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