Note Conceptuelle d'évaluation d'impact (Equipe CREA)

1. TECHNICAL PROPOSAL
IMPACT EVALUATION OF KENYA NUTRITION IMPROVEMENT
THROUGH CASH AND HEALTH EDUCATION (NICHE)
PROGRAM
Technical Workshop on Impact Evaluation Methods
24 June – 05 July, 2019
Nairobi Safari Club, Nairobi, Kenya
BECHO Isabelle
John Njoroge Maara
Kwami Ossadzifo Wonyra
Mamadou Nouhou Diallo
Samson Katengeza

2. OUTLINE
Background
Description of intervention
Research questions
Hypotheses
Conceptual framework – theory of change
Sampling design
Empirical model and estimation strategy

3. BACKGROUND
Chronic malnutrition among children can be reduced by improving women’s
nutrition during and after pregnancy.
Cash transfer programs can increase consumption and food security, dietary
diversity, and infant and young child feeding.
However its direct impact on malnutrition indicators (e.g. stunting, wasting and
under nutrition) remains mixed.
Interventions entailing both cash transfers and nutritional counselling have
shown a decrease in stunting, underweight and wasting among children.
Hence a NICHE program to provide additional cash and health and nutrition
information to facilitate positive behavior change that will reduce malnutrition.

4. DESCRIPTION OF THE INTERVENTION
Key interventions of NICHE program include:
1. Cash transfer top-up
2. Nutrition counseling
3. Integrated approach (i.e. cash transfer top-up and nutrition counselling)
Target population:
• Households with a pregnant woman or with a child under the age of two years
Two population of interest:
1. Those currently on cash transfer and eligible for cash transfer top-up and
nutrition counselling.
2. Those without any cash transfer program
Duration:
• The initial duration of the program is three years.

5. Geographical
location
Kitui
county
Machakos
County

6. RESEARCH QUESTIONS
1. What is the impact of cash transfer top up on nutritional status in cash
transfer population?
2.
3. What is the impact of nutrition counselling on prevalence of chronic
malnutrition (e.g. stunting) in cash transfer population?
4.
5. What is the impact of integrated approach (Cash transfer top up +
nutrition counselling) on prevalence of chronic malnutrition (e.g.
stunting) in cash transfer population?
6.
7. What is the impact of cash transfer top up on prevalence of chronic
malnutrition (e.g. stunting) in non-cash transfer population?
•

7. RESEARCH QUESTIONS - OUTCOMES
Based on stated research questions, the program has the following outcomes
Main outcome: Nutritional status
1. Linear Growth and Weight of children
2. Stunting
•
Intermediate outcomes
1. Utilization of health services
2. Frequency of meals (consumption)
3. Adherence to breast feeding

8. HYPOTHESES
The following hypotheses are therefore developed
Main hypotheses
1. Cash Transfer Top Up intervention improves nutritional status.
2. Nutrition Counseling intervention improves nutritional status.
3. The integrated Cash Transfert Top Up and Counseling
intervention improves nutritional status more than each
intervention alone.
Secondary hypotheses
1. Cash Transfert Top Up intervention improves secondary outcomes
2. Counseling intervention improves nutritional status

9. CONCEPTUAL FRAMEWORK – THEORY OF CHANGE
•
•
Consumption
Prevalence of
good
nutrition
Behavior
Change
CASH
TRANSFER
NUTRITION
COUNSELING
²
§ Stunting
§ Improvement in
linear growth
and weight
§ Frequency of prenatal
visits
§ Frequency of child
feeding
§ Timely provision of
child supplimentaray
food
INTERVENTIONS
INTERMEDIATE
OUTCOMES
FINAL OUTCOME

10. EVALUATION DESIGN (1)
Target Population
CURRENT
BENEFICIRIES OF
CASH TRANSFER
TOP UP
TOP UP
+COUNSELINGS
COUNSELINGS
No TOP UP
No COUNCELINGS
Comparison groups
Treatment groups

11. EVALUATION DESIGN(2)
Target Population
NO CURRENT
BENEFICIRIES OF
CASH TRANSFER
TOP UP
NO TOP UP
NO CASH
Comparison groups
Treatment groups

12. IMPACT IDENTIFICATION STRATEGY
Experimental design (RCT)
With the target population of current beneficieries of cash transfer, the RCT will
have 4 arms (i.e. will randomly select 4 groups)
1. P1: Cash Transfer Top Up intervention
2. P2: Nutrition Counseling intervention
3. P3: The integrated approach (with Cash Transfer Top Up and
Counseling intervention)
4. Comparison group without cash transfer top-up and nutrition counseling
For the population without cash transfer, the RCT will have 2 arms
1. P1: Cash Transfer Top Up intervention
2. Comparison group without cash transfer top-up

13. Graphical approach
Base line
Improvement in
linear growth
Follow up
Counseling only
With Top up only
Comparaison group
Integrated (with Top
Up+ Counseling)

14. Graphical approach
Base line
Prevalence of
stunting
Follow up
With Counseling only
With Top up only
Integrated (with Top
Up+ Counseling)
Outcome for control
group

15. SAMPLING DESIGN
Unit: Household
Concerns: Spillovers hence will use cluster-sampling technique
Settings
• Total number of households currently receiving cash transfer
• variance of our outcome in the target population
• ICC
• Type 1 error
• Type 2 error

16. SAMPLING DESIGN
n
Treated
nCT
nCounseling
nCT+CounselingControl

17. EMPIRICAL MODEL AND ESTIMATION STRATEGY
+ ++ + + + + +
Variables
1. P1: Cash Transfert Top Up intervention (P=1, Top Up only, P=0, No Top Up & No Counseling)
1.
2. P2: Counseling intervention (P=1, received counseling only, & P=0, No Top Up & No Counseling)
1.
3. P3: The integrated intervention (P=1, received both Top Up & Counseling, P=0, No Top Up & No
Counseling)
4.
5. T: (0 for baseline , 1 for Follow up)
6.
7. X: vector of control variables
8.
9. is the error term

18. Variables description
1. Dependent variables:
• Linear growth and child weight
• Prevalence of malnutrition (e.g. stunting)
2.
3. Indipendent variables
• Treatment variables (receiving cash transfer top up and receiving nutrition
counselling)
• Control variables
• Household characteristics (gender, houshold size, education,
occupation)
• Household endowments (income, expenditure, farm size, assets etc)
• Instutitions (distance to health center, access to information etc)
• Access to organizations (e.g. those implementing similar programs)
•
EMPIRICAL MODEL AND ESTIMATION STRATEGY

19. The paramters in the stated model will be estimated using DID estimation strategy
This method assumes that in the absence of treatment, the average change in the response
variable would have been the same for both the treatment and control groups.
And this will estimate the ATT assuming full compliane or LATE if not compliance
• Advantages of this estimation strategy:
• Controls for unobserved heterogeneity
• Control of spillovers over effects
• Disadvantages and weakeneses of this estimation strategy
• Ethical issues
• Cost of data collection
•
EMPIRICAL MODEL AND ESTIMATION STRATEGY

20. Thanks for your
attention
Merci pour votre
attention