The general objective of this study is to explore the feasibility of producing RUTF and/or RUSF in Zambia. The main specific objectives for Milestone 1, the results of which this report describes, are to assess the market dynamics of RUTF and RUSF in Zambia, estimate costs of local production, assess current and potential demand in Zambia and the region, and recommend on overall feasibility of local production.
In agreement with FCDO, this study phase focuses on lipid based RUTF and RUSF in sachets used for treatment of severe and moderate acute malnutrition (SAM/MAM) of children from six months of age, as per the treatment guidelines of Zambia and the relevant national and international regulations and standards.
The study consisted of document review, a stakeholder mapping, key informant interviews (30 interviews, involving 40 people), estimation of demand, and cost comparison. Data collection took place between July and October 2021.
]]>This assessment provides an external and critical view of the EVA-BHN programme. It provides learning for improving the programme effectiveness over the remaining 16 months, for informing the design of potential future DFID health programme(s) in Pakistan and for communicating with stakeholders.
The assessment was conducted in October – December 2017 through a desk review of international evidence, and programme documentation and data, and through a visit to four of the programme districts and the two province capitals where qualitative data was collected. Eight focus groups with community group members and 55 key informant interviews were conducted across the two provinces. Findings in this report come from a desk review of EVA monitoring data, EVA research and case studies and also from the limited primary data collection of the assessment. It is not possible to generalise many of the findings, but they give information that can be used.
This programme has produced an innovative and high-quality community voice and accountability system that is showing some signs of increasing accountability and government responsiveness. Programme MIS data is almost accurate and can be improved with minor adjustments.
However, the programme has not adequately analysed and addressed at policy level the serious health systems issues, not least health financing, human resource management and access to medicines and supplies. There is evidence that this could be limiting government engagement.
The full report is available here.
Suggested citation:
Taylor, G. and Khan, S. (2018). Empowerment Voice and Accountability for Better Health and Nutrition (EVA-BHN) Assessment: Executive Summary. London, UK: High-Quality Technical Assistance for Results (HEART).
The assessment was conducted in October, November, and December 2017 through a desk review of international evidence and programme documentation and data, as well as through a visit to four of the programme districts and the two province capitals, where qualitative data was collected. Eight focus group discussions (FGDs) with community group members and 55 key informant interviews were conducted across the two provinces. Findings in this report come from a desk review of EVA-BHN monitoring data, EVA-BHN research and case studies, and also from the limited primary data collection. It is not possible to generalise many of the findings, but they give useful information and insights.
EVA-BHN is an £18.86 million health voice and accountability programme working at community, district, and province level in Punjab and Khyber Pakhtunkhwa (KP) since February 2014. It is part of the Department for International Development’s (DFID) Provincial Health and Nutrition Programme (PHNP), which supports delivery of an Essential Health Services Package (EHSP) by the governments of Punjab and KP.
Suggested citation:
Taylor, G. and Khan, S. (2018). Empowerment, voice and accountability for better health and nutrition (EVA-BHN) – Independent assessment. London, UK: High-Quality Technical Assistance for Results (HEART).
Results show that the average household food insecurity gap (incidences when households cannot meet their food needs) dropped from 3.6 months to 2.3 months (The World Bank Group, 2013). A qualitative survey in Tigray, Northern Ethiopia, revealed that receipt of PSNP food-aid was linked socio-demographic attributes, among which marital status, age and size of family were decisive factors (Adazi et al., 2017). There is no evidence that PSNP reduces chronic or acute undernutrition (Berhane et al., 2017).
Realistic planning for a nutrition intervention is a critical component of implementation, yet effective approaches have been poorly documented (Schauer et al., 2017). Those that are documented and published are self-evaluations (e.g. USAID (2017), UNICEF (2017b) and World Food Programme Ethiopia (WFP Ethiopia, 2017). Government data is also a major source: the US Government’s ‘Feed the Future’ initiative reports that it contributed to reductions in the number of underweight (low weight for age) children by 17%, child stunting (short for age) by 4%, and child wasting (low weight for height) by more than 30% from 2013 to 2015 in Ethiopia (USAID Feed the Future, 2016).
However, the change in prevalence of stunting for Ethiopia was not statistically significant, meaning the margin of error of the survey sample was too great to conclusively demonstrate change. Some published estimates of need were made before the Humanitarian Requirements Document (HRD), which is conducted to facilitate early planning and resource mobilisation for donors.
]]>ORIE provided operations research, impact evaluations, costing and cost effectiveness studies for the ambitious £52 million, six-year, Department for International Development (DFID)-funded Working to Improve Nutrition in Northern Nigeria (WINNN) programme, which supports the government to improve maternal, newborn and child nutrition in five northern states. ORIE worked closely with key federal and state government stakeholders to ensure that findings reached them and informed their policies.
ORIE findings contributed to changes in policy and practice by the WINNN programme and government. They included:
Since 2012 ORIE has produced more than 25 separate studies which were the result of five years of activities that included rigorous mixed methods impact evaluations, operational research, and research capacity building among Nigerian academics.
Key endline outputs, all available on the HEART website, include the Integrated Evaluation Report, a summary of key findings from all ORIE studies; a set of five thematic briefs which summarise learning from over the past six years of studies and implementation on governance, micro-nutrient supplementation, infant and young child feeding practices, community-based management of acute malnutrition (CMAM) and gender and that were co-produced in collaboration with WINNN implementing partners, and; a rigorous mixed methods impact evaluation (including quantitative and qualitative studies); and reports which analyse the cost and cost effectiveness of the programme.
Findings were appropriately packaged to make the messages more accessible to different audiences, making use of research summaries, policy briefs, blogs, infographics and other products. Overall, ORIE reports have been downloaded so far more than 60,000 times.
In August 2017, ORIE started the dissemination phase of its final findings. The ORIE-WINNN launch event was held in Abuja on 2- 3 August 2017 and brought together around 100 key stakeholders from many sectors and institutions in Nigeria across federal, state and local government, civil society organisations, non-governmental organisations, universities, and donors.
The official presentation of the findings was followed by lively learning workshops on key strategic themes. The five workshops encouraged stakeholders to discuss the key issues arising from ORIE findings and explore implications for future nutrition policy and practice. The workshops were well received and covered important topics around governance, gender, CMAM, micronutrient supplementation and IYCF.
The reports were highly rated by key stakeholders, as were our key engagement and dissemination meetings. At the dissemination event held in Abuja early in August 2017, 95% of participants rated their level of satisfaction with ORIE events and reports over the last five years as good or excellent.
We expect ORIE evidence to continue to have an impact on policy and practice in nutrition, in Nigeria and beyond, after the project closes.
Post written by Marta Moratti, who is a a monitoring & evaluation consultant at OPM.
This blog was posted on Medium on 6 October 2017. Reposted with permission. The Operations Research and Impact Evaluation (ORIE) project, is a Department for International Development (DFID)-funded consortium led and managed by Oxford Policy Management (OPM). The research outputs and studies were carried out in collaboration with London School of Hygiene and Tropical Medicine (LSHTM), Save the Children UK (SCUK), the Institute of Development Studies (IDS) and the Nigerian based institutions Ibadan University and the Food Basket Foundation International (FBFI).
]]>In the West African region, maize, rice, sorghum, millet, cassava, yam, cowpea and livestock are considered to be the food staples (Engel & Jouanjean, 2013: 1). Key cross-border food staples traded between East African states are maize and maize flour, beans, wheat and wheat flour, rice, sorghum and sorghum flour, and sesame (East Africa Cross-Border Trade Bulletin, 2017). Crossborder food trade in the South African sub-region focusses on rice, beans and maize (Ibrahim, 2015: 140).
]]>This report seeks to understand whether select countries that have more fully embraced and championed the SUN strategy have also witnessed greater progress in mounting a scalable and effective response to malnutrition. It explores whether multilateral coinvestments in nutrition policy and planning, in line with SUN aims and objectives, translate into change on the ground that sustains local ownership and leadership.
]]>The WINNN programme improved mother’s attendance at Maternal Neonatal and Child Health Week (MNCHW) events and mother’s IYCF knowledge and practices but had no impact on anthropometric indicators. The research finds that WINNN was well-aligned with government priorities and that government planning, coordination and forecasting improved during the course of the programme. In terms of efficiency, the CMAM and IYCF components of the programme are found to very cost-effective relative to international standards. While WINNN contributed to an increase in political commitment and funding for nutrition initiatives in Nigeria, funding levels are still not sufficient to meet necessary scale-up targets.
A summary of the report is available here.
Suggested citation: Hansford, F., Visram, A., Jones, E., Ward, P. (2017), ‘Integrated Evaluation Report of the WINNN Programme: Operations Research and Impact Evaluation’, Oxford Policy Management, Oxford, UK
]]>Key messages
While there has been progress in public financing for nutrition, public funding is still very low compared to the need. Nutrition work remains largely reliant on donor funding. State governments should be continuously encouraged to increase their funding for nutrition, and to access funding from federal and donor sources.
ORIE briefs are also available on the following themes:
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