Evaluating India’s Intensified Diarrhea Control Fortnight: an analysis of the National Family Health Survey, 2015-2016

Abstract

Background Oral rehydration solution (ORS) has the potential to avert deaths from diarrheal diseases. Nevertheless, in poor nations only about half of children with diarrhea receive ORS. Since 2014, India has run an annual Intensified Diarrhea Control Fortnight to increase ORS treatment. A key element of the Fortnight plan is the free distribution of ORS to over 100 million homes with young children. Methods We compared ORS usage reported in the 2015/2016 National Family Health Survey in the 3 months before the 2015 and 2016 Fortnights to the 2 months after. We control for state fixed effects and for observable characteristics of the child and household. To reduce data mining, we use a machine learning method – cross-fit partialing-out lasso logistic regression. Results Our point estimate is that ORS usage rose 1.9 percentage points after the Fortnight, closing about 3% of the gap to universal usage. The increase is not statistically significant at conventional levels. These estimates are inconsistent with government claims that, in 2015, 63% of homes received free ORS. Conclusion The Fortnight did not achieve most of its goals. The intervention could benefit from more transparent monitoring, a more rigorous evaluation, and improvements in operations.