Embed Size (px)
Citation preview
Improvements in Growth
Monitoring: Lessons from the Bihar
Child Support Programme
November 2016
Structure of the presentation
About the BCSP
Evidence
Lessons
November 2016 © 2016 Oxford Policy Management Ltd 2
The Bihar Child Support Programme
Implemented in two blocks in Gaya District in 261 AWCs since 2014
9,040 direct beneficiaries
Women enrol after first trimester and receive Rs 250 per month until the child is two years old (total 30 months), if they meet certain conditions
Additional bonus of up to Rs 2000 if the mother does not become pregnant again within two years and the child is not underweight at the age of two
Total value Rs 9500
Cash transfer is made directly to the bank account of the mother
No exclusion criteria
Mixed methods impact evaluation based on a quasi-experimental model with matched control areas - Baseline conducted in August 2013, Midline conducted August – October, 2015
November 2016 © 2016 Oxford Policy Management Ltd 3
The BCSP tests different types of conditions
November 2016 © 2016 Oxford Policy Management Ltd 4
Conditions include:
– Monthly Attendance at Village Health, Sanitation and Nutrition Days
– Weight Gain Monitoring during Pregnancy
– Child Growth Monitoring
– Correct treatment of diarrhoea
– Receipt of IFA supplements
– Birth Registration
– Exclusive Breastfeeding under 6 months
– Measles Vaccination
Conditions are relaxed if services are not available
Evidence
November 2016 © 2016 Oxford Policy Management Ltd 5
Large effects on uptake of services at the AWC
Transmission mechanism:
nudge beneficiaries to avail
basic preventive and promotive
services
Legitimises the role of the AWW
and provides a “hook” for
promoting demand for services
November 2016 © 2016 Oxford Policy Management Ltd 6
0% 20% 40% 60% 80% 100%
Attendance at VHSNDs(pregnancy)
Attendance at VHSNDs (child)
Weight Gain Monitoring duringPregnancy
Child Weight Monitoring
Receipt of IFA supplementationduring pregnancy
Birth Registration
Baseline value Impact estimate Non-significant impact estimate
Increased Weight Monitoring of Pregnant Women
Proportion of pregnant women was checked at least once
November 2016 © 2016 Oxford Policy Management Ltd 7
65.00%
75.30%
82.20%
67.30%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
Treatment Control
Baseline Midline
Increased Growth Monitoring of Children
Proportion of children whose weight was checked at least once since birth
increased significantly
November 2016 © 2016 Oxford Policy Management Ltd 8
33.90%
41.00%
65.50%
39.00%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
Treatment Control
Baseline Midline
Effects of increased service uptake
41 % of women who had their
weight checked at least once during
pregnancy were underweight
77% of these women reported a
change in behaviour in response to
growth monitoring results
November 2016 © 2016 Oxford Policy Management Ltd 9
67.6%
54.1%
44.1%
23.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Started eatingmore nutritious
food
Started eating agreater quantity of
food
Started drinkingmilk
Started takingmedicines/
supplements (e.g.IFA tablets)
Ways in which women changed their behavior after being told that they were
underweight
Limited effects on nutrition behaviour
Very low awareness of their status
as conditions by AWWs and
beneficiaries (7% of beneficiaries
named these as conditions)
Conflicting advice by service
providers
Lack of counselling
Cannot monitor or verify whether
the beneficiary is meeting the
condition or not – rely on self
reporting
November 2016 © 2016 Oxford Policy Management Ltd 10
0% 20% 40% 60% 80% 100%
Exclusive Breastfeeding until 6months
Correct Treatment of Diarrhoea
Baseline value Impact estimate Non-significant impact estimate
Lessons
A small value CCT can lead to big changes in the uptake of community health
and nutrition services
Beneficiary understanding of the complexities of the scheme is limited –
simplest conditions are most easily understood, and met
Uptake of simple services such as growth monitoring can improve certain
nutrition behaviours
November 2016 © 2016 Oxford Policy Management Ltd 11
Thank you
This assessment has been carried out by Oxford Policy Management with support from the Children’s Investment Fund Foundation (CIFF) and the Department for International Development (DFID). For further information, please contact [email protected] or [email protected].
OPM India 4/6 First Floor, Siri Fort Institutional Area, New Delhi 110049, IndiaTel: +91 (0)11 4808 1111Email: [email protected]: www.opml.co.uk
