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HKI GAAP Presentation January 2013

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Presentation given by HKI at GAAP final technical workshop in Addis Ababa, January 2013

Presentation given by HKI at GAAP final technical workshop in Addis Ababa, January 2013


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  • Addis Ababa -January 9, 2012
  • Physical capital through project inputs and productsFinancial capital through increased revenue from household gardens Social capital through village model farms and behavior change communication strategyHuman capital through agriculture and nutrition training and improved knowledge and adoption of best practices in agriculture and nutrition and subsequent improved nutritional status
  • HH durables, agricultural assets and livestock
  • Impact estimates:HH DurablesMen = -0.56 (1.03);n=1380, NSWomen = 2.89 (2.09); n=1380, NSAgricultural assets Men = -1.36 (0.43);n=1380, p=0.003Women = 1.02 (0.30); n=1380, p= 0.001
  • Impact estimates: Men = 3.67 (1.71); n=1380, p=0.036 Women = 2.75 (0.78); n=1380, p=0.001
  • Round 1: 85% of beneficiaries (compared to 4% of non-beneficiaries) had a home garden and for 91% of these women this was new since joining the program.The vast majority of the women credit the program with increasing the increasing production of vegetables and 74% also thought the program had increased production of chickens.
  • Nearly half of respondents in all groups report that men generally inherit land when wife passes; unless children are mature enough to inherit itMore than half of respondents in all groups report that women do not inherit land from their husband after his passing due to tradition and related inheritance and usage rules (depends on whether there are children, age of woman, etc.)
  • To discontinue practices respondents nearly all thought that village chiefs/leaders would need to take the lead.For sensitization and granting land, respondents had more varied opinions stating that traditional leaders, government and local authorities as well as non-governmental organizations should be involved.with the greater proportion of women in control (26%) as compared to intervention villages (7%) stating this as an obstacle to women’s ability to use landFor provision of inputs and sensitizationrespondents nearly all thought that government or non-governmental organizations would need to take the lead.For granting land, respondents had more varied opinions stating that traditional leaders, husbands, government and local authorities as well as non-governmental organizations should be involved.
  • Close or equal to 90% of all respondents report nochangesin men’s ability to own land over the past 2 yearsOver 90% of men and women in control villages report no changes in women’s ability to own land. In beneficiary villages however, some change is reported (see next slide), due to land grants by HKI or husbands, and establishment of (community) gardens for women.The changes that were cited in regards to changes in women’s ability to own land primarily had to do with women in intervention villages being granted land by their husbands or HKI, that they now have community gardensThe changes that were mentioned related to changes in women’s ability to use land primarily revolved around increased women’s access to land due to transfers from men and advocacy and to support provided to women in terms of inputs and equipment. Men in beneficiary villages also cited the production trainings provided by HKI as increasing women’s capacity to use land and that the women were now using the land at the VMF for production.
  • The most notable change in knowledge related to important times to wash hands was the change related to washing hands before feeding children. At endline a little less than half of the caregivers interviewed living in HC villages correctly stated this time for hand washing whereas only about 30% of caregivers living in control villages and OWL villages correctly identified this important time to wash hands. There was about a 12% difference in the change proportion from baseline to endline between caregivers living in HC villages as compared to those living in control villages who correctly stated this. About 65% of the caregivers interviewed also knew that hands should be washed before eating. Very few caregivers mentioned that it was also important to wash their hands after using the toilet (about 10%) or after cleaning a child who had defecated (about 5%). This is an area that could be improved in future programs as these are common routes through which children get exposed to infectious agents.
  • Nearly all children who were between the ages of 3 and 12 months at the time of the endline evaluation had been breastfed, as was seen among the children included in the baseline study. A greater proportion of caregivers in all types of villages reported having initiated breastfeeding within the first hour of birth as compared to those interviewed at baseline, and caregivers from both types of treatment villages were more likely than those in the control villages to report having done this ideal practice. The difference between OWL villages and control villages was about 16% and was statistically significant. The proportion of caregivers who had exclusively or predominately breastfed their children < 6 months of age in the previous 24 hours was similar across the control and treatment villages.
  • Very few children met their minimum dietary diversity requirements (4 out of 7 food groups) at baseline. At endline, although the percentage of children that met this requirement increased in all groups, there were still only 17% of children who had met the minimum requirements across the sample of children who had both baseline and endline data. At endline, children in the two treatment groups were almost twice as likely to have met their requirements for minimum dietary diversity. However, only the difference in the change from baseline to endline between the OWL treatment group and the control group was statistically significant (p< 0.10).
  • At baseline only about 10% of the children between the ages of 6 and 12 months had eaten iron-rich foods during the 24 hours prior to the baseline survey. At the time of the endline survey when these children were between 21 and 40 months of age more than half of them had eaten an iron-rich food during the 24 hours before participating in the endline survey. Children living in OWL villages were the most likely to have eaten an iron-rich food in the previous 24 hours and the change in proportion from baseline to endline was about 15% greater among children living in OWL villages as compared to those living in control villages.
  • After two years of participating in the E-HFP program, children living in HC treatment villages had a higher mean hemoglobin concentration than those living in control villages. The difference in change from baseline to endline was about 0.5 g/L between the control group and the health committee treatment group.
  • The impact of the E-HFP program on improving hemoglobin concentration was even more evident among children who were 3-5.9 months of age at the time of the baseline study. Again children living in HC villages had a significantly higher mean hemoglobin concentration as compared to those living in control villages. Among these younger children the difference in the change of hemoglobin concentration over the two years of program implementation was 0.76 g/dL between the control group and the HC treatment group.
  • As is common among young children at-risk for nutritional deficiencies children’s growth was already faltering at 3-12 months of age (at basleine) and declined as children got older. However, there were no significant differences between the control and the treatment groups in the change in HAZ over time. Furthermore, there were no significant differences between the treatment groups in the change in the prevalence of stunting, WAZ scores or the prevalence of underweight among children who were 3-12 months of age at baseline.
  • The improvements in the WHZ scores and decline in the prevalence of wasting are noteworthy. However, again there were no statistically significant differences between the control group and either of the treatment groups for changes in the prevalence of wasting or for the change in WHZ scores from baseline to endline. The changes in prevalence for the three groups was (control = -15%, older women leaders = -17% and health committee –23%). It is possible that we did not have enough power to detect differences between the treatment and control groups for this outcome.
  • Transcript

    • 1. ENHANCED HOMESTEADFOOD PRODUCTION FORIMPROVED FOOD SECURITYAND NUTRITION IN BURKINAFASOHelen Keller International (HKI) andthe International Food Policy Research Institute (IFPRI)
    • 2. E-HFP program in Burkina Faso Burkina Faso  Eastern region, Gourma Province, Fada district Sahel  Water shortages inhibit having a second cultivation season High prevalence of acute and chronic malnutrition  Food insecurity  Suboptimal maternal and child nutrition and health practices  Limited availability of and access to health services
    • 3. Overall objective of the E-HFP Program inBurkina Faso To improve the nutritional status of infants and young children through a set of production and nutrition interventions targeted to women with children 3-12 months of age through three primary program impact pathways 1. Increased availability of micronutrient-rich foods through household production during the secondary agriculture season. 2. Income generation through the sale of surplus household production. 3. Increased knowledge and adoption of optimal nutritional practices including consumption of micronutrient-rich foods
    • 4. Program theory framework for HKI’s E-HFP programin Burkina Faso Inputs Process Outputs Outcomes Impact Agriculture and Village Model Establishment Improvements Increased Increased Income Women’s zoological inputs Farms (VMF) of individual in fruit and availability of empowerment distributed established farms (40 vegetable micronutrient improved women per production -rich fruits village) and HKI, APRG and Training in vegetables governmental plant and Women’s assets structures animal Improvements increased in small Increased (Ministries of production techniques for ruminant and availability of Health, Improved poultry food from Agriculture, master trainers maternal and production animal origin Animals, child health Improvements in Environment, and and nutrition Training in Training in household the Promotion of outcomes plant and plant and Adoption of consumption Women, local authorities and animal animal agriculture officials) work production production practices together techniques for techniques for Village Farm beneficiaries Leaders (VFL) Improvements in Beneficiaries nutrition and Develop a training received and feeding practices strategy in animal; understood BCC training for children, and plant agriculture on ENA pregnant women production training practices for and breastfeeding techniques mothers master trainers Develop a behavior change Improvements in communication BCC training BCC training Beneficiaries Adoption of care & hygiene (BCC) strategy on ENA on ENA received and ENA practices for with regards to practices for practices for understood practices by children, pregnant Essential village health beneficiaries BCC training beneficiaries women and Nutrition Actions workers on ENA breastfeeding (ENA) (VHW) practices mothers
    • 5. Study Design Longitudinal impact evaluation Social network census Operations research Qualitative research on gender related topics including ownership and control over agricultural assets
    • 6. Impact Evaluation Cluster randomized design  30 intervention villages (~1200 households and 120 village farm leaders (VFL))  15 “older women leader” villages (OWL)  15 “health committee” villages (HC)  15 control villages (~800 households) Longitudinal  Baseline Feb-Apr 2010 (target children 3-12 months of age)  Endline Feb-Apr 2012 (target children 21-40 months of age) Household interview  Male household head and female key respondent including gender disaggregated modules on asset ownership, agricultural production, income, household expenditures, knowledge on nutrition, household food security, dietary diversity, etc.  Anthropometric measures and hemoglobin status of target children
    • 7. Operations Research and GAAP Qualitative Research Operations Research GAAP Qualitative ResearchRandom sample of Beneficiaries: n=120 Beneficiaries: n=145beneficiaries and Non-beneficiaries: n=60 Non-beneficiaries: n=75non-beneficiariesPurposive sample of VFL: n=60 VFL: n=60key informants OWL: n=30 OWL: n=30 HC: n=30 HC: n=30 Master agriculture trainers: n=18 Land owners: n=30 Master nutrition trainers: n=24 Focus groups: n=24 (12m; 12f)Data collection May-June 2011 May-June 2011 May-June 2012 May-June 2012Methods Semi-structured interviews Semi-structured interviews and focus group discussions
    • 8. Key Questions for GAAPKey Questions Impact Social Qualitative Analysis evaluation network research Status censusHow do women and men view ownership of assets? x On-goingDid the EHFP program increase women’s ownership of assets? x CompleteDid the EHFP program also influence men’s asset holdings? x CompleteWere women able to maintain control over the EHFP activities and x x Completeoutputs?Did the land agreements and/or project activities influence x Completecommunity norms related to women’s land ownership or land rights?What trade-offs were women required to make in order to x On-goingparticipate in the EHFP program?Did exposure to nutrition education diffused through village health x Completecommittee members (HC) increase knowledge and uptake of newpractices as compared to that diffused through older womenleaders (OWL) or vice versa?What are the characteristics of social networks that increase or x On-goingdecrease of nutritional human capital within villages?
    • 9. Did the EHFP program increase women’s and/ormen’s ownership of assets?
    • 10. Ownership of assets: Household durablesand agricultural assets35 9 8 ***30 725 620 5 *** 415 310 25 1 00 Mens Mens Womens Womens Mens Mens Womens Womens agricultural agricultural agricultural agricultural durables durables durables durables assets assets assets assets baseline endline baseline endline baseline endline baseline endline Treatment Control Treatment Control Note: Comparison is to a control group that did not receive any program services. All estimates controlled for baseline age, sex, clustering, and attrition. All values are coefficient (SE). *** p <0.01
    • 11. Ownership of assets: livestock25 **201510 ***50 Mens small livestock Mens small livestock Womens small livestock Womens small livestock baseline endline baseline endline Treatment Control Note: Comparison is to a control group that did not receive any program services. All estimates controlled for baseline age, sex, clustering, and attrition. All values are coefficient (SE). * *p<0.05, *** p <0.01
    • 12. Were women able to maintain control over theEHFP activities and outputs?
    • 13. Control over EHFP activities and outputs:Gardens, seeds, and vegetablesOperations research: Round 1 Operations research: Round 2(2011) (2012)100% 100% 90% 90% 80% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% Responsible Owns land Makes Manages Responsible Owns land Makes Manages for care of for garden decisions on revenue for care of for garden decisions on revenue garden produce generated garden produce generated Beneficiary Husband Joint Beneficiary Husband Joint
    • 14. Control over EHFP activities and outputs:ChickensOperations research: Round 1 Operations research: Round 2(2011) (2012)60% 60%50% 50%40% 40%30% 30%20% 20%10% 10% 0% 0% Allowed to sell chickens Keeps income from Responsible for decicions Keeps income from chickens on chickens chickens Beneficiary Husband Beneficiary Husband
    • 15. Control over EHFP activities and outputs:GoatsOperations research: Round 1 Operations research: Round 2(2011) (2012)80% 80%70% 70%60% 60%50% 50%40% 40%30% 30%20% 20%10% 10% 0% 0% Who makes decisions Who makes decisions Who keeps income Beneficiary Husband Joint Beneficiary Husband Joint
    • 16. Did the land agreements and/or project activitiesinfluence community norms related to women’s landownership or land rights?
    • 17. Community norms related to women’s landownership and land rights: Land acquisition Land for agricultural purposes is primarily obtained through inheritance and gifts. In general, men obtain land through inheritance. Women generally obtain land through marriage/widowhood or through gifts.
    • 18. Community norms related to women’s land ownershipand land rights: Obstacles to owning land Respondents in both beneficiary villages (56%m-63%f) and non- beneficiary villages (46%m-51%f) reported obstacles to women’s ability to own land, mainly due to traditional / social barriers The most commonly cited ways to improve women’s ability to own land were to:  Discontinue traditional customs and practices  Sensitize stakeholder’s about women’s ability to own land  Grant pieces of land to women Respondents in both beneficiary villages (36%m-40%f) and non- beneficiary villages (24%m-36%f) reported obstacles to women’s ability to use land, mainly due to lack of inputs such as seeds, fertilizers or tools and lack of rainfall as well as traditional practices. The most commonly cited ways to improve women’s ability to use land were to:  Provision of inputs  Sensitize stakeholder’s about women’s ability to own land  Grant pieces of land to women
    • 19. Community norms related to women’s land ownership and land rights: Perceived changes in women’s ability to own and use land by both women and men Women Men HC OWL All Control HC OWL All Control (n=70) (n=75) (n=145) (n=75) (n=58) (n=60) (n=118) (n=63)Change in 46 (66) 49 (65) 95 (62) 11 (15) 32 (55) 36 (60) 68 (57) 14 (22)opinionabout whocan own anduse landChange in 18 (26) 15 (20) 33 (23) 1 (1) 16 (28) 15 (25) 31 (26) 2 (3)ability toown landChange in 29 (41) 32 (43) 61 (42) 3 (4) 27 (47) 21 (35) 48 (41) 1 (2)ability touse land
    • 20. Trade-offs required for participation inthe EHFP program Only 11% of beneficiaries (13/118) stated that taking care of the garden interferes with their other activities (e.g. outside work and domestic tasks). None of the beneficiary women interviewed thought that taking care of their chickens interfered with their other activities. 18% of women (16/89) stated that there were costs to working at the VMF including having to neglect their domestic work, taking care of their children, not being able to go to the market, and that it takes time to go and work at the VMF.
    • 21. Did exposure to nutrition education diffused through village health committeemembers (HC) increase knowledge and uptake of new practices as comparedto that diffused through older women leaders (OWL) or vice versa?
    • 22. Impact of the EHFP program on nutrition knowledge: IYCF practices Children < 6 Begin giving Begin giving Give breast months of age liquids other semi-solid Give milk within should not drink than breast foods at 6 colostrum the first hour any liquids milk at 6 months of to children after birth other than months of age breast milk age N=1,138 N=1,144 N=1,129 N=1,142 N=1,149OWL villages 0.16*** 0.092*** 0.23** 0.13** 0.13** (0.054) (0.029) (0.094) (0.063) (0.055)HC villages 0.17*** 0.080*** 0.23*** 0.19*** 0.17*** (0.052) (0.029) (0.078) (0.059) (0.059)p-value 0.006 0.009 0.006 0.007 0.011Note: Comparison is to a control group that did not receive any program services. Estimates controlled for baselineage, sex, clustering, and attrition. ** p < 0.05, *** p<0.01
    • 23. Impact of the EHFP program on health-related knowledge: Hand-washing practices 50% 45% ** 40% 35% 30% Control villages 25% Older women leader 20% villages 15% Health committee villages 10% 5% 0% Before feeding a Before feeding a child, baseline child, endlineNote: Comparison is to a control group that did not receive any program services. Estimates controlled for baselineage, sex, clustering, and attrition. ** p < 0.05
    • 24. Impact of the EHFP program on IYCF practices: Breastfeeding practices among children 3-12 months of age at endline 100% 90% 80% 70% ** 60% 50% 40% 30% 20% 10% 0% Child everInitiated breastfeeding < 1 h breastfeeding, children breastfed, children < 6 breastfed Exclusively after birth Predominately < 6 mo Control villages Older women leader villages Health committee villagesNote: Comparison is to a control group that did not receive any program services. Estimates controlled for baselineage, sex, clustering, and attrition. ** p < 0.05
    • 25. Impact of the EHFP program on IYCF practices: Dietarydiversity among children 3-12 months of age at baseline25% * Met minimum dietary diversity20% requirement n=69115% Older women 0.12* leaders10% (0.070) Health committee 0.098 (0.077) 5% p-value 0.14 Note: Comparison is to a control group that did not receive any program services. All estimates controlled 0% for baseline age, sex, clustering, and attrition. All values are coefficient (SE). * p<0.10 Met minimum dietary Met minimum dietary diversity requirement at diversity requirement at baseline endline Control villages Older women leader villages Health committee villages
    • 26. Impact of the EHFP program on infant and young child feeding practices: Intake of iron-rich foods among children 3-12 months of age at baseline70%60% ** Iron-rich foods50% n=66240% Older women 0.15** leaders30% (0.072)20% Health committee 0.023 (0.090)10% p-value 0.13 Note: Comparison is to a control group that did not0% receive any program services. All estimates controlled for baseline age, sex, clustering, and attrition. All Had iron-rich foods at Had iron-rich foods at values are coefficient (SE). * *p<0.05 baseline endline Control villages Older women leader villages Health committee villages
    • 27. Impact of the EHFP program on nutritional status of children: Hemoglobin among children 3-12 months of age at baseline10.0 9.8 * Hemoglobin 9.6 (g/dL) n=1144 9.4 Older women leaders 0.24 (0.31) 9.2 Health committee 0.49* (0.27) 9.0 p-value 0.19 8.8 Note: Comparison is to a control group that did not receive any program services. All estimates controlled for baseline age, sex, clustering, and attrition. All 8.6 values are coefficient (SE). * p<0.10 Baseline hemoglobin (g/dL) Endline hemoglobin (g/dL) Control villages Older women leader villages Health committee villages
    • 28. Change in hemoglobin from baseline to endline among children 3-5.9 months of age at baseline10.0 9.8 ** Hemoglobin (g/dL) 9.6 n=449 Older women 0.044 9.4 leaders (0.32) 9.2 Health committee 0.76** (0.30) 9.0 p-value 0.043 Note: Comparison is to a control group that did not receive any program services. All estimates controlled 8.8 for baseline age, sex, clustering, and attrition. All values are coefficient (SE). * *p<0.05 8.6 Baseline hemoglobin (g/dL) Endline hemoglobin (g/dL) Control villages Older women leader villages Health committee villages
    • 29. Impact of the EHFP program on nutritional status of children: HAZ among children 3-12 months of age at baseline0.0-0.2 Baseline HAZ Endline HAZ-0.4-0.6-0.8-1.0-1.2-1.4-1.6-1.8-2.0 Control villages Older women leader villages Health committee villages
    • 30. Impact of the E-HFP program on nutritional status ofchildren: Wasting among children 3-12 months of ageat baseline35%30%25%20% Control villages15% Older women leader villages Health committee villages10%5%0% Baseline prevalence of Endline prevalence of wasting wasting
    • 31. SummaryKey Question SummaryDid the EHFP program increase women’s Yes, the E-HFP program had a positive impact onownership of assets? womens ownership of agricultural assets and small livestock.Did the EHFP program also influence men’s Yes, the E-HFP program had a negative impact onasset holdings? mens ownership of agricultural assets which was about equal to the positive impact on women’s ownership of agricultural assets. The program had a positive impact on men’s ownership of small livestock which was larger than that for women.Were women able to maintain control over Yes, especially in regards to the garden activities.the EHFP activities and outputs? The vast majority of women were primarily responsible for decisions related to what to grow in the garden and were able to keep the income generated from the sale of the produce.
    • 32. SummaryKey Question SummaryDid the land agreements and/or project Yes, in beneficiary villages some change was notedactivities influence community norms related in people’s opinions about who could own and useto women’s land ownership or land rights? land. In addition both men and women in beneficiary villages reported that women’s ability to own and use land had actually changed in the past two years whereas this was rarely reported in control villages.What trade-offs were women required to Only about 11% of respondents reported thatmake in order to participate in the EHFP taking care of their gardens affected their otherprogram? activities. 18% said that working at the VMF had costs (e.g. time and neglect of domestic work).Did exposure to nutrition education diffused There do seem to be some differences althoughthrough village health committee members there is not yet a clear pattern of effects by method(HC) increase knowledge and uptake of of dissemination. Analysis of related data is on-new practices as compared to that diffused going.through older women leaders (OWL) or viceversa?