The COVID-19 pandemic and resulting lockdowns had significant negative impacts on communities in South Asia served by Action Against Hunger according to two rapid assessment surveys. The surveys found that household incomes decreased drastically, food insecurity increased in many areas, and stress and anxiety levels remained high. Action Against Hunger used the survey results to refocus their work on continuing routine services while also providing COVID-19 relief in the hardest-hit areas where income loss was highest and access to health services was most reduced.

1. DELIVERING FOR NUTRITION IN SOUTH ASIA
Implementation Research in the Context of COVID-19
02/12/2021
Isha Rangnekar
Officer – Nutrition and Research
Action Against Hunger, India
Dr. Pawankumar Patil1, Isha Rangnekar1, Gyanika Narayanaswamy, Nancy Gupta,
Aakanksha Pandey1, Rashmi Panigrahi1, Snigdha Sahal1
1Action Against Hunger India
UNDERSTANDING THE
REALITY: THE PANDEMIC
AND ITS EFFECTS

2. BACKGROUND
• Action Against Hunger India works in 4 states towards the prevention, early
detection, and treatment of malnutrition.
• In the three states of Maharashtra, Madhya Pradesh, and Rajasthan, the
primary beneficiaries include malnourished children, pregnant, and
lactating women.
• The outbreak of coronavirus disease (COVID 19), first reported in
December 2019 has continued to be a global pandemic.
• The three intervention states of Action Against Hunger India were among
the top ten states in terms of number of COVID 19 cases being reported.
• The imposed lockdown created multiple challenges in accessing the basic
healthcare and nutrition services.
• It also caused a sudden halt in Action Against Hunger India’s on-field
activities.
• The unprecedented situation made it imperative to assess the impact of
the pandemic in the intervention areas to prioritize actions.

3. • To assess the impact of COVID-19 pandemic and the subsequent lockdown on access to health and
nutrition services, food security and livelihood of the fragile communities served by Action Against
Hunger, India.
• To formulate data-driven strategies for prioritization and continuation of Action Against Hunger India's
health and nutrition services for vulnerable communities.
RATIONALE

4. RAJASTHAN
• Rural tribal
MADHYA PRADESH
• Rural tribal
MAHARASHTRA
• Rural tribal – Dharni and Palghar
• Urban slum – Mumbai (Andheri
and Govandi)
Dhar
📍
Baran📍
Dharni
📍
Palghar
📍
Mumbai
📍
Descriptive analysis and crosstabulation were conducted for quantitative data.
Inductive analysis was done for qualitative data.
METHOD
Jan
‘20
Feb
‘20
Mar
‘20
Apr
‘20
May
‘20
Jun
‘20
Jul
‘20
Aug
‘20
Sep
‘20
COVID-19
outbreak in
India
Nationwide
imposed
lockdown
RAS 1
(N = 257)
RAS 2
(N = 616)
Two mixed-methods, cross-sectional, rapid assessment surveys (RAS) with
structured and semi-structured questionnaires
• Pregnant women
• Lactating mothers
• Caregivers of SAM/MAM children
DATA
COLLECTION
SURVEY DESIGN
DATA
ANALYSIS
Malnutrition
status of
children
Needs and
support
IYCF
practices
Food
insecurity
Access to health
and nutrition
services
IPC measures
and WASH
practices
Income
loss
Mental
health
DOMAINS OF
ASSESSMENT

5. RESULTS

6. IMPACT OF LOCKDOWN ON MONTHLY HOUSEHOLD INCOME
51
57 63
3
56
67
76
7
4
17 11
16
19
62
24
60
19
68
26
48
20
7
4
9
38
18
36
6
32 33
5
100
26
96
16
0%
20%
40%
60%
80%
100%
Before After Before After Before After Before After Before After Before After
Baran Dhar Dharni Palghar Andheri Govandi
Household income (%) (N=247)
INR 0 INR 0-1000 INR 1001-5000 INR 5001 and above
4 6 7 13 8
19
8
6 3 7
2
28
20
40
1
1
1
4
51
63
41
59
50
52
63
49
4
27
2
37
49
26
50
28
48
6
18
4
94
52
97
51
0%
20%
40%
60%
80%
100%
Before After Before After Before After Before After Before After Before After
Baran Dhar Dharni Palghar Andheri Govandi
Household income (%) (N=520)
INR 0 INR 0-1000 INR 1001-5000 INR 5001 and above
23
38
48
26
52
69
0
20
40
60
80
Baran Dhar Palghar Dharni Andheri Govandi
Average income loss (%)
0-25% (IR 1) 26-50% (IR 2) 51-75% (IR 3) 76-100% (IR 4)
67
57 66
94
79
91
0
20
40
60
80
100
Baran Dhar Palghar Dharni Andheri Govandi
Average Income Loss (%)
0-25% (IR 1) 26-50% (IR 2) 51-75% (IR 3) 76-100% (IR 4)
RAS 1 (May '20) RAS 2 (Aug '20)
• After the COVID 19 lockdown, there
was a drastic reduction in income for a
majority of respondents across all
locations.
• Among the six surveyed locations,
respondents from Dharni, Andheri and
Govandi experienced the highest
percentages of average income loss.
• By Aug '20, there was a great reduction
in the percentage of respondents with
no monthly household income.
• However, 48-96% of the respondents
across all locations still had income less
than Rs.5000/month.

7. SOURCES OF FINANCIAL SUSTAINABILITY DURING LOCKDOWN
• With sudden loss of income, by May
'20, utilization of savings became the
most prominent form of financial
sustainability for respondents from all
locations.
• By Aug '20, with ease of lockdown to
some extent, financial sustainability
from ongoing income started factoring
in.
• However, the dependence on loans
also increased at most of the locations.
27 26 23
12
25 25
49 55
41 62
71
48
49
21
22
23
29
23
24
26 53
42
11
9
0
20
40
60
80
100
120
140
160
Baran
(N=45)
Dhar
(N=47)
Palghar
(N=64)
Dharni
(N=26)
Andheri
(N=28)
Govandi
(N=44)
Financial sources during lockdown (%) (N=254)
Ongoing income from job/work Savings Loans Other
44
18
10
39 37 34
32
30 46
31
54
44
34
61
24
29
28 54
46
21
50 16
1
3
0
20
40
60
80
100
120
140
160
Baran
(N=93)
Dhar
(N=87)
Palghar
(N=90)
Dharni
(N=90)
Andheri
(N=67)
Govandi
(N=89)
Financial sources during lockdown (%) (N=516)
Ongoing income from job/work Savings Loans Other
RAS 1 (May ‘20) RAS 2 (Aug ‘20)
‘Other’ sources include Government cash vouchers, selling assets, PMGKY, MGNREGA

8. HOUSEHOLD FOOD INSECURITY
RAS 1 (May '20) RAS 2 (Aug '20)
47 52
58
65
27
44
7
12
12
11
12
19
44 22
17
16
19
8
2
15 14
8
42
28
0%
20%
40%
60%
80%
100%
Dharni
(N = 59)
Palghar
(N = 60)
Dhar
(N = 59)
Baran
(N = 62)
Govandi
(N = 59)
Andheri
(N = 36)
Household Food Insecurity Prevalence (%)
(N = 335)
Secure (FI 1) Mildly Insecure (FI 2)
Moderately Insecure (FI 3) Severely Insecure (FI 4)
• In the initial phase of lockdown, more
than 50% of the households at most
locations experienced food insecurity
with more than 25% of the households
facing severe food insecurity.
• By Aug '20, food security improved to
some extent in Andheri, Baran, Dhar and
Palghar.
• However, during the same period, food
insecurity in Govandi worsened with 42%
households experiencing severe
insecurity.
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
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0%
20%
40%
60%
80%
100%
Dharni
(N = 26)
Palghar
(N = 64)
Dhar
(N = 47)
Baran
(N = 45)
Govandi
(N = 45)
Andheri
(N = 28)
Household Food Insecurity Prevalence (%)
(N = 255)
Secure (FI 1) Mildly Insecure (FI 2)
Moderately Insecure (FI 3) Severely Insecure (FI 4)
Household food insecurity calculated using the 'Household Food Insecurity Access Scale (HFIAS)
for Measurement of Food Access: Indicator Guide' by FHI 360/FANTA

9. STRESS AND ANXIETY
29
7
2 6 7 6
42
29
24 21
34
25
20
34 52 51
40
33
5
3
7 9 4
7
3
27
15 13 13
30
0%
20%
40%
60%
80%
100%
Baran
(N= 93)
Dhar
(N=89)
Palghar
(N=91)
Dharni
(N=90)
Andheri
(N=67)
Govandi
(N=89)
Frequency of feeling stress and Anxiety (%)
(N = 519)
Never Once a week 2-3 days a week 3-5 days a week Everyday
• The sudden lockdown had its implications
such as disruption in access to health and
nutrition services, movement restrictions,
and drastic loss of income.
• The fear of infection additionally weighed in
to all these aspects.
• A reflection of this can be seen in the
frequency of stress experienced by the
respondents on a weekly basis.
• At both timepoints, the frequency of feeling
stress and anxiety was more than 2-3 days a
week for a majority of the respondents.
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE][CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE][CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE]
[CELLRANGE][CELLRANGE]
[CELLRANGE]
[CELLRANGE]
0%
20%
40%
60%
80%
100%
Baran
(N = 45)
Dhar
(N = 47)
Palghar
(N = 64)
Dharni
(N = 26)
Andheri
(N = 28)
Govandi
(N = 45)
Frequency of feeling stress and anxiety (%)
(N = 255)
Never Once a week 2-3 days a week 3-5 days a week Everyday
RAS 1 (May 20) RAS 2 (Aug 20)

10. • Building on RAS learnings, Action Against Hunger India re-strategized their work to continue reaching
out to beneficiaries and maintaining routine services along with providing COVID-19 related additional
critical support.
• Relief efforts were initiated and remained continued in targeted areas where there was high income
loss, food insecurity, and drastic reduction in accessing health and nutrition services.
• Such utilization focused rapid assessments can aid in identifying hotspots demanding immediate
attention and developing rapid response to similar future crises and disasters.
POLICY IMPLICATIONS

11. THANK YOU!