This document summarizes the results of a study on the social return on investment (SROI) of a nutrition intervention program in urban poor settings in Nairobi, Kenya. The study found that the intervention led to many benefits, including improved breastfeeding practices, increased male involvement in childcare, and reduced illness in children. It also identified some negative outcomes, such as women foregoing work to breastfeed. The SROI ratio calculated was $71 for every $1 invested, indicating high social value. While the intervention showed success, future programs should address potential negative impacts and support combining work with breastfeeding.

1. “Measure what is
measureable, and make
measurable what is not so”
Galileo

2. Social Return on Investment
of a Nutrition Intervention in
Urban Poor Settings, Nairobi

3. What is SROI?
• Approach to program, project and policy
evaluation that aims to account for non-financial
outcomes using monetary values to represent
them
– Explores unintended outcomes
– Values non-financial outcomes
– Values real or “perceived” changes for identified
stakeholders

4. How is SROI Implemented
Reporting, using and embedding
Calculating the SROI
Establishing impact
Evidencing outcomes and giving them a value
Mapping outcomes
Establishing scope and identifying key stakeholders

5. Rationale of MIYCN-SROI
1. To find out what MIYCN
intervention outcomes
impacted on key
stakeholders
2. What these impacts are
worth to the key
Stakeholders

6. Methods
Qualitative Interviews (FGDS,
IDIS, KIIS) with stakeholders to
determine outcomes
Quantitative study using questionnaires to quantify
and value outcomes
Value games to value the
outcomes without monetary
values

7. Key Results
• A multitude of positive changes reported
by the various stakeholders
• A few negative outcomes reported by
some stakeholders
• Women and children were the main
beneficiaries

8. Mothers
Outcome Comments
Empowerment &
increased
confidence to
make appropriate
MIYCN related
decisions
“When I gave birth, my husband told me
that I should stop working until the baby
is 2 years, so my mother-in-law was
asking, ‘Is the baby an egg that he
should be breastfed for 2 years?’ She
said that when the navel heals, the baby
should stop breastfeeding. So based on
what we were taught by the CHW, his
father refused, so we decided that the
baby breastfeeds for 6 months and then
he starts eating, and then he continues to
breastfeed until 2 years and put my job
aside”. (Mother, Urban Slums)

9. Fathers
Outcome Comments
Improvement in
male
involvement in
child care
“It was excellent because not many people
feel that the father should also take care
of the baby, people just think it’s the
mother…” “I was taught….and I was told
to at least be participating also…..” (IDI
Father Viwandani)

10. Children
Outcome Comments
Reduced
illness and
malnutrition
“We used to go to hospital often and spend
money that was not to be spent... In a month
I would take the child to hospital two or three
times and I would pay not less than ksh.500
or ksh.1000, so I feel that it did boost me”
(IDI father)

11. CHVs
Outcome Comments
Increased psychosocial
and financial stress for
CHVs
“you go to counsel a mother and
she tells you ‘I even did not eat, I
slept hungry’ So I used to be forced
to call my supervisor/the team
leader because at times I did not
have money, …So we were forced
to contribute and give her. Maybe
the mother has three days since
delivery, you cannot tell her to go
and work. So you will have to
support her…. So it was a big
change that I did not expect” (FGD
CHVs)

12. Social Return Calculation
SROI measures the value of social
benefits created by an organisation, in
relation to the relative cost of achieving
those benefits, expressed in a SROI
ratio:
SROI ratio = present value
value of inputs

13. Social Value
SROI ratio = USD$ 71:1
67%
17%
16%
1%
SROI ratio breakdown
Mothers Children Siblings Others

14. Conclusions
• Intervention demonstrated many benefits:
– Improvement in breastfeeding practices and nutritional outcomes
– Male involvement in child care
– Unexpected benefits that could only be accounted for and quantified
using the SROI approach
• Some negative outcomes identified, for example women
foregoing work in order to optimally breastfeed
• Study indicates potential benefits of scaling up the
government proposed baby friendly community initiative
• Future interventions should consider ways of mitigating
potential negative outcomes which may include finding ways
of helping women combine work with optimal breastfeeding

15. Policy Implications
National & County Governments & Donors
• Fund and Implement BFCI - a priority health
promotion tool
• Fund the Community Health Strategy which is the
cornerstone of the BFCI

16. For More Information
MIYCN Project: http://aphrc.org/projects/maternal-infant-and-young-child-nutrition-project-
miycn/
MIYCN-SROI Project: http://aphrc.org/projects/maternal-infant-and-young-child-nutrition-
miycn-social-return-on-investment-sroi-project/
Short report: http://aphrc.org/publications/social-return-investment-assessment-baby-
friendly-community-intervention-urban-poor-settings/
Policy Brief: http://aphrc.org/publications/measuring-value-baby-friendly-community-
intervention-nairobis-slums/
SROI Blog: http://socialvalueofnutrition.org/

17. Other References
1. Kimani-Murage EW, Norris SA, Mutua MK, Wekesah F, Wanjohi M, Muhia N, Muriuki P, Egondi
T, Kyobutungi C, Ezeh AC, Musoke RN, McGarvey ST, Madise NJ, Griffiths PL. Potential
effectiveness of Community Health Strategy to promote exclusive breastfeeding in urban poor
settings in Nairobi, Kenya: A quasi-experimental study . Developmental Origins of Health and
Disease [DOHaD] Journal; 2016; 172-84 doi: 10.1017/S2040174415007941
2. Milka Wanjohi, Paula Griffiths, Frederick Wekesah, Peterrock Muriuki, Nelson Muhia, Rachel N
Musoke, Hillary N Fouts, Nyovani J Madise, Elizabeth W Kimani-Murage. Sociocultural factors
influencing breastfeeding practices in two slums in Nairobi, Kenya. International Breastfeeding
Journal 2017 12:5. DOI: 10.1186/s13006-016-0092-7.
3. Goudet S, Kimani-Murage EW, Wekesah F, Wanjohi M, Griffiths P, Bogin B, Madise NJ: How
does poverty affect children’s nutritional status in Nairobi slums? A qualitative study of the root
causes of undernutrition. Public Health Nutrition (2016); doi:10.1017/S1368980016002445.
4. Kimani-Murage EW, Wekesah F, Wanjohi M, Kyobutungi C, Ezeh AC, et al. (2014) Factors
affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in
Kenya. Matern Child Nutr.
5. Kimani-Murage EW, Kyobutungi C, Ezeh AC, Wekesah F, Wanjohi M, et al. (2013) Effectiveness
of personalised, home-based nutritional counselling on infant feeding practices, morbidity and
nutritional outcomes among infants in Nairobi slums: study protocol for a cluster randomised
controlled trial. Trials 14: 445.

18. Acknowledgements
• Unit of Nutrition and Dietetics, MoH &
Nutrition Stakeholders in Kenya
• Transform Nutrition/DFID
• Wellcome Trust
• Loughborough University
• Tim Goodspeed, SocialValueUK

19. Elizabeth Kimani-Murage, PhD
Research Scientist, APHRC
ekimani@aphrc.org; @Liz_Kimani