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

1. ENHANCED HOMESTEAD
FOOD PRODUCTION FOR
IMPROVED FOOD SECURITY
AND NUTRITION IN BURKINA
FASO
Helen Keller International (HKI) and
the 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 in
Burkina 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 program
in 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 Research
Random sample of Beneficiaries: n=120 Beneficiaries: n=145
beneficiaries and Non-beneficiaries: n=60 Non-beneficiaries: n=75
non-beneficiaries
Purposive sample of VFL: n=60 VFL: n=60
key 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 2012
Methods Semi-structured interviews Semi-structured interviews
and focus group discussions

8. Key Questions for GAAP
Key Questions Impact Social Qualitative Analysis
evaluation network research Status
census
How do women and men view ownership of assets? x On-going
Did the EHFP program increase women’s ownership of assets? x Complete
Did the EHFP program also influence men’s asset holdings? x Complete
Were women able to maintain control over the EHFP activities and x x Complete
outputs?
Did the land agreements and/or project activities influence x Complete
community norms related to women’s land ownership or land rights?
What trade-offs were women required to make in order to x On-going
participate in the EHFP program?
Did exposure to nutrition education diffused through village health x Complete
committee members (HC) increase knowledge and uptake of new
practices as compared to that diffused through older women
leaders (OWL) or vice versa?
What are the characteristics of social networks that increase or x On-going
decrease of nutritional human capital within villages?

9. Did the EHFP program increase women’s and/or
men’s ownership of assets?

10. Ownership of assets: Household durables
and agricultural assets
35 9
8 ***
30
7
25 6
20 5 ***
4
15
3
10 2
5 1
0
0 Men's Men's Women's Women's
Men's Men's Women's Women's 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: livestock
25
**
20
15
10
***
5
0
Men's small livestock Men's small livestock Women's small livestock Women's 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 the
EHFP activities and outputs?

13. Control over EHFP activities and outputs:
Gardens, seeds, and vegetables
Operations 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:
Chickens
Operations 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:
Goats
Operations 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 activities
influence community norms related to women’s land
ownership or land rights?

17. Community norms related to women’s land
ownership 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 ownership
and 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)
opinion
about who
can own and
use land
Change in 18 (26) 15 (20) 33 (23) 1 (1) 16 (28) 15 (25) 31 (26) 2 (3)
ability to
own land
Change in 29 (41) 32 (43) 61 (42) 3 (4) 27 (47) 21 (35) 48 (41) 1 (2)
ability to
use land

20. Trade-offs required for participation in
the 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 committee
members (HC) increase knowledge and uptake of new practices as compared
to 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=1,149
OWL 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 0.011
Note: Comparison is to a control group that did not receive any program services. Estimates controlled for baseline
age, 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, endline
Note: Comparison is to a control group that did not receive any program services. Estimates controlled for baseline
age, 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 villages
Note: Comparison is to a control group that did not receive any program services. Estimates controlled for baseline
age, sex, clustering, and attrition. ** p < 0.05

25. Impact of the EHFP program on IYCF practices: Dietary
diversity among children 3-12 months of age at baseline
25%
* Met minimum
dietary diversity
20%
requirement
n=691
15% Older women
0.12*
leaders
10% (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 baseline
70%
60% ** Iron-rich
foods
50%
n=662
40% Older women
0.15**
leaders
30%
(0.072)
20% Health committee 0.023
(0.090)
10%
p-value 0.13
Note: Comparison is to a control group that did not
0% 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 baseline
10.0
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 baseline
10.0
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
baseline
0.0
-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 of
children: Wasting among children 3-12 months of age
at baseline
35%
30%
25%
20%
Control villages
15% Older women leader villages
Health committee villages
10%
5%
0%
Baseline prevalence of Endline prevalence of
wasting wasting

31. Summary
Key Question Summary
Did the EHFP program increase women’s Yes, the E-HFP program had a positive impact on
ownership of assets? women's ownership of agricultural assets and small
livestock.
Did the EHFP program also influence men’s Yes, the E-HFP program had a negative impact on
asset holdings? men's 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. Summary
Key Question Summary
Did the land agreements and/or project Yes, in beneficiary villages some change was noted
activities influence community norms related in people’s opinions about who could own and use
to 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 that
make in order to participate in the EHFP taking care of their gardens affected their other
program? 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 although
through 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 vice
versa?