Implementation research gap map

Overview

This implementation research gap map (IRGM) provides quick and easy access to published and grey literature on the implementation of nutrition-specific interventions in India. It focusses on interventions that broadly classify as food supplementation, fortification, micronutrient supplementation, behaviour change counselling (BCC) and management of severe and acute malnutrition and maps these against 17 implementation outcomes at the programme, frontline worker (FLW) and participant level. It examines interventions targeted towards pregnant and lactating women and children below two years of age, given that the first 1000 days are critical and can have a profound impact on the child’s ability to grow and thrive.

Our systematic search of 13 databases and hand-search of 32 organisational websites yielded 24,133 records, which filtered down to 368 included papers that met our inclusion criteria after various rounds of screening based on population, interventions, comparators, outcomes and study design. The IRGM includes literature published between 2000-2018.

Drawing on the analysis of the 368 included papers, the IRGM reveals concentrations of evidence, where we may know more than we think, and key gaps where limited or no evidence exists. The IRGM will be a useful tool for policymakers who want to learn more about programme implementation and also point researchers to where gaps in evidence exists and more studies are needed.

International Food Policy Research Institute provided funding for project.

Main Findings

• The evidence base is large, but unevenly distributed among intervention types, with most of the research focusing on BCC, micronutrient supplementation and bundled interventions*.
• Fortification through micronutrient powder, delayed cord clamping and weighed during pregnancy are some of the least studied interventions.
• Given the India focus, over 66 percent of the included papers assess various components of the Integrated Child Development Services (ICDS) programme, a flagship national level programme that seeks to address the issue of under-nutrition among young children and nursing mothers.
• In terms of distribution across states, Uttar Pradesh, Bihar, Gujarat, Odisha and Maharashtra are top 5 most studied states.
• Most papers evaluate programmes for participant level uptake and coverage of the intervention, followed by FLW compliance, programme resources and participant knowledge.
• Barriers and facilitators are discussed and measured only in a small fraction of papers, and mostly in the case of bundled interventions.

Research Implications

Despite the impressive body of literature that the IRGM points to, there remain important limitations that future implementation research needs to address:

1. For a large body of included literature, the primary objective was not to study programme implementation. The papers therefore do not systematically capture relevant programmatic information or use laid out guidelines or manuals to assess implementation fidelity.
2. There is clear preference for studying implementation outcomes that are easy to measure and often tracked as part of regular programme monitoring.
3. There is limited attempt to understand if programme reach and other implementation outcomes vary by demographics of the targeted group. Only 78 papers do some kind of sub-group analysis for implementation outcomes.

Read the report | Read brief

Notes:

*In bundled interventions, we categorised studies that measured implementation outcomes at the system-level like quality of Anganwadi Centres (centres promoted under ICDS programme) and FLW job satisfaction.
**Study design (Other) mostly includes either pre-post studies or cross-sectional studies.
***Delivery platform (Others) mostly includes community health workers or service providers, who are not a part of ICDS, National Health Mission, Self-Help Groups or the healthcare system.
**** Nutritional outcome (Others) includes nutritional outcomes, which do not fall under any of the above listed categories like stunting, wasting, anaemia, underweight or over-weight. Some indicators coded as ‘Others’ includes Body Mass Index of target group, only height increase of target group and weight increase of target group. All nutritional outcomes have been coded at the level of the paper and not at the level of the implementation outcomes.