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.