Operations Research Case Study: HKI/Nepal – Baitadi with NTAG & SMJK Action Against Malnutrition through Agriculture
May 26, 2015
Operations Research Case Study:
HKI/Nepal – Baitadi with NTAG & SMJK
Action Against Malnutrition through Agriculture (“AAMA”)
CORE May 2, 2012
Background
HKI has implemented Homestead Food Production (HFP) programs linked with nutrition education for >20 years to improve simultaneously food access, quality and utilization
Evidence of impact on production, consumption, income, inconclusive on nutritional status
Lack of highly rigorous studies to evaluate both impact and quality of delivery (process)
Background
AAMA child survival project began Sept 2008 Project strategy combines HFP to improve access to nutrient dense plant and animal-source foods with Essential Nutrition Actions to promote optimal nutrition practices (“EHFP”)
Targets mothers with children in nutritional “window of opportunity”
Baitadi and Kailali [and Bajura] districts of Far Western Region
Research to answer long-standing challenge
Operations Research Objectives Community randomized control trial to determine
impact of EHFP on nutritional status (growth) of children < 2yrs and use program impact pathways to demonstrate plausibility
Hypothesis: Exposure to EHFP will reduce stunting by 10% underweight by 10% wasting by 5% In children 12-48 months of age exposed to program
during critical window Randomization by Illaka (4/4 of total 12), resulting in
n=21 intervention and n=20 control VDCs. Cross-sectional design; baseline survey n=2,106 HH
Impact
Supportive supervision
Project Monitoring and Evaluation
Input Process Outputs Outcomes
HKI, NTAG, SMJK, District Health, Agriculture and Livestock Offices, District Development Committee
HKI partners with local NGOs and
government
Village Model Farms
(VMF) established
Small animal production established
Increased production of nutrient-rich fruits & vegetables
HFPB groups established
Linkages to VMF, FCHVs and health
services
Agriculture inputs including seeds,
saplings and poultry
Nutrition & BCC-related
education
Improved and
developed gardens
established
Increased Income
Beneficiaries understand
nutrition education
Improved child care
and feeding practices
Beneficiaries understand agriculture
training
Increased animal
source food production
Increased household
consumption
Improved maternal and child
health and nutritional
status
Agriculture-related training
Out
com
e in
dica
tors
Impa
ct i
ndic
ator
s
Proc
ess/
Out
put i
ndic
ator
s
AAMA Program Impact Pathways schema
Support for Research
MCHIP staff was generous with technical support on research design, sample size challenges, spillover risks
IFPRI collaboration also contributed to PIP, research design
Strong project team including SMJK; input from Asia/Pacific Regional Nutrition Advisor and HQ Nutrition Program Manager
Additional funding from WB, Alive & Thrive, USAID/Nepal
Research Challenges
Defining age range for survey sample to capture maximum exposure to intervention during critical window of a “moving target”
Lengthy preparation before project fully operational (baseline survey; formative research; establish and supply VMFs; HFP training of trainers, VMFs, mothers; ENA training for FCHVs/VMFs, mothers; seasonal lag until production) vs. 4 year project life
Logistical difficulties of FW hill region Increasing equity of model
Operations Research
Have used LQAS following program pathways (targeting children <2 years - non-comparable with baseline). Findings informed steps to: Strengthen formative supervision of VMFs to
improve support to mothers; simplify reference materials
Strengthen poultry input supply systems in partnership with district livestock office
Address water constraints in partnership with district agriculture office
Add facilitation skills training to strengthen training impact
Address knowledge gaps of FCHV on ENA and HFP
Operations Research-successes Garden diversity increasing Dietary diversity increasing Reported EBF rates increasing Intake of Fe and VA rich foods, eggs
increasing Poultry cultivation accepted despite
cultural taboos “Superflour” use growing “Lactation management” major impact
Sharing Operations Research findings
Process monitoring results are shared on monthly basis with the project team, on a quarterly basis with FCHVs and health workers to improve performance, and regularly with other implementation partners
Strong and weak pathways on impact schema identified through data reviewed annually
Four HKI internal bulletins on “program implementation lessons learned” with government and development partners have been developed and disseminated
Additional Publications
Analyses of baseline data on HH food insecurity in Kailali and Baitadi (one published; one under review)
Manuscript on formative research process nearly complete but stalled due to time constraints
Additional nested sub-study (A&T) examining impact of EHFP vs. EHFP + micronutrient powders
Eventually findings of impact evaluation (end line survey August 2012)
Governance Impact
Additional support from USAID/Nepal has allowed HKI to reinforce GON strategy for multisectoral planning and collaboration to reduce malnutrition, including multisectoral nutrition plan
National, FWR and district planning workshops to define joint objectives and areas for integration VMFs integrated into extension system District-level nutrition & food security working groups Recognition of synergies and potential between
Agriculture, Health, Local Government Final results will ideally provide additional
momentum
Multisectoral governance for nutrition and food security at all levels
Thank you