CMS3 March 2012 presentation

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Dr Rie Goto from Cambridge gave a presentation based on the outputs of Survey 7 and she has enhanced the powerpoint used on the basis of feedback from Shiree.

Dr Rie Goto from Cambridge gave a presentation based on the outputs of Survey 7 and she has enhanced the powerpoint used on the basis of feedback from Shiree.

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  • 1. Monitoring the changes insocio-economic & nutritional status of extreme poor householdsChange Monitoring System (CMS3) - March 2010 to March 2012 Professor Nick Mascie-Taylor and Dr Rie Goto University of Cambridge
  • 2. shiree Change Monitoring System (CMS) Shiree has robust survey, monitoring and evaluation structureCMS 1 The Household Profile To provide the baseline from which to monitor change over time – all beneficiariesCMS 2 Monthly Snapshot To enable an assessment of trends monthly – all beneficiariesCMS 3 Socio-economic and To provide in depth socio-economic and nutritional Anthropometric data allowing an assessment of longer term change Surveys and the impact of project interventions – random sample in Scale Fund NGO beneficiariesCMS 4 Participatory Review To provide a forum for beneficiaries to explain changes and Project Analysis in their lives and the reasons for these changes, as well as creating a platform for Innovation Fund NGOs to adapt and improve their innovations according to the needs of beneficiaries – group discussion in Innovation Fund NGO beneficiariesCMS 5 Tracking Studies To provide quality longitudinal tracking studies documenting the dynamics of extreme poverty as it is experienced and changes in beneficiaries’ lives as a result of project interventions – small selection of beneficiaries+ CMS6
  • 3. shiree Change Monitoring System (CMS) Shiree has robust survey, monitoring and evaluation structureCMS 1 The Household Profile To provide the baseline from which to monitor change over time – all beneficiatriesCMS 2 Monthly Snapshot To enable an assessment of trends monthly – all beneficiariesCMS 3 Socio-economic and To provide in depth socio-economic and nutritional Anthropometric data allowing an assessment of longer term change Surveys and the impact of project interventions – random sample in Scale Fund NGO beneficiariesCMS 4 Participatory Review To provide a forum for beneficiaries to explain changes and Project Analysis in their lives and the reasons for these changes, as well as creating a platform for Innovation Fund NGOs to adapt and improve their innovations according to the needs of beneficiaries – group discussion in Innovation Fund NGO beneficiariesCMS 5 Tracking Studies To provide quality longitudinal tracking studies documenting the dynamics of extreme poverty as it is experienced and changes in beneficiaries’ lives as a result of project interventions – small selection of beneficiaries
  • 4. 6 NGOs in Round One Phase One Scale FundCARE ‘Community Led, Voice and Value Chain’ 20,000 Community-led development, Social economic HHs empowerment, Increased wider policy-making processUttaran ‘Khas Land Transfar and Income Generation’ 12,000 Khas land (public land) transfer to the landless people, Reduced corruption, Building income and livelihood capacityNETZ ‘Asset Transfer and Land’ 9,000 Targeting women and ethnic minority (Adibashi), Asset transfer and increased income, Reduced vulnerabilityPractical Action ‘Technology Transfer, Skills Development and Market’ 16,850Bangladesh Technology and skill development of sandbar cropping in(PAB) char lands (riverine islands), Secured market accessSave the ‘Social Entitlements, Asset Transfer and Market’ 15,000Children (SCF) Enhanced capacity to access to safety-net, Assets and livelihood transfer, Access to health, education water facilityDushtha ‘Social Mobilisation, Asset Transfer and Small Business’ 10,000Shasthya Develop technical skill and business capacities, ImproveKendra (DSK) water and health using common assets and servicesThree additional Round 2 Scale Fund NGOs (Concern, Oxfam, Caritas) commencedwork in 2012 and will be analysed in future reports.
  • 5. CARE:Gaibandha, PAB:Nilphamari, Gaibandha,Rangpur, Nilphamari,Lalmonirhat Rangpur, LalmonirhatNETZ:Rajshahi, Naogaon, DSK:Chapai-Nawabgonj Dhaka slums (Karail, Kamrangichar) Uttaran: Satkira, Khulna SCF: Khulna, Bagerhat
  • 6. Design of annual panel nutrition surveysCohort 1 - 384 households (64 HHs from Phase One 6 NGOs)Cohort 2 - additional cohort from urban slum (DSK) and Adivashi (NETZ) in 2011Cohort 3 - adding 3 NGOs in Phase Two in 2012(including 10% estimated attrition each year)Cohort 2010 2011 2012 2013 2014 2015 1 384 345 310 279 251 226 2 128 115 104 94 85 3 192 172 154 138 Total 384 473 617 555 499 449 Within subject change Comparing with additional cohort Testing for recruitment homogeneity Follow-upCMS3 surveys conducted 3 times a year in March, July and October/Novemberbetween March 2010 and 2012 and annual nutrition survey conducted each yearin March.
  • 7. CMS3 Round 7 - Annualnutrition and socio-economic surveys in 201226 February-16 April 2012 (total 50days including 12 days training)It was a combined survey withInnovation Fund Round 1&2Endline survey covering 25 Districtsin Bangladesh covering 1472 HHs CMS3 annual nutrition survey covered: Cohorts 1&2 – 512 HHs Cohort 3 – 128 HHs
  • 8. Total 45 research members including international nutrition advisor (Cambridge University), shiree staff, NGO Research Assistants, enumerators and measurersTraining of enumerating andanthropometric measurement and performing careful quality control
  • 9. MeasurementsNutritional statusAnthropometric indicators: weight, length/height – BMI (adults) and z-scores (childbelow 5 years of age)Biochemical indicators: haemoglobin using HemoCue (portable analyser)
  • 10. Socio-economicquestionnaire Socio-demographic characteristics of the household (including age, maritalstatus, household/family size, education, disability, and occupation)Morbidity reportHousehold and homestead land ownershipHouse condition (size, structure, source of drinking water, electricity and toiletfacilities)Cash loans and savingsAssets – animals, working equipment and belongingsIncome – cash and in-kindExpenditure – covering food, household and work relatedFood intake and food security
  • 11. ResultsSample attrition for analyses Number of households which completed information all through surveys from March 2010 March July October March July November March 2010 2010 2010 2011 2011 2011 2012Cohort Survey Survey Survey Survey Survey Survey Survey 1 2 3 4 5 6 7 1 384 376 352 336 329 316 303 2 128 (128) (128) (128) 3 192Nutrition Yes - - Yes - - Yes SES Yes Yes Yes Yes Yes Yes Yes
  • 12. NGO Attrition (%) Female headed households (%) CARE 25.0 16.7 DSK (Urban) 45.3 62.9 NETZ 14.1 58.2 PAB 10.9 28.1 SCF 17.2 45.3 UTTARAN 14.1 36.4 Total Rural 16.3 37.3 Total 21.1 40.3In total 303 households participated in the seven surveys from the initial sampleof 384 households, an attrition rate of 21% between surveys 1 and 7.There was greater attrition in the urban sample (45%) than in the ruralareas (16%).In total 303 households, information was collected on 1111 individuals ofwhom 634 were adults, 315 children aged between 5 and 15 years and 162children under 5 years of age.
  • 13. Male and female headed households and family sizeIn the total sample 40.3% ofhouseholds were female headed(FHHs). Mainly widowed (62.3%)and divorced/abandoned (23.0%).Mean family size increasedsignificantly from 3.35 in survey 1to 3.67 in survey 7. FHHs weresmaller by, on average, 1.3 familymembers (4.2 vs 2.9). SchoolingOnly 25.0% of heads of households had attended school significantly more soin male (MHHs, 35.3%) than FHHs (12.1%).Between surveys 1 and 4 school attendance in children increasedsignificantly from about 76% to 86% and rose to 89% in survey 7.
  • 14. Chronic illnessChronic illness fell significantly between surveys 1 (15.6%) and 4 (4.2%) butthere was no change between surveys 4 and 7 (4.8%). % Survey 1 4 7 p (1&4) p (1&7) p (4&7) Head 27.7 7.6 8.6 <0.001 <0.001 ns All adults 23.2 7.3 8.0 <0.001 <0.001 ns Children 5-15 5.1 1.0 1.0 0.004 0.003 ns <5 children 3.3 0.8 0 ns 0.035 ns Total 15.6 4.2 4.8 <0.001 <0.001 ns
  • 15. Morbidity statusThe health status of family members was determined on the day of the survey andover the previous 7 and 30 days. Morbidity status (%) of all family member in the previous 30 days All adults: fever, cough, eye and skin infections fell between surveys 1, 4 and 7 while passing of worms fell 1&7 All <0.001 between surveys 1 and 4 only. In children 5 to 15 years of age: the prevalence of fever and cough both fell between surveys 1 and 4 but not between surveys 4 and 7. Under 5 year old children: there were reductions in fever and cough and passing of worms.
  • 16. Employment(%) MHHs FHHs Survey 1 4 7 1 4 7Unemployment 5.9 4.6 4.2 6.1 2.8 0.9Agricultural day labourer 36.0 31.8 31.5 16.5 17.4 15.7Other day labourer 18.8 9.2 13.7 9.6 11.9 4.3Domestic maid 0.5 2.9 1.8 31.3 21.1 14.8Rickshaw 16.5 20.2 18.5 0 0 0Skilled labour 3.8 4.6 2.4 0.9 1.8 2.6Fishing/aquaculture 4.8 6.4 7.1 2.6 2.8 2.6Livestock 0 0 1.8 0 2.8 6.1Cottage/garment 1.1 0.6 1.2 0.9 1.8 2.6Petty trade 8.6 16.2 15.5 10.4 18.3 11.3Begging/scavenging 3.8 3.5 1.2 16.5 11.0 9.6Housework 0 0 1.2 5.2 8.3 25.2MHHs - Petty trading increasedFHHs - Decreased unemployment and domestic maid, but begging stillremained an important source of income (9.6%).
  • 17. The number of days worked fell significantly between surveys 4 and 7 while advanced sale of labour generally fell. Between surveys 4 and 7 self employment increased by 10% and self employed worked, on average, significantly more days. Mean number of days and hours worked by head of household(days) Overall MHHs Urban Self vs non-self Survey 4 7 4 7 4 7 4 7In the last 7 days 4.43 4.32 4.42 4.05 4.97 4.31 4.99 4.90In the last 14 days 8.84 8.89 8.83 8.58 10.00 8.66 9.80 10.05In the last 30 days 18.59 18.78 18.55 18.20 20.77 18.37 20.77 21.55Hours worked in the last 6.36 5.84 6.95 6.49 6.00 6.17 6.20 5.587 days NB: Red shows significant difference (at least <0.01) between survey 4 and 7
  • 18. Land ownershipHouseholds owning land increased significantly from 15.2% in survey 1 to31.4% in survey 7 MHHs - The increase in ownership occurred between surveys 1 and 4 FHHs - ownership increased across all surveys.Land ownership by head of household(%) MHHs FHHs Survey 1 4 7 1 4 7Land owned0 81.2 64.6 65.2 90.2 82.0 73.80.1-2.49 7.7 15.5 14.4 4.1 8.2 4.12.50-4.99 5.0 8.8 7.2 4.1 5.7 12.35.0+ 6.1 11.0 13.3 1.6 4.1 9.8- yes total 18.8 35.4 34.8 9.8 18.0 26.2Cultivated – yes 2.2 2.2 7.2 0 0.8 4.1Share cropped – yes 4.4 9.3 18.2 0 3.3 4.1Free use – yes 4.4 10.0 16.0 0 4.1 6.6
  • 19. Household ownership, size and structureOwning house: The percentage of households owning their own house increasedsignificantly from 72.6% to 80.2% between surveys 1 and 4 and fell slightly to78.5% in survey 7. Home ownership Survey 1 4 7 Own 26.7 25.1 26.4 Rent 12.7 11.9 12.2 Live with parent 2.7 1.0 1.7 Live with parent-in-law 1.0 0.7 0.3 Rent free with family 6.0 4.3 5.6 Rent free non-family 5.0 2.0 1.7 Own house on khas land or someone else’s land 46.0 55.1 52.1 Own any house 72.7 80.2 78.5
  • 20. House size: mean reported size of houses increased from 14.0 square metres insurvey 1 to 15.5 square metres in survey 4 and to 16.2 square metres in survey 7,but the increase was only significant in MHHs.The smallest dwellings were in the urban slums (mean 10 square metres). By male and female headed household By NGOs House material: There was no significant change in materials used in house construction over this time period; walls were primarily made of grass etc, mud or tin sheet, roofs of tin sheet and floors of mud.
  • 21. Electricity, water supply and defecation practicesElectricity: There was no significant change in electricity or water supplybetween surveys. In rural areas about 95% of households had no electricitysupply whereas 85% of urban dwellers had access to electricity.Water: Nearly all urban households obtained their water from a piped supply ortubewell while over 80% of rural households obtained their water from a tubewell.Defecation: There was a highly significant reduction in open defecation inrural areas down from 36.9% in survey 1, to 19.8% in survey 4 and 15.3% insurvey 7 and concomitant increase in use of ring/slab/sanitary latrine up from49.6% in survey 1 to 78.4% in survey 7.Defecation Urban Rural Totalpractice Survey Survey Survey 1 4 7 1 4 7 1 4 7Open 2.9 0 0 36.9 19.8 15.3 33.0 17.5 13.5Hanging 11.4 5.7 8.6 2.2 0.4 1.9 3.3 1.0 2.6Pit 14.3 2.9 8.6 11.2 9.0 4.5 11.6 8.3 5.0Ring/slab 31.4 42.9 40.0 48.5 69.0 75.0 46.5 65.7 70.9Sanitary 40.0 48.6 42.9 1.1 1.9 3.4 5.6 7.3 7.9
  • 22. Loans and cash savingsLoans: There was no consistent pattern to either the number or amount ofloans over the seven surveys.NB: Five sources of cash loan were identified (i) free informal (ii) informal loans with interest(iii) interest loans from samity (iv) interest loans from microfinance institutions and (v) interestloans from a bank or the Government of Bangladesh.
  • 23. Cash savings: In survey 1, 36% of households had some cash savings increasingto 84% in survey 4 and falling to 81% in survey 7.The mean amount increased significantly from 489 Taka in survey 1 to 4095Taka in survey 6 and then fell to 3665 Taka in survey 7. By male and female headed HH By NGOs Urban DSK UTTARAN after Survey 5
  • 24. AssetsAnimal ownership: There was a highly significant increase in animalownership between surveys 1 and 4 (up from 28.4% to 63.9%) followed by avery slight fall in survey 7 (63.4%). Significant increases in 1&4 Survey p (1&4) p (1&7) p (4&7) Cattle <0.001 <0.001 <0.001 Calf 0.022 <0.001 <0.001 Goat <0.001 <0.001 ns Poultry <0.001 <0.001 0.042 Pig ns ns ns Total <0.001 <0.001 ns
  • 25. Ownership of any animal by NGO (%)NGOs Survey 1 4 7 P (1&4) P (1&7) P (4&7)CARE 39.6 54.2 60.4 ns 0.031 nsDSK 2.9 2.9 8.6 ns ns nsNETZ 29.1 94.5 98.2 <0.001 <0.001 nsPAB 22.8 56.1 64.9 <0.001 <0.001 nsSCF 30.2 83.0 71.7 <0.001 <0.001 nsUTTARAN 38.2 65.5 56.4 0.006 <0.001 nsTotal 28.4 63.0 63.4 <0.001 <0.001 ns
  • 26. There were highly significant increases in the amount spent on purchasinganimals between the three surveys in both MHHs and FHHs. Overall there wasan eightfold increase in spending on animals.The value of animals increased significantly between surveys 1, 4 and 7. Mean value of animals by head of Mean value of animals by NGO household
  • 27. Ownership of working equipment: increased from 56.1% in survey 1 to 74.6%in survey 4 and 84.5% in survey 7.Increases occurred in both MHHs and FHHs and in all three surveys MHHsowned more working equipment (over 90% of MHHs owned workingequipment in survey 7 compared with 76% of FHHs).The value of working equipment only increased significantly between surveys1 and 4. Mean value of equipment by head of Mean value of equipment by NGO household
  • 28. Working equipment 1 4 7 p (1&4) p (1&7) p (4&7)ownershipNet 9.9 17.8 18.5 <0.001 <0.001 nsRickshaw 4.3 15.8 18.5 <0.001 <0.001 nsBoat 1.0 2.0 2.6 ns ns nsSewing Machine 0.3 4.3 4.6 <0.001 <0.001 nsCottage industry 0.3 1.3 - ns - -Agri equipment (more than 1) 49.5 66.7 79.2 <0.001 <0.001 <0.001Total ownership 56.1 74.6 84.5 <0.001 <0.001 <0.001Ownership of any 1 4 7 p (1&4) p (1&7) p (4&7)working equipmentCARE 58.3 81.3 87.5 0.013 <0.001 nsDSK 20.0 37.1 37.1 ns ns nsNETZ 70.9 76.4 92.7 ns 0.002 0.022PAB 59.6 73.6 92.9 ns <0.001 nsSCF 50.9 75.5 86.8 0.004 <0.001 nsUTTARAN 63.6 90.9 92.7 0.001 <0.001 nsTotal ownership 56.1 74.6 84.5 <0.001 <0.001 <0.001
  • 29. Ownership of household belongings: increased significantly (there werelarge increases in ownership of a mobile phone, wooden box, mattress andchair), more so in MHHsOverall the number of household goods owned increased from 3.2(maximum 13) in survey 1 to 4.6 in survey 7.Mean number of household goods Mean number of household goodsowned by head of household owned by NGO
  • 30. The value of household equipment increased significantly betweensurveys 1, 4 and 7.Mean value of household goods by Mean value of household goods byhead of household NGO
  • 31. Total assets: Overall the value of assets rose by, on average, 7000 Taka between surveys 1 and 4, and by 3000 Taka between surveys 4 and 7 (Taka 2,311, 9,322 and 12,413 in survey 1, 4 and 7 respectively) MHHs had significantly higher value of assets in surveys 1 and 7 and the gap was widening.Average amount spent on 1 4 7 p (1&4) p (1&7) p (4&7)assetsAnimals 1293 6899 9201 <0.001 <0.001 <0.001Equipment 263 2045 2086 <0.001 <0.001 nsHousehold belongings 1681 3482 4851 <0.001 <0.001 nsHousehold belongings + shop* - 4329 6797 - - <0.001Total assets 2311 9322 12413 <0.001 <0.001 <0.001Total assets + shop* - 10166 14360 - - <0.001 *the question conducted only in surveys 4 and 7
  • 32. Mean value of total assets by head Mean value of total assets by NGOof household
  • 33. IncomeThe mean income for male and female headed households by survey wascalculated based on HIES criteria which do not include in-kind income.Overall mean income increased consistently from 1,776 Taka/month in survey 1to 3,298 Taka/month in survey 7 - there was not consistent improvement withinurban and rural areas. (These increased income does not take into account theinflation between March 2010 and March 2012)Mean income in household per month by Mean income in household per month by NGOMHHs and FHHs
  • 34. MHHs per capita income (27.4 Taka pppd) was significantly higher thanFHHs (21.4 Taka pppd) and the difference was apparent in all seven surveys.Over the seven surveys the mean per capita income in the urban area wassignificantly higher than the rural areas.Rural MHHs earned on average 5.4 Taka pppd more than FHHs (23.9 versus 18.5Taka pppd, respectively). Households from CARE and UTTARAN had the highestmean income pppd (24.2 and 26.9, respectively) and SCF the lowest (17.4 Takapppd). Mean income pppd by MHHs and FHHs Mean income pppd by NGO
  • 35. Mean income per household *Red shows significant difference between MHHs and FHHs Urban Rural Total MHHs FHHs Total MHHs FHHs Total MMHs FHHs Total1 3428 2514 2853 2093 867 1635 2189 1164 17762 4527 3570 3925 2013 900 1603 2193 1390 18733 6051 3745 4627 1858 888 1494 2160 1383 18484 6439 4531 5240 3130 1454 2505 3368 2009 28215 6423 3303 4462 3453 1594 2760 3667 1902 29566 5721 2868 3927 3624 1892 2978 3774 2068 30877 6595 4701 5405 3698 1888 3023 3906 2396 3298Mean income per capita Urban Rural Total MHHs FHHs Total MHHs FHHs Total MHHs FHHs Total1 25.3 25.8 25.6 19.4 12.8 17.0 19.9 15.1 18.02 35.9 34.7 35.1 18.3 12.8 16.3 19.6 16.8 18.53 46.7 37.1 40.6 16.3 12.9 15.1 18.5 17.2 18.04 52.0 45.4 47.9 26.2 19.1 23.6 28.1 23.8 26.45 54.2 33.0 40.9 29.9 19.6 26.1 31.6 22.0 27.86 46.2 28.0 34.7 30.1 22.4 27.2 31.3 23.4 28.17 53.1 45.9 48.6 29.9 25.2 28.2 31.6 28.9 30.5
  • 36. In-kind income FHHs had significantly greater in-kind income than MHHs for the first three surveys but thereafter MHHs had greater in-kind income.NETZ had the highest in-kind income in surveys 6 and 7.
  • 37. The percentage that in-kind income contributed to total income in the totalsample and it ranged between 18% and 23% in the total sample.In FHHs the percentage tended to fall from survey 1 to survey 7 and to rise inMHHs. There was no consistent pattern by NGOs.
  • 38. Expenditure *Red shows significant difference between MHHs and FHHsMonthly mean expenditure (HIES, Taka per month) Urban Rural TotalSurvey MHHs FHHs Total MHHs FHHs Total MHHs FHHs Total1 4410 4202 4279 2342 1464 2014 2491 1957 22762 4136 3277 3592 2037 1179 1717 2168 1520 19093 5985 4772 5281 2406 1250 1980 2674 1816 23384 6391 4401 5140 2926 1476 2385 3175 2004 27045 5562 4343 4796 1376 1444 1503 2943 2098 26016 6253 3857 4702 2992 1841 2564 3211 2208 28067 7518 4710 5753 2853 1707 2425 3188 2248 2810Monthly mean expenditure per capita (HIES, Taka per month) Urban Rural TotalSurvey MHHs FHHs Total MHHs FHHs Total MHHs FHHs Total1 34.2 47.3 42.4 21.6 25.0 22.9 22.5 29.0 25.12 31.8 32.0 31.9 18.5 17.3 18.1 19.4 19.6 19.53 45.2 46.8 46.1 21.7 18.3 20.4 23.4 22.9 23.24 50.8 46.3 48.0 25.7 19.7 23.5 27.5 24.5 26.35 45.8 43.9 44.7 23.1 20.6 22.2 24.8 24.8 24.86 47.7 38.2 41.5 25.0 22.9 24.2 26.6 25.6 26.27 58.3 45.7 50.4 23.4 22.8 23.2 25.9 26.9 26.3
  • 39. Total per capita expenditure increased significantly over the seven surveys from a lowin survey 2 of 19.5 Taka pppd to the highest in survey 7 of 26.3 Taka pppd.There were no significant differences between MHHs and FHHs.Overall the urban areas had greatest expenditure. The rural analyses indicated nosignificant differences in overall means, by head of household or between NGOsover the seven surveys. Mean total expenditure pppd by head Mean total expenditure pppd by NGO of household
  • 40. Food expenditureMean food expenditure pppd by MHHs Mean food expenditure pppd by NGOand FHHsMHHs spent more on food, on average, than FHHs (17.5 vs 15.5 Taka pppd),although the difference appeared to be decreasingUTTARAN moved from having the lowest mean of any rural NGO in survey 1 tohaving the highest mean food expenditure of the rural NGOs in survey 7
  • 41. Household expenditureMean household expenditure pppd by Mean household expenditure pppd byMHHs and FHHs NGOThere was no significant difference between MHHs and FHHsSignificantly higher spending in the urban area was found, but there were nosignificant differences between the overall rural means by NGOs
  • 42. Work-related expenditure Mean work-related expenditure pppd by Mean work-related expenditure pppd by MHHs and FHHs NGOThe amount spent on work-related items increased significantly across the surveysfrom 20 Taka to 106 Taka between surveys 1 and 7Considerably more spent in the urban areas, on average, than in the rural areas(mean 193 versus 48 Taka, respectively) although the gap appears to be lessening
  • 43. Difference between income and expenditure (net income)Households went from a debit in surveys 1 to 3 (-437, -33, -52 Taka/monthrespectively) to increasing credit in surveys 4 to 7 (+565, +891, +989 and +1076Taka/month, respectively).MHHs were significantly more in credit than FHHs over the 7 surveys by, onaverage, 400 Taka/month.When the average of the seven surveys was calculated all NGOs were in creditranging from 3 Taka/month to 778 Taka/month.Mean monthly net income by MHHs and FHHs Mean monthly net income by NGOs
  • 44. Household food intake and security Rice was eaten by nearly all households in all seven surveys. Comparison of March 2011 and March 2013 revealed an increase in fresh fish consumption, pulses, green and other vegetables. Number of days Survey p food consumed 1 2 3 4 5 6 7 Rice - 0 0 0 0.3 0 0.3 0 0 1 0 0 0.3 0 0.3 0 0 2 0 0.3 0 0 0 0 0 3+ 100 99.7 98.3 100 99.3 100 100 Flour <0.001 0 71.6 63.7 67.0 78.2 68.3 63.4 77.6 1 11.6 17.3 16.2 7.9 10.9 14.5 8.9 2 8.3 11.7 10.9 6.9 10.6 10.2 6.3 3+ 8.6 7.3 5.9 6.9 10.2 11.9 7.3 Pulse <0.001 0 62.0 38.0 36.6 55.4 36.6 46.5 43.6 1 23.8 33.0 26.4 24.1 21.8 15.5 21.5 2 9.2 21.0 23.4 14.2 23.4 21.1 20.5 3+ 5.0 8.0 13.5 6.3 18.2 16.8 14.5
  • 45. Number of days Survey pfood consumed 1 2 3 4 5 6 7Potato <0.001 0 1.7 3.0 8.6 0.7 1.7 4.6 0.7 1 1,3 3.0 8.3 0 2.0 1.7 1.0 2 5.9 10.7 13.9 0.3 5.9 6.6 2.0 3+ 91.1 83.3 69.2 99.0 90.4 87.1 96.4Green vegetables <0.001 0 17.8 6.7 5.6 14.2 4.0 4.6 7.3 1 16.8 11.3 14.6 22.8 10.2 14.5 16.2 2 29.7 26.3 28.8 31.7 29.7 27.7 37.0 3+ 35.6 55.7 51.0 31.4 56.1 53.1 39.6Other vegetables <0.001 0 5.3 5.7 17.2 9.6 5.6 1.7 3.0 1 4.0 6.7 8.3 10.6 10.6 3.6 5.3 2 23.4 22.3 19.9 18.8 17.2 8.9 20.1 3+ 67.3 65.3 54.6 61.1 66.7 85.8 71.6Fruits <0.001 0 92.1 57.0 56.6 74.3 33.7 57.4 70.0 1 5.6 27.3 17.5 8.9 24.4 16.5 12.2 2 1.0 7.7 14.6 11.2 21.1 12.9 9.9 3+ 1.3 8.0 11.3 5.6 20.8 13.2 7.9
  • 46. Number of days Survey pfood consumed 1 2 3 4 5 6 7Milk 0.007 0 92.4 85.3 86.8 85.5 77.2 75.9 81.5 1 5.0 7.7 5.0 8.6 8.9 10.9 5.6 2 1.0 4.0 4.3 1.7 3.6 4.6 4.3 3+ 1.7 3.0 4.0 4.3 10.2 8.6 8.6Eggs <0.001 0 70.6 54.0 57.0 42.2 38.9 36.3 35.0 1 23.1 31.0 21.2 24.8 28.7 22.8 28.4 2 3.6 10.7 16.9 18.5 16.8 21.1 22.1 3+ 2.6 4.3 5.0 14.5 15.5 19.8 14.5Fresh fish <0.001 0 38.0 20.7 9.9 24.8 17.8 12.5 16.2 1 35.0 34.0 24.5 27.1 23.1 14.5 21.1 2 16.5 21.7 28.1 21.5 18.8 21.5 19.5 3+ 10.6 23.7 37.4 26.7 40.3 51.5 43.2Dried fish ns 0 74.3 80.7 81.1 79.9 76.6 76.2 77.2 1 9.9 9.3 6.3 7.6 5.3 8.3 6.9 2 9.2 5.0 4.3 5.9 7.3 7.9 8.3 3+ 6.6 5.0 8.3 6.6 10.9 7.6 7.6
  • 47. Number of days Survey pfood consumed 1 2 3 4 5 6 7Poultry <0.001 0 96.0 92.3 91.1 84.8 84.8 80.9 79.2 1 3.0 6.7 7.9 11.2 10.6 13.9 13.2 2 0.3 0.3 0.7 3.3 3.6 4.3 5.3 3+ 0.7 0.7 0.3 0.7 1.0 1.0 2.3Meat <0.001 0 90.1 92.7 97.7 92.4 88.4 84.5 82.8 1 7.6 5.0 1.0 6.6 9.2 9.9 11.9 2 1.7 0.7 0.3 0.7 2.0 2.0 4.3 3+ 0.7 1.7 1.0 0.3 0.3 3.6 1.0Mean foods eaten 5.9 7.1 7.0 6.7 7.7 7.6 7.3 <0.001Mean food 4.3 5.0 4.9 4.8 5.3 5.3 5.2 <0.001diversity
  • 48. Overall food diversity rose from 4.3 in survey 1 to 5.3 in surveys 5 and 6 beforefalling slightly to 5.2 in survey 7.There was no significant difference between MHHs and FHHs.Mean number of food types consumed Mean number of food types consumed by NGOby MHHs and FHHsNB: The extent of household food diversity was determined in two ways (a) based on the mean of thenumber of foods eaten (maximum 13) and (b) based on the 7 food groups (grains, roots and tubers, legumesand nuts, dairy products, flesh foods, eggs, vitamin A rich fruits and vegetables and other fruit andvegetables) as defined by WHO and UNICEF.
  • 49. The households were asked about the coping strategies they used as a result offinancial hardship in the seven days prior to the survey. There were significantimprovements in all 10 strategies between surveys 1 and 7.Mean food coping strategy by MHHs and Mean food coping strategy by NGOFHHs
  • 50. Social empowermentOverall the responses were quite consistent. More women in survey 7 felt therewere people who could be relied upon to help and less women in surveys 4 and 7felt frightened of moving alone outside their village. Male Females Survey Agree Neither Disagree Agree Neither DisagreeInvesting in children’s 1 97.6 2.4 - 97.6 2.4 -education is the best use of 4 85.7 10.7 3.6 85.7 10.7 3.6my scarce resources 7 95.2 2.4 2.4 95.2 2.4 2.4If you earn money or 1 73.8 2.4 23.8 73.8 2.4 23.8receive a loan, you decide 4 79.5 4.8 15.7 79.5 4.8 15.7how to use the money 7 66.7 1.2 32.1 66.7 1.2 32.1You feel confident that you 1 73.8 3.6 22.6 73.8 3.6 22.6can face whatever the 4 78.6 6.0 15.5 78.6 6.0 15.5future brings/holds 7 66.7 1.2 17.9 66.7 1.2 17.9What you say matters in 1 98.8 - 1.2 98.8 - 1.2decisions in your 4 98.8 - 1.2 98.8 - 1.2household 7 97.6 - 2.4 97.6 - 2.4There are people outside 1 54.8 6.0 39.3 54.8 6.0 39.3your family you can rely on 4 57.1 2.4 40.5 57.1 2.4 40.5for help 7 57.1 4.8 38.1 57.1 4.8 38.1
  • 51. Adult nutritional statusThe mean weights of head of household increased significantly over the three surveysin both male and female adults and the average weight gain between surveys 1and 7 was 0.7kg.Mean BMI also increased significantly across the three surveys by 0.4 kgm-2and there were concomitant reduction in CED percentages.Mean haemoglobin did not show any significant change over the surveys butthe percentage who were anaemic fell in males but increased slightly in females. Weight BMI Haemoglobin Average Average + 0.7kg + 0.4 kgm-2
  • 52. Decreased total 5.3% Decreased in Male 7.7% (Female ns) Male Female Total Survey 1 4 7 1 4 7 1 4 7Mean valuesWeight 46.6 46.9 47.7 41.1 41.4 41.6 43.6 43.9 44.3BMI 18.2 18.2 18.5 18.6 18.8 19.0 18.4 18.5 18.8Haemoglobin 132.3 134.4 133.7 116.5 115.3 116.5 123.6 123.9 124.2CategoriesBMI <18.5 52.7 49.5 47.3 56.1 54.4 50.9 54.6 52.2 49.3Anaemic 39.6 33.0 31.9 57.9 58.8 59.6 49.8 47.3 47.3
  • 53. There were no significant changes between surveys although in the total samplethe percentage with CED and anaemia fell by nearly 5%. Head Survey CED + anaemic CED only Anaemic only Normal Total 1 32.2 22.4 17.6 27.8 4 27.3 24.9 20.0 27.8 7 27.3 22.0 20.0 30.7
  • 54. Child nutritional statusThere was no significant change in mean height-for-age and weight-for-ageacross the three surveys.There was a highly significant improvement in haemoglobin concentrationwith an increase in mean of over 8 g/l. Average + 8.0 g/L
  • 55. The percentage of children who were Anaemiastunted fell significantly between -24.8%surveys 1 and 7 while the percentage ofchildren who were underweightincreased; the prevalence of wastingreduced between surveys 1 and 4 butincreased back to baseline level in Stuntingsurvey 7. -9.3%The prevalence of childhood anaemiafell significantly over the surveys.Mean Survey Prevalence Survey 1 4 7 1 4 7Height-for-age -1.94 -2.02 -1.81 Stunting 52.0 49.3 42.7Weight-for-age -1.89 -1.95 -1.90 Underweight 44.6 49.3 50.7Weight-for-height -0.88 -0.96 -1.14 Wasted 20.5 13.3 20.5Haemoglobin 106.4 111.1 114.7 Anaemic 60.8 45.3 36.0
  • 56. Summary ✔ ✔= significant improvement, ✔ = trend of improvement 1&4 1&7 4&7 Family size ✔ ✔✔ ✔ Illness - ✔✔ ✔✔ Land ✔✔ ✔✔ ✔ House ownership - ✔ - House material - - - Loan - - - Cash savings ✔✔ ✔ ✔ Assets ✔✔ ✔✔ ✔✔ Income ✔✔ ✔✔ ✔✔ Expenditures - - - Net income ✔✔ ✔✔ ✔✔ Food ✔✔ ✔✔ ✔✔ Adult weight and BMI ✔✔ ✔✔ ✔✔ Adult anaemia - - - Child z-scores - - - Child stunting - ✔✔ - Child anaemia ✔✔ ✔✔ ✔✔
  • 57. Discussions(1) Many indicators of economical situation in households (e.g. land, saving,asset, income, expenditure) showed improvement from 1 year of theintervention and generally keep to show the upward trend after 2 years.(2) Number of asset increased from survey 1 to 4 but not in survey 7, but thevalue increased in survey 7 – how much the assets generate income?(3) Amount of cash savings, income/expenditure increased, but nochange of loans(4) Household food intake and security also improved sharply after 1 yearof intervention. BMI and weight in adults showed significant improvement,but not hemoglobin - intervention increased energy intake but still do notimprove ‘quality’ of food such as animal protein.
  • 58. Discussions(5) After 2 years of intervention, child chronic undernutrition (stunting)showed improvement which may related the reduction of morbidity.However they also showed a sign of acute undernutrition (wasting andunderweight) at survey 7 – perhaps other factors such as breastfeedingand weaning practice and poor energy intake may also related.(6) Child anaemia status improved at surveys 4 and 7 – less than nationalaverage (i.e. 68% of under 5 years of age in rural area). More opinions?
  • 59. How can we know whether there is improvement in the lifestyle of the ultra poor?Areas worth investigating are:-1. Do households sustain themselves about the poverty line or does churningpoverty occur (which might be seasonal or the result of some health shock orother life event)?2. Is there any relationship between an absolute measure of poverty (thepoverty line) and multidimensional poverty in the ultra poor and is thishomogeneous in urban and rural areas?3. How well does an absolute measure of poverty predict multidimensionalpoverty in the ultra poor?
  • 60. How they are close to the above poverty line? – measurement of improvementChronic poverty is commonly defined as ‘a state of poverty where individuals,households or regions are trapped in severe and multi-dimensional povertyfor an extended period of time, perhaps even across generations’. Duration,multidimensionality and severity are therefore the key characteristics of chronicpoverty, and these are mutually reinforcing characteristics (Hulme et al., 2001).
  • 61. Three measures of income poverty;(1) Poor or not poor (yes or no, Headcount index) All indicators use(2) Depth of poverty (Poverty Gap Index, PGI) ‘poverty line’(3) Inequality of poverty (Squared Poverty Gap Index, SPGI) Poverty Gap = How much would have to be transferred to bring their expenditure (or income) up to the poverty line Poverty line Population ranked by consumption
  • 62. Poverty Gap and Poverty Gap Index e.g. Poverty line is 125Individual A B C D Sum Poverty Gap IndexIncome 100 100 150 150Poverty Gap 25 25 0 0PG / Poverty line 25 / 125 = 25 / 125 = 0 0 0.20 + 0.40 / 4 = 0.20 0.20 0.20 = 0.10 0.40 (10%)Income 80 120 150 150Poverty Gap 45 5 0 0PG / Poverty line 45 / 125 = 5 / 125 = 0 0 0.36 + 0.40 / 4 = 0.36 0.04 0.04 = 0.10 0.40 (10%)
  • 63. Squared Poverty Gap Index Poverty line is 125Individual A B C D Sum Poverty Gap IndexIncome 100 100 150 150Poverty Gap 25 25 0 0PG / Poverty line 25 / 125 = 25 / 125 = 0 0 0.20 0.20Squared Poverty 0.202 0.202 0 0 0.08 0.08 / 4Gap =0.04 =0.04 =0.02 (2%)Income 80 120 150 150Poverty Gap 45 5 0 0PG / Poverty line 45 / 125 = 5 / 125 = 0 0 0.36 0.04Squared Poverty 0.362 0.042 0 0 0.1312 0.1312 / 4Gap =0.1296 =0.0016 =0.0328 (3.28%)
  • 64. Thank you to our beneficiaries and all the staff who contributed to making these surveys possible!