olney 2016 ehfp evaluation presentation_re_sakss_conference_final2

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


25 villages randomly assigned Control group


15 Villages 75 Women

60 KI

2011

Apr.-

May


15 villages 75 Women

75 Men 75 KI


58 KI


70 Men58 KI




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




Was

ting

(%)

-8.8 pp**

Wasting prevalence, children aged 3-12 mo at baseline

0 205

101520253035404550

Control villages




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


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


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


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!!

olney 2016 ehfp evaluation presentation_re_sakss_conference_final2

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