Health Impacts of the Aspirational Districts Program in India: Evidence from District Level NFHS-5 Data

Background: Aspirational Districts (ADs) initiative was launched by Government of India in 2018 with the objective of reducing inter-district economic and social inequalities with health and nutrition, education, agriculture and water resources, financial inclusion and skill development and infrastructure as the focus areas for development. 117 most backward districts across the country were identified as aspirational districts (ADs) which received priority in funding and scheme implementation so that these districts can catch up with the rest of the districts. We conduct an impact evaluation of the AD initiative on the health and nutrition outcomes.Methods: The research employed a quasi-experimental approach, utilizing the difference-in-differences (DID) method and another method that combined propensity score matching with DID.Findings: The research found a positive impact of the AD program on maternal health through an increase in the percentage of home births attended by Skilled Birth Attendants (SBA) in the Aspirational Districts (ADs) by on an average 1.26% in the ADs. In addition, with respect to family planning an increase of 0.44% was found in percent of male sterilization. Additionally, weak evidence suggests a 3% improvement in ADs for immunization against the first dose of measles vaccine and three doses of penta or hepatitis B vaccine was observed. No strong evidence of adverse impacts of the AD initiative exist.Interpretation: The Aspirational District (AD) initiative, a flagship program of the Indian government, aims to address inter-district economic and social inequalities. Our research evaluated the impact of AD on health and nutrition outcomes. Using PSM-DID, we found significant improvements in home births attended by skilled birth attendants and an increase in percentage of male sterilization in ADs. No strong evidence of any adverse impact of AD was observed. Covid-19 pandemic and inter-sector competition for resources within a district might have undermined the performance of ADs on health and nutrition outcomes. Future research efforts should be put for a holistic impact evaluation of all the targeted sectors and outcomes of the AD initiative.Funding: None.Declaration of Interest: None of the authors have competing interests.