Lessons Learned from the Evaluation of Helen Keller international’s 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 International’s 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.
Increase production
Enhanced-Homestead Food Production (EHFP) program in Burkina Faso
Establish Village Model Farms
Provide agriculture
training
Provide nutrition
and health-related training
Establish home
gardens
Distribute agriculture
and zoological
inputsProgram enhancements:
• Targeted to mothers with children 3-12 mo of age
• Increased focus on women• Improved behavior change
communication (BCC) strategy
Increase income &
assets
Increase consumption
Improve nutrition,
health and hygiene practices
Improve maternal & child
health & nutrition
outcomes
Study design for HKI’s EHFP program in Burkina Faso
200 9
2010
Feb.
-M
ay
443 households400 women395 children
55 eligible villages (water + population criteria)
15 villages randomly assigned Older Women Leader (OWL) BCC
512 baseline households
15 villages randomly assigned Health Committee (HC) BCC
514 baseline households
25 villages randomly assigned Control group
741 baseline households
15 Villages 75 Women
60 KI
2011
Apr.-
May
441 households407 women376 children
15 villages 75 Women
75 Men 75 KI
14 Villages 70 Women
58 KI
14 Villages 70 Women
70 Men58 KI
597 households565 women511 children
15 Villages 75 Women
15 Villages 75 Women
75 Men
2012
Mar
.-Jun
e
What impact did the EHFP program have on children’s and women’s nutritional status and women’s empowerment?
2 y impact on children’s stunting, wasting and diarrhea
* P<0.01, ** P<0.05Olney et al., Journal of Nutrition 2015
Diarrhea prevalence, children aged 3-12 mo at baseline
0 20
5
10
15
20
25
30
35
Control villages
Older women leader villages
Health committee villages
Survey time point, y
Dia
rrhe
a (%
) -15.9 pp **-9.8 pp *
0 20
5
10
15
20
25
30
35
Control villages
Older women leader villages
Health committee villages
Survey time point, y
Was
ting
(%)
-8.8 pp**
Wasting prevalence, children aged 3-12 mo at baseline
0 205
101520253035404550
Control villages
Older women leader villages
Health committee villages
Survey time point, y
Stun
ting
(%)
**
Stunting prevalence, children aged 3-12 mo at baseline
2 y impact on children’s anemia
0 270
75
80
85
90
95
100
Control villagesOlder women leader villages Health committee villages
Survey time point, yA
nem
ia (%
)
-14.6 pp**
Anemia prevalence, children aged 3-5.9 at baseline
0 270
75
80
85
90
95
100
Control villagesOlder women leader villages Health committee villages
Survey time point, y
Ane
mia
(%)
Anemia prevalence, children aged 3-12.9 at baseline
* P<0.01, ** P<0.05Olney et al., Journal of Nutrition 2015
2 y impact on mother’s underweight and body mass index (BMI)
** P<0.05 for DID estimates, * P<0.10 for interaction.
Olney et al., Journal of Nutrition 2016
Change in the prevalence of underweight among women1
0 210%
15%
20%
25%
30%
Control Intervention
Survey time point, y
Und
erw
eigh
t (%
)
-8.7 pp**
Change in women’s body mass index (BMI) by underweight status at baseline1
0 217
18
19
20
21
22
Underweight BL, control Underweight BL, interventionNot underweight BL, control Not underweight, intervention
Survey time point, y M
ean
BM
I
0.52*
2 y impact on women’s overall empowerment, decision-making and social capital
** P<0.05 for DID estimates.
Olney et al., Journal of Nutrition 2016
0 20
10
20
30
Overall score (0-37)
Control Program
Survey time point, y
3.1**• 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 children‘s and women’s nutritional status and women’s 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 men’s and women’s opinions about
women’s 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 • Children’s 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
Quiñones 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!!