Nutrition mobile services that send information start to your phones. MaFAAS

1. Mobile Value Added
Nutrition Extension
Services and Women
Economic Empowerment
(WEE-Care) in Mchinji and
Lilongwe Districts
Chimwemwe Jemitale
EXTENSION WEEK FOR
THE MaFAAS
Friday 29th
July 2016

2. WE-Care Programme – Hewlett Foundation
Phase 1
• Where: Malawi, Uganda, Ethiopia, Zimbabwe, Colombia, Philippines
• When: October 2014 – March 2016
• What:
Develop and test innovative research methodologies (RCAs, HCS, RCTs, Effectiveness Reviews).
Implement research and learn about outcomes of change strategies.
Influence Development Policy and Practice
Phase 2
• Where: 3 African Countries
• When: April 2016 – December 2017
• What:
Deepen the evidence base, and strengthen influencing capacity on WEE and unpaid care;
Develop and test a variety of influencing resources, strategies, and approaches
Capture and disseminate learning about effective influencing for policy change on WEE and unpaid care

3. Unpaid Care Work
Is the provision of services for family and community members outside of the market
Child care
Elderly care
Care of ill or disabled
Care of community members
Cooking
Cleaning
Washing, mending, ironing clothes
Fetching water
Collecting firewood
WE-Care Programme – What do we mean by Care?
Care is a
‘social
good’,
not a
‘burden

4. • Improved care of people has a widespread, long-term, positive impact on wellbeing and
development
• Care is a ‘social good’, not a ‘burden’
• Care provision is critical to address inequality and vulnerability, both for care providers
and receivers
Investing in Care is Important

5. Care Responsibility
Women face heavy and unequal care
responsibilities which not only impede efforts
to promote women's equal enjoyment of
human rights but also has devastating effects
on her and her children nutritional status.
Woman “Looking after children can be a burden
because we postpone doing other things like
going to the field in order to prepare them for
school but sometimes, during farming season,
women neglect the children as they want to
concentrate on farming activities”
CORE CONSIDERATIONSCORE CONSIDERATIONS
Example of Mitundu, Lilongwe: hours per week spent
Oxfam, Dec. 2014

6. • Recognise care work
• Reduce difficult, inefficient tasks
• Redistribute responsibility for care
more equitably - from women to
men, and from families to the
State/employers
• Represent carers in decision
making
The 4 Rs – Transforming Care

7. mNutrition in Malawi (mAgri + mHealth)
Managing Donor:Lead Partner GCP:
Content Agri
M&E Agri:
National Content
Development Committee
• Min of Ag & Food Security
• Dept of Extension
Services…
SMS
IVR
Groups
Individuals
ConnectingtoOxfamProgrammes
Content Health
Technical Working Group
• Min of Health
• DNHA
•…
M&E Health:
Mobile ServiceHealth + Agri
Content Data Base
Other
Organisations
•Save the Children
•UNICEF…
WE-Care
Donor:
212 mChikumbe / 321 Platform
Global Content Partner:

8. Is the daily allocation of time to non-paid care work different between women small-holder farmers that access mNutrition
services (health and agriculture) through a mobile phone vs women SH farmers who do not access mNutrition services?
The RCT in a Nutshell
•Who: 160 Participants – 80 Control & 80 Treatment
•Where: Mitundu (120 participants) and Mchinji (40 participants)
•When: December 2015 – March 2016
•What:
o Treatment: 24 messages (12 Health & 12 Agriculture)
o Control: 12 messages
RCT Steps:
•Baseline: April 2015
•RCT implementation
•Endline: March 2016
RCT Steering Committee:
•3 Ministries: Agriculture, Health and Gender
•1 Private Company: Airtel Malawi
•2 NGOs: HNI and Oxfam
Randomised Control Trial

9. Randomised Control Trial Design - Messages
Treatment Group - 24 Messages Control Group - 12 Messages
Breastfeed your
baby more often
when they are
sick. It will give
strength to fight
the illness, avoid
weight loss, and
recover more
quickly.
Wash, peel, grate
and dry sweet
potato. Store
grates in a cool dry
place. The grates
should be
pounded or milled
into flour for use in
different products.
Weed at 2 weeks
after planting and
subsequently
when weeds
appear.
Delay in weeding
can cause
significant
reduction in soya
bean yields
Breastfeeding
Cooking
AgronomicPractices
Directly Related to Unpaid Care Work Directly Related to Income
Generating Activities
Lake Malawi is
very beautiful and
it is the only lake
in the world where
you can find the
tasty Chambo fish
Interestingfactsandgreetings
Not related to Care Work or
Income Generating Activities

10. Findings - RCT End-line
Baseline mean (n=594) Treatment mean (n=80) Control mean (n=78)
Primary Care Hours
Number of hours spent on care as a primary activity.(Women) 5.30 5.27 5.40
Primary/Secondary care hours
Respondent 6.04 6.06 6.23
Hours for income generating activities
Respondent 1.7 2.6 1.5
Sleep hours
Respondent 10.8 8.67 9.26
How often does the husband do specific care activities each week
1.11 1.78 1.60
Activities undertaken by respondents and other household members in a 24 hour period with regard to care:
• No significant difference in total primary care hours between control and treatment groups and when compared to the baseline.
• There is an increase of over 70% in the time allocated to income generating activities in the treatment group compared
to the control group.
• Overall there is a significant reduction in the sleep hours of the treatment group, which is in line with findings from other
WE-Care countries where Oxfam analysed the impact of Oxfam's livelihoods programmes on time allocation.

11. Findings - RCT End-line
Preliminary findings point to a low uptake of messages that are directly related to care work
activities (e.g. cooking or breast-feeding), showing no significant difference in the total care
hours between control and treatment groups and when compared to the baseline. However,
there is a deprioritization of certain care work activities in the treatment group.
The analysis points to an early uptake of those messages related to income generating
activities, resulting in an overall increase of time dedicated to these activities in the
treatment group.
Overall there is a significant reduction in the sleep hours and personal care of the
treatment group, which is in line with findings from other WE-Care countries where Oxfam
analysed the impact of Oxfam's livelihoods programmes on time allocation.
An increment in the time dedicated to income generating activities could potentially lead to
increased nutrition levels through access and consumption of higher quantities of nutritious
foods. However, the deprivation of sleep can have negative effects on health and nutrition levels
of the beneficiaries.

12. Findings - RCT End-line – Implications for mNutrition
The overall goal of the mNutrition programme is to increase the nutrition levels of women and
children, and this is more directly achieved through the food messages and health
practices. The agricultural messages aim to directly influence the income levels of the
recipient household and indirectly result into increased nutrition levels of women and
children.
If both types of messages are received simultaneously, this study points to a prioritisation
of those messages directly related to income generating activities in detriment of those
directly linked to health and food practices.
Need for new approach to promote uptake of health and food messages as well as agriculture
and for parallel intervention to reduce the amount of time dedicated to unpaid care work,
which could level the negative impact of the messages in sleep hours of the recipients.

13. Frequency of the messages
•Only 4 messages in the first 1.5
months
•Messages sent daily since Feb 16th
Challenges during implementation of the RCT
Information Spillovers:
•Some people in the treatment group
sharing messages with control group
•Individual vs village randomisation
Challenges with the handsets:
•Availability of electricity
•Batteries
•Mobiles damaged or lost

14. END
Communication Materials
•WE-Care Programme Report (RCAs,
RCT and findings)
•RCA toolkit
LINKING UNPAID CARE WORK
AND MOBILE VALUE ADDED
SERVICES IN MALAWI
WE-Care Programme