Evaluating Impacts of Nodal Anganwadi Centres in Bihar, India: A Quasi-Experimental Approach

Aims & Objectives: This project was an evaluation study of the Uddeepan Programme in the state of Bihar. The Programmewas an initiative of the Bihar Government’s Sector Wide Approach to Strengthen Health (SWASTH). Theprogram provided one additional worker, the Uddeepika, to a cluster of Anganwadi centres (AWCs), the village level institutions responsible for delivering nutrition and health services to pregnant women,young mothers and their children. All AWCs that fell within the jurisdiction of the lowest level of electedgovernment in India, the Gram Panchayat (GP), were included in a cluster. Uddeepikas, hired from within the GP, were required to have higher levels of education than other AWC workers, and to have a score of60% or higher in an entrance examination designed specifically for the project. The program was piloted in 2014 with intended coverage of all GPs in a set of 9 “Phase 1” districts, with plans for a subsequentextension of the program to additional districts based on the success of the pilot.

Methodology: In this study, approximately 4500 households and 300 AWCs were surveyed twice (i.e. baseline and end line surveys) in 100 GPs in 4 districts viz. Katihar, Supaul, Madhepura and Kishanganj. Using quasi-experiential technique and mixed method for analysis.

Findings: The study highlighted the difficulties in implementing policies in relatively backward regions that attempt to recruit workers of higher ability, while yet restricting employment to people from the local geography. In the case of this program, the result was only a small reduction in human capital constraints, at the cost of significant delays in program implementation and hence in exposure to the benefits of the program. Despite this, the positive effect of the program on child WAZ suggests the importance of policies that addresses physical labour resource constraints in local institutions responsible for the nutrition and health of mothers and their children.

Recommendation: This research suggests that reductions in labour constraints enhanced child nutrition through the improvements that affected the delivery of basic services, such as the provision of Take Home Rations and mid-day meals. More importantly, our research showed that even relatively smaller changes in population per-worker ratio can significantly improve child nutrition and health, suggesting that a relatively low cost approach that provides one additional worker to a cluster of AWCs may have considerable value.