Lessons Learned from the Evaluation of Helen Keller ...
Lessons Learned from the Evaluation of Helen Keller internationals Enhanced Homestead Food Production (EHFP) Program Presented by: Deanna Olney, PhD* October 19, 2016 * Olney, Dillon, Ruel, Nielsen. Lessons learned from the evaluation of Helen Keller Internationals Enhanced Homestead Food Production Program. AOTR Background The agriculture sector can improve nutrition especially through integrated agriculture and nutrition programs. Consistently improve agriculture production and dietary diversity (Leroy et al. 2008, Girard et al. 2012). Also posited to improve nutrition outcomes by simultaneously addressing the direct and underlying causes of undernutrition (Ruel et al. 2013). However, limited documented evidence exists about their impacts on nutrition outcomes and how impacts are achieved. Rigorous, comprehensive evaluations that include impact and process evaluations are needed to generate this evidence. Enhanced-Homestead Food Production (EHFP) program in Burkina Faso
Distribute agriculture and zoological inputs Establish Village Model Farms Establish home gardens Increase production Program enhancements: Targeted to mothers with children 3-12Provide mo of age agriculture Increased focus on women training Improved behavior change communication (BCC) Provide
strategy nutrition and healthrelated training Increase income & assets Increase consumption Improve nutrition, health and hygiene practices Improve maternal & child health & nutrition outcomes Study design for HKIs EHFP program in Burkina Faso 15 villages randomly assigned
Older Women Leader (OWL) BCC 512 baseline households 2012 Mar.-June 2011 Apr.-May 2010 Feb.May 200 9 55 eligible villages (water + population criteria) 15 villages randomly assigned Health Committee (HC) BCC 514 baseline households 25 villages randomly assigned Control group 741 baseline households 14 Villages 70 Women 58 KI 15 Villages
75 Women 15 Villages 75 Women 60 KI 443 households 400 women 395 children 15 villages 75 Women 75 Men 75 KI 441 households 407 women 376 children 14 Villages 70 Women 70 Men 58 KI 597 households 565 women 511 children 15 Villages 75 Women
75 Men What impact did the EHFP program have on childrens and womens nutritional status and womens empowerment? 2 y impact on childrens stunting, wasting and diarrhea 35 30 25 0 2 Survey time point, y Control villages Older women leader villages Health committee villages 35 30 25 20
** Diarrhea prevalence, children aged 3-12 mo at baseline Diarrhea (%) 50 45 40 35 30 25 20 15 10 5 0 Wasting prevalence, children aged 3-12 mo at baseline Wasting (%) Stunting (%) Stunting prevalence, children aged 3-12 mo at baseline 20
15 -8.8 pp** 15 10 10 5 5 0 -15.9 pp ** -9.8 pp * 0 2 Survey time point, y Control villages Older women leader villages Health committee villages
* P<0.01, ** P<0.05 Olney et al., Journal of Nutrition 2015 0 0 2 Survey time point, y Control villages Older women leader villages Health committee villages 2 y impact on childrens anemia Anemia prevalence, children aged 3-5.9 at baseline Anem ia (% ) Anem ia (%) Anemia prevalence, children aged 3-12.9 at baseline 100 95
100 95 90 90 85 85 80 80 75 75 70 0 2 Survey time point, y Control villages Older women leader villages Health committee villages
* P<0.01, ** P<0.05 Olney et al., Journal of Nutrition 2015 70 -14.6 pp** 0 2 Survey time point, y Control villages Older women leader villages Health committee villages 2 y impact on mothers underweight and body mass index (BMI) Change in womens body mass index (BMI) by underweight status at baseline1 Mean BMI U n d e rw e ig h t (% ) Change in the prevalence of underweight among women1
Survey time point, y Control Intervention ** P<0.05 for DID estimates, * P<0.10 for interaction. Olney et al., Journal of Nutrition 2016 0 2 Survey time point, y Underweight BL, control Underweight BL, intervention Not underweight BL, control Not underweight, intervention 2 y impact on womens overall empowerment, decisionmaking and social capital Overall score (0-37) 3.1** 30 20 10 0
0 2 Survey time point, y Control Program ** P<0.05 for DID estimates. Olney et al., Journal of Nutrition 2016 Significant impacts on meeting with other women, purchasing and health care decisions No impact on spousal communication, social support, family planning decisions or infant and young child feeding decisions. How did the EHFP program work to improve childrens and womens nutritional status and womens empowerment?
Production consumption pathway: What worked? Process evaluation Improved knowledge of optimal agriculture practices and adoption of some key practices Perceived increases in production of chickens, eggs and vegetables Impact evaluation Beneficiary women owned more chickens Beneficiary women produced more micronutrient-rich foods Production consumption pathway: What needed improvement? Process evaluation Water constraints HKI worked to decrease water constraints through a variety of methods such as creating new wells and boreholes, repairing existing water sources, using drip irrigation kits, etc. Perceived inadequacies in supplies Motivation and compensation of local implementers Timing and duration of the program Impact evaluation Impact on household level production Production income pathway:
What worked? Process evaluation Positive changes in mens and womens opinions about womens ability to own and use land changed Beneficiary women maintained control over their gardens, food produced and income generated Impact evaluation Beneficiary compared to non-beneficiary women: Owned more agriculture assets Owned more chickens Produced more micronutrient-rich foods Knowledge adoption of optimal health and nutrition practices pathway: What worked? Process evaluation Knowledge of some optimal health, hygiene and nutrition practices improved Impact evaluation Knowledge and adoption of some key practices improved Mothers intake of micronutrient-rich foods increased Childrens dietary diversity increased Knowledge adoption of optimal health and nutrition practices pathway: What
needed improvement? Process evaluation Home visit frequency Motivation of local level program implementers Technical abilities and quality of program implementation by OWLs Understanding of BCC topics related to prevention and treatment of anemia HKI retrained nutrition trainers and in turn beneficiaries in the topics related to the prevention and treatment of anemia Impact evaluation Further improvements in knowledge and adoption of some of the promoted practices Conclusions The EHFP program improved child and maternal nutritional status and maternal empowerment Further reductions in anemia, diarrhea and stunting are needed Possible ways to achieve this are: Intervening earlier and for longer Improving delivery and utilization of some program components Re-examining issues related to motivation and compensation of program implementers Including additional interventions designed to address some of the other causes of undernutrition such as water, sanitation and hygiene (WASH) interventions or the provision of a fortified complementary food for children 6-24 mo of age
Acknowledgements Study participants in Burkina Faso Helen Keller International (HKI) HKI Burkina Faso: Abdoulaye Pedehombga, Marcellin Ouedraogo, Hippolyte Rouamba, Olivier Vebamba, Ann Tarini, Dr. Jean Celestin Somda and Fanny Yago-Wienne HKI headquarters: Victoria Quinn, Jennifer Nielsen Local implementing non-governmental organizations (NGOs) Burkina Faso - Association d'Appui et de Promotion Rurale du Gulmu (APRG) Research team at the International Food Policy Research Institute (IFPRI) and Michigan State University IFPRI and Michigan State: Andrew Dillon IFPRI: Marie Ruel, Mara van den Bold, Elyse Iruhiriye, Lilia Bliznashka, Julia Behrman, Esteban Quiones and Jessica Heckert Funding: The Office of U.S. Foreign Disaster Assistance (OFDA) of the U.S. Agency for International Development (USAID) Gender, Agriculture, and Assets Project (GAAP), supported by the Bill and Melinda Gates Foundation European Commission (EC) CGIAR Research Program on Agriculture for Nutrition and Health (A4NH) led by the International Food Policy Research Institute (IFPRI) THANK YOU!!
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