India’s public health challenge today no longer lacks proven solutions, but the complexity of delivering them consistently and equitably at scale remains. From anemia and parasitic infections to access to safe drinking water, the country has robust national programs in place. Yet outcomes hinge on how effectively these policies translate into last-mile action. This is where organizations like Evidence Action play a critical systems-strengthening role.
In this interview with TheCSRUniverse, Ankur Garg, Executive Vice President & India Country Director at Evidence Action, offers a grounded look at how evidence, cost-effectiveness, and implementation discipline can drive sustained public health outcomes. Drawing from the organization’s deep engagement with flagship government initiatives such as National Deworming Day, Iron and Folic Acid supplementation under Anemia Mukt Bharat, and safe water programs, the conversation moves beyond headline coverage numbers to examine adherence, data-driven course correction, and institutional ownership. The discussion also situates anemia prevention within a broader human capital lens- linking nutrition to education, gender equity, and long-term productivity.
Read the full interview for more insights:
Q. To begin with, could you briefly outline Evidence Action’s work in India – what are the main areas that you work in and the scope and scale of your projects?
A. Evidence Action, through its technical partner EAII Advisors, partners with governments to translate strong public health policies into effective large-scale delivery. In India, Evidence
Action supports the implementation of the National Deworming Day (NDD) Program in 3 states,
Iron and Folic Acid (IFA) Supplementation Program in 7 states, and the India Safe Water Program in 2 states and light-touch technical assistance in one state.
Under our health and nutrition vertical, we focus on two major child and adolescent health programs: school-based deworming under National Deworming Day and Iron and Folic Acid supplementation under Anemia Mukt Bharat. These programs reach children at critical developmental stages—from 6 months to 19 years—when health and nutrition investments strongly influence growth, learning readiness, and future productivity. Our India Safe Water program is based on evidence that shows water treatment is one of the most cost-effective ways to save children’s lives. Evidence Action uses In-Line Chlorination (ILC), a technology installed directly into piped water systems, automatically chlorinating all water that passes through.
Evidence Action works as a technical assistance partner, embedded within government systems like schools and anganwadis strengthening implementation planning, operational processes, and coordination across departments. Because this work is institutionally owned and integrated into public infrastructure, it’s designed to be sustainable at scale.
The National Deworming Day initiative reached 220+ million children in 11 states in 2020, making it one of the world’s largest programs of its kind. Under IFA supplementation, in 2024 alone, we reached approximately 27 million children across five states.
Q. You support large-scale IFA supplementation in multiple states, particularly through schools. What distinguishes your approach from more conventional nutrition interventions and how does it reflect in broader outcomes of your programs?
A. We don’t operate a parallel nutrition project—we support governments to strengthen their existing flagship programs in practice. Coverage isn’t just a tablet handed to a child, but whether tablets are actually consumed as intended. This matters because anemia reduction depends on consistent adherence over time, not one-time reach.
We focus on last-mile consistency and evidence-based corrective measures. Iron supplementation is well-proven; the challenge is ensuring it reaches millions of beneficiaries regularly and predictably.
We bring experience from other large-scale public delivery platforms, using structured cycles, defined target groups, and standardized protocols to reinforce implementation discipline.
Evidence Action operationalizes cost-effectiveness through a Data-to-Action model: collecting data to identify gaps in real time, drive corrective actions, and ensure resources deliver sustained anemia reduction. We’ve built strategic expertise in critical, underserved areas—expanding IFA coverage to private schools and pioneering systematic interventions for under-5 anemia prevention.
Q. Evidence Action is known for its emphasis on evidence and cost-effectiveness. How do data, monitoring, and feedback loops inform course correction and ensure that IFA programs translate into sustained outcomes?
A. Evidence first is a core value for us—we follow the data wherever it leads. We prioritize decision-grade, actionable data explicitly designed to strengthen implementation, not just track targets.
Cost-effectiveness drives every decision. We track both government and technical assistance costs to assess value for money and identify where support creates the greatest gains in coverage and impact.
Our monitoring systems identify delivery bottlenecks early through routine checks by regional coordinators and independent monitors, enabling real-time course correction. Findings are systematically reviewed in structured district and block-level forums where roles, timelines, and corrective actions are clearly defined.
Coverage and compliance surveys complement this by diagnosing where and why gaps persist—interviewing students, parents, and service providers to surface last-mile barriers. We leverage technology and AI-enabled tools to accelerate analysis, allowing teams to focus on decision-making rather than data processing.
Working with independent evaluators maintains methodological rigor while keeping data collection practical and sustainable at scale. Together, these systems enable continuous course correction, ensuring IFA programs deliver sustained anemia reduction cost-effectively.
Q. What have been the biggest operational or behavioural challenges in driving uptake and adherence to IFA supplementation at scale and how did you address them?
A. Adherence at scale isn’t just about tablets, it’s about making the system predictable and the intervention trusted. Operationally, ensuring a reliable last-mile supply chain is critical. We’ve addressed this by supporting better target estimation, streamlined distribution planning, stock monitoring tools, and regular data reviews so issues are identified and corrected early.
Frontline readiness is equally important. We help departments simplify training materials, provide clear job aids, and strengthen review mechanisms so frontline workers feel confident about dosage, schedules, and reporting.
Behaviorally, adherence is influenced by perceptions, concerns about side effects, lack of understanding of benefits, or irregular consumption. We support age-appropriate communication and community sensitization, equipping frontline workers with simple messages about why supplementation matters during growth and learning years. Integrating supplementation into routine school and anganwadi schedules helps normalize it as regular health practice.
Data visibility is cross-cutting. Without timely information, it’s difficult to know whether low coverage is due to supply, delivery, or acceptance issues. When supply is reliable, frontline workers are confident, and communities understand the purpose, uptake improves and programs become sustainable.
Q. There is growing evidence linking iron deficiency to attention, cognition, and learning outcomes. How important is it for India to view anemia not just as a health issue, but as an education and productivity concern and is your organization advocating in this direction?
A. It’s extremely important for India to view iron deficiency not only as a health concern but as a human capital issue affecting learning, educational attainment, and long-term productivity. This is particularly critical given that nearly 60% of Indian children aged 6-59 months are anemic (NFHS-5), with prevalence remaining high among school-age children and adolescents in critical learning and growth phases.
Iron plays a vital role in brain development, attention, and energy levels. When children and adolescents are iron deficient, it affects their ability to concentrate, participate actively in school, and absorb learning. This has direct implications for how well children engage in the classroom and build the foundation for future economic participation.
By supporting reliable delivery of IFA supplementation through school and anganadi platforms, we contribute to improved learning readiness and school participation alongside health gains.
Because these interventions are delivered through both health and education platforms, they naturally sit at the intersection of the two sectors.
Q. Anemia disproportionately affects adolescent girls and young women. How do you see IFA programs contributing to gender equity, educational continuity, and long-term economic participation?
A. Anemia among adolescent girls isn’t just a health concern, it’s closely linked to gender equity, education continuity, and long-term economic participation. Adolescence is a critical window. Girls enter this phase with increased iron requirements, and their nutritional status during these years carries forward into adulthood, including the childbearing years.
Addressing iron deficiency at this stage is both an immediate health intervention and a future investment, supporting young women today and influencing maternal and child health outcomes in the next generation.
When iron deficiency goes unaddressed, it leads to fatigue, reduced concentration, and lower physical stamina, disrupting school attendance and classroom engagement during key educational years. Regular IFA supplementation helps reduce these barriers by systematically reaching adolescent girls through schools and community platforms, including those who may not otherwise access services.
Over the longer term, improved iron status supports better cognitive function, physical capacity, and overall well-being—influencing a young woman’s ability to complete education, transition into skills or employment pathways, and participate productively in the workforce.
From a public health standpoint, preventing anemia during adolescence also reduces the future burden of disease, often reflected in disability-adjusted life years. Early and consistent intervention supports both individual opportunity and broader societal gains.
Q. What insights from Evidence Action’s broader nutrition portfolio have been integrated into the IFA Supplementation program’s approach to reaching students in private schools?
A. Recognizing that nearly a quarter of school-aged children attend private schools, we adopted a strategic approach from our National Deworming Day experience—beginning with systematic mapping, followed by rigorous advocacy to secure inclusion at state and district levels.
We ensured close coordination with private school associations and government departments to align planning, budgeting, and operational processes with Anemia Mukt Bharat guidelines. Capacity building of teachers and nodal staff was prioritized through structured training, while drug supply and logistics were streamlined to ensure timely availability and adherence to weekly supplementation schedules.
Monitoring and reporting mechanisms were strengthened through real-time data collection and periodic review meetings, ensuring accountability and high-quality coverage.
This integrated approach extends IFA supplementation to children in private schools equitably, addressing iron deficiency while maintaining consistency with government school programs—ultimately contributing to improved health, nutrition, and learning outcomes at scale.
Q. As discussed above, anemia prevention intersects with multiple systems- health, education, women and child development. How important is convergence across ministries and frontline delivery systems, and where do you see the biggest coordination gaps today?
A. Convergence is fundamental to anemia prevention, well reflected in the Government of India’s Anemia Mukt Bharat strategy bringing together health, education, and women & child development.
When efforts are aligned, delivery becomes more predictable and efficient. An important but often less visible aspect is recognition of each other’s roles and contributions. Frontline delivery depends on teachers, health workers, and anganwadi staff working toward the same goal.
Coordination challenges still arise in operational synchronization—aligning timelines for distribution, ensuring consistent reporting flows, and maintaining regular joint review mechanisms at district and block levels. Differences in administrative processes and data systems can slow coordination.
Another gap is ensuring convergence at policy level translates into joint ownership at the last mile. If the full system doesn’t move together, delivery weakens at the frontline. Our role as a technical partner is supporting these practical coordination processes—helping institutionalize joint planning, shared monitoring, and regular review forums so combined efforts translate into reliable service delivery.
Q. What policy or implementation-level shifts would you like to see from the government to accelerate progress on anemia reduction?
A. Improving compliance and regular supplementation among children under five is critical, where delivery depends heavily on community-based platforms and caregiver engagement. Clearer processes, stronger follow-up mechanisms, and uninterrupted supply at the community level are important.
Maintaining a reliable and uninterrupted supply chain across all delivery points remains fundamental. Even short disruptions affect coverage and confidence. Strategic use of anemia testing, particularly for high-risk groups, can complement routine supplementation by identifying severe cases and informing local planning.
Supportive supervision and robust monitoring systems are key. Regular review, feedback, and problem-solving at district and sub-district levels help translate policy into consistent action on the ground. Finally, ensuring supplementation is viewed as a universal service across school platforms, including private schools, will help close remaining coverage gaps and strengthen equity in reach.
Q. Looking ahead, how do you envision the role of organizations like Evidence Action evolving as India moves toward more outcome-driven public health programs?
A. As India moves toward outcome-driven public health programs, our role evolves from primarily supporting implementation scale to helping systems become more analytical, adaptive, and equity-oriented.
When the focus shifts to outcomes, the key question becomes not only “Was the program delivered” but “Who benefited and who did not?” That shift brings greater attention to populations requiring more deliberate focus—like early childhood (under-5 years) where interventions have lifelong implications for cognitive development, or students in private schools who may not be fully visible in routine public systems.
We can add value by helping governments interpret data to reveal such gaps, strengthening feedback loops between implementation performance and population outcomes, and supporting course correction where disparities emerge. Outcome-driven programs also require the discipline of rigorous cost-effectiveness analysis and counterfactual thinking — understanding not just what happened, but what would have happened without the intervention and whether alternative approaches could deliver greater impact per rupee invested.
Another dimension is supporting governments in linking service delivery metrics with broader development outcomes, learning readiness, attendance, long-term productivity, so public health programs are seen as investments in human capital, not only service coverage.
The future role is less about adding new programs and more about being a systems performance partner—helping governments sharpen measurement, improve responsiveness, and ensure outcome gains are equitable and sustained across age groups and delivery platforms.
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