"programme_id","programme_title","programme_language","programme_type","other_program","iso3code","country_name","program_location","area","status","start_date","end_date","brief_description","references","related_policy","new_policy","partner_gov","partner_government_details","partner_un","partner_un_details","partner_ngo","partner_ngo_details","partner_donors","partner_donors_details","partner_intergov","partner_intgov_details","partner_national_ngo","partner_nat_ngo_details","partner_research","partner_research_details","partner_private","partner_private_details","partner_other","partner_other_details","cost","fsector_0","fpartner_0","fdetails_0","fsector_1","fpartner_1","fdetails_1","fsector_2","fpartner_2","fdetails_2","fsector_3","fpartner_3","fdetails_3","fsector_4","fpartner_4","fdetails_4","fsector_5","fpartner_5","fdetails_5","fsector_6","fpartner_6","fdetails_6","fsector_7","fpartner_7","fdetails_7","fsector_8","fpartner_8","fdetails_8","fsector_9","fpartner_9","fdetails_9","fsector_10","fpartner_10","fdetails_10","fsector_11","fpartner_11","fdetails_11","fsector_12","fpartner_12","fdetails_12","fsector_13","fpartner_13","fdetails_13","fsector_14","fpartner_14","fdetails_14","fsector_15","fpartner_15","fdetails_15","fsector_16","fpartner_16","fdetails_16","fsector_17","fpartner_17","fdetails_17","fsector_18","fpartner_18","fdetails_18","fsector_19","fpartner_19","fdetails_19","fsector_20","fpartner_20","fdetails_20","fsector_21","fpartner_21","fdetails_21","fsector_22","fpartner_22","fdetails_22","fsector_23","fpartner_23","fdetails_23","fsector_24","fpartner_24","fdetails_24","fsector_25","fpartner_25","fdetails_25","fsector_26","fpartner_26","fdetails_26","fsector_27","fpartner_27","fdetails_27","fsector_28","fpartner_28","fdetails_28","fsector_29","fpartner_29","fdetails_29","fsector_30","fpartner_30","fdetails_30","fsector_31","fpartner_31","fdetails_31","fsector_32","fpartner_32","fdetails_32","fsector_33","fpartner_33","fdetails_33","fsector_34","fpartner_34","fdetails_34","fsector_35","fpartner_35","fdetails_35","fsector_36","fpartner_36","fdetails_36","fsector_37","fpartner_37","fdetails_37","fsector_38","fpartner_38","fdetails_38","fsector_39","fpartner_39","fdetails_39","fsector_40","fpartner_40","fdetails_40","fsector_41","fpartner_41","fdetails_41","fsector_42","fpartner_42","fdetails_42","fsector_43","fpartner_43","fdetails_43","fsector_44","fpartner_44","fdetails_44","fsector_45","fpartner_45","fdetails_45","fsector_46","fpartner_46","fdetails_46","fsector_47","fpartner_47","fdetails_47","fsector_48","fpartner_48","fdetails_48","fsector_49","fpartner_49","fdetails_49","action_id","theme","topic","new_topic","micronutrient","micronutrient_compound","target_group","age_group","place","delivery","other_delivery","dose_frequency","impact_indicators","me_system","target_pop","coverage_percent","coverage_type","baseline","post_intervention","social_det","social_other","elena_link","problem_0","solution_0","problem_1","solution_1","problem_2","solution_2","problem_3","solution_3","problem_4","solution_4","problem_5","solution_5","problem_6","solution_6","problem_7","solution_7","problem_8","solution_8","problem_9","solution_9","other_problems","other_lessons","personal_story","language" "6085","Weekly iron and folic acid supplementation (WIFS)/de-worming program","English","Community/sub-national","","VNM","Viet Nam","Yen Bai, Vietnam","Rural","on-going","01-2006","","
Periodical deworming and weekly supplementation of iron was offered free of charge to more than 52 000 women in the province. The acceptance of the intervention and the nutritional outcomes were followed up. In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.
","Pasricha SR, et al. Baseline Iron Indices as Predictors of Hemoglobin Improvement in Anemic Vietnamese Women Receiving Weekly Iron-Folic Acid Supplementation and Deworming (2009). American Journal of Tropical Medicine and Hygiene 81;1114-9.
Phuc TQ, et al. Lessons learned from implementation of a demonstration program to reduce the burden of anemia and hookworm in women in Yen Bai Province, Viet Nam. (2009). BMC Public Health.; 9: 266.
Casey GJ, et al. Long-term weekly iron-folic acid and de-worming is associated with stabilised haemoglobin and increasing iron stores in non-pregnant women in Vietnam. (2010) PLoS ONE 5, e15691.
Casey GJ., et al. Weekly iron-folic acid supplementation with regular deworming is cost-effective in preventing anaemia in women of reproductive age in Vietnam PLoS ONE [in print]
","","","Health","Provincial Health Department","World Health Organization (WHO)","","","","","","","","","","Research/academia","University of Melbourne","","","","","80 000 USD/ year initially provided by the University of Melbourne, as a starting up (including training activities and development of education material) after the first years the Provincial Health Department covered the running cost. WHO donated the deworming drugs.","Research/academia","","University of Melbourne","Government","","Provincial Health Department","UN","World Health Organization (WHO)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6084","Acute malnutrition","Iron and folic acid supplementation","","Folic acid|Iron","","Women of reproductive age (WRA)","15-45 years","Yen Bai province","Primary health care center","","Weekly iron-folic acid tablets; 200mg ferrous sulphaet/0.4 mg folic acid
Deworming every 4 months with one albendazole tablet (400 mg) in the first year and 6-monthly thereafter
","Anemia prevalence
","Periodical prevalence surveys and compliance monitoring by the research and training centre for community development.
","52000 (In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.)","missing","","STH infection 75%","(after 30 months) STH infection 22%","Vulnerable groups","","Intermittent iron and folic acid supplementation for menstruating women>>>Intermittent iron and folic acid supplementation for menstruating women>>http://www.who.int/elena/titles/iron_women","Adherence","Independent monitoring started early to be able to modify training and packaging","Financial resources","No solution","","","","","","","","","","","","","","","","","","","In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.
","English" "6085","Weekly iron and folic acid supplementation (WIFS)/de-worming program","English","Community/sub-national","","VNM","Viet Nam","Yen Bai, Vietnam","Rural","on-going","01-2006","","Periodical deworming and weekly supplementation of iron was offered free of charge to more than 52 000 women in the province. The acceptance of the intervention and the nutritional outcomes were followed up. In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.
","Pasricha SR, et al. Baseline Iron Indices as Predictors of Hemoglobin Improvement in Anemic Vietnamese Women Receiving Weekly Iron-Folic Acid Supplementation and Deworming (2009). American Journal of Tropical Medicine and Hygiene 81;1114-9.
Phuc TQ, et al. Lessons learned from implementation of a demonstration program to reduce the burden of anemia and hookworm in women in Yen Bai Province, Viet Nam. (2009). BMC Public Health.; 9: 266.
Casey GJ, et al. Long-term weekly iron-folic acid and de-worming is associated with stabilised haemoglobin and increasing iron stores in non-pregnant women in Vietnam. (2010) PLoS ONE 5, e15691.
Casey GJ., et al. Weekly iron-folic acid supplementation with regular deworming is cost-effective in preventing anaemia in women of reproductive age in Vietnam PLoS ONE [in print]
","","","Health","Provincial Health Department","World Health Organization (WHO)","","","","","","","","","","Research/academia","University of Melbourne","","","","","80 000 USD/ year initially provided by the University of Melbourne, as a starting up (including training activities and development of education material) after the first years the Provincial Health Department covered the running cost. WHO donated the deworming drugs.","Research/academia","","University of Melbourne","Government","","Provincial Health Department","UN","World Health Organization (WHO)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","8875","","Deworming","","","","Women of reproductive age (WRA)","15-45","Yen Bai ","Community-based","","","Hookworm prevalence
","","250000","missing","","","","Vulnerable groups","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "8891","Double Burden of Malnutrition: Hub in West Africa","English","Multi-national","","BEN|BFA|MLI","Benin|Burkina Faso|Mali","Benin|Burkina Faso|Mali","Urban","on-going","01-2008","01-2014","The 6-year partnership project (2008-2014) involves TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Developement, academic and research institutions from Benin, Burkina Faso and Mali, Helen Keller International, an international NGO, and WHO as special collaborator. The purpose of the project is to strengthen capacity of partner countries to address the double burden of the coexistence of undernutrition and nutrition-related chronic diseases.The strategy includes: 1) Workforce training in nutrition with two new regional university programs in Benin, a Master's and an undetrgraduate professional program (licence), as well as continuous intensive courses on Nutrition Transition and Chronic Diseases, and Community Management of acute malnutrition; 2) Action research in communities (Benin) and schools (Benin and Burkina Faso), and other studies on the nutrition transition and the double burden of malnutrition; 3) Communication for the public with development of a food guide for Benin, and the development of advocacy tools for policy and programs focusing on diabetes.
","Website: www.poleDFN.org
Publications:
Delisle H. Findings on dietary patterns in different groups of African origin undergoing nutrition transition. Applied Physiol Nutr Metab 2010; 35: 224-8.
Daboné C, Receveur O, Delisle H. Poor nutritional status of schoolchildren in urban and peri-urban areas of Ouagadougou. Nutrition Journal 2011; Apr 19;10:34.
Delisle H, Ntandou G, Agueh V, Sodjinou R, Fayomi B. Urbanisation, nutrition transition and cardiometabolic risk: the Benin Study. Brit J Nutr 2011; 107: 1534-44 (doi:10.1017/S0007114511004661)
Sossa J, Delisle H, Agueh V, Makoutodé M, Fayomi B. Four-year trends in cardiometabolic risk factors according to baseline abdominal obesity status in West-African adults: The Benin Study. J Obesity 2012 doi: 10.1155/2012/740854
Zeba A, Delisle H, Renier G, Savadogo B, Banza B. The double burden of malnutrition and cardio-metabolic risk widens the gender and socioeconomic health gap: a study among adults in Burkina Faso (West Africa). Public Health Nutr 2012; 15: 2210-9
Zeba A, Delisle H, Rossier C, Renier G. Association of high-sensitive C-reactive protein (hsCRP) with cardio-metabolic risk factors and micronutrient deficiencies in adults of Ouagadougou; Burkina Faso. Brit J Nutr (Accepted)
Delisle H, Agueh V, Fayomi B. Partnership research on nutrition transition and chronic diseases in West Africa – trends, outcomes and impacts. BMC International Health & Human Rights 2011; 11 (suppl 2): S10 http://www.biomedcentral.com/bmcinthealthhumrights/supplements/11/S2
Delisle H, Agueh V, Fayomi B. Recherche en partenariat sur la transition nutritionnelle et les maladies chroniques en Afrique de l’ouest – évolution, résultats et retombées. CRDI, 2011. Disponible à : http://www.crdi.ca/irsm10etudesdecas
Delisle H, Receveur O, Agueh V, Nishida C. Pilot-testing of the Nutrition-Friendly School Initiative in West Africa in Ouagadougou (Burkina Faso) and Cotonou (Benin). Global Health Promotion (in press)
Sossa C, Delisle H, Agueh V, Makoutodé M, Fayomi B. Insulin resistance status and four-year changes in other cardiometabolic risk factors in West-African adults: The Benin Study. (NMCD, in press)
Daboné C, Delisle H, Receveur O. Cardiometabolic risk factors and associated features in 5th grade school children in Ouagadougou, Burkina Faso. Int J Child Health Nut 2012 (In press)
Daboné C, Delisle H, Receveur O. Predisposing, facilitating and reinforcing factors of healthy and unhealthy food consumption in schoolchildren. A study in Ouagadougou, Burkina Faso (West Africa). Global Health Promotion 2012 (in press)
Delisle H. Empowering our profession in Africa. World Nutrition 2012; 3: 269-84: http://www.wphna.org/2012_may_hp6_this_month.htm
","8811|8621|8622|8554","","","","","","Helen Keller International (HKI)","Particularly in Burkina Faso","","","","","National NGOs","Mali: Santé-Diabète (French NGO)","Research/academia","Benin: Regional Public Health Institute (IRSP); Faculty of Health Sciences, Abomey-Calavi University; Appiled Biomedical Science Institute (ISBA); Burkina Faso: Research Institute on Health Sciences (IRSS); Ouagadougou University (Medicine; CRSBAN); Mali: University of Bamako and university hospital; University of Montreal, Canada, TRANSNUT, Department of Nutrition","","","","","Total: ~5 million CAD, including 3 million CAD provided by Canadian International Development Agency","Bilateral and donor agencies and lenders","Canadian International Development Agency (CIDA)","University of Montreal contributes ~1.3 million CAD and African partner institution, ~700.000CAD","Research/academia","Research/academia","NFSI implemented on a pilot basis in primary schools of Cotonou (n=6) and in Ouagadougou (n=6). In Ouagadougou, quasi-experimental approach, with 6 matched control schools. Baseline study conducted on nutritional status of pupils (nearly 900), and hygiene and eating practices. Implementation with Nutrition & Health Committees in schoolds. DFN project trained in nutrition education and surveillance (using anthropometry). Other activities elected by individual schools.
","Nutritional status of pupils after 3 years of NFSI implementation, and their hygiene and eating practices.
","","Undefined","Undefined","","Baseline study in Ouagadougou in 2009","Due in 2013
","Sex","","","","","","","","","","","","","","","","","","","","","","","","","","English" "8891","Double Burden of Malnutrition: Hub in West Africa","English","Multi-national","","BEN|BFA|MLI","Benin|Burkina Faso|Mali","Benin|Burkina Faso|Mali","Urban","on-going","01-2008","01-2014","The 6-year partnership project (2008-2014) involves TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Developement, academic and research institutions from Benin, Burkina Faso and Mali, Helen Keller International, an international NGO, and WHO as special collaborator. The purpose of the project is to strengthen capacity of partner countries to address the double burden of the coexistence of undernutrition and nutrition-related chronic diseases.The strategy includes: 1) Workforce training in nutrition with two new regional university programs in Benin, a Master's and an undetrgraduate professional program (licence), as well as continuous intensive courses on Nutrition Transition and Chronic Diseases, and Community Management of acute malnutrition; 2) Action research in communities (Benin) and schools (Benin and Burkina Faso), and other studies on the nutrition transition and the double burden of malnutrition; 3) Communication for the public with development of a food guide for Benin, and the development of advocacy tools for policy and programs focusing on diabetes.
","Website: www.poleDFN.org
Publications:
Delisle H. Findings on dietary patterns in different groups of African origin undergoing nutrition transition. Applied Physiol Nutr Metab 2010; 35: 224-8.
Daboné C, Receveur O, Delisle H. Poor nutritional status of schoolchildren in urban and peri-urban areas of Ouagadougou. Nutrition Journal 2011; Apr 19;10:34.
Delisle H, Ntandou G, Agueh V, Sodjinou R, Fayomi B. Urbanisation, nutrition transition and cardiometabolic risk: the Benin Study. Brit J Nutr 2011; 107: 1534-44 (doi:10.1017/S0007114511004661)
Sossa J, Delisle H, Agueh V, Makoutodé M, Fayomi B. Four-year trends in cardiometabolic risk factors according to baseline abdominal obesity status in West-African adults: The Benin Study. J Obesity 2012 doi: 10.1155/2012/740854
Zeba A, Delisle H, Renier G, Savadogo B, Banza B. The double burden of malnutrition and cardio-metabolic risk widens the gender and socioeconomic health gap: a study among adults in Burkina Faso (West Africa). Public Health Nutr 2012; 15: 2210-9
Zeba A, Delisle H, Rossier C, Renier G. Association of high-sensitive C-reactive protein (hsCRP) with cardio-metabolic risk factors and micronutrient deficiencies in adults of Ouagadougou; Burkina Faso. Brit J Nutr (Accepted)
Delisle H, Agueh V, Fayomi B. Partnership research on nutrition transition and chronic diseases in West Africa – trends, outcomes and impacts. BMC International Health & Human Rights 2011; 11 (suppl 2): S10 http://www.biomedcentral.com/bmcinthealthhumrights/supplements/11/S2
Delisle H, Agueh V, Fayomi B. Recherche en partenariat sur la transition nutritionnelle et les maladies chroniques en Afrique de l’ouest – évolution, résultats et retombées. CRDI, 2011. Disponible à : http://www.crdi.ca/irsm10etudesdecas
Delisle H, Receveur O, Agueh V, Nishida C. Pilot-testing of the Nutrition-Friendly School Initiative in West Africa in Ouagadougou (Burkina Faso) and Cotonou (Benin). Global Health Promotion (in press)
Sossa C, Delisle H, Agueh V, Makoutodé M, Fayomi B. Insulin resistance status and four-year changes in other cardiometabolic risk factors in West-African adults: The Benin Study. (NMCD, in press)
Daboné C, Delisle H, Receveur O. Cardiometabolic risk factors and associated features in 5th grade school children in Ouagadougou, Burkina Faso. Int J Child Health Nut 2012 (In press)
Daboné C, Delisle H, Receveur O. Predisposing, facilitating and reinforcing factors of healthy and unhealthy food consumption in schoolchildren. A study in Ouagadougou, Burkina Faso (West Africa). Global Health Promotion 2012 (in press)
Delisle H. Empowering our profession in Africa. World Nutrition 2012; 3: 269-84: http://www.wphna.org/2012_may_hp6_this_month.htm
","8811|8621|8622|8554","","","","","","Helen Keller International (HKI)","Particularly in Burkina Faso","","","","","National NGOs","Mali: Santé-Diabète (French NGO)","Research/academia","Benin: Regional Public Health Institute (IRSP); Faculty of Health Sciences, Abomey-Calavi University; Appiled Biomedical Science Institute (ISBA); Burkina Faso: Research Institute on Health Sciences (IRSS); Ouagadougou University (Medicine; CRSBAN); Mali: University of Bamako and university hospital; University of Montreal, Canada, TRANSNUT, Department of Nutrition","","","","","Total: ~5 million CAD, including 3 million CAD provided by Canadian International Development Agency","Bilateral and donor agencies and lenders","Canadian International Development Agency (CIDA)","University of Montreal contributes ~1.3 million CAD and African partner institution, ~700.000CAD","Research/academia","Research/academia","The Master's program in Public Health Nutrition started at the Regional Institute of Public Health in 2009 and a first cohort of 10 graduates finished in 2011. A new cohort of 10 students started in October 2012. Regarding the 3-year undergraduate professional program in Nutrition and Dietetics, the 3-year program is offered at the Faculty of Health Studies School of Nutrition since 2010. A first cohort of 20 will get their degree (licence) in July 2013.
","Number, sex, and position of graduates
","","N/A","N/A","","","","Sex","","","","","","","","","","","","","","","","","","","","","","","","","","English" "8891","Double Burden of Malnutrition: Hub in West Africa","English","Multi-national","","BEN|BFA|MLI","Benin|Burkina Faso|Mali","Benin|Burkina Faso|Mali","Urban","on-going","01-2008","01-2014","The 6-year partnership project (2008-2014) involves TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Developement, academic and research institutions from Benin, Burkina Faso and Mali, Helen Keller International, an international NGO, and WHO as special collaborator. The purpose of the project is to strengthen capacity of partner countries to address the double burden of the coexistence of undernutrition and nutrition-related chronic diseases.The strategy includes: 1) Workforce training in nutrition with two new regional university programs in Benin, a Master's and an undetrgraduate professional program (licence), as well as continuous intensive courses on Nutrition Transition and Chronic Diseases, and Community Management of acute malnutrition; 2) Action research in communities (Benin) and schools (Benin and Burkina Faso), and other studies on the nutrition transition and the double burden of malnutrition; 3) Communication for the public with development of a food guide for Benin, and the development of advocacy tools for policy and programs focusing on diabetes.
","Website: www.poleDFN.org
Publications:
Delisle H. Findings on dietary patterns in different groups of African origin undergoing nutrition transition. Applied Physiol Nutr Metab 2010; 35: 224-8.
Daboné C, Receveur O, Delisle H. Poor nutritional status of schoolchildren in urban and peri-urban areas of Ouagadougou. Nutrition Journal 2011; Apr 19;10:34.
Delisle H, Ntandou G, Agueh V, Sodjinou R, Fayomi B. Urbanisation, nutrition transition and cardiometabolic risk: the Benin Study. Brit J Nutr 2011; 107: 1534-44 (doi:10.1017/S0007114511004661)
Sossa J, Delisle H, Agueh V, Makoutodé M, Fayomi B. Four-year trends in cardiometabolic risk factors according to baseline abdominal obesity status in West-African adults: The Benin Study. J Obesity 2012 doi: 10.1155/2012/740854
Zeba A, Delisle H, Renier G, Savadogo B, Banza B. The double burden of malnutrition and cardio-metabolic risk widens the gender and socioeconomic health gap: a study among adults in Burkina Faso (West Africa). Public Health Nutr 2012; 15: 2210-9
Zeba A, Delisle H, Rossier C, Renier G. Association of high-sensitive C-reactive protein (hsCRP) with cardio-metabolic risk factors and micronutrient deficiencies in adults of Ouagadougou; Burkina Faso. Brit J Nutr (Accepted)
Delisle H, Agueh V, Fayomi B. Partnership research on nutrition transition and chronic diseases in West Africa – trends, outcomes and impacts. BMC International Health & Human Rights 2011; 11 (suppl 2): S10 http://www.biomedcentral.com/bmcinthealthhumrights/supplements/11/S2
Delisle H, Agueh V, Fayomi B. Recherche en partenariat sur la transition nutritionnelle et les maladies chroniques en Afrique de l’ouest – évolution, résultats et retombées. CRDI, 2011. Disponible à : http://www.crdi.ca/irsm10etudesdecas
Delisle H, Receveur O, Agueh V, Nishida C. Pilot-testing of the Nutrition-Friendly School Initiative in West Africa in Ouagadougou (Burkina Faso) and Cotonou (Benin). Global Health Promotion (in press)
Sossa C, Delisle H, Agueh V, Makoutodé M, Fayomi B. Insulin resistance status and four-year changes in other cardiometabolic risk factors in West-African adults: The Benin Study. (NMCD, in press)
Daboné C, Delisle H, Receveur O. Cardiometabolic risk factors and associated features in 5th grade school children in Ouagadougou, Burkina Faso. Int J Child Health Nut 2012 (In press)
Daboné C, Delisle H, Receveur O. Predisposing, facilitating and reinforcing factors of healthy and unhealthy food consumption in schoolchildren. A study in Ouagadougou, Burkina Faso (West Africa). Global Health Promotion 2012 (in press)
Delisle H. Empowering our profession in Africa. World Nutrition 2012; 3: 269-84: http://www.wphna.org/2012_may_hp6_this_month.htm
","8811|8621|8622|8554","","","","","","Helen Keller International (HKI)","Particularly in Burkina Faso","","","","","National NGOs","Mali: Santé-Diabète (French NGO)","Research/academia","Benin: Regional Public Health Institute (IRSP); Faculty of Health Sciences, Abomey-Calavi University; Appiled Biomedical Science Institute (ISBA); Burkina Faso: Research Institute on Health Sciences (IRSS); Ouagadougou University (Medicine; CRSBAN); Mali: University of Bamako and university hospital; University of Montreal, Canada, TRANSNUT, Department of Nutrition","","","","","Total: ~5 million CAD, including 3 million CAD provided by Canadian International Development Agency","Bilateral and donor agencies and lenders","Canadian International Development Agency (CIDA)","University of Montreal contributes ~1.3 million CAD and African partner institution, ~700.000CAD","Research/academia","Research/academia","Food-based dietary guidelines, including an illustrated food guide, is being developed in Benin with partner institutions. The urban population in particular is targeted. These nutrition communication tools were based on WHO/FAO recommendations and on recent dietary intake studies in the southern part of Benin.
","Formal acceptation of dietary guidelines by authorities of Benin
","","Approximately 3 million people (urban and peri-urban population of southern Benin)","Undetermined","","","","None","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","Urban|Rural","completed","01-2010","01-2011","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Behaviour change communication and/or counselling for improved complementary feeding was reported to the Global Nutrition Policy Review (GNPR) 2009-2010SamplingStudy participants were drawn from 45 communities in the nine project districts. The communities were selected based on the presence of mother support groups and church-based groups. In each district, purposeful sampling was used to select the female caregivers.1 The criterion used for selecting female respondents was that they were caregivers of children 6-24 months. Fathers2 of children 6-24 months, health workers, and community group leaders were selected using convenience sampling. Data collection methodsBoth qualitative and quantitative methods were used to conduct this study. Data were collected using a structured survey, in-depth interviews, and focus group discussions (FGDs) (see Appendix 2 for the study tools). Findings from all three sources were triangulated for the purpose of validation.Structured surveyEach study community was divided into six sub-areas, and one caregiver was selected from each sampled household within each sub-area, for a total of six participants per community.3Households in the cluster were numbered, and one was randomly selected. In a sampled household where there was more than one caregiver for the child aged 6-24 months, data collectors purposefully sampled for the interview one mother or caregiver who regularly fed the index child. In a situation where the selected caregiver had more than one child aged 6-24 months, the older one was selected as the index child. In-depth interviewsBased on the classification of health facilities in Brong Ahafo Region, we identified and selected four categories to use in the data collection exercise: district hospitals, clinics, health centers, and Community-Based Health Planning and Services compounds. In each district, five health workers were interviewed, including two health workers from the district hospital responsible for child welfare clinics (growth monitoring sessions) and one from each of the other three facility categories. Leaders of mother support groups and church-based groups at the community level whose activities could impact infant and young child feeding practices were also interviewed. In each district, five of these groups were randomly selected from a list of such groups within the district. Identification and sampling of the groups was done with the help of district-level health staff.
","From October 2010 to December 2011, the project:•Aired 855 radio spots with key messages on complementary feeding on Radio BAR, Omega FM, Success FM, Jerryson FM, Chris FM, Adarz FM, Star FM, and Royals FM. An additional 340 spots are scheduled to air in January 2012.Distributed 5,860 posters with key messages.Distributed 19,428 flyers with key messages.Trained 196 health workers and 137 community group leaders in appropriate complementary feeding practices and the use of BCC materials. Reached around 2,500 community group members with appropriate complementary feeding messages through trained group leaders.
","","45 communities in 9 selected districts in Brong- Ahafo region","45 communities in 9 selected districts in Brong- Ahafo region (","","Initiation of complementary feeding; Frequency of feeding; Feeding a variety of foods to children 6-24 months; Knowledge of three food groups; Caregivers who followed the World Health Organization’s (WHO) recommended practice of starting complementary foods at 6 months; Caregivers who gave fortified complementary foods to their children aged 6 to 9 months two or more times per day; Caregivers who gave their children aged 6 to 9 months porridge thick enough to stay on a spoon.","","Socio-economic status","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","","","","","","","","","","","","","","","","","","","","","","Engaging District Health Management Teams is integral to success. IYCN and partners engaged district heads early in the process. As a result, they demonstrated strong support for the activities and they are poised to monitor the community-level activities to ensure effective rollout, dissemination, and distribution of BCC materials.Partnerships can help to expand reach. By collaborating with the BCS Project and leveraging a national behavior change communication campaign, the project was able to expand reach of the complementary feeding messages. Although the social marketing strategy targets the Brong Ahafo region, radio spots and BCC materials will be spread across the country as part of the Healthy Eating for Good Life campaign. Local partners at the district level, such as World Vision Ghana, also carried messages into districts outside of the project’s target area.Job-aids are necessary in communicating behavior change messages. Health workers in the target districts welcomed posters and leaflets that contained key messages and were grateful for them. It certainly made work easier for them. Since the orientations, community workers have displayed posters on walls in vantage points in all the communities and caregivers discussed the contents of the leaflets at community meetings.
","In addition to breastmilk, we give local dishes like palm nut soup with soya beans, banku and groundnut soup, fufu with soup, kontomire [cocoyam leaf] with soya beans, and fish soup. We also give them oranges and pineapple — FGD with women Sunyani West District.At weighing, we are taught how to dress the child, breastfeeding, cleanliness, sleeping under mosquito nets, and family planning, how to feed the child. — FGDs with women Jaman South and Sunyani West Districts“I learned a lot of things here. You see my son likes the breastmilk and the only other thing he will eat is porridge; so I am going to read this leaflet so that it will guide me on what to feed him. You see he is my firstborn so his health is important to me.” —Nursing mother“This project is a good start of what we want to see in the community; that the caregiver is empowered to be in charge of the health and good development of their children. What I would also like to see is strengthening the skills and competencies of the health providers so that [they] would be able to help caregivers do appropriate feeding especially for the children under two years.” —Mrs. Wilhelmina Okwabi, Deputy Director of Health Services (Nutrition)“I was part of the data collection process and listening to the preliminary results gives me a sense of ownership; also the results show what is happening in the district and it shows us the work we are doing in the districts. We’ve learnt a lot here. We are going back to educate the mothers on what they are not doing well and encourage them to continue the good feeding practices.” —Technical officer, Vivian Dapaah District“We are thinking of ending malnutrition in children in line with Millennium Development Goal 4. If we don’t feed them well we cannot achieve this. That is why this [IYCN] project is very important and timely for the Regional Health Directorate.” —WS Supiimeh, Regional Health Promoter
","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","","","","","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Nutritional care and support for people living with HIV/AIDS was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","","","","","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Distribution of insecticide-treated bednets was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>>Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>http://www.who.int/elena/titles/bednets_malaria_pregnancy","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","Urban|Rural","completed","01-2010","01-2011","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Deworming of children 0-2 years was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","Urban|Rural","completed","01-2010","01-2011","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Maternal deworming in pregnancy was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","","","","","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Preventive treatment of malaria in women was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","Urban|Rural","completed","01-2010","01-2011","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Distribution of complementary foods was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","Urban|Rural","completed","01-2006","01-2011","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Nutritional care and support for people living with HIV/AIDS was reported to the Global Nutrition Policy Review (GNPR) 2009-2010Study preparation and data collectionDue to the post-election violence that occurred in Kenya in January and February 2008, initiation of this study was postponed from its original start date of January 2008 to May 2008 to ensure the safety of the field team. The study team for Western Province included one field supervisor and four research assistants who were fluent in the local Luhya and Swahili languages. The study team for Eastern Province included one field supervisor and four research assistants who were fluent in Kamba, Swahili, and Kikuyu. A data analyst was also hired to enter and clean data in real time, as well as to assist with data analysis. Study procedural training was held with the entire study team, led by Dr. Kiersten Israel-Ballard and Ms. Margaret Waithaka, May 19–23, 2008. This included pretesting the data collection tools, revising all translations as needed, and piloting them in multiple languages at a local clinic. The study launch was on May 26 for Eastern Province, with field support from Dr. Israel-Ballard, and June 2 for Western Province, with field support from Ms. Waithaka. The data collection tools utilized in this study are available upon request.Study populations and proceduresThis cross-sectional study was designed to collect formative research data in a descriptive manner. This study took place at APHIA II (AIDS, Population and Health Integrated Assistance [USAID-funded program]) affiliated sites in the Kakamega, Vihiga, Hamisi, and Bungoma Districts of Western Province and in the Kitui, Makueni, Kibwezi, Machakos, Mwala, Yatta, Mwingi, and Mbooni Districts of Eastern Province. These regions were selected to include food-secure areas of Western Province and food-insecure areas of Eastern Province. Data collection occurred between May and September 2008. According to the 2007 Kenya AIDS Indicator Survey, Eastern Province had an HIV prevalence of 4.7 and Western Province of 5.1.This study was composed of a convenience sample of quantitative in-depth interviews, brief post-counseling exit interviews, and counseling session observations. A total of 386 women older than 18 years of age were recruited. In-depth interviews were conducted with 285 women (137 in Eastern Province, 148 in Western Province). Women known to be HIV positive were recruited from PMTCT clinics, comprehensive care centers, and postnatal wards at local clinics and referral hospitals, as well as from support groups affiliated with the health centers. Inclusion criteria included being HIV infected, having an infant <18 months of age, and having stopped breastfeeding between 1 week to 6 months prior to participation. Survey questions focused on the period over which breastfeeding cessation took place, including the age of the infant, liquids and foods fed during this period and their associated costs and availability, infant illness, breast health, general challenges, as well as a 24-hour dietary recall to capture current infant feeding practices and challenges. Infant weight and mid-upper arm circumference (MUAC) were measured to capture current nutritional status.Post-counseling exit interviews were conducted with 80 women (50 in Eastern Province, 30 in Western Province) who had not participated in the cross-sectional survey. The difference in sample size between provinces was due to clinic staffing shortages, resulting in the lack Kenya Infant Feeding Assessment 5 of individual postnatal counseling in Western Province; group PMTCT counseling was more commonly practised Women known to be HIV positive were recruited upon leaving an antenatal or postnatal PMTCT counseling session at a health facility. Inclusion criteria included being HIV positive, being pregnant, or having an infant <12 months of age. Counseling session observations occurred 22 times with different women and in various clinics (9 in Eastern Province, 13 in Western Province). Inclusion criteria included being HIV positive, being pregnant, or having an infant <12 months of age. In Eastern Province, four of these observations were antenatal and five were postnatal; in Western Province nine were antenatal and four were postnatal. Antenatal mothers were recruited in the antenatal care (ANC) clinic in the PMTCT section. Postnatal mothers were recruited in the comprehensive care center or in the maternal and child health (MCH) ward. Three observations were of ANC group counseling sessions rather than individual sessions; two in Western, one in Eastern. The observer used a check list to indicate whether a specified topic had been covered during the session. Although recruitment criteria were inclusive of both antenatal and postnatal mothers with infants under 12 months of age, most (n = 8) of the mothers interviewed postnatally had infants of only 1 month of age, while one mother had a 3-month-old and another had a 9-month-old infant, thus limiting the infant age ranges. All clients who met the recruitment criteria and consented to join the study during the recruitment period were recruited. To ensure eligibility and guardianship of the infant we required identification documents prior to enrollment. Additionally, 11 local stakeholders, including district and provincial nutritionists and nursing officers from Nairobi and Eastern and Western Provinces, were informally interviewed to gather their perceptions and attitudes toward infant feeding in the context of HIV in their communities.
","Weightfor-age (WFA) z-score,Upper-arm-circumference-for-age z-scoreMUACcount of the number of morbidities (0 to 5) the infant experienced during or subsequent to weaning, chosen from a list of five morbidities (respiratory symptoms, diarrhea, dehydration symptoms, fever, and refusal to eat)
","To monitor the progress of infant feeding and HIV activities, IYCN provided reporting tools which included a form to help APHIA II Western-supported PMTCT counselors accurately report on their facility-based activities in a standardized way, and to provide an opportunity to share successes and challenges; an observation checklist to provide structured feedback to facility-based counselors to improve their counseling and facilitation skills; and a reporting form for community-based workers to report on infant feeding activities. Subsequently, several PMTCT and HIV partners adopted the tools for use in their programs.
","*","Western and Eastern Province","","","","Vulnerable groups","","Infant feeding for the prevention of mother-to-child transmission of HIV>>>Infant feeding for the prevention of mother-to-child transmission of HIV>>http://www.who.int/elena/titles/hiv_infant_feeding","","","","","","","","","","","","","","","","","","","","","","Confirming our post-counseling exit interview findings, we observed that few counselors discussed safe water as part of their AFASS assessment. Yet, this is a crucial factor for decision-making in this study population given that the most common water sources cited among mothers interviewed were rivers, dams, or open ponds. We also noted that the costs of replacement feeding were rarely mentioned. Interestingly, we observed more emphasis placed on risks from replacement feeding than on those from breastfeeding during ANC, but the opposite emphasis during postnatal visits, perhaps due to the perceived fear of infecting an otherwise healthy-looking infant. Regardless of when the counseling takes place, an accurate representation of risks and benefits associated with all infant feeding options needs to be conveyed to mothers. It was reassuring to note that most counseling sessions included discussion around how to stop breastfeeding, including mentioning that cessation should not occur until 6 months and that AFASS criteria should be in place, and providing an explanation of how a mother should physically stop breastfeeding (i.e., reduce number of breastfeeds per day) and how long the transition should take. However, as with the exit interviews, few mentioned manual expression to prevent breast pathologies. Although complementary foods were often discussed, mothers needed more detailed information on Kenya Infant Feeding Assessment 28 timing, frequency, quantity, diversity, and appropriate local foods to be able to optimally feed their infants. Although infants were often weighed, their growth progress was rarely discussed with the mother. Effective growth monitoring should also include growth promotion, which includes dialogue with the mother in order to identify and address problem areas before they lead to growth faltering or malnutrition.
","“I feel that those who fully understand/grasp the counseling are most likely to exclusively breastfeed.” - District Nursing Officer Western Province“If you take a mother through one-on-one counseling, most will then exclusively breastfeed successfully.” - District Nursing OfficerWestern Province
","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","","","","","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Deworming of children 0-2 years was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","Urban|Rural","completed","01-2006","01-2011","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Distribution of insecticide-treated bednets was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>>Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>http://www.who.int/elena/titles/bednets_malaria_pregnancy","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","","","","","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Maternal deworming in pregnancy was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","","","","","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Preventive treatment of malaria in women was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","","","","","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Management of MAM was reported to the Global Nutrition Policy Review (GNPR) 2009-2010. Protocol used: IMAM
","","","","National coverage","","","","","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","","","","","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Management of SAM was reported to the Global Nutrition Policy Review (GNPR) 2009-2010. Protocol used: intergrated management of acute Malnutrition
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11473","A2Z: The USAID Micronutrient and Child Blindness Project","English","Multi-national","","TZA","United Republic of Tanzania","Dar es Salaam, Tanzania","Urban|Rural|Peri-urban","completed","01-2006","01-2011","A2Z: The USAID Micronutrient and Child Blindness Project consolidates, builds, and expands on USAID's long-term investment in micronutrients, child survival, and nutrition. A2Z takes proven interventions to scale, introduces innovation, expands services, and builds sustainable programs to increase the use of key micronutrient and blindness interventions to improve child and maternal health. With work in vitamin A supplementation of children, newborn vitamin A, food fortification, maternal and child anemia control, monitoring and evaluation, and health systems strengthening, A2Z's focus countries have included Bangladesh, Cambodia, the East, Central and Southern Africa region, India, Nepal, Philippines, Tanzania, Uganda and West Bank.
","While Tanzania has achieved high vitamin A supplementation coverage over the past few years, there is concern that this achievement is fragile because of decentralization. A2Z is supporting national, zonal, regional, and district health teams to institutionalize twice-yearly distributions through ongoing advocacy and routine planning and budgeting. This activity is conducted in collaboration with the National Program for Extension of Tools and Strategies, the Tanzania Essential Health Interventions Project, Ifakara Health Research and Development Centre, the Tanzania Food and Nutrition Center (TFNC), and UNICEF. To foster sustainable vitamin A supplementation, the A2Z project is supporting behavior change communication through community workers and a popular radio serial. Based on information gathered on sustainability indicators by TFNC with support of A2Z and HKI, those districts that have not yet integrated funding for vitamin A supplementation in their plans are receiving additional technical support. Several resources developed in Tanzania are available to ensure program sustainability.
","Given the twice-yearly nature of the VAS program as well as its historic evolution from immunization campaigns, it is easy for district staff to see the program as separate from their regular day-to-day work. Considering the program to be part of the routine work for the district is critical for sustainability, and is reflected in both attitudes and the support provided to the program. Ninety-one (76%) of the 119 districts regarded implementation of the twice-yearly VAS and deworming program to be a routine activity. About 84% considered VAS and deworming a very important service, and 99% thought the service should continue. Although the majority of the districts viewed VAS/deworming as a routine activity, more than half (55%) had not yet included VAS/deworming services in their routine supervision checklist. Moreover, payment of allowances to staff for VAS/deworming while at their normal duty stations implies that these services were viewed as special rather than routine. The allowance scheme in particular, with an excessive number of supervisors at some distribution sites and inadequate supervision at other sites, may increase a district’s vulnerability to a decline in coverage. Overall, 11 districts (9%) were judged vulnerable with low sustainability related to supervision and monitoring
","Those districts that have not yet integrated funding for vitamin A supplementation ","","","","","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","Others, please specify below","For an activity to be sustained, it must be considered part of the district’s regular activities, and thus must be included in the annual planning process.","Management","The VAS program requires clear management for effective and efficient implementation, and thoughtful management also reflects the value placed on the program. Poor management may make the program vulnerable, and less likely to be sustained in an effective fashion.","Supplies","The VAS program depends on effective logistics, and capsule and promotional materials must reach distribution sites on time and in adequate quantities for the program to be effective. Poor logistics supply management makes the program vulnerable. Adequate communication between programs and departments within district councils facilitated effective use of available resources in 117 (98%) of the districts assessed.","Financial resources","Ensuring adequate provision for the VAS/deworming program within the basket fund can improve the financial sustainability of the program.","Insufficient staff","Twice yearly VAS distribution involves extended outreach to communities, and thus requires significant mobilization of both health staff and community volunteers. Failure to plan for adequate human resources is likely to place districts at risk of not sustaining their coverage achievements.","","","","","","","","","","","","Planning
Districts should be encouraged to budget for the program in their own CCHP budget including the basket fund which is considered the most reliable source of funds. Once basket funds are planned, they cannot be reallocated
Advocacy and community ownership
The program is more likely to continue effectively if it is understood and valued by community members who are involved with planning and implementation.
Management and Leadership
Efforts should be made to protect the current best practices in management and leadership reported in most of the districts.
Logistics Supply
Key actors at the national level need to ensure timely procurement and delivery of supplies to the districts
Supervision and Monitoring
Districts should determine the appropriate number of site supervisors to contain costs and include VAS/deworming in the routine supervision checklist to ensure that children missed during the twice-yearly events are reached through “mop up” actions.
Advocasy and Community Ownership
The successful efforts to date should continue to build community ownership of the program through well-designed, regular sensitization meetings and advocacy to engage the community, mobilize participation, and raise the profile of VAS/deworming events.
Availability of Financial Resources
Ensuring adequate provision for the VAS/deworming program within the basket fund can improve the financial sustainability of the program.
Availability of Human Resources
Local councils and the central government need to fill staff positions and find secure mechanisms to ensure mobilization of adequate human resources to sustain service delivery.
Programme Effectiveness
Efforts should be made to maintain the high performance of the majority of districts and help the few low performing districts improve their coverage.
","","English" "11473","A2Z: The USAID Micronutrient and Child Blindness Project","English","Multi-national","","TZA","United Republic of Tanzania","Dar es Salaam, Tanzania","Urban|Rural|Peri-urban","completed","01-2006","01-2011","A2Z: The USAID Micronutrient and Child Blindness Project consolidates, builds, and expands on USAID's long-term investment in micronutrients, child survival, and nutrition. A2Z takes proven interventions to scale, introduces innovation, expands services, and builds sustainable programs to increase the use of key micronutrient and blindness interventions to improve child and maternal health. With work in vitamin A supplementation of children, newborn vitamin A, food fortification, maternal and child anemia control, monitoring and evaluation, and health systems strengthening, A2Z's focus countries have included Bangladesh, Cambodia, the East, Central and Southern Africa region, India, Nepal, Philippines, Tanzania, Uganda and West Bank.
","With advocacy from A2Z/HKI and other donors, the Government of Tanzania in December 2006 adopted a policy for the use of zinc for the treatment of diarrhea. A2Z/HKI provided technical support to the National IMCI coordinator to incorporate zinc therapy as part of diarrhea management and developed modified IMCI guidelines. Zinc treatment and low osmolarity solution oral rehydration salts (ORS) have been incorporated into the National Standard Therapeutic Guidelines. The project facilitated formative research to learn about the health-seeking practices of the community around diarrhea by Ifakara Health Research and Development Centre and Johns Hopkins University. The formative research also tested the acceptability of zinc treatment for diarrhea among mothers and caretakers. The findings of the study are expected to be used to assist in the development of health worker training modules and behavior change communication materials for use by the Ministry of Health and Social Welfare and the community.
","Under-five mortality rate
","","","","","","","Vulnerable groups","","Zinc supplementation in the management of diarrhoea>>>Zinc supplementation in the management of diarrhoea>>http://www.who.int/elena/titles/zinc_diarrhoea","","","","","","","","","","","","","","","","","","","","","","The project facilitated formative research to learn about the health-seeking practices of the community around diarrhea by Ifakara Health Research and Development Centre and Johns Hopkins University.
","","English" "11483","The MOST Project","English","Multi-national","","ETH|GHA|ZAF|UGA|ZMB","Ethiopia|Ghana|South Africa|Uganda|Zambia","Ethiopia|Ghana|South Africa|Uganda|Zambia","Urban|Rural|Peri-urban","completed","01-1997","01-2001","Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Twice a year, at designated times, the three programs distribute capsules to children aged six months to five years. Each program follows a campaign model based upon intensified social mobilization and service delivery over two to seven days. The twice-yearly events have created a cadre of field-tested personnel in the three countries, who are skilled at working with the local communities and at promoting their support and active participation. All three programs have been associated with National Immunization Days (NIDs), a WHO global program to eradicate polio. Since NIDs were held annually, however, they provided an opportunity for only one dose of vitamin A each year. Because children with vitamin A deficiency should receive a supplement at least twice a year (every four to six months), another mechanism was needed for the second dose. Relying exclusively upon facility-based distribution to deliver the second dose was not a viable option for several reasons, but in particular because healthfacility attendance for older children was not high enough to ensure adequate coverage in the one-to-five-year age group.
In Zambia, the first non-NIDs vitamin A supplementation program was launched in August 1999, and later renamed Child Health Week (CHW) to make the focus on the child more explicit. It was also felt that, instead of limiting activities to a vertical vitamin A supplementation program, the opportunity should be seized to deliver an integrated service that included not only vitamin A capsules but also other health services such as de-worming, health education, immunization, family planning, prenatal care, and growth monitoring. Districts were encouraged to provide an integrated package of services commensurate with their local capacity and need — as long as vitamin A supplementation remained the core activity during that week. In Zambia, the first NIDs campaign took place in 1997, and was a nationwide undertaking. The program was scaled down to about half the districts in recent years. Since 1999, the focus has shifted to priority districts, where communities have been at a constant risk of cross-border polio infections due to civil-war-related migrations from neighboring countries. This narrower focus is referred to in Zambia as sub-NIDS.
The first round of vitamin A supplementation in Ghana was integrated into NIDs in 1996. By 1999, a detailed plan was developed to implement a nationwide stand-alone supplementation program for the second round. In 2000, the Ministry of Health (MOH) carried out the first vitamin A standalone capsule distribution in the country’s ten regions. Since that date, the program has become a two- to three-day stand-alone event used to deliver a second dose of vitamin A to all children 6 to 59 months of age. Volunteers from the Ghana Education Service, along with personnel from other decentralized departments, assist with the supervision and capsule-distribution effort. Community-based volunteers are in direct contact with caregivers and children and also work very closely with health workers, assemblymen, chiefs, opinion leaders, gong-gong beaters, and other community leaders to mobilize beneficiaries, administer vitamin A, and maintain distribution records.
In contrast to Zambia and Ghana, Nepal followed a phased approach to program implementation. Integration of vitamin A into NIDs in Nepal was initiated in 1997,
four years after a supplementation program was established in 8 of the country’s 75 districts. The second distribution campaign has since been phased in at a rate of eight to ten districts per year. By 2001, the program covered all but three politically unstable districts. Under the program, high-dose vitamin A capsules are distributed to all children aged 6 to 59 months during a twoday event.
","
Ghana
A monitoring team consisting of national, regional, and district supervisors carries out organized and random spot checks. Where necessary, vitamin A capsule administrators are assisted in performing their tasks. Capsule-distribution teams use all means of transportation available within the region and district, whether these be 4x4 vehicles, 2x4 pickups, motorcycles, or bicycles. MOH, district assemblies, decentralized departments, and local and international NGOs provide fuel and contribute to vehicle maintenance. At the end of each day, tally sheets are counted and summary sheets completed. Data are compiled by sub-district and district health management teams. After all figures are checked for accuracy, district coverage is calculated. District coverage data are sent to the regional nutrition officers and senior medical officers of public health, who compile regional coverage figures before sending them to the Nutrition Unit in Accra. Using regional figures, the Nutrition Unit estimates national coverage.
Zambia
Monitoring teams consisting of national, provincial, and district staff carry out systematic or random observations, depending on what they are monitoring. Where necessary, vitamin A capsule administrators are assisted in performing their tasks. At the end of each day, tally sheets are counted, summary sheets completed, and data compiled. District figures are then checked for accuracy, after which district coverage is calculated and the results forwarded to NFNC.
","Ghana: 3.5 million children ","Ghana: Exceeded target in May 2001; Zambia: 28 percent in 1999, 88 in Febraury 2002","","serum retinol levels of &lt;20 ug/dl,night-blindness prevalence,vitamin A supplementation coverage for children,subclinical vitamin A deficiency,","serum retinol levels of <20 ug/dl,night-blindness prevalence,vitamin A supplementation coverage for children,subclinical vitamin A deficiency,","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","Insufficient staff","In Zambia and Ghana, it has been somewhat more difficult to generate a consistent cadre of volunteers for the vitamin A distribution. In each country, districts mobilize health post and sub-health post staff, identify extended outreach sites (including clinics, schools, and community centers),and then recruit community members to assist them with their activities. In Ghana, this has been relatively successful since there have been adequate clinic staff and a manageable number of outreach sites. In spite of this, many districts have continued to do some house-to-house visits to ensure high coverage. In Zambia, it has been more difficult to recruit community volunteers, and the clinic staff have been stretched to cover outreach sites.","","","","","","","","","","","","","","","","","","","","","Robin Houston (2003). Why They Work: An analysis of three successful public health interventions - Vitamin A supplementation programs in Ghana, Nepal, and Zambia
Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Five data collection methods were used:
During the fieldwork, the enumerators worked in pairs. The enumerators were not allowed to use the instruments in the facilities where they worked. Each pair spent a full day at a health facility. Field supervisors supported the enumerators during the data collection and checked the questionnaires for consistency and completeness. This was to ensure that the data collected was accurate as possible.
","""""Many pregnant mothers do not come to ANC because they had several normal pregnancies and think all will continue to go on well always.”
- Health worker, Apac
“ The health worker at the health centre is very rude, she has no time for us; so we fear even asking questions or discussing any issue about our health. So I go all the way to Naguru health clinic and only here if I have no money for transport.”
- A pregnant woman, Kojja, Mukono
“ I think these tablets for blood should be given only to pregnant women who have no blood. It may cause a high blood level and lead to high blood pressure.”
- TBAs, Kyampisi
“ Women with increased blood should not take these tablets (iron and folic acids) because their heartbeats will increase and they will sweat very much.”
- TBAs, Seeta Nazigo
“ Some mothers say it smells and they throw away the tablets soon after the clinic.”
- Pregnant mothers, Kojja
“ Some mothers do not like taking tablets when they are pregnant.”
- Pregnant mothers, Seeta Nazigo
Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Ethiopia
MOST is providing technical and implementation support to the Ministry of Health in the development of a national micronutrient program. The program is a cooperative effort between the MOH, USAID/Ethiopia, MOST, and UNICEF. Program components include strengthening of the newly formed nutrition division at the MOH and the micronutrient committee; development of a locally designed vitamin A supplementation strategy and its pilot test; support for initial trials of vitamin A sugar fortification in one of the country's four sugar factories; and support for information, education, and communication activities.
South Africa
MOST is working with counterparts at the University of the Western Cape (UWC) to support and strengthen a new vitamin A supplementation program being started by the Department of Health in Eastern Cape province. MOST is also supporting a pilot initiative by UWC that aims to incorporate micronutrient interventions into the Eastern Cape Integrated Nutrition Program.
.
","","","","","","","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","","","","","","","","","","","","","","","","","","","","","","","","English" "11483","The MOST Project","English","Multi-national","","ETH|GHA|ZAF|UGA|ZMB","Ethiopia|Ghana|South Africa|Uganda|Zambia","Ethiopia|Ghana|South Africa|Uganda|Zambia","Urban|Rural|Peri-urban","completed","01-1997","01-2001","Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Government agencies encouraged the initial development of fortification: NFNC promoted initial research, sponsored meetings, and coordinated activities related to fortification; MOH researched the legal framework; the National Institute for Scientific and Industrial Research (NISIR) provided technical guidance; the Food and Drug Control Laboratory (FDCL) conducted monitoring and evaluation; and the Zambian Revenue Authority (ZRA) examined the tax structure. Industry acceptance allowed planning to begin, but donor support was critical to the development of the program: the U.S. Agency for International Development (USAID) was the lead financer of the project and provided technical assistance, UNICEF provided spare parts, and the Japanese International Cooperation Agency (JICA) provided spectrophotometers for Zambia Sugar and the FDCL.
While legislation was still being developed, Zambia Sugar went ahead with the launch of fortified Whitespoon Sugar on May 15, 1998. Zambia Sugar began its fortification program at 15 mg/kg, but cost considerations led the company to reduce the level to 10 mg/kg within three months. In May 1997, one year before fortification began, a consultant estimated the cost of fortifying 100,000 metric tons of sugar at 16 mg/kg to be around $1 million U.S., while fortifying at 20 mg/kg would cost almost $1.25 million.24 Reducing the level from 16 to 10 mg/kg could thus have reduced costs by approximately $375,000 a year.
","Modified Relative Dose Response Test (MRDR) in children
","The first outside tests of fortificant levels in sugar were controversial. Four months after the launch of fortified sugar, a team consisting of representatives from the MOH, the NFNC, and NISIR visited the Zambia Sugar mill. The team tested samples from the mill at the FDCL; these tests showed far lower levels of vitamin A than those shown in tests by Zambia Sugar. The government’s tests indicated a range of 0–13.6 mg/kg, while Zambia Sugar’s tests indicated a range of 9–21 mg/kg for the same samples. Zambia Sugar believes that the samples suffered sedimentation in the transport to the government laboratory and that this explains the different results.
MOST, the USAID micronutrient program, sponsored the creation of training manuals for health inspectors and Food and Drug enforcement officers, as well as a national training workshop from September 24 to October 7, 2000. The workshop focused on inspection procedures and methods, provided laboratory training where appropriate, and included a trip to the Zambia Sugar plant. Since the implementation of that program, Zambia Sugar has expressed satisfaction with law enforcement efforts. UNICEF subsequently funded workshops at the district level, using reproductions of the training manuals that had been produced with MOST funding.
","nationwide","..","","","","Vulnerable groups","","","Financial resources","","Communication","","Financial resources","","Adherence","","","","","","","","","","","","","","","","","English" "11499","Food by Prescription","English","Community/sub-national","","ETH","Ethiopia","Addis Ababa, Ethiopia|Amhara, Ethiopia|Dire Dawa, Ethiopia|Harari, Ethiopia|Oromia, Ethiopia|Southern Nations, Nationalities, and People's Region, Ethiopia|Tigray, Ethiopia","Urban|Rural|Peri-urban","on-going","01-2009","01-2013","
For pre-antiretroviral treatment and antiretroviral treatment patients, clinical malnutrition is a risk factor for HIV and mortality. Malnutrition can also negatively impact birth outcomes among HIV-positive women. As HIV infection progresses, challenges to maintenance of adequate nutritional status—mal-absorption of nutrients, hyper-metabolism, etc.—increase and can adversely affect adherence to and effectiveness of drug treatments.
Food by Prescription provides food and nutritional support to malnourished HIV+ individuals in the form of therapeutic and supplementary feeding at health facility levels. The project serves severely malnourished people living with HIV/AIDS, HIV+ pregnant women, HIV+ women in their first six months post-partum, their infants, and orphans and vulnerable children. To ensure the program’s success, USAID works with the Ethiopian Ministry of Health and HIV/AIDS Prevention and Control Office, as well as the Food and Nutrition Technical Assistance (FANTA) project. Food by Prescription serves as a critical component of PEPFAR, a broader effort to strengthen integration of nutrition into HIV services. In order to reduce the cost associated with importation of nutrients and food commodities, the project will also collaborate with the public and private sector to explore the possibility of local production for some of the required food commodities.
Expected Results:
Two qualitative data collection rounds were included, with the following objectives:
a) Adherence and compliance: The objective of the first was to elaborate and contextualize the findings of the quantitative impact study, by exploring ration utilization and participant perceptions of the costs and benefits of participation in the FBP program. It sought to validate the assumption that participants were receiving and consuming the rations prescribed as per the program protocol and to identify the constraining factors and solutions for improved participant adherence. This component of the study also addressed issues of service provider participation, and the barriers and constraints to delivery that may have impacted the effects of the program on individuals.
b) Default and non-response: While the first qualitative study sought to identify constraints to adherence from a group of “successful” participants, a second study was designed to investigate the experience of “unsuccessful” participants, aiming to identify possible limitations to adherence among individuals who either defaulted from the program or failed to respond to the intervention.
The objective of the second qualitative study was to understand in greater depth the range of reasons for default among FBP program participants, as well as the range of reasons for poor weight gain among other participants.
The study was designed as a quasi-experimental effectiveness evaluation, with a comparison group of clinics selected from a geographic area similar to those in which the intervention was being evaluated. Originally, the study was designed to reflect the existence of a food support program being implemented by WFP in limited urban areas for households containing individuals with HIV. As the WFP program was providing a household ration to participant households, there was a concern that the measured impact of the FBP program could be biased by the presence or absence of the WFP program.
Therefore, the study sample was stratified to include three cohorts of participants who were followed longitudinally: two groups of adult PLHIV meeting FBP enrollment criteria in ART clinics at selected health facilities, one from sites offering both the FBP program and the WFP program, and another from sites offering FBP only. Participants from these two groups were recruited for the study at the time when they enrolled in the FBP program. The third group, a comparison group, was composed of FBP-eligible adults recruited from FBP Phase II sites, i.e., where the program had not yet been rolled out but would do so during Year Two of the program.
However, after the FBP program and the impact study had commenced, the WFP program was phased out. Despite this, the three study groups were maintained, with the idea that the two treatment groups could be pooled eventually if the baseline characteristics of the two did not differ significantly.
","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Zambia, Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Zambia is making core investments in four key areas:
1. Oilseeds, legumes, maize and horticulture value chains
2. Enabling Environment
3. Economic Resilience
4. Nutrition
Target Regions
Feed the Future is focusing its efforts in two areas: the Eastern Province, with a value chain focus on oilseeds, legumes and maize; and selected peri-urban districts near Lusaka, connecting to Eastern Province, with a particular focus on horticulture.
Highlights
Comprehensive Africa Agriculture Development Programme (CAADP) process. Zambia’s CAADP Compact was signed in January 2011, and development of the Zambia CAADP Country Investment Plan has begun. Through this Compact the Government of the Republic of Zambia is committed to the following:
Diversification of staple crop production. Diversification of selected staple value chains will:
Gender. The Zambia strategy strives to maximize the positive impact on female farmers and ensure equitable benefits for men and women by:
CORE INVESTMENT AREA 1: DIVERSIFICATION OF PRODUCTION AND INCOME – UPGRADE VALUE CHAINS
The first set of core investments in the Zambia FTF strategy contributes to systems transformation, with a primary focus on oilseeds and legumes and targeted interventions in the maize value chain, and a secondary focus on horticulture.
Feed the Future Value Chain Investments
USAID/Zambia will have several programs that contribute significantly to upgrading the oilseeds, legumes and maize value chains. This will be accomplished through several planned mechanisms, including: 1) the Production, Finance and Improved Technology Plus program, which is designed to increase food security and decrease hunger through agriculture-led growth and inclusive market access by smallholder farmers; and 2) public-private partnerships including Global Development Alliances (GDAs) to leverage private sector activity and promote market sustainability through private sector models. These efforts will stimulate agricultural growth and significantly contribute to the Millennium Development Goal 1 of halving the proportion of people living in extreme poverty and suffering from hunger by 2015. The programs will build on previous USAID-funded activities by closely linking efforts to enhance input supply with output markets, promoting value-added rural enterprises linked to selected value chains, and ensuring that women fully benefit from value chain development. One of the challenges of the previous program, given its focus on private sector sustainability, was to ensure female participation. Lessons learned from the successful Production, Finance and Improved Technologies (PROFIT) program, which closes in 2011, will be incorporated into new programs.
Programs will focus specifically on maize and oilseed/legume (particularly, groundnut, soya and sunflower) value chains in Eastern province and horticulture value chains in peri-urban Lusaka. Through this geographic focus, USAID-funded FTF activities will reach up to 25 percent of Zambian men and women smallholder farmers. Maize value chain work will focus on increasing productivity in order to meet food security. Smallholders will be benefit from an integrated approach that provides for maize food security and enables smallholders to diversify into commercial crops.
Illustrative Examples of Value Chain Activities
In-depth analysis of selected value chains. The program will conduct in-depth economic value chain analysis including market (both domestic and export) assessments, competition/profitability analyses, gender analyses, and strategies for Zambian value chains to improve competitiveness in light of market opportunities and constraints.
Value chain finance. Both the demand and supply side of value chain finance will be addressed to increase the competitiveness of selected value chains. Options to increase access to production and processing credit may include insurance, operating leases and expansion of e-banking. Activities to expand access to credit and financial services to both men and women will be assessed and implemented through a variety of mechanisms, partners and tools, including intermediary businesses, credit guarantees, microfinance and commercial banking products oriented to benefit smallholder farmers.
Provide local trade information and services. Local provider(s) of trade information and services will be supported to aid producers’ entry into local, regional and international markets, including sanitary and phytosanitary protocols, import requirements, customs and borders procedures, and contact points. The program will take extra effort to ensure equal access to information for women. The Zambia Agricultural Commodity Exchange (ZAMACE) will require support that will be gradually phased out, with the goal of achieving sustainability through self-sufficient funding of operations within three years.
Target regional export markets. The program will develop a strategy for targeting profitable export markets for Zambian products initially in the maize, legume and horticulture sectors. USAID/Zambia’s experience thus far has shown that in many cases regional markets provide more opportunities for exporters (particularly smallholders) than more distant international markets. Efforts will be made to ensure both men and women producers can access export markets.
Promote rural enterprise and cooperative development, particularly in value-added processing of selected value chains. Activities will also address marketing constraints faced by smallholder farmers, in particular women. The project will identify key agents that can create rural employment and opportunities for value addition, including cooperatives, traders, processors and agribusinesses that warehouse commodities. Governance, operations and capacity of Zambian organizations and firms that link farmers to value-added markets, including animal feed, high protein products, cooking oil and canned vegetables, will be strengthened. In particular, women-based producer and marketing associations will be organized around selected value chains.
",".
","USAID/Zambia will monitor and evaluate programs and activities throughout the strategy period to ensure that those investments are achieving objectives and maximizing returns to investments. Though many of the investments will be managed and monitored primarily by USAID, some investments will originate from other USG agencies and by government, donors, or the private sector. The Zambia CAADP Country Investment Plan will provide a framework for the development of a more comprehensive national effort in agriculture and poverty reduction that will be supported through the USG FTF effort. CAADP monitoring is addressed below. The M&E framework for the USG FTF strategy outlined in this section will be inclusive and involve all government agencies investing in FTF areas, particularly in the FTF priority geographic area, Eastern province.
The geographic focus, co-location of investments, and the timing of the initiation of new investments provide the opportunity to establish a solid impact assessment framework as well. USAID/Zambia’s approach to monitoring and evaluation will be comprised of three components: 1) project-level reporting; 2) performance management/monitoring and evaluation; and, 3) external impact assessment to capture the aggregate impact of all investments and the relative contribution of different interventions to the extent feasible.
The FTF strategy will be implemented primarily through two of the USAID/Zambia CDCS Development Objectives (DO) and will meet the requirements of CDCS Development Objectives: (1) engage in """"rigorous"""" impact evaluations; and (2) build local capacity for monitoring and evaluation. The USAID/Zambia Mission has committed to implementing the operational research, managing for results, evaluation and local capacity-building model in its CDCS, and this will apply as well to FTF.
PERFORMANCE MANAGEMENT
The FTF Performance Monitoring Plan will include indicators measuring progress towards achieving results at all levels. For each indicator, the data source and methodology, baseline, targets, and a calendar of performance management tasks, including a schedule for data collection, will be included. The selection of indicators to include in the PMP will be driven by ongoing and planned activities, the availability of baseline, and provisions made to ensure availability of data for the reference reporting period.
To monitor performance, the Mission will establish baselines and collect data for standard and customized indicators to track whether desired results are occurring and whether performance is on target. All programs receiving FTF resources will be expected to develop monitoring and evaluation strategies that are consistent with the USG Zambia’s FTF framework.
Initial stakeholder workshops will be held for the purposes of
Given that FTF has the intention to work with a broader range of partners, including local organizations, it is expected that some partners will have more limited reporting capacity. These organizations will need greater assistance, and it may be necessary to delegate the responsibility for some monitoring and reporting to external entities.
For higher level objectives, tracking performance will be beyond the manageable interest of individual projects. In particular, changes in incomes, nutritional status, and some community-level variables among others will be more appropriately measured across the program areas. The FTF Team is developing a consortium of stakeholders to assess existing data sources, and intends to identify an external entity to coordinate baseline and periodic data collection for specific indicators.
An FTF M&E plan will be finalized by the end of Fiscal Year 2011, outlining all indicators and the reporting responsibilities by all USAID/Zambia’s partners. Key FTF required indicators to be tracked and reported are listed in Annex B. Additional project-specific and other relevant indicators not included in the FTF required indicators will be added. It is important to note that all appropriate indicators will be sex-disaggregated.
EVALUATION
In line with the new evaluation policy, the FTF program intends to conduct a number of performance evaluations and impact evaluations. Evaluations of two programs closing in 2011, PROFIT and C-FAARM, will be useful for the FTF learning agenda. The USG FTF has a unique opportunity with a defined geographic focus and the initiation of new activities to establish an impact assessment framework to assess high level impact, as well as to identify the relative contribution of different intervention, such as value chain upgrading versus household level management skills. USAID/Zambia will work with partners and other agencies to develop an impact assessment methodology that is consistent with and contributes to the project performance monitoring framework, but will also test several development hypotheses.
An initial baseline survey will be conducted in Eastern province to establish current levels of key variables including incomes, nutritional status, household production and asset patterns, and agriculture technology levels. This baseline will draw from the latest survey methodologies, particularly recent work on gender and asset control24. An appropriate sampling framework will be established to assess impact, most likely on a biannual basis. A randomized approach will be considered for a sub-sample to maintain the integrity of the impact assessment; however, flexibility will be needed to consider mid-term correction in order to ensure the greatest impact over the period of the strategy.
In the context of the development challenges and opportunities identified in Zambia and outlined in Section 1.1, several development hypotheses are of interest for the impact assessment. In particular, the relative contribution will be assessed of community-level versus household-level interventions to reducing poverty and undernutrition, as well as the additional value of the co-location of interventions. Another hypothesis of interest to be tested is: By increasing productivity, improving household food security and linking smallholders to markets for agriculture commodities, FTF interventions will reduce the incentives for exploiting the natural resource base.
Performance Evaluation
The FTF program will schedule performance evaluations to focus on descriptive and normative questions including: project or program achievements (either at an intermediate point in execution or at the conclusion of an implementation period); program implementation; program perception and value; and other questions pertinent to program design, management and operational decision-making. These performance evaluations will incorporate before-after comparisons whenever feasible.
Impact Evaluation
The FTF program will conduct impact evaluations to measure the change in development outcomes attributable to FTF interventions. Impact evaluations will be based on cause-effect models and will require a credible and rigorously-defined counterfactual control. Impact evaluations with treatment and control groups help provide the strongest evidence of a relationship between interventions and measured outcomes. One hypothesis to be explored includes identifying increased benefits from combined interventions, particularly income-augmenting and nutrition-related activities. In the nutrition portfolio, the differential effect of geographically co-locating health programs active in nutrition with agriculture programs working on the productivity and diversity side of the nutrition equation can be tested.
LINK TO GOVERNMENT MONITORING SYSTEMS
USAID/Zambia has provided extensive support to the Government of Zambia in monitoring the agricultural sector, and in analyzing government data through the Food Security Research Project (FSRP). This support will continue and can be drawn upon to monitor agricultural trends. In addition, FSRP has expertise in analyzing surveys such as the biannual Living Conditions Monitoring Survey (LCMS) which tracks poverty levels, and the Supplemental Surveys, which provide quality agricultural data. This expertise can be leveraged for improved performance monitoring by the GRZ, as well as for FTF performance.
The CAADP framework focuses largely on performance in the agricultural sector. For national performance toward other MDGs, particularly those related to nutrition and gender impacts, the FTF team will work with additional partners to identify appropriate data sources and performance monitoring modalities. For example, the Nutrition Cooperating Partners sub-group may be instrumental in the creation of a data monitoring platform according to the SUN Movement principles. However, the Zambia FTF framework will focus its efforts largely on performance for the targeted FTF areas and the contribution of these changes to national levels.
","Overall, an estimated 263,000 vulnerable Zambian women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty","","","Increased productivity and income from selected value chains (gross margin per unit of land or animal of selected product); Number of farmers, processors, and others who have applied new technologies or management practices as a result of USG assistance (disaggregated by sex); Value of incremental sales (collected at farm/firm level) attributed to FTF implementation (disaggregated by targeted commodity) (disaggregated by sex of household head); Value of new private sector investment in the agriculture sector or food chain leveraged by FTF implementation (Change in value – investments local and international); Increase in employment in value-added processing enterprises linked to selected commodities.","Increased productivity and income from selected value chains (gross margin per unit of land or animal of selected product); Number of farmers, processors, and others who have applied new technologies or management practices as a result of USG assistance (disaggregated by sex); Value of incremental sales (collected at farm/firm level) attributed to FTF implementation (disaggregated by targeted commodity) (disaggregated by sex of household head); Value of new private sector investment in the agriculture sector or food chain leveraged by FTF implementation (Change in value – investments local and international); Increase in employment in value-added processing enterprises linked to selected commodities.","Vulnerable groups","","Biofortification of staple crops>>>Biofortification of staple crops>>http://www.who.int/elena/titles/biofortification","","","","","","","","","","","","","","","","","","","","","","","","English" "11545","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","ZMB","Zambia"," Eastern Province, Zambia|Lusaka-Eastern Province, Zambia|Lusaka-Central Province, Zambia","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Zambia, Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Zambia is making core investments in four key areas:
1. Oilseeds, legumes, maize and horticulture value chains
2. Enabling Environment
3. Economic Resilience
4. Nutrition
Target Regions
Feed the Future is focusing its efforts in two areas: the Eastern Province, with a value chain focus on oilseeds, legumes and maize; and selected peri-urban districts near Lusaka, connecting to Eastern Province, with a particular focus on horticulture.
Highlights
Comprehensive Africa Agriculture Development Programme (CAADP) process. Zambia’s CAADP Compact was signed in January 2011, and development of the Zambia CAADP Country Investment Plan has begun. Through this Compact the Government of the Republic of Zambia is committed to the following:
Diversification of staple crop production. Diversification of selected staple value chains will:
Gender. The Zambia strategy strives to maximize the positive impact on female farmers and ensure equitable benefits for men and women by:
Feed the Future Value Chain Research & Development Program
Research features prominently in the Feed the Future Initiative. The FTF research strategy has three objectives: advancing the productivity frontier, transforming production systems and enhancing dietary quality and food safety. The sustainable use of natural resources and adaptation to global climate changes are additional objectives. R&D investments will include several sub-components, through collaboration between international agriculture research centers, GRZ research institutes and public universities, private sector and other partners. The project will also incorporate a competitive grants program to promote public-private research and technology adoption. A key objective of the program is to enable these entities to directly implement activities within the life of the program. All programs will outline the steps, process and timeline to enable Zambian Government, NGO and other entities to be able to directly implement selected project activities within two years after the project has begun field implementation. Finally, to be effective, the programs must also actively involve both men and women in research design and trials to ensure appropriateness to their relative needs.
Some of the key issues that the agricultural research program in Zambia will address are outlined below.
The approach should include preliminary analysis to identify high pay-off interventions with the greatest potential to increase incomes and improve nutrition for a large number of smallholder maize-based farm households, with particular attention to gender-based constraints. These interventions may include varieties, management, alternative farm resource allocation and post-harvest approaches.
Possible components of a program include:
Low Productivity and Limited Production of Groundnuts--Limiting Their Contribution to Household Nutrition, Incomes and Women’s Empowerment
Illustrative activities include:
Widespread Aflatoxin Contamination--Reducing Food Quality and Limiting Exports
Responses to the aflatoxin problem in Zambia may include:
Role of Zambian Women in Science
The FTF strategy will also invest in the development of Zambian women scientists. The African Women in Research and Development (AWARD) program has successfully supported the career of up to nine Zambian women scientists in private and public research organizations as well as civil society organizations. The AWARD Fellows are paired with a leading scientist mentor in their field who supports the development of professional skills. Training in leadership and other professional skills such as writing and communication is provided. A current AWARD Fellow recently conducted a workshop on gender in the aquaculture sector, highlighting the importance of considering gender constraints in this sector. The AWARD Fellows also become mentors to younger women, thus extending the benefits of the program. The FTF strategy will continue this investment throughout the program and work with these scientists in order to strengthen the participation of women in agricultural research.
","
.
","
USAID/Zambia will monitor and evaluate programs and activities throughout the strategy period to ensure that those investments are achieving objectives and maximizing returns to investments. Though many of the investments will be managed and monitored primarily by USAID, some investments will originate from other USG agencies and by government, donors, or the private sector. The Zambia CAADP Country Investment Plan will provide a framework for the development of a more comprehensive national effort in agriculture and poverty reduction that will be supported through the USG FTF effort. CAADP monitoring is addressed below. The M&E framework for the USG FTF strategy outlined in this section will be inclusive and involve all government agencies investing in FTF areas, particularly in the FTF priority geographic area, Eastern province.
The geographic focus, co-location of investments, and the timing of the initiation of new investments provide the opportunity to establish a solid impact assessment framework as well. USAID/Zambia’s approach to monitoring and evaluation will be comprised of three components:
The FTF strategy will be implemented primarily through two of the USAID/Zambia CDCS Development Objectives (DO) and will meet the requirements of CDCS Development Objectives:
The USAID/Zambia Mission has committed to implementing the operational research, managing for results, evaluation and local capacity-building model in its CDCS, and this will apply as well to FTF.
PERFORMANCE MANAGEMENT
The FTF Performance Monitoring Plan will include indicators measuring progress towards achieving results at all levels. For each indicator, the data source and methodology, baseline, targets, and a calendar of performance management tasks, including a schedule for data collection, will be included. The selection of indicators to include in the PMP will be driven by ongoing and planned activities, the availability of baseline, and provisions made to ensure availability of data for the reference reporting period.
To monitor performance, the Mission will establish baselines and collect data for standard and customized indicators to track whether desired results are occurring and whether performance is on target. All programs receiving FTF resources will be expected to develop monitoring and evaluation strategies that are consistent with the USG Zambia’s FTF framework.
Initial stakeholder workshops will be held for the purposes of
Data quality assessments will be conducted regularly to ensure consistency and completeness. Data collected through monitoring will be used for periodic reports to stakeholders. Given that FTF has the intention to work with a broader range of partners, including local organizations, it is expected that some partners will have more limited reporting capacity. These organizations will need greater assistance, and it may be necessary to delegate the responsibility for some monitoring and reporting to external entities.
For higher level objectives, tracking performance will be beyond the manageable interest of individual projects. In particular, changes in incomes, nutritional status, and some community-level variables among others will be more appropriately measured across the program areas. The FTF Team is developing a consortium of stakeholders to assess existing data sources, and intends to identify an external entity to coordinate baseline and periodic data collection for specific indicators.
An FTF M&E plan will be finalized by the end of Fiscal Year 2011, outlining all indicators and the reporting responsibilities by all USAID/Zambia’s partners. Key FTF required indicators to be tracked and reported are listed in Annex B. Additional project-specific and other relevant indicators not included in the FTF required indicators will be added. It is important to note that all appropriate indicators will be sex-disaggregated.
EVALUATION
In line with the new evaluation policy, the FTF program intends to conduct a number of performance evaluations and impact evaluations. Evaluations of two programs closing in 2011, PROFIT and C-FAARM, will be useful for the FTF learning agenda. The USG FTF has a unique opportunity with a defined geographic focus and the initiation of new activities to establish an impact assessment framework to assess high level impact, as well as to identify the relative contribution of different intervention, such as value chain upgrading versus household level management skills. USAID/Zambia will work with partners and other agencies to develop an impact assessment methodology that is consistent with and contributes to the project performance monitoring framework, but will also test several development hypotheses.
An initial baseline survey will be conducted in Eastern province to establish current levels of key variables including incomes, nutritional status, household production and asset patterns, and agriculture technology levels. This baseline will draw from the latest survey methodologies, particularly recent work on gender and asset control24. An appropriate sampling framework will be established to assess impact, most likely on a biannual basis. A randomized approach will be considered for a sub-sample to maintain the integrity of the impact assessment; however, flexibility will be needed to consider mid-term correction in order to ensure the greatest impact over the period of the strategy.
In the context of the development challenges and opportunities identified in Zambia and outlined in Section 1.1, several development hypotheses are of interest for the impact assessment. In particular, the relative contribution will be assessed of community-level versus household-level interventions to reducing poverty and undernutrition, as well as the additional value of the co-location of interventions. Another hypothesis of interest to be tested is: By increasing productivity, improving household food security and linking smallholders to markets for agriculture commodities, FTF interventions will reduce the incentives for exploiting the natural resource base.
Performance Evaluation
The FTF program will schedule performance evaluations to focus on descriptive and normative questions including: project or program achievements (either at an intermediate point in execution or at the conclusion of an implementation period); program implementation; program perception and value; and other questions pertinent to program design, management and operational decision-making. These performance evaluations will incorporate before-after comparisons whenever feasible.
Impact Evaluation
The FTF program will conduct impact evaluations to measure the change in development outcomes attributable to FTF interventions. Impact evaluations will be based on cause-effect models and will require a credible and rigorously-defined counterfactual control. Impact evaluations with treatment and control groups help provide the strongest evidence of a relationship between interventions and measured outcomes. One hypothesis to be explored includes identifying increased benefits from combined interventions, particularly income-augmenting and nutrition-related activities. In the nutrition portfolio, the differential effect of geographically co-locating health programs active in nutrition with agriculture programs working on the productivity and diversity side of the nutrition equation can be tested.
LINK TO GOVERNMENT MONITORING SYSTEMS
USAID/Zambia has provided extensive support to the Government of Zambia in monitoring the agricultural sector, and in analyzing government data through the Food Security Research Project (FSRP). This support will continue and can be drawn upon to monitor agricultural trends. In addition, FSRP has expertise in analyzing surveys such as the biannual Living Conditions Monitoring Survey (LCMS) which tracks poverty levels, and the Supplemental Surveys, which provide quality agricultural data. This expertise can be leveraged for improved performance monitoring by the GRZ, as well as for FTF performance.
The CAADP framework focuses largely on performance in the agricultural sector. For national performance toward other MDGs, particularly those related to nutrition and gender impacts, the FTF team will work with additional partners to identify appropriate data sources and performance monitoring modalities. For example, the Nutrition Cooperating Partners sub-group may be instrumental in the creation of a data monitoring platform according to the SUN Movement principles. However, the Zambia FTF framework will focus its efforts largely on performance for the targeted FTF areas and the contribution of these changes to national levels.
","Feed the Future aims to help an estimated 834,000 vulnerable Tanzanian women, children and family members—mostly smallholder farmers—escape hunger and poverty","","","","","Vulnerable groups","","Biofortification of staple crops>>>Biofortification of staple crops>>http://www.who.int/elena/titles/biofortification","","","","","","","","","","","","","","","","","","","","","","","","English" "11545","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","ZMB","Zambia"," Eastern Province, Zambia|Lusaka-Eastern Province, Zambia|Lusaka-Central Province, Zambia","Rural|Peri-urban","on-going","01-2011","01-2015","
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Zambia, Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Zambia is making core investments in four key areas:
1. Oilseeds, legumes, maize and horticulture value chains
2. Enabling Environment
3. Economic Resilience
4. Nutrition
Target Regions
Feed the Future is focusing its efforts in two areas: the Eastern Province, with a value chain focus on oilseeds, legumes and maize; and selected peri-urban districts near Lusaka, connecting to Eastern Province, with a particular focus on horticulture.
Highlights
Comprehensive Africa Agriculture Development Programme (CAADP) process. Zambia’s CAADP Compact was signed in January 2011, and development of the Zambia CAADP Country Investment Plan has begun. Through this Compact the Government of the Republic of Zambia is committed to the following:
Diversification of staple crop production. Diversification of selected staple value chains will:
Gender. The Zambia strategy strives to maximize the positive impact on female farmers and ensure equitable benefits for men and women by:
CORE INVESTMENT AREA 2: ENABLING ENVIRONMENT AND POLICY DEVELOPMENT
As an additional key strategy component, FTF Zambia will support the development of favorable agriculture policy through policy research and advocacy for reform. For example, continued policy reform is needed for maize to be competitive in regional markets, including a consistent and open border policy; small government strategic reserve; price-band management; and, use of the e-voucher system in input provision. Another critical investment is support to the GRZ to advance and complete the CAADP process, i.e., by helping the government develop a realistic but ambitious Country Investment Plan.
Several important policy objectives will be supported by the USG toward creating an enabling environment to achieve FTF objectives. These include:
USAID/Zambia has awarded a five-year project (2010-2015) that will assist stakeholders through a program of research, policy analysis, outreach, and training. Assistance provided will also support key agricultural policy stakeholders throughout the development and implementation of the Comprehensive African Agriculture Development Program (CAADP). The project, the Food Security Research Project (FSRP), will work closely with the Agricultural Consultative Forum (ACF), a Zambian NGO that provides a forum for policy dialogue, Ministry of Agriculture and Cooperatives (MACO), the Ministry of Livestock and Fisheries Development (MLFD), the Central Statistical Office (CSO), and other selected Zambian organizations.
The FSRP and ACF will take center stage in carrying out independent research to form the basis for developing and promoting supportive agricultural policy in Zambia. The ACF will also remain flexible to build capacity of other Zambian institutions that support the goal of improving fact-based agricultural and economic policy formulation in Zambia to nurture local capacity and local dissemination of knowledge to the public through commissioning and mentoring of local groups to undertake policy analysis. ACF and FSRP efforts in the past have addressed sound market-based principles through institutional capacity building and empirically-based policy research. Those efforts will be intensified to better support the GRZ’s implementation of its CAADP Investment Plan, which is a critical component of the FTF.
New USG funding in the project will be directed to three general activities – capacity building, more active outreach within and beyond the agricultural sector, and improvements in the quality of basic agricultural data emerging from CSO and MACO. This work will be undertaken in collaboration with other efforts to improvements overall data collection management of the CSO, particularly that being spearheaded by the U.K. Department for International Development (DFID). FTF will also fund training to support public and civil society leaders engaged in the CAADP process, as well as training of women scientists.
Key Enabling Environment Program Areas
Analytical Capacity for Improved Agricultural Policy in Zambia. Weak human and institutional capacity to analyze agricultural policy contributes to the politicization of agriculture in Zambia and a weak business climate for agricultural investment. FTF assistance will improve the analytical capacity of Zambian stakeholders. Stronger ―home-grown‖ analytical capacity and greater public outreach will lead to a greater understanding of key issues affecting agriculture by both the public at large and policy makers within the government. Informed technocrats within the government, backed by a supportive public opinion, should be able to convince political leaders to make sound decisions in agricultural policy.
New Project Directions. Emphasis will be on ―Zambianizing‖ the research capacity, which previously was not deep enough, due to limited finances and limited scope of local institutions. Increased high-level USG attention to food security issues demands a more thorough understanding of GRZ priorities and donor commitments in the sector. FSRP and ACF activities will provide the analytical basis for future US and other donor investments in the agricultural sector to combat hunger and poverty, which are aligned with the GRZ’s CAADP Compact.
Thematic And Operational Support of the CAADP Agenda. FSRP has supported the CAADP Compact process, ensuring that critical agricultural policy issues are, and will be, reflected in future policy planning and programming. FSRP support has ensured Zambian ownership of the CAADP framework, including its policies, programs, and targets. FSRP will work with policy makers and stakeholders as before, but with the added mandate of contributing to the peer review process that is part of the CAADP framework, focusing specifically on public resource allocation, investments and the implementation of policies that are the backbone of the CAADP process. FSRP will advocate that the CAADP process include a wide range of stakeholders with broad food security objectives across all four CAADP Pillars, and not result in a concentrated focus on agricultural productivity.
Political Will and Technical Capacity Building. For civil society, the press, government technocrats, and other groups to effectively influence policy, they need fact-based positions and up-to-date information from credible entities. It is therefore important, and an explicit objective of FSRP, to put fact-based information in front of the body politic. Political will shifts when confronted by an aware and informed electorate.
On-going Research Areas
New Potential Research Areas
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USAID/Zambia will monitor and evaluate programs and activities throughout the strategy period to ensure that those investments are achieving objectives and maximizing returns to investments. Though many of the investments will be managed and monitored primarily by USAID, some investments will originate from other USG agencies and by government, donors, or the private sector. The Zambia CAADP Country Investment Plan will provide a framework for the development of a more comprehensive national effort in agriculture and poverty reduction that will be supported through the USG FTF effort. CAADP monitoring is addressed below. The M&E framework for the USG FTF strategy outlined in this section will be inclusive and involve all government agencies investing in FTF areas, particularly in the FTF priority geographic area, Eastern province.
The geographic focus, co-location of investments, and the timing of the initiation of new investments provide the opportunity to establish a solid impact assessment framework as well. USAID/Zambia’s approach to monitoring and evaluation will be comprised of three components:
The FTF strategy will be implemented primarily through two of the USAID/Zambia CDCS Development Objectives (DO) and will meet the requirements of CDCS Development Objectives:
The USAID/Zambia Mission has committed to implementing the operational research, managing for results, evaluation and local capacity-building model in its CDCS, and this will apply as well to FTF.
PERFORMANCE MANAGEMENT
The FTF Performance Monitoring Plan will include indicators measuring progress towards achieving results at all levels. For each indicator, the data source and methodology, baseline, targets, and a calendar of performance management tasks, including a schedule for data collection, will be included. The selection of indicators to include in the PMP will be driven by ongoing and planned activities, the availability of baseline, and provisions made to ensure availability of data for the reference reporting period.
To monitor performance, the Mission will establish baselines and collect data for standard and customized indicators to track whether desired results are occurring and whether performance is on target. All programs receiving FTF resources will be expected to develop monitoring and evaluation strategies that are consistent with the USG Zambia’s FTF framework.
Initial stakeholder workshops will be held for the purposes of
Given that FTF has the intention to work with a broader range of partners, including local organizations, it is expected that some partners will have more limited reporting capacity. These organizations will need greater assistance, and it may be necessary to delegate the responsibility for some monitoring and reporting to external entities.
For higher level objectives, tracking performance will be beyond the manageable interest of individual projects. In particular, changes in incomes, nutritional status, and some community-level variables among others will be more appropriately measured across the program areas. The FTF Team is developing a consortium of stakeholders to assess existing data sources, and intends to identify an external entity to coordinate baseline and periodic data collection for specific indicators.
An FTF M&E plan will be finalized by the end of Fiscal Year 2011, outlining all indicators and the reporting responsibilities by all USAID/Zambia’s partners. Key FTF required indicators to be tracked and reported are listed in Annex B. Additional project-specific and other relevant indicators not included in the FTF required indicators will be added. It is important to note that all appropriate indicators will be sex-disaggregated.
EVALUATION
In line with the new evaluation policy, the FTF program intends to conduct a number of performance evaluations and impact evaluations. Evaluations of two programs closing in 2011, PROFIT and C-FAARM, will be useful for the FTF learning agenda. The USG FTF has a unique opportunity with a defined geographic focus and the initiation of new activities to establish an impact assessment framework to assess high level impact, as well as to identify the relative contribution of different intervention, such as value chain upgrading versus household level management skills. USAID/Zambia will work with partners and other agencies to develop an impact assessment methodology that is consistent with and contributes to the project performance monitoring framework, but will also test several development hypotheses.
An initial baseline survey will be conducted in Eastern province to establish current levels of key variables including incomes, nutritional status, household production and asset patterns, and agriculture technology levels. This baseline will draw from the latest survey methodologies, particularly recent work on gender and asset control24. An appropriate sampling framework will be established to assess impact, most likely on a biannual basis. A randomized approach will be considered for a sub-sample to maintain the integrity of the impact assessment; however, flexibility will be needed to consider mid-term correction in order to ensure the greatest impact over the period of the strategy.
In the context of the development challenges and opportunities identified in Zambia and outlined in Section 1.1, several development hypotheses are of interest for the impact assessment. In particular, the relative contribution will be assessed of community-level versus household-level interventions to reducing poverty and undernutrition, as well as the additional value of the co-location of interventions. Another hypothesis of interest to be tested is: By increasing productivity, improving household food security and linking smallholders to markets for agriculture commodities, FTF interventions will reduce the incentives for exploiting the natural resource base.
Performance Evaluation
The FTF program will schedule performance evaluations to focus on descriptive and normative questions including: project or program achievements (either at an intermediate point in execution or at the conclusion of an implementation period); program implementation; program perception and value; and other questions pertinent to program design, management and operational decision-making. These performance evaluations will incorporate before-after comparisons whenever feasible.
Impact Evaluation
The FTF program will conduct impact evaluations to measure the change in development outcomes attributable to FTF interventions. Impact evaluations will be based on cause-effect models and will require a credible and rigorously-defined counterfactual control. Impact evaluations with treatment and control groups help provide the strongest evidence of a relationship between interventions and measured outcomes. One hypothesis to be explored includes identifying increased benefits from combined interventions, particularly income-augmenting and nutrition-related activities. In the nutrition portfolio, the differential effect of geographically co-locating health programs active in nutrition with agriculture programs working on the productivity and diversity side of the nutrition equation can be tested.
LINK TO GOVERNMENT MONITORING SYSTEMS
USAID/Zambia has provided extensive support to the Government of Zambia in monitoring the agricultural sector, and in analyzing government data through the Food Security Research Project (FSRP). This support will continue and can be drawn upon to monitor agricultural trends. In addition, FSRP has expertise in analyzing surveys such as the biannual Living Conditions Monitoring Survey (LCMS) which tracks poverty levels, and the Supplemental Surveys, which provide quality agricultural data. This expertise can be leveraged for improved performance monitoring by the GRZ, as well as for FTF performance.
The CAADP framework focuses largely on performance in the agricultural sector. For national performance toward other MDGs, particularly those related to nutrition and gender impacts, the FTF team will work with additional partners to identify appropriate data sources and performance monitoring modalities. For example, the Nutrition Cooperating Partners sub-group may be instrumental in the creation of a data monitoring platform according to the SUN Movement principles. However, the Zambia FTF framework will focus its efforts largely on performance for the targeted FTF areas and the contribution of these changes to national levels.
","","","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11545","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","ZMB","Zambia"," Eastern Province, Zambia|Lusaka-Eastern Province, Zambia|Lusaka-Central Province, Zambia","Rural|Peri-urban","on-going","01-2011","01-2015","
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Zambia, Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Zambia is making core investments in four key areas:
1. Oilseeds, legumes, maize and horticulture value chains
2. Enabling Environment
3. Economic Resilience
4. Nutrition
Target Regions
Feed the Future is focusing its efforts in two areas: the Eastern Province, with a value chain focus on oilseeds, legumes and maize; and selected peri-urban districts near Lusaka, connecting to Eastern Province, with a particular focus on horticulture.
Highlights
Comprehensive Africa Agriculture Development Programme (CAADP) process. Zambia’s CAADP Compact was signed in January 2011, and development of the Zambia CAADP Country Investment Plan has begun. Through this Compact the Government of the Republic of Zambia is committed to the following:
Diversification of staple crop production. Diversification of selected staple value chains will:
Gender. The Zambia strategy strives to maximize the positive impact on female farmers and ensure equitable benefits for men and women by:
CORE INVESTMENT AREA 3: ECONOMIC RESILIENCE
FTF investments in agricultural value chains will increase agricultural productivity and incomes. FTF investments in health and nutrition infrastructure will improve access to health and nutrition services and information at the district and community level. However, not all households will be able to benefit in the medium term from these investments. In addition, intra-household resource management, even in better-off agricultural households, can be a barrier to the translation of systemic investments in the agricultural and health infrastructure into improvements in benefits for women and children. The Zambia FTF strategy proposes a set of investments to address these two challenges. The investments will target households that are more vulnerable to food insecurity due to composition, illness, or other factors.
Economic Resilience Programming
FTF investments will focus on an integrated approach to building assets and risk reduction, and call for innovative models to link vulnerable households to value chain interventions and investments in community, district and provincial health systems. These programs will engage new partners and will be structured to ensure both small businesses and local partners have the capacity to participate. The program will enhance coping skills, build assets and increase rural incomes for vulnerable households in targeted areas, thereby significantly contributing to Millennium Development Goal 1 of halving the proportion of Zambians living in extreme poverty and suffering from hunger by 2015.
The vulnerable and very poor have some minimum set of assets but have been unable to move towards longer-term economic well-being and health. Frequently donor and government assistance to these households has been in the form of humanitarian relief, economic transfers or subsidies (e.g., of staple foods). USAID/Zambia seeks to support innovative ideas, concepts and programs to increase the economic resilience of the very vulnerable Zambian rural population in targeted areas.
Investments under this core investment area aim to increase the food security of vulnerable and very poor rural households in targeted areas through interventions that reduce the number of hunger months, improve nutrition and health practices, and increase the value of household assets and the ability of households to productively use those assets. These achievements are expected to contribute significantly to reducing stunting and underweight levels in the targeted households over a five-year period.
Activities will target vulnerable groups in rural areas with a minimum set of assets (land and/or labor) and fall below the poverty line of $1.25/day. These attributes characterize a majority of smallholder agricultural producers in Eastern province. To identify more vulnerable households it will be necessary to include households according to additional characteristics such as: female-headed - widowed or divorced; household with person living with AIDS (PLWA) or other chronic and debilitating diseases; household caring for or headed by orphan or vulnerable child (OVC); or disabled household head or member.
Potential Activities
Investments will build upon USAID-funded activities that work in agricultural growth, nutrition and economic resilience efforts, such as the Title II program, the Consortium for Food Security, Agriculture and Nutrition, AIDS, Resiliency and Markets (C-FAARM), closing out in 2011. The programs will implement innovative strategies and approaches to enable vulnerable rural households, including those affected by HIV/AIDS and other diseases, orphan and vulnerable child-headed households, and female-headed households, by improving food security through strengthened economic resilience. Special attention will be given to enabling very poor women to participate in expanding opportunities as producers, service providers and entrepreneurs.
Programs will take an integrated approach to improved food security – addressing availability, access and utilization components, as well as linkages to nutrition and health, and gender relations. Programs as diverse as micro-savings and lending, conditional cash transfers, ―farming as a family business‖ have all shown some potential to reduce vulnerability of poor households under specific conditions. Proposals will be expected to demonstrate scalability.
Recent evidence of preventive approaches to undernutrition in other countries provides direction for successful components of nutrition interventions. The promotion of Essential Nutrition Actions will be a fundamental component of all interventions. Other approaches will be considered. For example, a positive deviance model demonstrated that three-quarters of children under age five treated for undernutrition made significant weight gains when their diets included legumes and other high protein supplements, combined with improved health and sanitary practices, and access to clean water.18 Some microfinance schemes follow a positive deviance model in which seed capital is not injected into communities, but revolving loan funds are created based on the capital available within communities, and members increase their ability to borrow based on the amount of shares they are able (and willing) to invest in the loan fund. Savings-led financial services have been demonstrated to serve an important role in consumption smoothing. Small livestock may actually serve as savings accounts, easily converted into cash when needed. Approaches that target all farm household members, both men and women, have been shown to be effective in improving the use of resources and changing household food security. A recent gender assessment of the SIDA-funded agricultural support program reported that better internal management of household resources was a significant factor contributing to greater household food security for project participants, as measured by months of household food security19. Given strong evidence of the significance of women’s income to child nutrition, approaches that build better household management of resources and strengthen women’s effective control may have a high payoff.
Lessons learned from GCC/SL pilots on community and household use of forest resources will be incorporated into the FTF economic resilience activities. Many vulnerable households are dependent on communal resources for sources of wild foods and medicinal crops that supplement nutritional and income needs. Household use of agriculture and non-agricultural land, such as forests, for additional income will be examined to determine strategies that build resilience and improve land use, without increasing the pressure on non-agricultural lands.
","
It is envisaged that these activities will result in tangible benefits to households such as increased food availability, better management, and improved intra-household food allocation, with improved child food intake and greater diet diversity for vulnerable members. Some expected achievements leading to household level benefits include increased access of poor and very poor farming households to commercial sources of inputs and non-financial supporting services, including extension and agronomic services; increased productivity by poor and very poor farming households; application by very poor farming households of improved crop production and post-harvest practices; and increased access of poor and very poor farming households to financial services.
","
USAID/Zambia will monitor and evaluate programs and activities throughout the strategy period to ensure that those investments are achieving objectives and maximizing returns to investments. Though many of the investments will be managed and monitored primarily by USAID, some investments will originate from other USG agencies and by government, donors, or the private sector. The Zambia CAADP Country Investment Plan will provide a framework for the development of a more comprehensive national effort in agriculture and poverty reduction that will be supported through the USG FTF effort. CAADP monitoring is addressed below. The M&E framework for the USG FTF strategy outlined in this section will be inclusive and involve all government agencies investing in FTF areas, particularly in the FTF priority geographic area, Eastern province.
The geographic focus, co-location of investments, and the timing of the initiation of new investments provide the opportunity to establish a solid impact assessment framework as well. USAID/Zambia’s approach to monitoring and evaluation will be comprised of three components:
The FTF strategy will be implemented primarily through two of the USAID/Zambia CDCS Development Objectives (DO) and will meet the requirements of CDCS Development Objectives:
PERFORMANCE MANAGEMENT
The FTF Performance Monitoring Plan will include indicators measuring progress towards achieving results at all levels. For each indicator, the data source and methodology, baseline, targets, and a calendar of performance management tasks, including a schedule for data collection, will be included. The selection of indicators to include in the PMP will be driven by ongoing and planned activities, the availability of baseline, and provisions made to ensure availability of data for the reference reporting period.
To monitor performance, the Mission will establish baselines and collect data for standard and customized indicators to track whether desired results are occurring and whether performance is on target. All programs receiving FTF resources will be expected to develop monitoring and evaluation strategies that are consistent with the USG Zambia’s FTF framework.
Initial stakeholder workshops will be held for the purposes of:
Data collected through monitoring will be used for periodic reports to stakeholders.
Given that FTF has the intention to work with a broader range of partners, including local organizations, it is expected that some partners will have more limited reporting capacity. These organizations will need greater assistance, and it may be necessary to delegate the responsibility for some monitoring and reporting to external entities.
For higher level objectives, tracking performance will be beyond the manageable interest of individual projects. In particular, changes in incomes, nutritional status, and some community-level variables among others will be more appropriately measured across the program areas. The FTF Team is developing a consortium of stakeholders to assess existing data sources, and intends to identify an external entity to coordinate baseline and periodic data collection for specific indicators.
An FTF M&E plan will be finalized by the end of Fiscal Year 2011, outlining all indicators and the reporting responsibilities by all USAID/Zambia’s partners. Key FTF required indicators to be tracked and reported are listed in Annex B. Additional project-specific and other relevant indicators not included in the FTF required indicators will be added. It is important to note that all appropriate indicators will be sex-disaggregated.
EVALUATION
In line with the new evaluation policy, the FTF program intends to conduct a number of performance evaluations and impact evaluations. Evaluations of two programs closing in 2011, PROFIT and C-FAARM, will be useful for the FTF learning agenda. The USG FTF has a unique opportunity with a defined geographic focus and the initiation of new activities to establish an impact assessment framework to assess high level impact, as well as to identify the relative contribution of different intervention, such as value chain upgrading versus household level management skills. USAID/Zambia will work with partners and other agencies to develop an impact assessment methodology that is consistent with and contributes to the project performance monitoring framework, but will also test several development hypotheses.
An initial baseline survey will be conducted in Eastern province to establish current levels of key variables including incomes, nutritional status, household production and asset patterns, and agriculture technology levels. This baseline will draw from the latest survey methodologies, particularly recent work on gender and asset control24. An appropriate sampling framework will be established to assess impact, most likely on a biannual basis. A randomized approach will be considered for a sub-sample to maintain the integrity of the impact assessment; however, flexibility will be needed to consider mid-term correction in order to ensure the greatest impact over the period of the strategy.
In the context of the development challenges and opportunities identified in Zambia and outlined in Section 1.1, several development hypotheses are of interest for the impact assessment. In particular, the relative contribution will be assessed of community-level versus household-level interventions to reducing poverty and undernutrition, as well as the additional value of the co-location of interventions. Another hypothesis of interest to be tested is: By increasing productivity, improving household food security and linking smallholders to markets for agriculture commodities, FTF interventions will reduce the incentives for exploiting the natural resource base.
Performance Evaluation
The FTF program will schedule performance evaluations to focus on descriptive and normative questions including: project or program achievements (either at an intermediate point in execution or at the conclusion of an implementation period); program implementation; program perception and value; and other questions pertinent to program design, management and operational decision-making. These performance evaluations will incorporate before-after comparisons whenever feasible.
Impact Evaluation
The FTF program will conduct impact evaluations to measure the change in development outcomes attributable to FTF interventions. Impact evaluations will be based on cause-effect models and will require a credible and rigorously-defined counterfactual control. Impact evaluations with treatment and control groups help provide the strongest evidence of a relationship between interventions and measured outcomes. One hypothesis to be explored includes identifying increased benefits from combined interventions, particularly income-augmenting and nutrition-related activities. In the nutrition portfolio, the differential effect of geographically co-locating health programs active in nutrition with agriculture programs working on the productivity and diversity side of the nutrition equation can be tested.
LINK TO GOVERNMENT MONITORING SYSTEMS
USAID/Zambia has provided extensive support to the Government of Zambia in monitoring the agricultural sector, and in analyzing government data through the Food Security Research Project (FSRP). This support will continue and can be drawn upon to monitor agricultural trends. In addition, FSRP has expertise in analyzing surveys such as the biannual Living Conditions Monitoring Survey (LCMS) which tracks poverty levels, and the Supplemental Surveys, which provide quality agricultural data. This expertise can be leveraged for improved performance monitoring by the GRZ, as well as for FTF performance.
The CAADP framework focuses largely on performance in the agricultural sector. For national performance toward other MDGs, particularly those related to nutrition and gender impacts, the FTF team will work with additional partners to identify appropriate data sources and performance monitoring modalities. For example, the Nutrition Cooperating Partners sub-group may be instrumental in the creation of a data monitoring platform according to the SUN Movement principles. However, the Zambia FTF framework will focus its efforts largely on performance for the targeted FTF areas and the contribution of these changes to national levels.
","Feed the Future aims to help an estimated 834,000 vulnerable Tanzanian women, children and family members—mostly smallholder farmers—escape hunger and poverty","","","Increased productivity and income from selected value chains (gross margin per unit of land or animal of selected product) (disaggregated by sex); Increased expenditures (proxy for income) of rural households, including female-headed households; Prevalence of households with moderate or severe hunger (disaggregated by sex of household head); Per cent of children 6-23 months that receive a Minimum Acceptable Diet (disaggregated by sex); Number of vulnerable households benefiting from program activities through increased economic resilience (disaggregated by sex of household head); Women’s Dietary Diversity: Mean number of food groups consumed by women of reproductive age; Prevalence of exclusive breastfeeding of children under 6 months; Number of people with a savings account or insurance policy as a result of USG assistance (disaggregated by sex).","Increased productivity and income from selected value chains (gross margin per unit of land or animal of selected product) (disaggregated by sex); Increased expenditures (proxy for income) of rural households, including female-headed households; Prevalence of households with moderate or severe hunger (disaggregated by sex of household head); Per cent of children 6-23 months that receive a Minimum Acceptable Diet (disaggregated by sex); Number of vulnerable households benefiting from program activities through increased economic resilience (disaggregated by sex of household head); Women’s Dietary Diversity: Mean number of food groups consumed by women of reproductive age; Prevalence of exclusive breastfeeding of children under 6 months; Number of people with a savings account or insurance policy as a result of USG assistance (disaggregated by sex).","Vulnerable groups","","Breastfeeding – exclusive breastfeeding>>>Breastfeeding – exclusive breastfeeding>>http://www.who.int/elena/titles/exclusive_breastfeeding","","","","","","","","","","","","","","","","","","","","","","","","English" "11545","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","ZMB","Zambia"," Eastern Province, Zambia|Lusaka-Eastern Province, Zambia|Lusaka-Central Province, Zambia","Rural|Peri-urban","on-going","01-2011","01-2015","
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Zambia, Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Zambia is making core investments in four key areas:
1. Oilseeds, legumes, maize and horticulture value chains
2. Enabling Environment
3. Economic Resilience
4. Nutrition
Target Regions
Feed the Future is focusing its efforts in two areas: the Eastern Province, with a value chain focus on oilseeds, legumes and maize; and selected peri-urban districts near Lusaka, connecting to Eastern Province, with a particular focus on horticulture.
Highlights
Comprehensive Africa Agriculture Development Programme (CAADP) process. Zambia’s CAADP Compact was signed in January 2011, and development of the Zambia CAADP Country Investment Plan has begun. Through this Compact the Government of the Republic of Zambia is committed to the following:
Diversification of staple crop production. Diversification of selected staple value chains will:
Gender. The Zambia strategy strives to maximize the positive impact on female farmers and ensure equitable benefits for men and women by:
FTF Zambia is investing in capacity-building and training of health workers to improve nutrition services and nutrition education. The nutrition program will include a national mass media campaign around the Essential Nutrition Actions that will be linked to community-level behavioral and social change communications. Additionally, the program will build strong linkages to rural health services and nutrition interventions. The nutrition program is largely managed by USAID/Zambia’s Health and HIV Offices, but activities by the USAID Economic Growth Team and Centers for Disease Control will also contribute.
The Government of Zambia has recently refocused on the poor national nutrition levels by developing a National Nutrition Strategy and holding a National Nutrition Consultative Forum to discuss the strategy. Zambia has also been selected as an Early Riser under the Scaling Up Nutrition (SUN) Initiative promoted by the U.S. and a wide range of other donors. The USG participates in a recently formed Nutrition Donor Convener Group, chaired by DFID and UNICEF, under the Health Sector Working Group. The USG can play an important role in raising concern over nutrition levels within the country, coordinating USG and other donor investments, and supporting government efforts to intensify efforts to address undernutrition.
Nutrition Programming
FTF Agriculture and Food-based Nutrition Programming. FTF agriculture investments will contribute to improved nutritional outcomes through several approaches. Improved incomes for poor households as a result of improved agricultural practices and better market access can translate into improved household food availability, although this is usually not sufficient for changes in child nutritional status. FTF agricultural investments will also improve the quantity and quality of staple foods in Eastern province, resulting in reduced prices for poor households, most of which purchase food for several months of the year. In addition, FTF food-based strategies will result in more nutritious foods through strategies such as bio-fortification and breeding, particularly through increasing dissemination and production of beta-carotene-rich ―orange‖ maize and orange-fleshed sweet potatoes. Household-based approaches through the Economic Resilience programs, described in greater detail in Section 4.3 above, will focus on more equitable food distribution/income control and on communicating behavioral change messages on essential nutrition actions at the household level. These programs will also ensure that all nutrition-related activities are consistent with and support other nutrition programming, for example in nutrition training of agricultural workers and extension staff, or capacity-building of community workers other than community-based health workers. Other potential food based strategies include school feeding linkages with organizations such as the World Food Program, with the introduction of nutritious products such as soy-based products or orange-fleshed sweet potatoes.
FTF Nutrition-related Programming through the Health Sector. USG investments in the health sector are extensive and broad and make a major contribution to the status of Zambians’ health. Many of these programs have components that directly address nutrition through improving health outcomes, reducing incidence of diseases such as malaria, vaccine preventable diseases, intestinal worm infestation, etc., providing food to PLWA, and supporting orphans and vulnerable children, among others.
The USAID Health Office invests in four programs supporting systemic change in health services. These programs include support for:
The logistics program focuses on improvements in commodities and supply chains for a wide array of critical inputs such as antiretroviral drugs, family planning inputs, and bed nets. Social marketing is conducted for all important areas, including family planning, HIV prevention and inputs, and malaria. Broad spectrum media campaigns are conducted under the integrated behavior change communication investments. These campaigns are conducted at national, provincial and community levels to elicit change in a wide range of health-related behaviors.
The following national-level interventions will be considered:
Recommendations for rural areas include the following:
In addition to interventions that strengthen the health system and refocus efforts on nutrition behavior change, the FTF strategy proposes to link health, nutrition, economic resilience, and economic growth activities at the household-level, to the extent this is feasible and cost-effective. Two approaches will be adopted:
FTF Nutrition-related Investments through HIV/AIDS Programming. Another significant contributor to child malnutrition is the high rate of pediatric HIV/AIDS. Based on a 2010 technical update on WHO guidelines, for infants and young children known to be HIV-infected, mothers are strongly encouraged to breastfeed exclusively for the first 6 months and to continue breastfeeding, with adequate supplementary feeding, up to 2 years and beyond. Therefore all infants 6 months of age and older need additional, developmentally and nutritionally appropriate food sources, as breast milk is no longer sufficient. Hence, nutrition-related HIV/AIDS interventions are also under development by the USG in Zambia, and these investments will have an impact on the reduction of undernutrition in children below age 2.
High prevalence of Vitamin A deficiency in rural Zambia. Vitamin A deficiency is a long-standing public health problem in Zambia due to inadequate dietary intake. The Ministry of Health distributes vitamin A supplements during the twice-yearly child health weeks and sugar is fortified with Vitamin A. Nonetheless, according to the 2007 Zambia Demographic and Health Survey vitamin A deficiency (VAD) continues to affect 54 percent of Zambian children under 5 and women of reproductive age. These high levels of VAD may be attributed to the high prevalence of asymptomatic infections in the Zambian population. Increasing the intake of Vitamin A through a wider range of sources, combined with health interventions, including those to prevent and treat infectious disease, will decrease defiency in many vulnerable groups. Biofortified crops have a high potential to increase Vitamin A content in diets, particularly of rural households that produce their own food and have limited consumption of fortified products.
Potential agriculture activities include:
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.
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USAID/Zambia will monitor and evaluate programs and activities throughout the strategy period to ensure that those investments are achieving objectives and maximizing returns to investments. Though many of the investments will be managed and monitored primarily by USAID, some investments will originate from other USG agencies and by government, donors, or the private sector. The Zambia CAADP Country Investment Plan will provide a framework for the development of a more comprehensive national effort in agriculture and poverty reduction that will be supported through the USG FTF effort. CAADP monitoring is addressed below. The M&E framework for the USG FTF strategy outlined in this section will be inclusive and involve all government agencies investing in FTF areas, particularly in the FTF priority geographic area, Eastern province.
The geographic focus, co-location of investments, and the timing of the initiation of new investments provide the opportunity to establish a solid impact assessment framework as well. USAID/Zambia’s approach to monitoring and evaluation will be comprised of three components: 1) project-level reporting; 2) performance management/monitoring and evaluation; and, 3) external impact assessment to capture the aggregate impact of all investments and the relative contribution of different interventions to the extent feasible.
The FTF strategy will be implemented primarily through two of the USAID/Zambia CDCS Development Objectives (DO) and will meet the requirements of CDCS Development Objectives:
PERFORMANCE MANAGEMENT
The FTF Performance Monitoring Plan will include indicators measuring progress towards achieving results at all levels. For each indicator, the data source and methodology, baseline, targets, and a calendar of performance management tasks, including a schedule for data collection, will be included. The selection of indicators to include in the PMP will be driven by ongoing and planned activities, the availability of baseline, and provisions made to ensure availability of data for the reference reporting period.
To monitor performance, the Mission will establish baselines and collect data for standard and customized indicators to track whether desired results are occurring and whether performance is on target. All programs receiving FTF resources will be expected to develop monitoring and evaluation strategies that are consistent with the USG Zambia’s FTF framework.
Initial stakeholder workshops will be held for the purposes of:
Given that FTF has the intention to work with a broader range of partners, including local organizations, it is expected that some partners will have more limited reporting capacity. These organizations will need greater assistance, and it may be necessary to delegate the responsibility for some monitoring and reporting to external entities.
For higher level objectives, tracking performance will be beyond the manageable interest of individual projects. In particular, changes in incomes, nutritional status, and some community-level variables among others will be more appropriately measured across the program areas. The FTF Team is developing a consortium of stakeholders to assess existing data sources, and intends to identify an external entity to coordinate baseline and periodic data collection for specific indicators.
An FTF M&E plan will be finalized by the end of Fiscal Year 2011, outlining all indicators and the reporting responsibilities by all USAID/Zambia’s partners. Key FTF required indicators to be tracked and reported are listed in Annex B. Additional project-specific and other relevant indicators not included in the FTF required indicators will be added. It is important to note that all appropriate indicators will be sex-disaggregated.
EVALUATION
In line with the new evaluation policy, the FTF program intends to conduct a number of performance evaluations and impact evaluations. Evaluations of two programs closing in 2011, PROFIT and C-FAARM, will be useful for the FTF learning agenda. The USG FTF has a unique opportunity with a defined geographic focus and the initiation of new activities to establish an impact assessment framework to assess high level impact, as well as to identify the relative contribution of different intervention, such as value chain upgrading versus household level management skills. USAID/Zambia will work with partners and other agencies to develop an impact assessment methodology that is consistent with and contributes to the project performance monitoring framework, but will also test several development hypotheses.
An initial baseline survey will be conducted in Eastern province to establish current levels of key variables including incomes, nutritional status, household production and asset patterns, and agriculture technology levels. This baseline will draw from the latest survey methodologies, particularly recent work on gender and asset control24. An appropriate sampling framework will be established to assess impact, most likely on a biannual basis. A randomized approach will be considered for a sub-sample to maintain the integrity of the impact assessment; however, flexibility will be needed to consider mid-term correction in order to ensure the greatest impact over the period of the strategy.
In the context of the development challenges and opportunities identified in Zambia and outlined in Section 1.1, several development hypotheses are of interest for the impact assessment. In particular, the relative contribution will be assessed of community-level versus household-level interventions to reducing poverty and undernutrition, as well as the additional value of the co-location of interventions. Another hypothesis of interest to be tested is: By increasing productivity, improving household food security and linking smallholders to markets for agriculture commodities, FTF interventions will reduce the incentives for exploiting the natural resource base.
Performance Evaluation
The FTF program will schedule performance evaluations to focus on descriptive and normative questions including: project or program achievements (either at an intermediate point in execution or at the conclusion of an implementation period); program implementation; program perception and value; and other questions pertinent to program design, management and operational decision-making. These performance evaluations will incorporate before-after comparisons whenever feasible.
Impact Evaluation
The FTF program will conduct impact evaluations to measure the change in development outcomes attributable to FTF interventions. Impact evaluations will be based on cause-effect models and will require a credible and rigorously-defined counterfactual control. Impact evaluations with treatment and control groups help provide the strongest evidence of a relationship between interventions and measured outcomes. One hypothesis to be explored includes identifying increased benefits from combined interventions, particularly income-augmenting and nutrition-related activities. In the nutrition portfolio, the differential effect of geographically co-locating health programs active in nutrition with agriculture programs working on the productivity and diversity side of the nutrition equation can be tested.
LINK TO GOVERNMENT MONITORING SYSTEMS
USAID/Zambia has provided extensive support to the Government of Zambia in monitoring the agricultural sector, and in analyzing government data through the Food Security Research Project (FSRP). This support will continue and can be drawn upon to monitor agricultural trends. In addition, FSRP has expertise in analyzing surveys such as the biannual Living Conditions Monitoring Survey (LCMS) which tracks poverty levels, and the Supplemental Surveys, which provide quality agricultural data. This expertise can be leveraged for improved performance monitoring by the GRZ, as well as for FTF performance.
The CAADP framework focuses largely on performance in the agricultural sector. For national performance toward other MDGs, particularly those related to nutrition and gender impacts, the FTF team will work with additional partners to identify appropriate data sources and performance monitoring modalities. For example, the Nutrition Cooperating Partners sub-group may be instrumental in the creation of a data monitoring platform according to the SUN Movement principles. However, the Zambia FTF framework will focus its efforts largely on performance for the targeted FTF areas and the contribution of these changes to national levels.
","Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent s","","","Number of people trained in child health and nutrition through USG-supported programs; Anemia among women of reproductive age (%); Number of health facilities with established capacity to manage acute undernutrition; Prevalence of anemia among children 6-59 months; Number of children under five years of age who received Vitamin A from USG-supported programs; Number of children under five reached by USG-supported nutrition programs.","Number of people trained in child health and nutrition through USG-supported programs; Anemia among women of reproductive age (%); Number of health facilities with established capacity to manage acute undernutrition; Prevalence of anemia among children 6-59 months; Number of children under five years of age who received Vitamin A from USG-supported programs; Number of children under five reached by USG-supported nutrition programs.","Vulnerable groups","","Breastfeeding – exclusive breastfeeding>>>Breastfeeding – exclusive breastfeeding>>http://www.who.int/elena/titles/exclusive_breastfeeding","","","","","","","","","","","","","","","","","","","","","","","","English" "11605","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MWI","Malawi","Dedza|Mchinji|Lilongwe|Ntcheu|Mangochi|Balaka|Machinga","Rural|Peri-urban","on-going","01-2011","01-2015","
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Malawi, Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
","The USG will make investments in nutrition across three critical sectors; agriculture, health, and social protection, with nutrition as the lynchpin between these sectors. As such, the USG will implement a comprehensive approach that maximizes all three sectors and strengthens and links the nutrition components of each. These investments will be underpinned by a core set of nutrition indicators that are common across all programs, and will be supported by policy investments that mirror the comprehensive nature of nutrition programming by working with the Office of the President’s Cabinet (OPC) and the Ministries of Agriculture and Food Security, Health, and Gender.
Building on lessons and experiences from current programs implementing preventive nutrition activities (e.g., the WALA and BASICS projects), USG resources will scale up prevention of undernutrition and resiliency of communities, while maintaining critical investments in treatment and nutrition service delivery. The rationale for this shift is due to the overall high prevalence of chronic undernutrition (47 percent) and the low prevalence of acute undernutrition (4 percent), the latter of which has been achieved by sustained commitment to scaling up CMAM. As a result, the USG will aim to drive a decrease in stunting as the highest level objective in FTF. The USG plans to focus on cost-effective preventive nutrition interventions targeting the 1,000 days window of development (pregnancy through two years), including maternal nutrition; early and exclusive breastfeeding through six months; use of appropriate, diverse foods beginning at six months of age; targeted micronutrient supplementation; and improved hygiene and sanitation. Activities will be integrated into health, HIV, and agriculture platforms, taking full advantage of the resources that these programs have. These investments leverage funding from health (Global Health and Child Survival), agriculture (Development Assistance), and Title II to advance nutrition objectives. The Care Group model encompasses a combined FTF and GHI approach to reduce poverty, hunger, and undernutrition by joining two complementary lines of investment at an operational level:
The objectives of the Care Groups complement value chain development activities by building capacity of:
Community-Level Organizations and Integration with Government of Malawi Systems for Health and Agricultural Extension
The Care Group in the context of this model is notable in that it supports a sustainable and simultaneous approach to agriculture, nutrition, and microfinance. Cross-fertilization of nutrition and agricultural messaging and skill building, as well as the opportunity to create cross-sector targets and results frameworks allows for a uniquely comprehensive approach.
Volunteers are trained and facilitated to conduct community outreach and follow-up in both agricultural- and health-focused nutrition interventions, thus supporting an operational link between nutrition and agriculture programming. Each volunteer takes on responsibility for conducting outreach and follow-up to some 10-12 nearby households. Care Group volunteers also have access to agricultural inputs to start and maintain community gardens, as well as engage in income-diversification through activities such as establishing voluntary savings and loan activities. Access to these inputs provides motivation and support for implementing targeted nutrition-focused interventions focused on behavior change, including:
Linking the agriculture and value chain components of the project with health and nutrition promotion at the community level is especially advantageous in that it provides opportunities to address two key crosscutting areas:
Prevention Linked with Health Service Delivery
The USG’s approach to service delivery covers community level action, improvement of quality at all levels of facilities, and strengthening the central and district level systems of management. This provides a common platform for multi-thematic messages and programs, ensuring that there are ―no missed opportunities‖. It also ensures a focused yet comprehensive basic package accessible to the Malawian population that stretches across the continuum of care from community to facility and from facility to community. At the community level, the Health Surveillance Assistants (HSAs) and health volunteers will continue to focus on interpersonal counseling, limited preventive and curative care through village clinics and drug boxes, and to create demand for services at the health facilities across family planning, maternal and neonatal health, child health, nutrition, malaria and HIV areas. At the facility level, the USG will support improved quality of care for existing interventions that target integrated and comprehensive primary health care provision and performance based incentives. At the national, zonal and district levels, USG programs will continue to strengthen the financial, management and leadership capabilities of the Ministry of Health staff. Also, programs will work closely with the technical staff to provide technical assistance and work toward meaningful policy changes. At all levels, USG resources will focus on integration of social and behavior change communication efforts through community and facility level entry points.
An important element of the multi-year FTF Strategy is monitoring and evaluation, which is an iterative learning process that will put into place the principle of a sustained and accountable delivery approach. Program activities must be monitored through periodic field visits by Mission staff and ongoing monitoring and learning by implementing partners. Mission staff has a key role to play in monitoring and learning from partners both through oversight and input to design of project level M&E plans and systems and also through follow-up on quarterly reports and other communication with partners.
The integration of agricultural, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Also, the Malawi FTF Strategy will foster linkages among existing programs, which will harmonize key agriculture and nutrition and indicators across relevant areas of focus.
Building on this collaboration, both the Health and Sustainable Economic Growth (SEG) teams at USAID/Malawi will work together to integrate M&E systems and processes in order to track synergies and multiplier effects between the two sectors not captured through the agriculture/nutrition overlap. There is currently significant USG investment on the part of USAID through PEPFAR and GHI in health systems strengthening, family planning, and malaria and tuberculosis reduction among others in the geographic areas targeted through FTF. We believe it is critical to capture at the highest level the combined impact of FTF and GHI/PEPFAR in order to reduce duplication, increase the applicability of data across interventions and most importantly, learn across programs in order to improve and increase efficiency and impact of all USAID investments in Malawi. This integration of M&E function may take the form of harmonized M&E plans at the implementer level combined with joint monitoring visits by SEG and Health team members.
Reliable and well-defined monitoring, reporting and evaluation methods, roles and communication channels result in improved project and program management, promote ongoing learning and testing of development hypotheses and ensure accountability. A fully functioning M&E team and system further help to illustrate the Mission’s value added to overall development not only to key stakeholders in the USG, but also to the GoM and other development partners.
USAID/Malawi is currently refining Mission processes in line with the requirements and recommendations of the newly announced USAID Evaluation Policy. To that end, and in preparation for the Country Development Cooperation Strategy (CDCS), SEG will identify further impact evaluation questions and set aside funds for impact evaluation in 2011. This will serve as solid preparation for FTF-focused evaluation activities in subsequent years.
","Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition","Central and southern regions","","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Vulnerable groups","","Breastfeeding – exclusive breastfeeding>>>Breastfeeding – exclusive breastfeeding>>http://www.who.int/elena/titles/exclusive_breastfeeding","","","","","","","","","","","","","","","","","","","","","","","","English" "11605","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MWI","Malawi","Dedza|Mchinji|Lilongwe|Ntcheu|Mangochi|Balaka|Machinga","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Malawi, Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
","Although the main focus will be on preventing childhood undernutrition, USAID/Malawi will continue to support CMAM, building on past investments. Since 2005, USAID has supported the integration of CMAM in existing health care services. Partners are working at both the policy and community levels to ensure this integration. As of December 2009, 24 out of 28 districts are implementing CMAM in over 240 health facilities. The USG will support one additional year of the MoH’s CMAM Advisory Service to finalize the transition of complete CMAM scale-up to the GoM. An evaluation in 2012 will help inform the USG on the areas needing further investment.
Through two GDAs with Project Peanut Butter, a local producer of ready-to use therapeutic food (RUTF), USAID/Malawi’s support has resulted in an annual production capacity of over 1,200 MT of RUTF, which, when combined with production from a second local producer of RUTF, more than meets the total requirements of RUTF for Malawi, with capacity to export to neighboring countries. The USG will take advantage of this existing capacity to explore the development and promotion of ready to use supplementary and complementary foods.
","An important element of the multi-year FTF Strategy is monitoring and evaluation, which is an iterative learning process that will put into place the principle of a sustained and accountable delivery approach. Program activities must be monitored through periodic field visits by Mission staff and ongoing monitoring and learning by implementing partners. Mission staff has a key role to play in monitoring and learning from partners both through oversight and input to design of project level M&E plans and systems and also through follow-up on quarterly reports and other communication with partners.
The integration of agricultural, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Also, the Malawi FTF Strategy will foster linkages among existing programs, which will harmonize key agriculture and nutrition and indicators across relevant areas of focus.
Building on this collaboration, both the Health and Sustainable Economic Growth (SEG) teams at USAID/Malawi will work together to integrate M&E systems and processes in order to track synergies and multiplier effects between the two sectors not captured through the agriculture/nutrition overlap. There is currently significant USG investment on the part of USAID through PEPFAR and GHI in health systems strengthening, family planning, and malaria and tuberculosis reduction among others in the geographic areas targeted through FTF. We believe it is critical to capture at the highest level the combined impact of FTF and GHI/PEPFAR in order to reduce duplication, increase the applicability of data across interventions and most importantly, learn across programs in order to improve and increase efficiency and impact of all USAID investments in Malawi. This integration of M&E function may take the form of harmonized M&E plans at the implementer level combined with joint monitoring visits by SEG and Health team members.
Reliable and well-defined monitoring, reporting and evaluation methods, roles and communication channels result in improved project and program management, promote ongoing learning and testing of development hypotheses and ensure accountability. A fully functioning M&E team and system further help to illustrate the Mission’s value added to overall development not only to key stakeholders in the USG, but also to the GoM and other development partners.
USAID/Malawi is currently refining Mission processes in line with the requirements and recommendations of the newly announced USAID Evaluation Policy. To that end, and in preparation for the Country Development Cooperation Strategy (CDCS), SEG will identify further impact evaluation questions and set aside funds for impact evaluation in 2011. This will serve as solid preparation for FTF-focused evaluation activities in subsequent years.
","Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition","Central and southern regions","","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Vulnerable groups","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","","","","","","","","","","","","","","","","","","","","","","","","English" "11605","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MWI","Malawi","Dedza|Mchinji|Lilongwe|Ntcheu|Mangochi|Balaka|Machinga","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Malawi, Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
","The USG will support GoM's efforts towards fortification of prioritized centrally processed foods, namely: sugar, oil, wheat and maize flour, and complementary baby foods. Data from the National Micronutrient Survey shows that the consumption of these foods has increased over the last ten years. USAID health funding will continue to support the universal salt iodization program in order to sustain the gains made with previous investments. Although not sufficient to forestall stunting in children under five, one necessary input is a high quality, low-cost complementary food. The legume and dairy value chains present a unique opportunity for the development of such a product. Malawi will take advantage and work with existing food processors (e.g., Rab processors, Project Peanut Butter and Valid Nutrition) to develop a suitable product.
Prevention and control of micronutrient malnutrition will require a concerted effort by all USAID/Malawi’s health programs, namely, malaria, family planning, maternal, neonatal and child health, HIV/AIDS and nutrition. Possible USG support to SUN for specific activities with deliverables in FY11 include the following:
An important element of the multi-year FTF Strategy is monitoring and evaluation, which is an iterative learning process that will put into place the principle of a sustained and accountable delivery approach. Program activities must be monitored through periodic field visits by Mission staff and ongoing monitoring and learning by implementing partners. Mission staff has a key role to play in monitoring and learning from partners both through oversight and input to design of project level M&E plans and systems and also through follow-up on quarterly reports and other communication with partners.
The integration of agricultural, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Also, the Malawi FTF Strategy will foster linkages among existing programs, which will harmonize key agriculture and nutrition and indicators across relevant areas of focus.
Building on this collaboration, both the Health and Sustainable Economic Growth (SEG) teams at USAID/Malawi will work together to integrate M&E systems and processes in order to track synergies and multiplier effects between the two sectors not captured through the agriculture/nutrition overlap. There is currently significant USG investment on the part of USAID through PEPFAR and GHI in health systems strengthening, family planning, and malaria and tuberculosis reduction among others in the geographic areas targeted through FTF. We believe it is critical to capture at the highest level the combined impact of FTF and GHI/PEPFAR in order to reduce duplication, increase the applicability of data across interventions and most importantly, learn across programs in order to improve and increase efficiency and impact of all USAID investments in Malawi. This integration of M&E function may take the form of harmonized M&E plans at the implementer level combined with joint monitoring visits by SEG and Health team members.
Reliable and well-defined monitoring, reporting and evaluation methods, roles and communication channels result in improved project and program management, promote ongoing learning and testing of development hypotheses and ensure accountability. A fully functioning M&E team and system further help to illustrate the Mission’s value added to overall development not only to key stakeholders in the USG, but also to the GoM and other development partners.
USAID/Malawi is currently refining Mission processes in line with the requirements and recommendations of the newly announced USAID Evaluation Policy. To that end, and in preparation for the Country Development Cooperation Strategy (CDCS), SEG will identify further impact evaluation questions and set aside funds for impact evaluation in 2011. This will serve as solid preparation for FTF-focused evaluation activities in subsequent years.
","Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition","Central and southern regions","","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Vulnerable groups","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","","","","","","","","","","","","","","","","","","","","","","","","English" "11605","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MWI","Malawi","Dedza|Mchinji|Lilongwe|Ntcheu|Mangochi|Balaka|Machinga","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Malawi, Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
","USG investments in legume and dairy value chains are designed to boost competitiveness and promote diversification into higher-return value chains that will also spawn non-farm employment opportunities. While these investments in economic growth will be necessary to reduce poverty and hunger, they will be insufficient by themselves. Beyond growth, poverty reduction will require targeted interventions that address the needs of smallholder farmers (the rural poor) as well as more vulnerable populations. A significant smallholder need is to produce more from a very limited resource base. Conservation farming practices offer promise in this regard, by increasing yields, soil fertility and soil moisture content per unit area. Importantly CF offers a window of opportunity to increase yield from a fixed unit area, freeing up land for diversification of both other cereals and legumes. Improving market and input access and the affordability of business development and financial services tailored to the needs of smallholders is critical in order to ―pull‖ rural households into income-raising activities.
Integrating Nutrition with Value Chains (INVC)
INVC is designed to combine the livelihood benefits of an agricultural value chain approach with the nutrition benefits of increased dietary diversification. This centerpiece of Malawi’s FTF strategy will invest in the competitiveness of food staple value chains in which large numbers of smallholders, over 56 percent of whom are below the poverty line, participate, and link increased household production of nutritious crops to household consumption and improved nutritional status. INVC will link value chain development and increased household income to improved nutrition through diet diversification, and improvements in food storage, preparation, and consumption practices at the household level.
INVC’s value chain approach will focus on legumes (groundnuts and soy) and dairy, and is designed to facilitate change in both the individual value chains and the broader market and household-farming systems, looking for synergies across value chains such as common constraints and/or actors. A strong emphasis will be placed on improving the demand side of the value chain, by working to improve market linkages between input and output dealers through improved and more reliable services, including financial, business development, agronomic and livestock-related services. While most of INVC’s efforts will further develop and strengthen Malawi’s existing input and output markets serving the legumes and dairy value chains, the program will also include strengthening the capacity of processors and agribusinesses to meet export market demands, as well as building the capacity of smallholder suppliers to meet buyer demands. At the same time, INVC will work to mitigate the risks for rural households to diversify their income and food sources beyond maize through an option of conducting a vulnerability assessment for its target population and to access nutritional education that will help them translate a more diverse basket of food into improved nutrition. INVC will place a particular emphasis on women’s economic empowerment across all of its activities, including additional support and guidance to women owned businesses and women producers.
INVC will spur investment and innovation in the legume and dairy value chains through an Innovation and Investment Facility meant to provide INVC a tool to identify and support specific opportunities that can further strengthen the selected value chains and market systems within which they operate. An important use of the facility will be to buy down risk for a firm, farmer, or other value chain actor in order to encourage early adoption of new technologies, such as CF by smallholders, and spur sector-wide innovation. Facility partners may include private firms, GoM agencies, research institutes, NGOs or other local organizations, as well as other donors best placed to identify new solutions to key value chain and systemic43 constraints. This Innovation and Investment Facility will be a key instrument for developing the capacity of the private sector and will also have targets and incentives for the participation of women-owned enterprises or individuals.
A core principle of INVC will also be to build the capacity of the key value chain actors to address the competitiveness of their value chain through their own projects and interventions. As such, INVC will place a strong emphasis on building local capacity to contribute to and invest in agricultural transformation. While Malawi has numerous small businesses, local NGOs and private sector and civil society organizations, few, if any, have both the technical and administrative capacity to implement USAID projects without support. As such, INVC’s approach to capacity building will be to invest resources in local partners while leveraging their local knowledge and capacity to generate results. The project will have a target for graduating local partners to independent status that would allow them to receive USAID funds directly. As partners reach this independent status, they would take on current functions of INVC.
","An important element of the multi-year FTF Strategy is monitoring and evaluation, which is an iterative learning process that will put into place the principle of a sustained and accountable delivery approach. Program activities must be monitored through periodic field visits by Mission staff and ongoing monitoring and learning by implementing partners. Mission staff has a key role to play in monitoring and learning from partners both through oversight and input to design of project level M&E plans and systems and also through follow-up on quarterly reports and other communication with partners.
The integration of agricultural, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Also, the Malawi FTF Strategy will foster linkages among existing programs, which will harmonize key agriculture and nutrition and indicators across relevant areas of focus.
Building on this collaboration, both the Health and Sustainable Economic Growth (SEG) teams at USAID/Malawi will work together to integrate M&E systems and processes in order to track synergies and multiplier effects between the two sectors not captured through the agriculture/nutrition overlap. There is currently significant USG investment on the part of USAID through PEPFAR and GHI in health systems strengthening, family planning, and malaria and tuberculosis reduction among others in the geographic areas targeted through FTF. We believe it is critical to capture at the highest level the combined impact of FTF and GHI/PEPFAR in order to reduce duplication, increase the applicability of data across interventions and most importantly, learn across programs in order to improve and increase efficiency and impact of all USAID investments in Malawi. This integration of M&E function may take the form of harmonized M&E plans at the implementer level combined with joint monitoring visits by SEG and Health team members.
Reliable and well-defined monitoring, reporting and evaluation methods, roles and communication channels result in improved project and program management, promote ongoing learning and testing of development hypotheses and ensure accountability. A fully functioning M&E team and system further help to illustrate the Mission’s value added to overall development not only to key stakeholders in the USG, but also to the GoM and other development partners.
USAID/Malawi is currently refining Mission processes in line with the requirements and recommendations of the newly announced USAID Evaluation Policy. To that end, and in preparation for the Country Development Cooperation Strategy (CDCS), SEG will identify further impact evaluation questions and set aside funds for impact evaluation in 2011. This will serve as solid preparation for FTF-focused evaluation activities in subsequent years.
","Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition","Central and southern regions","","Percent change in agricultural GDP (monitor national trend); Per Capita expenditures of rural households (proxy for income) of USG targeted beneficiaries; Gender index; Gross margin per unit of land or animal of selected product; Value of incremental sales (collected at farm- level) attributed to FTF; Percent change in diversity of agricultural commodities produced by households; Number of newly created jobs attributed to FTF Value of new private sector investment in the agriculture sector or food chain leveraged by FTF","Percent change in agricultural GDP (monitor national trend); Per Capita expenditures of rural households (proxy for income) of USG targeted beneficiaries; Gender index; Gross margin per unit of land or animal of selected product; Value of incremental sales (collected at farm- level) attributed to FTF; Percent change in diversity of agricultural commodities produced by households; Number of newly created jobs attributed to FTF Value of new private sector investment in the agriculture sector or food chain leveraged by FTF","Vulnerable groups","","Biofortification of staple crops>>>Biofortification of staple crops>>http://www.who.int/elena/titles/biofortification","Supplies","A significant constraint to the development of competitive groundnut and soybean value chains is the inadequate production of breeder seed. Ten years ago, USAID/Malawi established a $250,000 revolving fund to support ICRISAT in contracting out groundnut breeder seed production, but the FISP addition of legume seed packs the significant gross margins of legumes has driven demand far beyond local seed production capacity. Given the importance of reliable input supplies to Malawi’s FTF strategy, USAID and Irish Aid will partner to expand local capacity for production of quality, certified legume seed. USAID will invest in expanding the existing revolving fund and link in the International Institute of Tropical Agriculture to enable the expansion of their efforts in soy breeder seed production. Irish AID will expand its assistance to small and medium sized enterprises to develop their capacity of to multiply groundnut seed – currently only one company (Seed Co.) is involved in soybean seed production using privately developed germplasm.","Infrastructure","Malawi also lacks an International Organization for Standardization (ISO) certified laboratory for testing and certifying groundnuts and soybeans, which limits access by exporters to broader export markets. Currently, companies that export groundnuts send samples to South Africa for testing, which is costly and limits export capacity. With Irish Aid support, ICRISAT and NASFAM are developing a low cost, rapid testing technology; however, achieving ISO certification will be costly. The EU and UNDP will also begin work next year on a project designed to support the processing and exports side of legume value chains, a major component of which will focus on bringing the Malawi Bureau of Standards up to ISO certification. USG resources will support GoM efforts to establish a national sanitary/phyto-sanitary (SPS) strategy and achieve COMESA SPS compliance, as well as to build the capacity of Bunda College and the MoAFS research stations to conduction aflatoxin mitigation research.","Financial resources","Access to finance remains a major constraint to smallholders investing in productivity enhancing technologies due to weak financial sector infrastructure, inadequate financial services options, and GoM regulatory capacity. USAID will jointly develop a Financial Sector Technical Assistance Project with the World Bank and DfID.","","","","","","","","","","","","","","","","","","English" "11605","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MWI","Malawi","Dedza|Mchinji|Lilongwe|Ntcheu|Mangochi|Balaka|Machinga","Rural|Peri-urban","on-going","01-2011","12-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Malawi, Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
","In view of the capacity challenges that exist, USAID will strengthen the capacity of the GoM to plan, implement, monitor and evaluate nutrition programs. With substantial funding increases anticipated through the FTF, USAID/Malawi will ensure that GoM institutions have adequate capacity to implement the various programs that will be designed under the initiative. This activity is in line with Strategic Objective Three of the NNPSP, which clearly outlines the capacity gaps and needs for the nutrition sector in Malawi. The USG will strengthen capacity of its partners, both government and non- governmental, as well as the private sector. USG support will be at three levels: community, institutional and tertiary. Irish Aid, the World Bank, CIDA, and the EU are all key donors in capacity building.
Strategic Analysis and Knowledge Support System (SAKSS)
Since 2008, USAID/Malawi has supported a SAKSS unit implemented through the International Food Policy Research Institute (IFPRI) at the MoAFS. The objectives of this activity are threefold: 1) generate demand-driven diagnostic and strategic research to fill key knowledge gaps, 2) establish an information and knowledge support system, in cooperation with the Southern Africa Regional Strategic Analysis and Knowledge Support System that has been set up to help promote peer and progress review of the CAADP, and 3) strengthen the capacity of national institutions, such as the MoAFS, in policy and strategy research. The Malawi Mission plans to extend the work of the SAKSS unit as part of capacity building support under FTF.
Malawi Agriculture Policy Strengthening (MAPS)
Strong civil society and private sector networks are critical to implementing the ASWAp in a way that responds to the evolving needs of its stakeholders. In recent decades, weak capacity and declining GoM interest in inclusive policy making is leading Malawi’s CAADP process towards a Government-owned rather than Country-owned process. Grounded in the CAADP principles of increasing stakeholder participation in the policy making process,44 the Malawi Agriculture Policy Strengthening (MAPS) program is designed to increase the participation of private sector and civil society stakeholders in agriculture policy dialogue.
MAPS will increase the profile, capacity and engagement of civil society and private sector stakeholders in agriculture policy development and implementation through a combination of capacity building interventions and establishing linkages between producers and consumers, including state and non-state actors, of high quality policy research. Though not exclusively, MAPS will focus on key stakeholders along the proposed FTF value chains.
MAPS capacity building activities will focus on improving organizational ability to meet its goals and objectives by strengthening administrative and financial management, organizational structure and strategic planning. The second focus of the project will strengthen policy analysis and advocacy capacity through building linkages between Malawian farmers and private sector associations and regional networks and research institutions, such as local and regional universities among civil society groups. MAPS will similarly link GoM counterparts to those research institutions to improve their ability to become informed consumers of stakeholder policy advocacy. These two components will account for the varying levels of development and readiness of organizations and associations in Malawi to take on advocacy activities. MAPS will also focus on elevating the voices of women in policy dialogue by targeting women-led civil-society/public service organizations for organizational capacity building and providing additional women-focused leadership training and gender equity sensitization to facilitate women taking on leadership roles within larger organizations.
","An important element of the multi-year FTF Strategy is monitoring and evaluation, which is an iterative learning process that will put into place the principle of a sustained and accountable delivery approach. Program activities must be monitored through periodic field visits by Mission staff and ongoing monitoring and learning by implementing partners. Mission staff has a key role to play in monitoring and learning from partners both through oversight and input to design of project level M&E plans and systems and also through follow-up on quarterly reports and other communication with partners.
The integration of agricultural, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Also, the Malawi FTF Strategy will foster linkages among existing programs, which will harmonize key agriculture and nutrition and indicators across relevant areas of focus.
Building on this collaboration, both the Health and Sustainable Economic Growth (SEG) teams at USAID/Malawi will work together to integrate M&E systems and processes in order to track synergies and multiplier effects between the two sectors not captured through the agriculture/nutrition overlap. There is currently significant USG investment on the part of USAID through PEPFAR and GHI in health systems strengthening, family planning, and malaria and tuberculosis reduction among others in the geographic areas targeted through FTF. We believe it is critical to capture at the highest level the combined impact of FTF and GHI/PEPFAR in order to reduce duplication, increase the applicability of data across interventions and most importantly, learn across programs in order to improve and increase efficiency and impact of all USAID investments in Malawi. This integration of M&E function may take the form of harmonized M&E plans at the implementer level combined with joint monitoring visits by SEG and Health team members.
Reliable and well-defined monitoring, reporting and evaluation methods, roles and communication channels result in improved project and program management, promote ongoing learning and testing of development hypotheses and ensure accountability. A fully functioning M&E team and system further help to illustrate the Mission’s value added to overall development not only to key stakeholders in the USG, but also to the GoM and other development partners.
USAID/Malawi is currently refining Mission processes in line with the requirements and recommendations of the newly announced USAID Evaluation Policy. To that end, and in preparation for the Country Development Cooperation Strategy (CDCS), SEG will identify further impact evaluation questions and set aside funds for impact evaluation in 2011. This will serve as solid preparation for FTF-focused evaluation activities in subsequent years.
","Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition","Central and southern regions","","Number of institutions/organizations undergoing capacity /competency assessments as a result of USG assistance; Number of institutions/organizations mature/viable in the competency areas strengthened as a result of USG assistance Frequency of GoM consultation with civil society/private sector on relevant policies; Comparison of programmatic objectives Pre and post FtF funding distribution; Number of new funding mechanisms","Number of institutions/organizations undergoing capacity /competency assessments as a result of USG assistance; Number of institutions/organizations mature/viable in the competency areas strengthened as a result of USG assistance Frequency of GoM consultation with civil society/private sector on relevant policies; Comparison of programmatic objectives Pre and post FtF funding distribution; Number of new funding mechanisms","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23002","chTIS Child Health Targets Impact Study","English","Pilot/research","","KHM","Cambodia","Siem Reap|Preah Vihear province|Kampong Chnang|Kampong Thom","Rural","on-going","07-2012","09-2016","The chTIS will build an evidence-base to demonstrate programme effectiveness of WV's 7-11 strategy through a 2-arm quasi-experimental study focusing on assessment of the impact of a Core Intervention Package: timed and targeted counseling, Community Care Coalitions, Citizens Voice in Action
Goal: To measure and report on the effectiveness of World Vision's core 7-11 programming to improve and enhance child health around the world in a scientifically rigorous manner that will withstand peer-review.
","","","National Interim Guidelines for the Management of Acute Malnutrition","","","","","World Vision International","World Vision Cambodia","","","","","","","Research/academia","Johns Hopkins University Bloomberg School of Public Health; National Institute of Public Health","","","","","","International NGOs","World Vision International","WV Australia","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23001","","Management of moderate malnutrition","Breastfeeding, Complementary feeding and health system strengthening","","","Infants and young children|Lactating women (LW)|Pregnant women (PW)","-9 to 59 months","Siem Reap, Preah Vihear, Kampong Chnang, Kampong Thom","Community-based|Primary health care center","","","Pregnancy
-ANC visits
-Proportion of women who were offered and accepted counseling and testing for HIV during most recent pregnancy, and received their test results
-Prevalence of anaemia in women of reproductive age
-Tetanus toxoid immunization
-Iron/Folate supplementation
-Food consumption
- Antihelminthic treatment
- Percent of pregnant women who slept under a LLIN the previous night
- Proportion of parents or caregivers practicing birth spacing
Birth
- Proportion of infants whose births were attended by skilled birth attendant
- Delivery at health facility
Postnatal
-Post birth wrapping
-Cord was kept clean and dry
-Breastfeeding practices: Immediate
-Breastfeeding practices: Exclusive
-Continued Breastfeeding
-Postnatal Care
-Care-seeking behavior
Birth to under five years
-Coverage of essential vaccines
-Proportion of parents or caregivers with children under 5 with presumed pneumonia who report that the child was taken to appropriate health provider
-Proportion of households where all children under five slept under a bednet (ITN/LLIN) the previous night
-Proportion of children who received correct treatment for malaria
-Hygienic practices
-Growth monitoring
-Complementary Feeding
-Vitamin A supplementation
-Anaemia
-Proportion of children given appropriate feeding during illness
-Proportion of young children receiving a minimum meal frequency
-Proportion of children consuming (daily) iron rich and fortified foods
-Proportion of children who received iron dose/tablet last week
-Proportion of children receiving minimum required food groups
-Prevalence of stunting in children under 5 years
-Prevalence of underweight in children under 5 years
-Prevalence of wasting in children under 5 years
","
","65,000","N/A","","Baseline report will be published around August 2014","N/A","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English"