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Nutrition
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Nutrition Section
The dominant modes in nutritional assistance have provision
of food as a commodity (Walker) and support to agricultural development (Coutts).
More recently, programmes have shifted
to microcredit schemes for longer term solutions to household food security (MkNelly).
Evaluation of donor-led programmes has dominated the literature in this
field (Bolini). The need for assessment of food needs in war affected
societies that have remained in a state of war for decades, such as southern
Sudan, have led to the development of techniques and terminology such as ‘food
economy assessment’ by organisations such as Save the Children Fund (SCF).
Agencies that are involved in emergency food supply are known to carry
out periodic evaluations, however these tend to remain in the domain of the
agencies, and not for general distribution., because they often contain
information that directly affect people’s lives.
Author:
Bollini, P., and Reich, M.R. Title:
The Italian fight against world hunger. A critical analysis of Italian aid for development in the 1980s. Source:
Soc Sci Med., Sep. 39 (5). p. 607-20,1994 Key words:
efficiency, development assistance, planning, fraud, politics, Italy Reviewer:
MEDLINE Description: During the 1980s, Italy expanded its development
assistance, soon becoming the fifth largest donor. Italian development
cooperation directed much effort to alleviate hunger, malnutrition and their
health consequences. This paper provides an evaluation of Italy's fight against
world hunger considering the political environment in which the policy was
conceived and implemented, the organizational structure behind the policy, and
the available quantitative indicators of outcome. The analysis shows how
powerful humanitarian drives, supported by inchoate thinking about development
problems and priorities, and by institutional and technical confusion, gave rise
to development programs below accepted standards. Poor financial planning and
the absence of proper mechanisms for project appraisal facilitated the capture
of some programs by domestic political and commercial interests. In 1992,
Italian magistrates began investigations into the extent of corruption in
development assistance; preliminary reports documented widespread waste and
ineffectiveness in major aid projects. Substantial changes in organization and
priorities are needed in order to control past practices of corruption, improve
the effectiveness of projects, and redirect Italian aid towards development
goals. Author(s):
Coutts, P., and Sharp, B. Title: An
introduction to the food economies of southern Sudan. Source: The Save the
Children Fund (UK) south Sudan Programme and World Food Programme, 1998 Key words:
food, food economy analysis, southern Sudan, SCF, WFP Description: This book describes the food economy analysis methodology
that has been employed by the World Food Programme and developed by the Food
Economy Analysis Unit of the Save the Children Fund (UK).
The use of this method has facilitated the determination of who exactly
needs relief food, in what quantities and for how long. The food economy analysis (FEA) approach can be used to
analyze any problem resulting in reduced access to one or more sources of food,
be it production failure due to natural causes (e.g. drought or flood), or
problems resulting from conflict and insecurity. Food economy analysis focuses on access to different food
sources, and not so much on food production and consumption patterns. The Authors describe in considerable detail, the different
food economy zones of southern Sudan, and the methods used to develop the food
economy picture. Two basic steps
are involved in food economy analysis: a baseline assessment, and a monitoring
assessment. In the first step, a baseline assessment provides an
overview of access to various food sources for different wealth groups in both
good years and bad in order to understand normal coping mechanisms. This reveals
the flexibility of the food economy and its ability to adapt to normal
agro-climatic and socio-economic variants.
Further analyses reveal the “norm”. In the second step, changes in the baseline are monitored
and analyzed. Using
information derived from key informants as well as other rapid rural appraisal (RRA)
techniques, access to various food options is assessed, and the contribution of
various foods to nutritional needs is calculated from their respective
nutritional values. This shows
whether different food sources can be expanded to compensate for losses,
otherwise referred to as “assessing the ‘coping mechanisms’ ”. When the remaining food sources are unable to meet the needs
for survival, the deficit can be calculated, allowing the needs of the
vulnerable group to be considered. The Authors raise cogent issues of food, nutrition,
post-harvest storage, food processing, seed availability and food aid enabling
cultivation in the context of southern Sudan household food security. (Note: the
concept of “food” in the book is as it relates to calorific requirement for
an adult to survive.) They also
analyze the impact of instability on food security, within the chronic emergency
situation as found in southern Sudan. They discuss how southern Sudanese have had to adapt
strategic food choices because of civil conflict. They conclude, based on years of food economy
assessments in southern Sudan, that “people’s greatest underlying fear is a
further reduction of assets and restricted access to alternative food
sources.” Author: MkNelly B.,
Dunford C. Title:
Impact of credit with education on mothers’ and their young
children’s nutrition: Lower Pra
Rural Bank Credit with Education Programmein
Ghana Source: Freedom from
Hunger, Research Paper No. 4, [email protected] Key words:
microcredit, health, nutrition, Ghana Reviewer:
Charlotte G. Neumann, University of California, USA Description:
Despite the popularity of microcredit, there has been
little evidence to date of the impact of such programs on maternal and child
nutrition and health. This report
presents the finding of a three-year longitudinal impact study of Credit with
Education in Ghana, conducted by Freedom from Hunger in collaboration with the
University of California, Davis (Programmein International Nutrition).
The research evaluated the impact of a combination of credit and
health/nutrition education on women’s economic capacity, their empowerment,
their health practices and ultimately their children’s nutritional status. Two major survey and anthropometric (heights and weights)
data collection rounds were carried out—a 1993 baseline and a 1996
follow-up—with different mother/child pairs participating in the two time
periods. A quasi-experimental
design was applied with randomization of study communities to receive or not
receive the programme until after completion of the evaluation research.
Programme impact is evaluated by comparing the differences between the
responses and measurements in the two data collection rounds (1993 and 1996) for
programme participants versus nonparticipants in programme communities and
residents in control communities. The evaluation found relative to nonparticipants and/or
residents in control communities, women in the programme had greater economic
capacity in terms of their monthly nonfarm earnings and personal cash savings.
Participants attributed their increased incomes most commonly to the
expanded scale of their income-generating activities, reduced inputs costs as a
result of buying in bulk or with cash and new activities or products made
possible by access to credit. Programme
participation was also associated with positive impact on aspects of women’s
empowerment such as their self-confidence, their status and networks in the
community and to some degree bargaining power within the family. Participants relative to nonparticipants and residents in
control communities demonstrated positive impact in a variety of key child
nutrition and health practices such as exclusively breastfeeding longer,
enriching traditional complementary foods and rehydrating children suffering
from diarrhea. Furthermore,
participation in income generation activities did not negatively affect
breastfeeding and weaning practices. Participant households also had significantly greater food
security (measured by the incidence and duration of a “hungry season”) than
nonparticipants. The nutritional
status of participants’ one-year-old children—both in terms of
weight-for-age and height-for-age—was also significantly improved between the
years relative to the children of residents of control communities. However, a similar positive effect was not found for maternal
nutritional status as measured by women’s body mass index (BMI). Due to a high repayment rate and interest payments, the
programmealso enjoyed a greater degree of cost recovery than most traditional
health or income-generating programs. Just
over 80% of the programs’ operating costs were covered by the interest paid by
borrowers on their loans. The study
concludes that the Credit with Education strategy is a promising strategy for
sustainable and widespread improvement of nutrition and food security. Author:
Walker, S., and Ncube, T. Title: An
evaluation of the 1995-1996 child supplementary feeding programme Source: Ministry of
Health and Child Welfare, Government of Zimbabwe and UNICEF Harare, 1998 Key words:
supplementary feeding, drought, programme evaluation, Zimbabwe Reviewer:
Alexandra Yuster, UNICEF Description: This evaluation aimed to measure the effectiveness of the
child supplementary feeding programme, review its operations, and assess whether
it is needed in the context of other drought relief efforts in Zimbabwe.
The evaluation was conducted over a five week period and covered seven
out of eight provinces (the ninth province, Harare, is urban and was not
included in the programme). Interviews and review of records were conducted at
national provincial and district levels, as well as at holding and feeding
points. Observation was also used at these points, and focus group
discussions were held with caregivers of children benefiting from the programme.
The Child Supplementary Feeding Programme (CSFP) was found
to have a mixed record in implementation effectiveness.
Food supplies were erratic, due to difficulties in the centralized
procurement system, transport, and communication between different levels.
Targeting was broader than originally intended, resulting in 1.2 million
children, or 81 % of the total under-5 population being registered for the
programme, far more than the numbers provided for in the distribution of food,
although only about 50% of this group actually participated.
Difficulties in monitoring and low use of information gathered prevented
the programme from making timely adjustments and also made monitoring of impact
difficult. While direct monitoring of impact did not prove possible, a
review of Ministry of Health nutrition monitoring data shows there was little
seasonal variation in malnutrition during the period of the programme, despite
the drought. This implies
that CSFP may have had some positive impact.
Concerns remain however that the programme tended to reach older children
(3-5 years, and some older) rather than the more vulnerable 1-2 year group, and
that some particularly affected areas may have been reached only sporadically
due to the broad targeting and logistical problems faced.
The feeding may also have often been used as a substitute rather than
supplementary means. Nevertheless, the contribution of CSFP in providing a
structure which could facilitate future feeding initiatives should they prove
necessary was acknowledged in the report. Based on these findings, the report recommends scaling back
the programme during non-drought years, to focus on other, more sustainable
forms of food security. As a safety net for the most vulnerable, piloting of
take-home rations should be tried, in order to reach younger family members.
Should future feeding programmes be necessary, more comprehensive and
stricter screening methods need to be introduced. Consideration needs to be
given to combining CSFP with other forms of drought relief, to reduce logistical
difficulties and increase efficiency. Distribution problems could be partially
addressed through more localized procurement. Improved guidelines are needed for
monitoring and use of data. Finally, CSFP provides opportunities for health
education, which should be more fully utilized in any future programming. |