This document discusses a study that used tele-monitoring to understand how a multi-sectoral maternal and adolescent nutrition program in India called Swabhimaan was impacted by COVID-19 lockdowns and adapted its services. Community health workers under the program continued providing home visits and nutrition services for at-risk groups, though group meetings and counseling sessions were halted during lockdowns. The study collected data over two rounds from 158 village organizations across 4 states to understand continuity of community actions and government nutrition services. Key findings showed adaptations made by women's groups to continue delivering services, and that tele-monitoring provided insights on continuity of the community-led program and capacity building needs.

1. DELIVERING FOR NUTRITION IN SOUTH ASIA
Implementation Research in the Context of COVID-19
2nd December, 2021
Neha Abraham, ROSHNI- Centre of Women
Collectives Led Social Action
Results from Swabhimaan Impact
Evaluation
Tele-monitoring continuity of adolescents
and women’s nutrition services in eastern
India during and after the COVID-19
lockdown

2. • Swabhimaan is a multi-sectoral maternal and adolescent
nutrition programme led by women’s groups under India’s
flagship poverty alleviation programme DAY-NRLM, MoRD
• Programme has a nested prospective non-randomized controlled
evaluation
• Nationwide lockdown disrupted nutrition services delivered by
women groups under the programme.
• DAY-NRLM self-help groups tasked to support COVID-19
response efforts in rural areas
• Critical to understand how field activities were impacted to inform
programming and support process monitoring for Swabhimaan
impact evaluation.
Rationale
Geographic scope
• 4 Districts (Purnea, Bastar, Koraput,
Angul)
• 5 Poorest DAY-NRLM Resource Blocks
• 356 Villages
• 1,25,097 households
• 0.6 million population
Bihar
Odisha
Chhattisgarh

3. • To understand the status of the services provided under Swabhimaan
during and post-lockdown in intervention blocks.
• To understand how activities have adapted in the field
• How tele-monitoring can be used to monitor and improve nutrition
service delivery.
Objectives

4. Target Groups
4.
5.
Tier 1 – Self Help
Groups
Tier 2 – Village
Organisations
Tier 3 – Cluster
Level Federations
Systems Actions
Community Actions
(led by Department of Health)
Strengthening access to outreach services
Delivery Platforms
Methods
(led by DAY-NRLM women’s groups)
For behaviour change and demand
generation for services
3.
1
1
Improve food and nutrition intake
Prevent micronutrient deficiencies and anemia
Increase access to VHSND services and special care to at-
nutritional risk (MUAC< 23cm)
WASH
Prevent early, poorly spaced or unwanted
pregnancies
2
3
4
5
• Civil Supplies
• Health and Family Welfare
• Woman & Child
• Public health and
Engineering
• Agriculture
Primary: Secondary:
Adolescent girls
Newly-wed couples
Pregnant women
Mothers of under-two
Family members,
particularly husbands
Duty bearers: at
community (AAA),
block and district
Nutrition interventions
Interventions
led by a
community
resource
person/
Poshan
Sakhi
Women groups involved for community
actions
4175
Self Help Groups
21
Cluster
Federations
258
Village Organizations
323
Poshan Sakhis

5. Methods
Sampling for Community Cadre:
• VO as primary unit; sample of 158 VOs drawn using PPS
method considering 5% margin for error
• VOs in villages with low cellular network coverage
excluded from sampling frame
• VOs from each state selected by systematic random
sampling
• At VO-level interviewed:
o 1 Community Resource Person
o 1 VO-Office bearer, preferably President
Design: Retrospective and concurrent
Data collection technique: Remote, rapid
Data collection site: Intervention blocks (5 blocks)
Time frame: Round 1 May-June, 2020,
Round 2 Feb – July, 2021
Participants: Community resource persons (Poshan
Sakhi/Kishori Sakhi), VO and CLF office bearers
Sampled village organizations from each intervention block
States District Block Total VOs Sampled VOs
Bihar Purnea
Kasba 33 19
Jalalgarh 39 23
Chhattisgarh Bastar Bastar 104 61
Odisha
Angul Pallahara 41 24
Koraput Koraput 53 31
Total 270 158

6. Tool
• Monthly monitoring formats adapted into interview schedules
• Close-ended questions on the status of community-led activities, systems actions,
• Responses recorded as ‘halted’, ’resumed’, or ‘continuing’, coverage recorded with numeric input, challenges and adptations as
qualitative notes
• Tools tested with 5% of the sample to check feasibility for telephonic administration
• Tools developed in consultation with the state government (State Rural Livelihoods Mission)
• Hosted on online software developed by Microware Computing and Consulting
Data collection
• A multidisciplinary technical advisory group designed study, developed
tools and trained data collectors.
• A team of six data collectors, including block level MIS coordinator
managed by a state supervisor collected data from each state
Analysis
• Descriptive analysis was conducted.
Methods

7. Results
Group based community meetings – During lockdown more than half
reported a halt in Bihar and Chhattisgarh, in Odisha, >73% reported
continuing. Resumed post unlock in Bihar and Chhattisgarh
Home visits to at-risk women and adolescent girls were continued
across states, more than 80% reported continued home visits during
both periods.
Food demonstration & groups based counselling sessions largely
halted in all states, 69% in Chhattisgarh and nearly 45% in Bihar and
Odisha. Later resumed in post-unlock, Bihar reported continuity at 95%
Development of Nutri-gardens for at-risk women and adolescent
girls continued despite lockdown hurdles in Bihar and Odisha. Post-
unlock continuity reached more than 90% in all states
Status of Community Actions

8. Results
Status of Systems Actions
• Women’s groups supported gap fill, adaptation for continued delivery of
nutrition services.
• Tele-monitoring process visibilised their efforts, and enabled an understanding of
adaptations on the ground
96.20
82.91 83.54
77.85
65.82
59.49
87.34
92.52
88.44
82.99
91.84
84.35
66.67
82.31
0.00
20.00
40.00
60.00
80.00
100.00
120.00
PDS ANC Services THR IFA
Supplementation
Calcium
supplementation
Mid day meal Home visits to hIgh
risk PW by ASHA
Chhattisgarh, Bihar, Odisha Combined
Continuity of nutrition services for adolescent girls and pregnant women as reported by
Poshan Sakhis and Kishori Sakhis
During Lockdown Post Lockdown

9. • Indicators were developed based on government/ SRLM’s
Monthly Programme Reporting format. This process can be
integrated with government MIS systems.
• Regular implementation can help create time-series data,
collected directly from the community at the block level
that can be used to evaluate the program implementation
strategy and support corrective action.
• Viable option in developing countries due to the rapid
digitization, can reduce the gap between monitoring and
intervention.
• Process helped identify areas of capacity building for
community-based FLWs, and can be used to design
programmes that integrate tele-based or digital
interventions for nutrition service delivery.
Policy implications
Generated practical insights on using tele-
monitoring to assess continuity of a community-
led programme, that is government owned
• Completion rate of > 98% in both rounds
• Familiarity with data collectors and indicators in
the questionnaire, minimised non-response
• Appointments, planning data collection around
respondents' work schedule, enabled better
reliability of data shared.
• Having three or less response options made it
easy for respondents to understand and answer
• Data collectors' gender impacted their ability to
reach respondents; gendered phone ownership
• Checking and validation of information
collected, selection bias