions. Another 13 blocks from the same three districts were randomly
allocated to the comparison groups which received standard government services. The
selection of three districts was based on the discussion between A&T team and the
Government of Gujarat. A team comprising of representatives from A&T, IFPRI and local
government worked closely to ensure matching and comparability between the intervention
and comparison blocks using a propensity score matching method prior to randomization to
intervention or comparison groups.
At baseline, information related to primary and secondary outcomes will be collected,
along with indicators along the pathway from program inputs to outcomes. Insights on
implementation will be documented throughout the evaluation period through routine
meetings with the implementation teams, field visits by the research team, review of
monitoring data collected by the implementation team, and backend data from the
supervisory and PRI apps. Endline will be collected after approximately one year from
baseline and will use mixed methods approach wherein surveys will be conducted at the
sector, village, and household levels and semi-structured interviews will be conducted
with the block and district staff. In addition, observations will be conducted of
interactions between supervisors and FLWs at the village level. Finally, an assessment of
child growth outcomes will be conducted after exploring the availability and data quality
of longitudinal data being gathered at AWCs by IIPH-G, contingent on data access and
approval from the state government.