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Lessons Learned Collecting Most Significant Change Stories in an Impact Evaluation in Malawi

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Presented by Valerie Flax at the 2016 AEA conference.

Published in: Health & Medicine
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Lessons Learned Collecting Most Significant Change Stories in an Impact Evaluation in Malawi

  1. 1. Lessons Learned Collecting Most Significant Change Stories in Impact Evaluation in Malawi Valerie Flax, PhD, MPH MEASURE Evaluation October 29, 2016 American Evaluation Association
  2. 2. Integrating nutrition in value chains  Mixed-methods evaluation • Overall question: Is an integrated value chain + nutrition program more effective in improving nutritional status of children < 3 years than a value chain alone?  Program impact measured through population-based household surveys  Program implementation measured, in part, through Most Significant Change (MSC) stories Background Malawi Feed the Future Impact Evaluation Target Districts
  3. 3. Nutrition and Health Investments Improved diet and feeding/care practices Increased legume production Increased Food Security Increased household income Demonstrations: Gardens/Cooking Improved Nutrition Reduced chronic malnutrition among children U3 Impact Community Care Groups Training care group volunteers on:  Health screening and services  Essential nutrition actions (ENA) and scaling up nutrition (SUN)  Food production, processing, and use Agriculture Value Chain Investments Agricultural Inputs: • Improved Seed • Technology • Fertilizers • Irrigation Agricultural Practices: • Diversification • Conservation farming • Demonstration farms & gardens Processing & Marketing: • Storage • Processing • Aggregation and Distribution • Retailing Increased farm income Increased Food Diversity Increase Use of Health ServicesNutrition Screening & Service Referrals Improved nutrition knowledge Nutrition Education: ENA and SUN
  4. 4. DAI - Prime Univ of Michigan - partner Save the Children - partner NASFAM FUM CADECOM MMPA Nkhoma Synod AG Technical Service Providers Nutrition Technical Service Provider Farmer’s Assoc. Farmer’s Assoc. Farmer’s Club Farmer’s Club Farmer’s Club Lead Farmer supports Club Soy Grp GN Grp Gender, Nutrition, HIV Group CCGCCG Volunteer Leader Volunteer Leader Volunteer Leader INVC Integration Model HH: U5 & PLW HH: U5 & PLW HH: U5 & PLW HH: U5 & PLW HH: U5 & PLW HH: U5 & PLW Community Care Group (CCG) Nutrition Promoter (120) 1 Promoter supports 3 CCGs (360 CCGs) Mentors 12 HH 1 CCG=12 Volunteer Leaders (4320 volunteers) Mentors 12 HH Mentors 12 HH District Coord. (3) Nutrition Asst. (6) Soy Grp Soy Grp Chili Grp Farming / Marketing Groups Group Action Committees Farmer Farmer Farmer Farmer Farmer Farmer Farmer Farmer’s Assoc. Assoc. Field Officers train Lead Farmers GVH/GACVillageDistrict Integration point of entry
  5. 5. Davis, Rick and Jess Hart (2005). The ‘Most Significant Change’ (MSC) Technique: A Guide to its Us http://www.mande.co.uk/docs/MSCGuide.pdf. Photo: Elizabeth T. Robinson/MEASURE Evaluation  From participants’ perspective, what aspects of the integrated program had the biggest impact on their lives?  How did the impacts of the program on participants’ lives change over time? Methods: Why MSC stories?
  6. 6.  26 nutrition promoters in two districts trained to collect stories  Each promoter collected one MSC story per month  Promoters met quarterly to review stories, select most significant, and document reasons selected  Data collected for one year  Data coded in Dedoose Methods
  7. 7. Word cloud Improved household health status Improved nutrition knowledge Improved farming practices More time or money Improved hygiene Increased sales of agricultural products Improved infant and young child feeding practices Improved health knowledge Results
  8. 8. “Even though my wife is the group member, I can still see changes in our family. Our child is healthy and we use soya to make milk and snacks. We also have porridge each morning that is making us healthy. In the past, we didn’t know much about soya and used to just sell it. Now we use it for nutrition and my child is healthy.” Improved health status and nutrition knowledge Results
  9. 9. “We are now able to save money because our children no longer get sick regularly and they are growing well. This is very significant because I am able to do my household chores. This year, I have been able to cultivate in the garden because my children are healthy.” More time and money Results
  10. 10.  Lead mothers get materials, but cluster members do not  Promoters are not getting their bicycle allowance  Competition between INVC and other projects  Lack of supervision of promoters  Inadequate male involvement in program  Participants and promoters want incentives for MSC stories Issues raised by nutrition promoters Results
  11. 11. Challenges to Using MSC  Length of program implementation before MSC collection  Level of education of nutrition promoters  Volunteer nature of program  Lack of “thick” description  Repetitive stories  Use of stories to highlight health promoter needs  Issues with voting on most significant stories
  12. 12.  MSC stories tell us what matters to participants, even if descriptions are “thin”  Quarterly meetings with promoters help to understand program implementation  The process may need to be adjusted to education level of data collectors  Consider utility of continuous MSC data collection Conclusions
  13. 13. Acknowledgements Centre for Public Health Research and Development  Agatha Bula  David Chilongozi  Jennifer Tseka MEASURE Evaluation  Gustavo Angeles  Milissa Markiewicz
  14. 14. This presentation was produced with the support of the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID- OAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of USAID or the United States government. www.measureevaluation.org

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