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Evaluation of Nutrition Improvements through Cash & Health Education Program in Kenya


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John Gachigi's (Government of Kenya) presentation at the Transfer Project Workshop in Arusha, Tanzania on 3rd April 2019.

Published in: Government & Nonprofit
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Evaluation of Nutrition Improvements through Cash & Health Education Program in Kenya

  2. 2. Background of NICHE Program • Stunting and other forms of children’s under nutrition, like wasting and underweight conditions, can be reduced by improving women’s nutrition during and after pregnancy, early and exclusive breastfeeding, and timely and appropriate complementary food (UNICEF, 2013) • Cash transfer programmes can increase consumption and food security, dietary diversity, and infant and young child feeding (de Groot et al., 2015; FAO, 2015), but its direct impact on stunting, wasting and under nutrition remains mixed. • But interventions entailing both cash transfers and nutritional counselling have shown a decrease in stunting, underweight and wasting among children. • These findings support the underlying premise of NICHE: that providing additional cash and health information will facilitate positive behaviour change that will reduce malnutrition, stunting and wasting among children in targeted households.
  3. 3. Objectives of the Study • To assess causal linkages between the programme and expected outcomes such as improvements in growth, food consumption, positive health, nutrition and hygiene behaviors. • To evaluate the effectiveness, efficiency and relevance of CT- OVC, additional CT and nutritional counselling in targeted households.
  4. 4. Study Area Kitui & Machakos Counties Arid & semi-arid lands High levels of Stunting & Malnutrition(45%)KITUI MACHAKOS
  5. 5. Study Population Drawn from existing CT-OVC Cash Beneficiary Households with: •Pregnant woman •Child aged 0-24 months. Total study population was =1500 •Treatment 1139 control 361 1199 pregnant women 1306 children
  6. 6. Study Design Randomized Control Trial (RCT) Arms Intervention Strategy Treatment arm • CT-OVC Cash Transfer • Additional Cash only—(USD 5 & USD 10) • Nutritional Counselling Control arm • CT-OVC Cash Transfer only
  7. 7. Study Methods Methods Quantitative Baseline survey (1500) Midline survey (592 &755) Endline survey (794) Qualitative FGDs CFA beneficiaries (13) NICHE beneficiaries (7) IDI (7) Knowledge quiz (794)
  8. 8. Results Anthropometric z-scores • Difference in Difference results for stunting, wasting and underweight are positive, but limited • Children in larger households are more likely to experience underweight and wasting • There is an underlying inverse relationship between income and stunting and underweight Nutrition • Exclusive breastfeeding: Treatment households were 7 percent more likely to practice exclusive breastfeeding • Complementary feeding: Treatment households were 11 percent more likely to practice complementary feeding
  9. 9. Results Child Health • Complete immunization: Control households were 12 percent more likely to have received immunization • Routine checkups: Treatment households were 12 percent more likely to have routine checkups • Household illness: Control households were more likely to have experienced malaria (6 percent) or gastrointestinal distress (7 percent) Pregnant Women • Dietary diversity: Improved by 32 percent among treatment households • ANC: Likelihood increased by 41 percent among NICHE participants • Delivery in a health facility: Treatment households increased from already- high 88 percent to near-universal of 99.8 percent
  10. 10. Discussion •NICHE is most effective when cash is readily available, relatively costless and predictable to obtain. •The biggest gains were made when smaller, more affordable purchases, such as soap or dietary inputs, were paired with lessons, such as on handwashing and dietary diversity, respectively. •There is a relationship between exposure to NICHE and a range of healthy behaviours like diversifying diets, establishing handwashing stations or complementary breastfeeding. •There is value and relevance of CHV visits and acknowledged household behaviour change favouring improved hygiene and diet.
  11. 11. Recommendations • Consider adding an MPESA option, which would avoid problems related to visiting banks, which can be long distances away and incur extra costs • Consider providing the cash transfer on a monthly basis, rather than a bi- monthly basis, and increasing the value of the transfer to align with other such programmes. • Encourage CHVs to provide information regarding when they will revisit to ensure that beneficiaries are present; establish a schedule. • Bring the beneficiary learning forums closer to the beneficiaries, thus reducing travel distance and transit time • Continue to reinforce best practice activities, particularly those that are not expensive
  12. 12. Next Steps on NICHE Program •Expansion of existing Nutrition-Sensitive Safety Net benefit to other counties •Approximately 50,000 individuals in 23,500 households under the Kenya Social Economic Inclusion Program (KSEIP) will be covered
  13. 13. Take Away Points • Combining counseling and cash transfers improves wellbeing and positive behavior change •Treatment households are far more likely to practice enhanced hygienic, dietary and infant care practices than comparison households •Collaboration between NICHE partners and with government partners facilitated rollout and hence the design of the new program
  14. 14. Acknowledgements Government of Kenya The Field Team Implementing & Funding Agencies
  15. 15. Asanteni Sana Asanteni Sana