1. Operations
Research Case
Study:
HKI/Nepal –
Baitadi
with NTAG & SMJK
Action Against
Malnutrition
through
Agriculture

2. 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)

3. 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

4. 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

5. AAMA Program Impact Pathways schema
HKI, NTAG, SMJK, District Health, Agriculture and Livestock Offices, District Development Committee
Input Process Outputs Outcomes Impact
Improved
Agriculture inputs and
including developed
seeds, saplings and Supportive gardens Increased Increased
Process/Output indicators
poultry supervision establishe production Income
d of nutrient-
rich fruits &
Outcome indicators
vegetables
Impact indicators
Village Improved
Model Farms Small animal maternal
(VMF) production
HKI partners Agriculture- and child
established established Increased
with local related health and
NGOs and training household nutritional
Increased
government consumption
animal status
HFPB groups
Beneficiaries source food
established
understand production
agriculture
Nutrition training
& BCC-
related
Linkages to education
VMF, FCHVs Improved
and health Beneficiaries child care
services understand and feeding
nutrition practices
education
Project Monitoring and Evaluation

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. Multisectoral governance for
nutrition and food security at all
levels

14. Thank you