India's Tamil Nadu Nutrition Program : Lessons and Issues in Management and Capacity Development
The Tamil Nadu Nutrition Program (TINP) is one of very few around the world that has reduced malnutrition on a large scale, and over a long period. It did well because it coupled good strategies and strong commitment at the sectoral level with good micro-design at the field level. Success factors included intensive sector analysis prior to the program's design, which helped build political and financial commitment to nutrition, as well as a sound technical basis for the program ; careful choice of committed managers, at least during the first ten years ; using paid village level workers, resulting in low drop-outs and high motivation ; well designed recruitment criteria, ensuring that field workers were competent and acceptable to clients ; a carefully planned training and supervision system, which was entirely field rather institution based-a model worth testing in other countries ; a focus on a small number of interventions, tightly targeted on high risk clients, which made field workers' jobs feasible ; an efficient management information system, which provided rapid feedback to clients at the local level, as well as program managers ; involving local communities through information campaigns before the program began, and using women's and children's groups to help with implementation. But TINP was not an unqualified success, and much can be learned from its weaknesses: the commitment and integrity of program management declined substantially after the first ten years, program performance might have suffered less if local communities had been empowered to play a greater role in worker supervision and quality control; the health referral system never worked well, and more could have been done to identify food insecure families, and enroll them in existing food security programs; TINP's support systems in nutrition communications, operational research and program evaluation remained weak, because capacity strengthening plans were not developed for them the Bank failed to carry out analytical work on management and capacity development issues, despite continuing capacity constraints in the nutrition program.