Inputs, Monitoring, and Crowd-out in India’s School-Based Health Interventions

Nutritional deficiencies are widespread in developing countries, affecting child health and learning. In India, nutritional deficiencies have led to efforts by the government to try various strategies to address the issue. Many of these programs rely on school infrastructure for implementation, such as the government mandated Mid-day Meal program, the world's largest school meals program. We evaluate the impact of three such school-based interventions on program implementation and child health in a rural district in India:

1. the distribution of a micronutrient mix (MNM) to be added to the school mid-day meal, using a randomized controlled trial;
2. a new government-run program, the Iron and Folic Acid (IFA) Supplementation program, which provided students with iron tablets, using a difference-in-differences strategy; and
3. monitoring of school meals, using random variation in monitoring intensity.

While we find significant and positive effects of distributing the MNM on micronutrients present in meals, we find no detectable effects on hemoglobin levels or on anthropometric measures of child health. We find suggestive evidence that the government's IFA supplementation improved hemoglobin, but our results indicate that the impact depends critically on how well the program is implemented. Increased monitoring of school meals, on the other hand, does improve hemoglobin levels. In addition, even though the additional monitoring only targeted meals, we find positive effects of the increased monitoring on how well the IFA program was implemented in schools. We find no effects of either intervention on learning, cognitive development or attendance. Finally, we find significant negative spillovers of the MNM intervention on how well the IFA program was implemented, suggesting that effort by school officials is crowded out by the introduction of the new MNM program.