Evaluation of Health System Development Initiative: Nutrition in West Bengal
Lalitha Swathi Vadrevu
Agency : HSDI, Underweight, ICDS, West Bengal
Objective : To evaluate the effectiveness of Health System development Initiative – Nutrition component in improving the child health status of the 6 focus districts in West Bengal. To determine if HSDI interventions have brought changes with respect to ICDS service delivery.
Background : West Bengal Health Systems Development Initiative is a novel reforms initiative by DFID to strengthen health systems in developing countries. It is a five year support programme to strengthen rural primary care, addressing both health and nutrition components. This report outlines the steps taken for the evaluation survey in six focus districts of West Bengal.
Methodology : The methodology was evaluative in nature. The study is an endline evaluation of the HSDI project. It attempts to see if the envisaged changes in nutrition and service delivery indicators have occurred within the HSDI period. No specific model or method was used to determine the effectiveness of the intervention over two years. Statistical analysis was carried out parallel to support the findings and to form a scientific base for the recommendations. The study was conducted in the districts of Cochbihar, Murshidabad, Malda, Uttar Dinajpur, Dakshin Dinajpur and Purulia.
Findings : The evaluation found many encouraging changes like the percentage moderately underweight for children between 0 – 35 months which showed a positive change of 5 percent in moderate and 3 percent in severe cases respectively, 16 percent in timely initiation of breast feeding within 1 hr of birth, 25 percent increase in coverage in supplementary nutrition services, 14 percent in coverage of Growth monitoring services, 30 percent increase in home visits by anganwari workers, and there has been a corresponding increase in the awareness about the IYCF practices in AWW, mothers and pregnant women. It was found that the perceived quality of SNP services was very much determined by the lack of supply issues, like irregular supply of SNP and other quality related issues and background characteristics while the way people perceive growth monitoring services has been attributed to the availability of infrastructure and training.
Recommendations : The improvement in the health indictors can be logically attributed to the changes during the program with respect to infrastructure (positive change of), trainings, human resource, HMIS changes and other inputs required for the services. Quality of services, which was a priority issue on the agenda, has shown to hold a mediocre status while the perceived quality of these services has been found to be affected by the changes envisaged during the program. The initiatives bore fruits even with respect to reaching out to pregnant women in Antenatal care services as seen by the increase in registrations, percentage receiving Iron folic acid tablets and those aware of the recommended practices during pregnancy and after child birth.
To evaluate the effectiveness of Health System development Initiative – Nutrition component in improving the child health