The Governance Behind Better Nutrition

The inclusion of Rajasthan’s Cash Plus programme in India’s Economic Survey 2025–26 is more than a recognition of a successful state initiative. It is an acknowledgement that some of India’s most stubborn nutrition challenges can be addressed when governments combine financial support with behavioural change and institutional innovation.The recognition comes alongside a landmark study in Nature Health evaluating Rajasthan’s government led Cash Plus model, which combined maternity cash transfers with targeted social and behaviour change communication. Based on more than 90,000 mother infant pairs, the study found a 21% reduction in low birth weight and significant improvements in maternal pregnancy weight, offering compelling evidence for a scalable approach to improving maternal and child nutrition.Yet the most important lessons from Rajasthan extend beyond the outcomes themselves. They lie in the governance choices that made those outcomes possible.The first lesson is that smart public financing can accelerate nutrition outcomes. By introducing MMMPY alongside PMMVY, Rajasthan extended maternity benefits to second pregnancies and moved closer to universal coverage up to second parity. Equally important, the state aligned existing communication resources and placed behaviour change at the centre of programme delivery. The convergence of cash support and targeted behavioural interventions strengthened the nutritional impact of public investments.The second lesson is that frontline workers are most effective when investments in training are matched by investments in motivation and support. As highlighted in the Economic Survey, Rajasthan went beyond conventional capacity building by equipping anganwadi workers, ASHAs and ANMs with practical counselling tools, structured guidance, supportive supervision and performance incentives. This transformed them into trusted agents of change, ensuring that programme benefits translated into better outcomes for women and children.The third lesson is that cash alone does not improve nutrition; purpose does. Rajasthan complemented financial assistance with sustained communication and actively engaged husbands, mothers-in-law and other family decision-makers. Nutrition outcomes improved not simply because cash reached women, but because families increasingly supported the behaviours needed to convert cash into better nutrition.The fourth lesson is that ease of access and ease of delivery go hand in hand. Rajasthan’s paperless MMMPY architecture reduced barriers for beneficiaries while improving efficiency, transparency and accountability for government systems. By making entitlements easier to access and benefits easier to deliver, the programme strengthened trust between citizens and the state, demonstrating that effective governance is as much about thoughtful design and user experience as it is about technology.The implications extend far beyond Rajasthan.For Indian states struggling with high levels of low birth weight, undernutrition and maternal health challenges, Rajasthan offers a practical blueprint rooted in government systems rather than externally driven pilots. The model demonstrates that substantial improvements can be achieved through convergence, administrative innovation and behaviour-centred design.Rajasthan’s experience also offers lessons for national policy. While PMMVY and Poshan Abhiyaan share a common objective, they continue to operate through separate administrative structures. Rajasthan demonstrates that integrating cash transfers with structured behaviour change interventions can create a more coherent and effective pathway for improving maternal and child nutrition.Finally, Rajasthan’s success offers lessons for the Global South.Many countries already operate some form of cash transfer or social protection programme. Yet evidence increasingly suggests that cash alone may not always deliver the full range of human development outcomes policymakers seek. Rajasthan’s experience demonstrates the value of complementing financial assistance with carefully designed behaviour change strategies that address social norms, household decision-making and community engagement.The exact results may differ across contexts, cultures and delivery systems. However, the underlying principle is widely applicable: combining economic support with behavioural interventions can produce outcomes greater than either approach alone.At a time when countries are searching for practical solutions to improve maternal and child health, Rajasthan has demonstrated that meaningful progress does not always require reinventing systems. It requires aligning resources, institutions, incentives and human behaviour around a common purpose. Its success is a reminder that when governance is both thoughtful and well executed, transformative change is not only possible, it is achievable at scale.(The views expressed are personal)This article is authored by Raghwesh Ranjan, senior director, IPE Global.