Opportunities for enhancing dietary diversity and environmental sustainability of supplementary nutrition program under the Integrated Child Development Services Scheme - a qualitative study in Srikakulam district, Andhra Pradesh

Abstract

Background

Malnutrition in all its forms remains a critical public health challenge in India. Public food procurement (PFP) serves as a potential entry point for addressing malnutrition while promoting sustainable food systems. The Integrated Child Development Services (ICDS) Scheme, a major PFP initiative in India, plays a crucial role in improving the nutritional status of vulnerable populations. This study explored opportunities to enhance dietary diversity and environmental sustainability within the Supplementary Nutrition Program (SNP) under ICDS in Andhra Pradesh.

Methods

An exploratory qualitative study was conducted in eleven purposively selected villages of two blocks of Srikakulam district, Andhra Pradesh engaging with program implementers and facilitators at grassroots level along with community members. Through key informant interviews and focus group discussions, the study first identified key stakeholders involved across the supply chain of SNP-ICDS and gathered selected stakeholders’ perceptions regarding program challenges and opportunities for food diversification while enhancing environmental sustainability. Data from the discussions were analysed using thematic analysis deploying inductive approach.

Result

Findings highlight operational challenges such as delays in delivery of food items through centralized supply chain, improper food storage and technological barriers with the online application used for distributing the take-home ration. Stakeholders emphasized the potential of local food procurement, establishment of kitchen gardens, and millet inclusion in the menu to enhance both dietary diversity and environmental sustainability. Additionally, strengthening community engagement, nutrition education, and skill-based training for grassroots workers were highlighted as crucial strategies for improving food acceptability and dietary diversity.

Conclusion

The study highlights opportunities to enhance dietary diversity and integrate environmental sustainability within the SNP-ICDS through local food procurement. Fostering community engagement and addressing logistical challenges, budget constraints could enhance program effectiveness. Advocacy for policy reforms at higher levels, particularly promotion of local procurement and decentralising fund allocation is recommended to enhance the effectiveness of SNP-ICDS.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-24313-8.

Background

Malnutrition in all its forms is a major contributor to death and disease globally. Sustainable Development Goal 2.2 specifically aims to “end malnutrition in all its forms”, with a particular focus on addressing nutritional needs of vulnerable groups like children under five, pregnant and lactating women, and adolescent girls by 2030 [1]. In India, child and maternal malnutrition remains the single largest risk factor, accounting for 15% of the total disease burden [2]. As per the National Family Health Survey 5 (2019–2021), India still has unacceptably high levels of malnutrition among children under 5 years of age with 35.5% being stunted, 19.3% wasted, 32.1% underweight, while 3.4% being overweight [3]. The Comprehensive National Nutrition Survey (2016–2018) reveals an increasing prevalence of Non Communicable Diseases (NCDs) among children and adolescents [4], with one in ten school-aged child and adolescent being pre-diabetic, and 5% having high cholesterol levels. Evidence also suggests that 18.7% of women aged 18 to 49 years are undernourished and 24% are overweight or obese [3]. The World Health Organization (WHO) has advocated for double-duty actions as a strategy to concurrently address multiple forms of malnutrition, including undernutrition, overnutrition and diet-related non-communicable diseases [5].

Food systems can lead to climate and environmental changes and at the same time are vulnerable to the same. Climate change is affecting food security through increasing temperatures, changing rainfall patterns, and high frequency of extreme events. These disruptions introduce instability in the food supply and reduce access to nutrient dense and healthy foods. On the other hand, unsustainable food production and consumption practices contribute to natural resource depletion, environmental degradation, and climate change. Together, these interconnected challenges are ultimately leading to food and nutrition security [6]. The report from Intergovernmental Panel on Climate Change (IPCC) identifies diversification in the food systems and consumption of healthy and sustainable diets as key strategies to reduce greenhouse gas emissions while also improving health outcomes [7].

Governments worldwide have a responsibility to tackle malnutrition in all its forms while promoting sustainable food systems in line with the Sustainable Development Goals, SDG 2 (Zero Hunger), and Target 2.4 that promotes sustainable food production systems. Transforming food systems to support both human and planetary health is therefore crucial. Public food procurement (PFP) presents a unique opportunity to attain these goals. PFP refers to food provision processes led by public authorities using public funds, and can expand across the entire food supply chain from production and purchasing to preparation, and distribution [8]. PFP is recognized as a key strategy for promoting healthy and sustainable diets due to its extensive reach and its potential to shape both food production and consumption [9]. India has several PFP programs with wide-reaching impact, aimed at addressing food and nutrition security for vulnerable groups, including young children, pregnant women, and lactating mothers.

The Integrated Child Development Services (ICDS) Scheme is a major PFP program in India, delivering crucial health and nutrition services to children under six years of age, and pregnant and lactating women, through Anganwadi centres (AWCs). The Supplementary Nutrition Program (SNP) under ICDS aims to bridge the protein-energy gap through Take-Home Rations (THR) and Hot Cooked Meals (HCM) provided to beneficiaries [7]. Despite notable progress, their effectiveness and outreach remain suboptimal owing to challenges such as inconsistent functioning of AWCs, irregular food distribution, inadequate quantity and quality of food, and limited budgetary allocations [10]. Another challenge is excessive emphasis on macronutrient content while ignoring the micronutrient content and overall nutritional quality [10–12].

SNP-ICDS has a potential to serve as a platform for double duty actions, thus addressing all forms of malnutrition among children. Food diversification can be a key strategy to improve both dietary quality and sustainability of meals provided by SNP-ICDS. Some innovations in this direction are incorporation of millets, and adding nutrient dense food groups such as milk, eggs, fruits, and green leafy vegetables to the current food basket. However, achieving this diversification requires careful consideration on investments to address budgetary constraints, local preferences and logistic feasibility [13]. Enhancing dietary diversity of any program requires a thorough understanding of food procurement and distribution, accessibility of foods to be included, local dietary patterns and preferences of the target group [13]. Thus, the present study aims to inform opportunities to improve health and environmental impact of SNP-ICDS in selected villages of Srikakulam district, Andhra Pradesh. To achieve this, we first, characterized food items and meals provided through the program, mapped various stages of the food supply chain and identified key stakeholders involved in its planning and implementation. Secondly, we explored perceptions of program stakeholders on key aspects of the program, gaps, and challenges in its implementation. Lastly, we explored stakeholder’s perceptions on practical solutions for diversifying foods provided for better health and nutrition of young children and women and enhancing environmental sustainability of the program.

Methods

This study is part of a broader research initiative that aims to develop a sustainable food systems intervention to enhance dietary diversity, reduce risk of malnutrition and diet-related NCDs with environmental co-benefits in rural communities of two states, Andhra Pradesh and Chhattisgarh, India. The present study is part of the formative component, examining the current functioning of one of the PFP programs to identify gaps and inform future interventions.

Study design, locale and duration

This study was conducted in 11 villages selected through convenience sampling from the Mandasa and Vajarapukotturu blocks (administrative unit at sub district level) of Srikakulam district of Andhra Pradesh, India. The selection of villages was based on ensuring equal representation of participants across two study blocks, logistic feasibility for data collection and local administrative support. Figure 2 provides a schematic representation of the study’s sampling strategy. The study was conducted between August 2024 to November 2024.

Fig. 2.

Steps in mapping of food supply chain and the stakeholders involved

Study participants

Study participants were sampled from a preliminary list of stakeholders involved directly or indirectly in the SNP-ICDS at the grassroots level. This comprised of (i) program implementers such as Anganwadi supervisor, Anganwadi worker (AWW), Anganwadi helper (AWH), (ii) facilitators like community health workers (Accredited Social Health Activist (ASHA)), Panchayati Raj Institution (PRI) members, village leaders, village/ward volunteers (appointed members of village secretariate), as well as (iii) program beneficiaries such as mothers of children (6 months to 6 years), and lactating women. Additional stakeholders involved in program implementation were identified during the stakeholder mapping exercise and were included in the study.

Data collection

Data were collected in two steps (Fig. 1). First, we mapped the SNP-ICDS food supply chain and identified key stakeholders involved. Subsequently, we conducted in-depth qualitative enquiries with selected stakeholders at the sub-block and village level.

Fig. 1.

Schematic workflow of the study

Mapping of food supply chain and stakeholders involved

We conducted participatory exercises with program implementation stakeholders to first identify the raw ingredients used for THR and HCM provided through SNP-ICDS and then map the supply chain of each ingredient along with the key stakeholders involved at various stages of the supply chain.

An adapted Net-Map tool [14] was utilized for this purpose. Net-Map is a group interview-based tool that facilitates understanding of the relationships and influences of stakeholders through visualisation exercises [14]. We adapted the tool (additional file 1) to elicit information on interconnections between key stakeholders influencing the flow of commodities across different supply chain stages, and purchase requisitions of commodities and their timely delivery. We also elicited information on the level of influence of each stakeholder, using a 0 to 5 scale. We specifically assessed their influence in (i) effective program implementation such as ensuring quality, timely delivery of food, and adequate quantities of foods distributed to program beneficiaries (ii) smooth disbursement of funds, (iii) ability to make changes in the program. The mapping activity was conducted as a participatory exercise using chart paper, markers, post-it notes, and coins (Fig. 2). The steps involved in this activity are illustrated in Fig. 2.

In-depth qualitative enquiries

Based on the mapping, specific stakeholders were identified for further in-depth qualitative enquiries. Key informant interviews (KIIs) were conducted with program implementation stakeholders, such as Anganwadi supervisor, AWWs, AWH, ASHAs. Details were elicited on various program procedures, such as procurement of raw ingredients, budget allocations, storage, meal preparation and distribution along with the implementation challenges faced. Their perceptions on quality and diversity of foods, and environmental impact of different stages of the supply chain were also sought.

Additionally, focus group discussions (FGDs) with program facilitators such as PRIs, village leaders, ward members as well as program beneficiaries were conducted. This aimed to gather information on acceptability of foods/meals distributed, expectations and gaps in the program along with local food preferences. Further, all the stakeholder groups were prompted for their suggestions on diversifying foods/meals provided under the program along with enhancing the environmental sustainability. The discussions conducted were audio recorded after taking prior consent from each participant.

Semi structured KII and FGD guides (additional files 2, 3 and 4) with open ended probes tailored to each stakeholder group were used for in-depth qualitative enquiries. The study tools were pretested, refined and finalized before the actual data collection. A Telugu speaking translator (trained by research team) facilitated the interviews and group discussions.

Data analysis

The recorded interviews and discussions were transcribed and translated from Telugu to English. For stakeholder mapping, different points of the food supply chain of the program, stakeholders, links, and levels of influence from all network maps were collated in a Microsoft Excel sheet informed by chart papers and interview transcripts. All information was combined and presented in a single stakeholder network map in which a node represents a stakeholder, the size of node represents the level of influence, and colour-coded arrows between nodes represent the direction and type of linkage. R software (version 4.4.1) was used for data visualization.

Data analysis of in-depth interviews and focus group discussions was done using N-Vivo (version 12). The content of the transcripts was coded and analysed using thematic analysis deploying inductive approach. This involved delving through the dataset, identifying patterns, and systematically coding. Finally, different themes were derived on key aspects of the program influencing dietary diversity and environmental sustainability and the potential opportunities to improve the same.

The nutrient content of the raw ingredients used in HCM and THR items provided per beneficiary was calculated using the Indian Food Composition Table [15] and nutritional labels for packaged products. For the nutrient calculation for HCM, the amount of food ingredients provided per beneficiary was taken from the state government website [16] and vegetables were excluded since the amounts for these were not specified. The nutrient composition was then compared with the nutritional standards set by the Ministry of Consumer Affairs, Food and Public Distribution [17] to assess the adequacy of the supplementary foods provided.

Results

Key findings from supply chain and stakeholder mapping exercise

A total of 12 stakeholders from four villages participated in the stakeholder mapping exercise (Table 1). We conducted one mapping exercise in each village.

Table 1.

Details of participants for network mapping exercise

S. no	Village code	Participant’s designation*	Number of participants
1.	V1	AWW, AWH, ASHAs	4
2.	V2	AWW, AWH, ASHA, MSK	4
3.	V9	AWW, AWH	2
4.	V10	AWW, AWH	2

Anganwadi Worker (AWW),Anganwadi Helper (AWH),Accredited Social Health Activist (ASHA),Mahila Samrakshna Karyadarshi (MSK, a member of village secretariate)

Food items and meals distributed through the supplementary nutrition program under integrated child development services scheme

The AWCs provides HCM to children aged three to six years daily and THR to children aged six months to three years and pregnant and lactating women monthly. Tables 2 and 3 present the details of food items and meals provided as part of HCM and THR respectively. The detailed nutritional content of these food items can be found in the additional file 5. The THR provided to pregnant and lactating women exceeds the recommended nutritional standards [17] for energy and carbohydrates by more than twofold (Table 4). In addition, the protein, fat, calcium, and iron content surpass the recommended values (Table 4). This is due to provision of additional supplementary food items, referred to as “nutrient kits,” funded through the state government’s budget. For children aged 6 months to 3 years, the combined nutrient content of THR items exceeds the recommended amounts for all nutrients, except for fat in the 1 to 3-year age group (Table 4). The calcium and iron contents of THR are very high as compared to the recommended standards, mainly contributed by the micronutrient fortified premix, Balamrutham.

Table 2.

Weekly Cyclic menu for hot-cooked meals (HCM) for children (3 to 6 years)

Days	Menu
Monday	Boiled rice, pulse preparation, cucumber, boiled egg, milk
Tuesday	Pulihora, tomato-pulse preparation, boiled egg, milk
Wednesday	Rice, pulses preparation mixed with green leafy vegetable, egg curry, milk
Thursday	Rice, vegetable sambhar, green leafy vegetable curry, boiled egg, milk
Friday	Rice, ridge gourd/bottle gourd-pulse preparation, drumstick leaves/spinach curry, boiled egg, milk
Saturday	Vegetable rice, green leafy vegetable curry, vegetable sambhar, boiled egg, milk

Pulihora is a traditional rice preparation with tamarind, curry leaves, and spices. Sambhar is a south-Indian delicacy prepared with lentils and vegetables

Note: Milk (100 ml), Egg (1 whole) each day

Table 3.

Monthly take home ration provisions

Pregnant and lactating women		Children 6 months to 3 years
Food item	Amount/month	Food item	Amount/month
Rice	3 Kg	Balamrutham*	2.5 Kg
Pulses	1 Kg
Palm oil	500 gm
Egg	25 pcs	Egg	25 pcs
Milk	5 L (200–250 ml/day)	Milk	2.5 L (100 ml/day)
Nutrition kit
Ragi	2 Kg
Rice flakes	1 Kg
Jaggery	250 gm
Dates, dry	250 gm
Groundnut chikki/brittle	250 gm

Note: Balamrutham is the micronutrient fortified premix food with wheat, bengal gram dal, milk powder, oil and sugar as key ingredients

Table 4.

Comparison of THR and HCM nutritional composition with recommended nutritional standards for supplementary food provided under ICDS as per gazette notification by Ministry of consumer affairs, 2023 [17]

Beneficiaries	Energy		Protein		Fat		Carbohydrate		Calcium		Iron		Total Folates		Vitamin A
Pregnant and lactating women	200%	↑	158%	↑	113%	↑	269%	↑	208%	↑	147%	↑	81%	↓	84%	↓
Children 6–12 months	264%	↑	211%	↑	141%	↑	NA	-	519%	↑↑	1453%	↑↑	231%	↑	581%	↑↑
Children 12–36 months	132%	↑	106%	✔	84%	↓	NA	-	384%	↑↑	509%	↑↑	158%	↑	363%	↑↑
Children 3 to 6 years	108%	✔	129%	✔	77%	↓	131%	↑	112%	✔	71%	↓	141%	↑	165%	↑

Note: ✔ indicates that the recommendation is met as per the guidelines, ↑ suggests that the nutrient content is higher than recommended, ↑↑ provides very high amount of the nutrient than recommended, ↓ provides below the recommendation

Supply chain for food items distributed under SNP-ICDS: process overview and key stakeholders

Raw ingredients for hot cooked meals, like rice, pulse (red gram), and palm oil, are sourced by Food Corporation of India (FCI) warehouses/godowns (Fig. 3). The Food Corporation of India (FCI) is a nodal agency that manages procurement, storage, transportation, and distribution of food commodities under the Public Distribution System (PDS). The PDS is managed by the Ministry of Consumer Affairs, Food and Public Distribution and provides subsidized food commodities to economically disadvantaged groups in the community as well as other supplementary feeding programs in school and Anganwadi centres. Items are delivered from FCI godowns at various levels viz. state, district, and block to the village level fair price shop, which is a commodity distribution outlet. Finally, they are transported to AWCs via a vehicle (mobile dispensing units). Vegetables, roots, tubers, sugar, salt, and spices are purchased from local markets by the AWWs (Fig. 3).

Fig. 3.

Supply chain of SNP-ICDS and key stakeholders involved

Food Corporation of India (FCI), Project Director (PD), Mandal Revenue Officer (MRO), Upper Divisional Clerk (UDC), Child Development Project Officer (CDPO), Mobile Dispensing Unit operator (MDUo), Anganwadi worker (AWW), Anganwadi Helper (AWH), Mahila Samraksha Karyadarshi (MSK)

Take-home ration items are supplied through impanelled producers and suppliers (commonly known as private contractors) via private godowns registered with the Ministry of Women and Child Development, Government of Andhra Pradesh. Blended premix (Balamrutham) is supplied through centralized production agency at the state level (Andhra Pradesh Foods Limited) while other THR items (eggs, milk, nutrition kits) are procured through government appointed suppliers in the same/nearby districts. These are then transported to district and then block level private godown before they finally reach the AWC.

Contrary to food ingredient supply, information regarding purchasing decisions starts from AWCs (Fig. 3). Based on enrolment of beneficiaries, the AWW generates requirements for THR items and raw ingredients for HCM using a mobile based application (named as YSR Sampoorna Poshana). The AWW also submits indent order copies physically to the Anganwadi supervisor who communicates these to the Child Development Project Officer (CDPO) at the block level (Table 5). A clerk (upper divisional clerk, UDC) processes documents and forwards indent to the block level FCI godown under Department of Food and Civil Supplies for food items procured through PDS (Table 5) (Fig. 3). Through the mobile application, an indent order is created in the account of Project Director (ICDS in-charge at district level). The order is then placed for the concerned district with the state-level private agency for Balamrutham and with suppliers for providing items like eggs, milk, and nutrition kits at the district level. Key stakeholders identified through network mapping along with their responsibilities is presented in Table 5.

Table 5.

Key stakeholders identified through network mapping along with their responsibilities

Key stakeholders identified	Department	Responsibility
Project Director (PD)	Women and Child Development	SNP- ICDS in-charge at district level
Deputy Tehsildar, Mandal Revenue Officer (MRO)	Food and Civil Supplies	In-charge of block/mandal level stock point
Upper Divisional Clerk (UDC)	Women and Child Development	Oversees supply requests at block level
Child Development Project Officer (CDPO)		SNP-ICDS in-charge at the block level
Anganwadi supervisor		Link between CDPO and AWW, foresees activities of a group of AWCs (cluster)
Anganwadi worker (AWW)		Frontline nutrition worker, delivers nutrition and health services under the ICDS scheme
Anganwadi helper (AWH)		Cooks and distributes the food, assists AWW
Private contractor		In-charge of divisional level godown for THR, transports THR to different AWCs
Fair Price Shop (FPS) Dealer	Food and Civil Supplies	Fair Price Shop/godown owner
Mobile Dispensing Unit operator (MDO)		Supplies food commodities from village godown at the doorstep of AWCs through a vehicle
Panchayat head (Sarpanch), Mahila Samraksha Karyadarshi (MSK)	Panchayati Raj Institution	Members of village secretariat (gram sachivalayam), a local self-government, responsible for periodic quality checking of food at AWC
Market vendor	-	Supplies raw ingredients for HCM
Beneficiaries	-	Recipients of food distributed at AWC

The Influence level of stakeholders varied across different types of influence (Fig. 4). Stakeholders at the grassroots level, such as AWW and AWH were deemed most influential in ensuring effective program implementation, followed by the CDPO and Anganwadi supervisor. Stakeholders at the mid-level hierarchy including the CDPO, UDC and Anganwadi supervisor were identified as most influential for ensuring smooth disbursement of funds. The Project Director (responsible for overseeing implementation of ICDS services at district level) was recognized as the single most influential person for budget allocations, making changes in food supply chain and logistics, and menu adjustments such as modifying recipes, or adding new food items to the menu within the program. Figure 4 illustrates the stakeholders identified and their influence levels for effective program implementation and smooth disbursement of funds.

Fig. 4.

Key stakeholders and their level of influence

Each node represents a stakeholder, greater size of node represents greater level of influence. Colour coded arrows represent interconnections between stakeholders with respect to food flow (green) and information flow related to indent order (blue). Stakeholders such as Mandal Revenue Officer, Mobile Dispensing Officer, members of village secretariate appear as isolated nodes indicating that these stakeholders belong to the network but are not interconnected with others with respect to flow of commodities, and making/receiving purchase requisitions

Key findings from in-depth interviews and focus group discussions

Specific stakeholders identified through the network mapping exercise were contacted for in-depth interviews and focus group discussions. This resulted in a total of 5 in-depth interviews and six focus group discussions in 10 villages (Table 6).

Table 6.

Details of participants for interviews and focus group discussions

S.no	Village code	Participant type	Total	Male	Female
KII 1.	V2	AWW, AWH	2	-	2
KII 2.	V4	AWW, AWH	2	-	2
KII 3.	V5	AWW, AWH, ASHA	3	-	3
KII 4.	V11	AWW, AWH	2	-	2
KII 5.	-	Private contractor	1	1	-
FGD 1.	V6	PRI members, community leader	5	-	5
FGD 2.	V7	PRI members, Anganwadi supervisor, AWWs	5	3	2
FGD 3.	V1	PRI members, community leader, AWWs, ASHAs	9	5	4
FGD 4.	V9	PRI members, AWW, ASHA	7	3	4
FGD 5.	V11	PRI members, village volunteers, AWW, ASHA	18	5	13
FGD 6.	V13	Community leader, community members	6	2	4
FGD 7.	V8	Community members	6	1	5

Anganwadi Worker (AWW), Anganwadi Helper (AWH), Accredited Social Health Activist (ASHA), Mahila Samrakshna Karyadarshi (MSK) and village volunteers are members of village secretariate, Panchayati Raj Institution (PRI)

Key aspects across supply chain stages impacting dietary diversity and environmental sustainability

Procurement of food items distributed as take-home ration and food ingredients for hot cooked meals

The THR food items and HCM raw ingredients obtained via PDS were reported to be delivered timely, facilitated by the online indent system through the mobile application. However, some AWWs mentioned occasional delays in receiving supplies from the PDS (rice, pulses, and palm oil). This may be attributed to the longer supply chain and supply of food products from the FCI godowns at various levels viz. state, district, and block to the village level fair price shop and finally to the AWCs. The budget allocated for procurement of food ingredients from local markets was perceived as inadequate with no considerations for market price fluctuations. Delays in bill reimbursement, sometimes extending beyond three to four months, posed challenges in purchasing necessary food ingredients (Fig. 5).

Fig. 5.

Key aspects across different supply chain stages impacting dietary diversity and environmental sustainability, with potential improvement opportunities

Storage of take-home ration and ingredients for hot cooked meals

Raw food items were stored within the AWC or adjacent school buildings, typically stored for a short duration (4–5 days). However, one AWW raised concerns about storage challenges, due to pests and rodents, leading to food wastage, especially during the rainy season, suggesting installation of well-sealed and secured doors for protection.

Distribution of take-home ration

The distribution of THR was facilitated through a mobile-based software called ‘YSR Sampoorna Poshana’. AWWs reported technological challenges with the software’s built-in face recognition system and data synchronization due to network issues, which adds to their already demanding schedules and occasionally results in delays (Fig. 5).

“We face problems with this face recognition. For these photos our union conducted a strike, and we did not take the photos. But they cut my salary for 3 days.” - AWW, Village 11.

Preparation of hot-cooked meals

AWWs follow a state-level standardized weekly HCM menu (Table 2) with flexibility to include locally available vegetables based on community preferences. Regional greens like gogu (Roselle), amaranth, and spinach are commonly used in curries or pulse preparations. Some AWWs also prepare scrambled eggs with vegetables instead of boiled eggs to diversify diets and improve acceptability.

ICDS functionaries and members of PRIs, perceived the quality of HCM as good, mentioning variety in meals and inclusion of diverse food groups. Both ICDS functionaries and PRIs expressed willingness to further diversify the menu.

“The menu given is well planned. The menu has leafy vegetables, vegetables and everything. We cannot plan a menu which is much better. Our rice has more quality and the one in the ration shop is different as it is fortified rice”- AWW, Village 4.

“The menu is good. The children are being taken care in a good manner. Till date, all the recipes are tasty”- PRI member, Village 1.

Utilization and acceptability of take-home ration and hot cooked meals among community members

The community members were satisfied with the nutritional quality of the foods distributed.

“The food being given now is enough for a pregnant or lactating mother. Everything is protein food. I do not need anything else”- Respondent 1 (woman), Village 13.

It was highlighted that the milk (5 L, for one month) gets used up within few days due to intra-household distribution (Fig. 5). Concerns were raised regarding fortified rice, with most community members perceiving the fortified rice kernels as plastic rice due to its lighter weight and tendency to float in water when cooked. The dissatisfaction with fortified rice could potentially decrease the consumption of other accompanying food items, such as green leafy vegetables and pulse preparations. Recommendations were made to increase frequency of green leafy vegetables and introduce new foods such as Figer millet preparations, vegetable curries. Local recipes preferred by children, such as lemon rice, pulses with green leafy vegetables, and mixed vegetable curries with rice, were identified during discussions.

The key aspects across the program’s supply chain stages that impact dietary diversity and environmental sustainability, along with potential opportunities for improvement is provided in Fig. 5.

Potential opportunities identified to diversify meals and enhance environment sustainability

Local production/procurement of food items

Most community members reported growing different crops in their farms and kitchen gardens. One of the opportunities identified was introduction of kitchen gardening at the AWC or other common space at the panchayat level. Some of the facilitators for construction of kitchen gardens were willingness among the stakeholders, support from higher authorities with supply of seeds, availability of space in most AWCs and newly launched water security program (Hiramandalam Lift Scheme) [18]. Both the ICDS functionaries and PRIs opined that if they are provided with necessary support such as fencing, water supply, seeds, and training they are willing to construct kitchen gardens.

“We must release panchayat funds; there is a provision for that. You will have to create awareness in the staff, and support us initially”- PRI, Village 6.

“When we go to markets, we get vegetables with chemicals and pesticides. If we can grow vegetables without pesticide, that would be better. The taste between these two varieties differs a lot. We have allocated money to buy the vegetables. But they should be available here”- Anganwadi Supervisor, Village 7.

Some AWWs reported attempting kitchen gardening outside the center but faced challenges sustaining it due to the absence of fencing or a protective boundary.

“Our main problem is grazing of animals. They release the animals for grazing, and they eat away everything. When gate was there, we had no problem. The wall is also broken in half. Therefore, we stopped growing plants”- AWW, Village 2.

Some stakeholders also highlighted other barriers for kitchen gardening intervention such as space constraints, limited water availability and dependency on rain for growing crops. Some villages were reported to be endemic to chronic kidney disease of unknown etiology (CKDu) [19], leading to misconceptions and concerns about using groundwater, perceived as a potential cause of the disease.

Inclusion of millets

In the current menu, finger millet was provided as a take-home ration to pregnant and lactating women. Program stakeholders and community members expressed that millets are beneficial for health and are preferred by them. AWWs recognized the importance of nutrition education in promoting millet consumption. Additionally, suggestions were made to include Ragi malt in the menu, similar to its provision in schools under the PM-POSHAN program.

“Our suggestion is to increase the quantity of millets and decrease the amount of rice. People will get accustomed to eating these millets slowly and the health will improve”- PRI, Village 6.

“Millets are liked by everyone, but people need to be made familiar about more varieties of millets. Only ragi is liked in this area. Fox tail millet, little millet and Kodo millet are not known to people. These need to be introduced from the childhood for community to develop a taste for it. We need to educate the mothers that millets are healthy” - AW Supervisor, Village 7.

Nutrition education

The ICDS functionaries perceived nutrition education sessions, currently provided monthly, as an important strategy for promoting good nutrition behaviour. These include demonstrating recipe ideas, using Balamrutham such as laddoos, dosa, Ukkili (traditional sweet), and biscuits to encourage mothers to incorporate it into child’s diet and encouraging consumption of fortified rice. Building on these existing efforts, nutrition education can be expanded further to enhance awareness and adoption of diverse, nutritious foods.

Skill based training of cooks

PRI members recommended hiring cooks with experience in bulk cooking to enhance acceptability of current preparations. Moreover, skill-based training for AWH on portion management and use of diverse food items could improve the nutritional value of HCM and can be imparted to beneficiaries to promote better nutritional outcomes within the community.

Logistics and supply chain dynamics for diet diversification and shortening supply chain

Stakeholders at grassroots level highlighted that intervention at higher policy levels is required to achieve changes such as meal diversification and shortening the food supply chain. The network mapping exercise identified the district-level Project Director as most influential stakeholder in this regard. Additionally, importance of allocating funds with consideration for market price fluctuations was also emphasized.

Discussion

The present study identified key areas for improvement and offer potential opportunities for enhancing dietary diversity and environmental sustainability within the SNP-ICDS in Srikakulam district, Andhra Pradesh. Stakeholder mapping identified AWWs and AWHs as most influential stakeholders at the grassroots level for ensuring effective program implementation. Mid-level stakeholders like the CDPO, supervisors, and clerk were key for fund disbursement, while the Project Director held a critical position in making higher-level decisions on budget allocations and changes in the menu. Supply side-stakeholders acknowledged efficient procurement of most food items. However, several operational challenges were reported, including delays in receiving food items from PDS, challenges in storage due to pest and rodents and technological barriers in face recognition system of online application used for distributing the THR. Additionally, the stakeholders perceived that the budget for purchasing food items from market were insufficient to cope with the market price fluctuations. These challenges can potentially affect distribution of diverse foods and hinder program effectiveness. Program beneficiaries expressed overall satisfaction with the nutritional quality of meals, though concerns were raised about the texture and digestibility of fortified rice. The study also identified potential opportunities, such as the establishment of kitchen gardens at AWCs, which could further enhance meal diversity along with local production and environmental sustainability. Nutrition education and skill-based training for AWWs and cooks were also emphasized as critical for improving food acceptability and dietary diversity.

The network mapping exercise in this study identified important stakeholders involved in the program, highlighted their respective influences for leveraging their roles for program improvement. The network mapping methodology has been used previously to identify stakeholders involved in infant and young child nutrition programs in South Asian countries [20], stakeholders working to address child stunting and anaemia in Ghana [21], and stakeholders involved in the development and implementation of front of pack labelling in China [22]. The insights into stakeholder influence are critical for effectively engaging with key stakeholders that have power to influence policies and effectively implement strategies to strengthen existing programs.

In the current study stakeholders reported delays in delivery of food items through the PDS. Centralized supply chains have been linked to logistical delays, inaccessibility in remote villages, corruption, limited dietary diversity and poor quality of foods, as highlighted in the national level evaluation of the ICDS program [10]. On the other hand, local food procurement contributes to sustainable development by offering social, economic, and environmental benefits. Research from countries like Poland, Vietnam, Brazil and Kenya demonstrates that decentralized food supply chains through local procurement can effectively address logistical delays and enhance dietary diversity in food programs. Brazil’s National School Feeding Program (SFP) and Kenya’s Home-Grown SFP successfully improved the variety of food offered and reduced transportation issues by sourcing from smallholder farmers [23, 24]. The SFP in Bangladesh that targets primary children of poor households, incentivizes women’s group to produce and supply vegetables. The initiative also empowers purchase committees to manage procurement costs, along with enabling governance for successful implementation [25]. These programs underscore the potential benefits of localized procurement over centralized supply chains in food programs. However, careful considerations relating governance structures, capital, capacity building at local levels, community engagement, quality control, and strong inventory management is crucial for effective program implementation [26, 27].

Stakeholders recommended local food production through establishment of kitchen gardens as a potential solution to tackle issues related to centralised supply chains. Institutional kitchen gardening has been recognized as a sustainable model for enhancing dietary diversity [28, 29]. The current study highlighted the potential of establishing institutional kitchen gardens if provided with additional support for seeds, capacity building, water and fencing. Similar findings have been reported in various studies conducted in low and middle income countries, underscoring operational challenges such as lack of time, space, work overload, need for appropriate funding for inputs, and community support in managing such kitchen gardening interventions [30, 31]. Inculcating a sense of shared ownership and responsibility within the community, and convergence with other government departments such as horticulture, water, rural development, and livelihood schemes can help in effective implementation of such intervention [24, 26]. Additionally, stakeholders in the present study were cognizant of the benefits of natural farming practices particularly avoiding use of chemicals and fertilizers. These practices are well-documented in the literature to support better health outcomes and contribute to environmental sustainability by preserving soil health, reducing water contamination, and promoting biodiversity [32, 33].

In the current study apprehensions were reported with the texture and digestibility of fortified rice. This could potentially decrease the consumption of other accompanying foods. Similar findings have been reported from states of Rajasthan, Maharashtra, Gujarat and Uttar Pradesh, where fortified rice is being supplied through PDS and the community being unaware of its importance, throw away the floating kernels [34]. Introducing new food items requires complementary strategies to ensure their acceptance. In Odisha, the incorporation of fortified rice into the SFP was supported by awareness campaigns, regular communication with program stakeholders, and community sensitization. Training on proper handling, including cleaning and cooking methods, was also provided to retain its nutritional value [35].

Stakeholders highlighted the role of nutrition education and skill-based training of AWWs for enhancing acceptability of meals. Studies from LMICs like Ghana and Kyrgyzstan have emphasized the role of training on food purchasing, food safety, nutrition, diet diversity, and low cost meal preparation for enhancing the efficiency of SPFs [36–38]. Additionally, Saksham Anganwadi and Poshan 2.0, (integrated nutrition support programme for young children, pregnant and lactating women) has capacity building of frontline functionaries on health and nutrition as its key pillars for improving the health and nutrition outcomes among SNP-ICDS beneficiaries. A progress report highlights the efficient use of online incremental learning modules on nutrition by supervisors and AWWs in Andhra Pradesh [39].

The study highlighted the use of digital platform (YSR Sampoorna Poshan) for raising indents and ensuring timely delivery of food ingredients. However, issues relating to face recognition systems and data synchronization led delays in distribution of THR. Similar findings have been highlighted in reports on digital tools like the ICDS-Common Application System and Poshan Tracker. These digital tools are crucial for beneficiary registration, AWC activity tracking, home visit scheduling, and access to training resources by AWWs and for monitoring real-time service delivery and nutritional outcomes by Supervisors and officials. Despite the potential of these digital platforms, persistent challenges such as dual data entry, difficulties in transitioning from previous systems, and limited training persists. This underscores the need for strengthening the digital systems, providing continuous support and training to AWWs and taking feedback at all levels for optimizing its use [40].

Advocacy efforts are vital for driving policy changes at both state and federal levels. The current study highlights the importance of advocacy efforts focusing on decentralized fund allocation i.e., providing funds directly to the grassroots level stakeholders, promoting local procurement of food items and contextualizing menu to reflect local preferences. Furthermore, reinforcing the optimal use of flexible funds for seasonal food items at the grassroots level is crucial. Prioritizing these strategies can ensure effective resource utilization and improved dietary diversity.

Strengths and limitations

The study deploys qualitative methods, including network mapping, in-depth interviews and focus group discussions from a wide range of stakeholders (both supply and demand side). This provides in-depth, context-specific insights into the SNP-ICDS program’s challenges and opportunities that quantitative data alone cannot offer. However, the study findings may not be generalizable to regions outside of Andhra Pradesh. The data mainly reflect perceptions from grassroots stakeholders and could be supplemented with inputs from mid-level program implementers and higher-level policymakers for a more comprehensive view. While the study identifies opportunities to improve public food procurement in participating communities, it does not fully explore the scalability of these solutions. Thus, further research is needed to validate the proposed interventions and assess their broader applicability.

Conclusion

The study suggests a significant opportunity to enhance dietary diversity and integrate environmental sustainability within the SNP-ICDS scheme by incorporating locally sourced food ingredients while promoting government supported initiatives such as institutional kitchen gardens as part of the SNP-ICDS. Program stakeholders expressed willingness to incorporate a more diverse range of local foods, but this requires addressing logistical challenges, technical capacity of the staff, budget constraints, and robust monitoring to ensure consistent supply and quality of food ingredients. Additionally, fostering collaboration across various government departments could substantially improve both diet diversity and sustainability, for instance, working with the horticulture department to create kitchen gardens as part of the AWCs. Fostering active community engagement can play a pivotal role in identifying culturally acceptable food options, mobilizing local resources and manpower to support institutional kitchen gardens and creating demand for diverse institutional meals for children. In addition, it is also crucial to promote diversification of household-level diets and fostering healthier eating habits. Ultimately, a holistic approach that integrates diversified diets, strengthens community involvement, builds the capacity of frontline workers, and ensures robust monitoring is essential for enhancing program efficiency and improving health and nutrition outcomes.

Abbreviations

NCDs

Non-Communicable Diseases

PFP

Public Food Procurement

ICDS

Integrated Child Development Services

AWCs

Anganwadi centres

SNP

Supplementary Nutrition Program

THR

Take-Home Ration

HCM

Hot Cooked Meals

AWW

Anganwadi worker

AWH

Anganwadi Helper

ASHA

Accredited Social Health Activist

PRI

Panchayati Raj Institution

FGD

Focus Group Discussion

KII

Key Informant Interview

MSK

Mahila Samrakshna Karyadarshi

EAR

Estimated Average Requirement

FCI

Food Corporation of India

PDS

Public Distribution System

CDPO

Child Development Project Officer

PM-POSHAN

Pradhan Mantri Poshan Shakti Nirman

SFP

School Feeding Program

Authors’ contributions

SGJ and PS conceived and designed the study. SGJ, AD, VS, SK conducted the qualitative data collection. SGJ and AD analysed the data. AD prepared the first draft of the manuscript. SGJ, PS, VS, SK critiqued and modified the draft. SGJ had final responsibility for the decision to submit for publication. All authors read and approved the final version.

Funding

This research was funded by the NIHR-Global Health Research Centre award scheme (Grant number GHRC for NCDs and EC: NIHR203247) using UK international development funding from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Ethical approval was taken from the Institutional Ethics Committee at The George Institute for Global Health, Delhi. Administrative permissions from authorities at district level (health department) and cluster level verbal consent from the village leaders were obtained before conducting the FGDs and interviews. Written informed consent was obtained from literate respondents, and third-party witnessed verbal consents were sought from illiterate respondents. All respondents were informed that the FGDs and interviews were being audio recorded. Personal identifiers were removed from the transcripts, and the data was anonymized to protect confidentiality.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.