The SHOUHARDO Program in Bangladesh was a large-scale nutrition and food security program funded by USAID and the Government of Bangladesh from 2004-2010 with total funding of USD 126 million. The program aimed to sustainably reduce chronic and transitory food insecurity among the most disadvantaged people in 18 districts of Bangladesh, reaching over 2 million beneficiaries across 400,000 households. Key outcomes of the program included significant reductions in stunting prevalence, increased access to healthcare and sanitation, women's empowerment, and strengthened community resilience.

1. The SHOUHARDO Program Impact (Transforming Lives)
CARE Bangladesh
Funded by USAID and the Government of Bangladesh
Total Funding: USD 126 Million
Duration: October 2004 – May 2010
Presented By: Faheem Khan (Chief of Party)

2. NUTRITION – IS IT REALLY THAT IMPORTANT………
The consequences of malnutrition include childhood
morbidity and mortality, poor physical and mental
development and school performance, and reduced adult size
and capacity for physical work
This in turn has an impact on economic productivity at the
national level (WHO, 1995a)

3. Goal and Working Area of SHOUHARDO
North Char
Haor
Goal:
Sustainably reduce chronic and
Transitory food insecurity of the
Most disadvantaged and hardest
Mid Char To reach 400,000 households
(2 million beneficiaries)
in 18 districts
Of bangladesh
Coastal

10. So why are we so confident………..

11. Less
Non-Formal Antenatal
Less Loans Care
More
Advance Labour Assets Iron/Folic
Higher Acid
Income
Less Better
Migration Services
Vitamin
Safe Water Reduce A
“Stunting”
Better Immunization
Food &
Health Env. Diet
Diversification
Sanitary Behaviour
Less Latrines Change
Underweight Hand
Less
Washing
Diarrhea Breast
Feeding

12. At least 3 antenatal visits Antenatal
- Baseline: 16% Care
- Endline: 58% - Baseline: 27%
- Difference: + 266% - Endline: 81% Iron/Folic
- Difference: + 197% Acid
- National: 32%
Better
Services
- Baseline: 68%
- Endline: 84% Vitamin
- Difference: + 22% A
- National: 76% Immunization
Mother (1.5 M of delivery)
Child (in last 6 mnth) - Baseline: 9%
- Baseline: 62% - Endline: 79%
- Endline: 86% - Difference: + 739%
- Difference: + 38%

13. HH Diet Diverse. Score
-Baseline: 5%
- Endline: 6% - Baseline: 89%
- Difference: + 26% - Endline: 93%
- Difference: + 4%
Diet
Diversification
Behaviour
Change
- Baseline: 60% Hand
- Endline: 94% Washing
- Difference: + 56% Breast
Feeding

14. Less - Baseline: 49%
Non-Formal - Endline: 21%
Less Loans - Difference: - 56%
More
Advance Labour Assets
Higher
Income - Baseline: 697
Less - Endline: 3,356
Migration - Difference: + 382%
- Baseline: 15% Income in BDT
- Endline: 4% - Baseline: 1,487
- Difference: - 75% - Endline: 3,390
- Difference: + 128%
Income Sources
- Baseline: 43%
- Baseline: 1.32
- Endline: 20%
- Endline: 1.64
- Difference: - 54%
- Difference: + 24%

15. HHs with 3 square meals/day
- Baseline: 34%
- Endline: 74%
- Difference: + 121%
# of Mnth Food Secure - Baseline: 57%
- Baseline: 5.5% - Endline: 72%
- Endline: 8.9% - Difference: + 25%
- Difference: + 62%
Sanitary
Safe Water
Latrines - Baseline: 14%
- Endline: 55%
Better - Difference: + 296%
Food &
Health Env. - Baseline: 56%
- Endline: 44%
- Difference: - 21%
Less Oral Rehydration
Underweight -Baseline: 57% - Baseline: 23%
Less - Endline: 9%
- Endline: 92%
Diarrhea - Difference: - 60%
- Difference: + 63%

16. So what was the final impact………..
60
56.1
Feb06
55
Prevalence of Stunting
50
45.6 45.8
45.3 Jan-Apr10
Feb06
Jan-May04
45
40
40.4
Nov08-Jan09
35 37.2
Mar-Aug07
30
25
2004 2005 2006 2007 2008 2009 2010
Source: BDHS 2004; NNSP-HKI 2006; BDHS 2007; HH Food Security Assessment by WFP, UNICEF, IPHN 2008/09; NNSP-HKI 2010

17. Could external factors be responsible……….
60
55
50
45
40 All 4 regions experienced significant
35
reduction in “stunting”
30
25 2004 2005 2006 2007 2008 2009 2010
Average reduction nationwide is 1.3 PP / annum and
ONLY 0.3 PP for the poorest quintile
SHOUHARDO achieved 4.5 PP / annum
Analysis from HKI data shows that stunting, in the same districts,
decreased from 45% in 2006 to 40% in 2010 (only 1.4 PPs per annum)
Only 10% HHs at endline confirmed assistance from other agencies

18. WHAT MAKES SHOUHARDO UNIQUE……………
This project stands apart from its predecessors in that
it is the first large-scale development program that, in
addition to direct nutrition interventions, including
food aid, addressed a broad range of structural causes
specific to the population in its area of operation using
a rights-based, livelihood approach
(Tim Frankenberger)

19. Programs need to fit into higher goals………..
SHOUHARDO II SOs USAID MDGs
SO1: Entitlement & Economic Growth &
Economic Growth Agriculture Development MDG 1: Eradicate
Poverty & Hunger
SO2: Health, Hygiene,
Democracy
Nutrition
MDG 2: Universal
Primary Education
SO3: Women Education & Training
Empowerment
Population & Health MDG 3: Women
SO4: Institutional
Empowerment
Strengthening
Environment
SO5: Disaster
Management and MDG 7: Environmental
Climate Change Sustainability
Disaster Management

20. Explaining the shouhardo approach….

21. Accurate “targeting” is key……….
Final Village Ranking
Dialogue with UP
Poverty Maps Dialogue with UZ Provisional Village Ranking
Dialogue with Communities
Master Baseline
Well-Being
Beneficiary &
Analysis
List Census

22. SO 1: “Availability of
nutritious food enhanced and protected

23. SO 1: “Availability of”
nutritious food enhanced and protected

24. SO 1: “Availability of”
nutritious food enhanced and protected

25. SO 1: “Availability of”
nutritious food enhanced and protected

26. SO 1: “Availability of”
nutritious food enhanced and protected

27. SO 1: “Availability of”
nutritious food enhanced and protected

28. SO 1: “Availability of”
nutritious food enhanced and protected

29. SO 1: “access” to
nutritious food enhanced and protected

30. SO 1: “access” to
nutritious food enhanced and protected

31. SO 1: “access” to
nutritious food enhanced and protected

32. SO 1: “access” to
nutritious food enhanced and protected

33. SO 1: “access” to
nutritious food enhanced and protected

34. SO 1: “access” to
nutritious food enhanced and protected

35. SO 1: “access” to
nutritious food enhanced and protected

36. SO 2: Improved health, hygiene, and nutrition status

37. SO 2: Improved health, hygiene, and nutrition status

38. SO 2: Improved health, hygiene, and nutrition status

39. SO 2: Improved health, hygiene, and nutrition status

40. SO 2: Improved health, hygiene, and nutrition status

41. SO 2: Improved health, hygiene, and nutrition status

42. SO 2: Improved health, hygiene, and nutrition status

43. SO 2: Improved health, hygiene, and nutrition status

44. SO 3: PEP women and adolescent girls empowered

45. SO 3: PEP women and adolescent girls empowered

46. SO 3: PEP women and adolescent girls empowered

47. SO 4: Local elected bodies & government service
providers work proactively with communities

48. SO 4: Local elected bodies & government service
providers work proactively with communities

49. SO 4: Local elected bodies & government service
providers work proactively with communities

50. SO 4: Local elected bodies & government service
providers work proactively with communities

51. SO 4: Local elected bodies & government service
providers work proactively with communities

52. SO 5: Community members & government
institutions are better prepared for, mitigate,
& respond to disasters and adapt to climate change

53. SO 5: Community members & government
institutions are better prepared for, mitigate,
& respond to disasters and adapt to climate change

54. SO 5: Community members & government
institutions are better prepared for, mitigate,
& respond to disasters and adapt to climate change

55. SO 5: Community members & government
institutions are better prepared for, mitigate,
& respond to disasters and adapt to climate change

56. SO 5: Community members & government
institutions are better prepared for, mitigate,
& respond to disasters and adapt to climate change

57. SO 5: Community members & government
institutions are better prepared for, mitigate,
& respond to disasters and adapt to climate change

58. SO 5: Community members & government
institutions are better prepared for, mitigate,
& respond to disasters and adapt to climate change

59. SO 5: Community members & government
institutions are better prepared for, mitigate,
& respond to disasters and adapt to climate change

60. SO 5: Community members & government
institutions are better prepared for, mitigate,
& respond to disasters and adapt to climate change

61. IMPROVED
HEALTH
Strategic Objective 1
Increased
Production
Strategic Objective 2
Strategic Objective 1
Availability
Groups”
“VDCs”
Utilization
Security
Access
WATSAN
Food
Security
Stability
Nutrition
DRR
Strategic Objective 5

62. So whAT CONTRIBUTED THE MOST TO
SUCH “EXTRAORDINARY” IMPACT………..

63. Percentage Points (Stunting)
-9
-8
-7
-6
-4
-3
-2
-1
-5
MCHN
+
Sanitation
MCHN
Sanitation
MCHN + Sanitation
MCHN
+
Ag/Fish
MCHN
MCHN + Agri / Fisheries
Agri/Fisheries
MCHN
Multiple treatment propensity scoring
+
Women Empowerment
MCHN
MCHN + Women Empowerment
Empowerment

64. Do we need to target everyone…………
Non-
PEP PEP

65. So in conclusion……………
Stunting prevalence fell by an extraordinary
4.5 PP per year
Communities and Key Stakeholders must be involved
from the outset
Common issues serve as a CATALYST to galvanize
communities
Empowering Women is KEY

67. AND FINALLY……………
Quote of the Week: -
“In order to support a population this large, we'll need to double
global food production. All while a changing climate leads to warmer
temperatures, more erratic rains and longer, more vicious droughts.
The only way we're going to get ahead of this curve is to fight poverty
and spur economic growth is to take advantage of three critical
opportunities today.
1. We have to help communities build real resilience to disasters-so
that droughts don't shatter development gains or give rise to
instability.
2. We need to strengthen food security and drive economic growth.
3. And we need to help countries reap a demographic dividend-
focusing on efforts that ensure all children can enjoy healthy,
productive lives.”
– USAID Administrator Rajiv Shah, Global Philanthropy Forum,
April 16, 2012