Lessons Learned from the Evaluation of Helen Keller international’s Enhanced Homestead Food Production (EHFP) Program

1. Lessons Learned from the Evaluation
of Helen Keller international’s
Enhanced Homestead Food
Production (EHFP) Program
Presented by: Deanna Olney, PhD*
October 19, 2016
* Olney, Dillon, Ruel, Nielsen. Lessons learned from the evaluation of Helen Keller
International’s Enhanced Homestead Food Production Program. AOTR

2. Background
• The agriculture sector can improve nutrition especially
through integrated agriculture and nutrition programs.
• Consistently improve agriculture production and dietary diversity
(Leroy et al. 2008, Girard et al. 2012).
• Also posited to improve nutrition outcomes by simultaneously
addressing the direct and underlying causes of undernutrition (Ruel
et al. 2013).
• However, limited documented evidence exists about their
impacts on nutrition outcomes and how impacts are
achieved.
• Rigorous, comprehensive evaluations that include impact
and process evaluations are needed to generate this
evidence.

3. Increase
production
Enhanced-Homestead Food
Production (EHFP) program in
Burkina Faso
Establish
Village
Model
Farms
Provide
agriculture
training
Provide
nutrition
and health-
related
training
Establish
home
gardens
Distribute
agriculture
and
zoological
inputs
Program enhancements:
• Targeted to mothers with
children 3-12 mo of age
• Increased focus on women
• Improved behavior change
communication (BCC)
strategy
Increase
income &
assets
Increase
consumption
Improve
nutrition,
health and
hygiene
practices
Improve
maternal
& child
health &
nutrition
outcomes

4. Study design for HKI’s EHFP
program in Burkina Faso
20092010
Feb.-May
443 households
400 women
395 children
55 eligible villages (water + population criteria)
15 villages randomly assigned
Older Women Leader (OWL) BCC
512 baseline households
15 villages randomly assigned
Health Committee (HC) BCC
514 baseline households
25 villages randomly assigned
Control group
741 baseline households
15 Villages
75 Women
60 KI
2011
Apr.-May
441 households
407 women
376 children
15 villages
75 Women
75 Men
75 KI
14 Villages
70 Women
58 KI
14 Villages
70 Women
70 Men
58 KI
597 households
565 women
511 children
15 Villages
75 Women
15 Villages
75 Women
75 Men
2012
Mar.-June

5. What impact did the EHFP
program have on children’s and
women’s nutritional status and
women’s empowerment?

6. 2 y impact on children’s
stunting, wasting and diarrhea
* P<0.01, ** P<0.05
Olney et al., Journal of Nutrition 2015
Diarrhea prevalence, children
aged 3-12 mo at baseline
0
5
10
15
20
25
30
35
0 2
Diarrhea(%)
Survey time point, y
Control villages
Older women leader villages
Health committee villages
-15.9 pp **
-9.8 pp *
0
5
10
15
20
25
30
35
0 2
Wasting(%)
Survey time point, y
Control villages
Older women leader villages
Health committee villages
-8.8 pp**
Wasting prevalence, children
aged 3-12 mo at baseline
0
5
10
15
20
25
30
35
40
45
50
0 2
Stunting(%)
Survey time point, y
Control villages
Older women leader villages
Health committee villages
**
Stunting prevalence, children
aged 3-12 mo at baseline

7. 2 y impact on children’s anemia
70
75
80
85
90
95
100
0 2
Anemia(%) Survey time point, y
Control villages
Older women leader villages
Health committee villages
-14.6 pp**
Anemia prevalence, children
aged 3-5.9 at baseline
70
75
80
85
90
95
100
0 2
Anemia(%)
Survey time point, y
Control villages
Older women leader villages
Health committee villages
Anemia prevalence, children
aged 3-12.9 at baseline
* P<0.01, ** P<0.05
Olney et al., Journal of Nutrition 2015

8. 2 y impact on mother’s
underweight and body mass
index (BMI)
** P<0.05 for DID estimates, * P<0.10 for interaction.
Olney et al., Journal of Nutrition 2016
Change in the prevalence of underweight
among women1
10%
15%
20%
25%
30%
0 2
Underweight(%)
Survey time point, y
Control Intervention
-8.7 pp**
Change in women’s body mass index (BMI) by
underweight status at baseline1
17
18
19
20
21
22
0 2
MeanBMI Survey time point, y
Underweight BL, control
Underweight BL, intervention
Not underweight BL, control
Not underweight, intervention
0.52*

9. 2 y impact on women’s overall
empowerment, decision-
making and social capital
** P<0.05 for DID estimates.
Olney et al., Journal of Nutrition 2016
0
10
20
30
0 2
Survey time point, y
Overall
score (0-37)
Control Program
3.1**
• Significant impacts on
meeting with other women,
purchasing and health care
decisions
• No impact on spousal
communication, social
support, family planning
decisions or infant and
young child feeding
decisions.

10. How did the EHFP program work
to improve children‘s and
women’s nutritional status and
women’s empowerment?

11. Production – consumption
pathway: What worked?
• Process evaluation
• Improved knowledge of optimal agriculture practices and
adoption of some key practices
• Perceived increases in production of chickens, eggs and
vegetables
• Impact evaluation
• Beneficiary women owned more chickens
• Beneficiary women produced more micronutrient-rich foods

12. Production – consumption
pathway: What needed
improvement?
• Process evaluation
• Water constraints
• HKI worked to decrease water constraints through a variety of methods
such as creating new wells and boreholes, repairing existing water
sources, using drip irrigation kits, etc.
• Perceived inadequacies in supplies
• Motivation and compensation of local implementers
• Timing and duration of the program
• Impact evaluation
• Impact on household level production

13. Production – income pathway:
What worked?
• Process evaluation
• Positive changes in men’s and women’s opinions about
women’s ability to own and use land changed
• Beneficiary women maintained control over their gardens,
food produced and income generated
• Impact evaluation
• Beneficiary compared to non-beneficiary women:
• Owned more agriculture assets
• Owned more chickens
• Produced more micronutrient-rich foods

14. Knowledge – adoption of
optimal health and nutrition
practices pathway: What
worked?
• Process evaluation
• Knowledge of some optimal health, hygiene and nutrition
practices improved
• Impact evaluation
• Knowledge and adoption of some key practices improved
• Mothers’ intake of micronutrient-rich foods increased
• Children’s dietary diversity increased

15. Knowledge – adoption of
optimal health and nutrition
practices pathway: What
needed improvement?
• Process evaluation
• Home visit frequency
• Motivation of local level program implementers
• Technical abilities and quality of program implementation by
OWLs
• Understanding of BCC topics related to prevention and
treatment of anemia
• HKI retrained nutrition trainers and in turn beneficiaries in the topics
related to the prevention and treatment of anemia
• Impact evaluation
• Further improvements in knowledge and adoption of some of
the promoted practices

16. Conclusions
• The EHFP program improved child and maternal
nutritional status and maternal empowerment
• Further reductions in anemia, diarrhea and stunting are
needed
• Possible ways to achieve this are:
• Intervening earlier and for longer
• Improving delivery and utilization of some program
components
• Re-examining issues related to motivation and compensation
of program implementers
• Including additional interventions designed to address some of
the other causes of undernutrition such as water, sanitation
and hygiene (WASH) interventions or the provision of a fortified
complementary food for children 6-24 mo of age

17. Acknowledgements
• Study participants in Burkina Faso
• Helen Keller International (HKI)
• HKI Burkina Faso: Abdoulaye Pedehombga, Marcellin Ouedraogo, Hippolyte Rouamba,
Olivier Vebamba, Ann Tarini, Dr. Jean Celestin Somda and Fanny Yago-Wienne
• HKI headquarters: Victoria Quinn, Jennifer Nielsen
• Local implementing non-governmental organizations (NGOs)
• Burkina Faso - Association d'Appui et de Promotion Rurale du Gulmu (APRG)
• Research team at the International Food Policy Research Institute (IFPRI) and
Michigan State University
• IFPRI and Michigan State: Andrew Dillon
• IFPRI: Marie Ruel, Mara van den Bold, Elyse Iruhiriye, Lilia Bliznashka, Julia Behrman,
Esteban Quiñones and Jessica Heckert
• Funding:
• The Office of U.S. Foreign Disaster Assistance (OFDA) of the U.S. Agency for
International Development (USAID)
• Gender, Agriculture, and Assets Project (GAAP), supported by the Bill and Melinda
Gates Foundation
• European Commission (EC)
• CGIAR Research Program on Agriculture for Nutrition and Health (A4NH) led by the
International Food Policy Research Institute (IFPRI)

18. THANK YOU!!