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Process evaluation improves delivery of a nutrition-sensitive agriculture programme in Burkina Faso.

ABSTRACT: Evidence is emerging from rigorous evaluations about the effectiveness of nutrition-sensitive agriculture programmes in improving nutritional outcomes. Additional evidence can elucidate how different programme components and pathways contribute and can be optimized for impact. The International Food Policy Research Institute, with Helen Keller International, designed a comprehensive framework to evaluate the delivery, utilization, and impact of Helen Keller International's enhanced homestead food production programme in Burkina Faso. After 18 months of implementation, a process evaluation was conducted to examine programme impact pathways, using key informant and semistructured interviews with implementing agents and beneficiaries, and with residents of control communities. Data were analyzed by International Food Policy Research Institute and reviewed with project managers and partners through multiple workshops to identify opportunities to strengthen implementation. Findings illuminated gaps between intended and actual delivery schemes, including input constraints, knowledge gaps among community agents in agriculture and young child nutrition practices, and lower than expected activity by community volunteers. In response, staff developed measures to overcome water constraints and expand vegetable and poultry production, retrained volunteers in certain techniques of food production and counselling for nutrition behaviour change, added small incentives to motivate volunteers, and shaped both immediate and long-term changes to the programme model. Working closely with International Food Policy Research Institute on the evaluation activities also expanded the repertoire of research methods and skills of Helen Keller International staff. Process evaluation can strengthen programme delivery, utilization, and design. Collaboration between researchers and implementers can improve programme effectiveness, project staff capacity, and advance delivery science.

SUBMITTER: Nielsen JN

PROVIDER: S-EPMC6865971 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Process evaluation improves delivery of a nutrition-sensitive agriculture programme in Burkina Faso.

Nielsen Jennifer N JN Olney Deanna K DK Ouedraogo Marcellin M Pedehombga Abdoulaye A Rouamba Hippolyte H Yago-Wienne Fanny F

Maternal & child nutrition 20171226 3

Evidence is emerging from rigorous evaluations about the effectiveness of nutrition-sensitive agriculture programmes in improving nutritional outcomes. Additional evidence can elucidate how different programme components and pathways contribute and can be optimized for impact. The International Food Policy Research Institute, with Helen Keller International, designed a comprehensive framework to evaluate the delivery, utilization, and impact of Helen Keller International's enhanced homestead foo ...[more]

PMID: 29278449

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Project description:Understanding the types of food systems interventions that foster women's empowerment and the types of women that are able to benefit from different interventions is important for development policy. SELEVER was a gender- and nutrition-sensitive poultry production intervention implemented in western Burkina Faso from 2017 to 2020 that aimed to empower women. We evaluated SELEVER using a mixed-methods cluster-randomized controlled trial, which included survey data from 1763 households at baseline and endline and a sub-sample for two interim lean season surveys. We used the multidimensional project-level Women's Empowerment in Agriculture Index (pro-WEAI), which consists of 12 binary indicators, underlying count versions of 10 of these, an aggregate empowerment score (continuous) and a binary aggregate empowerment indicator, all for women and men. Women's and men's scores were compared to assess gender parity. We also assessed impacts on health and nutrition agency using the pro-WEAI health and nutrition module. We estimated program impact using analysis of covariance (ANCOVA) models and examined whether there were differential impacts by flock size or among those who participated in program activities (treatment on the treated). Program impacts on empowerment and gender parity were null, despite the program's multipronged and gender-sensitive approach. Meanwhile, results of the in-depth gender-focused qualitative work conducted near the project mid-point found there was greater awareness in the community of women's time burden and their economic contributions, but it did not seem that awareness led to increased empowerment of women. We reflect on possible explanations for the null findings. One notable explanation may be the lack of a productive asset transfer, which have previously been shown to be essential, but not sufficient, for the empowerment of women in agricultural development programs. We consider these findings in light of current debates on asset transfers. Unfortunately, null impacts on women's empowerment are not uncommon, and it is important to learn from such findings to strengthen future program design and delivery.

Project description:The role of agriculture in reducing undernutrition is widely recognized, yet there is also consensus on the need to make the sector nutrition-sensitive. Evidence on the impact pathways from nutrition-sensitive agriculture (NSA) interventions, agricultural interventions with specific nutrition objectives, and actions detailing each temporal stage to reach nutrition outcomes is limited, however. We thus synthesized study results regarding impact of NSA interventions on nutrition outcomes relating to undernutrition, and constructed an impact pathway by mapping the evidence on each temporal stage from interventions to nutrition outcomes. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses to conduct and report our systematic review of studies on NSA interventions implemented in low- and lower-middle-income countries. Forty-three studies that met the inclusion criteria were extracted and synthesized across impact and pathways analyses. We carried out a thematic analysis of the effect of NSA interventions using evidence-based indicators and constructed the pathways by adopting a published framework on agriculture to nutrition pathways. Our findings reveal that NSA interventions can significantly improve dietary practices, and have the potential to enhance care practices and reduce occurrence of diseases, indicating their effectiveness in simultaneously addressing multiple determinants of undernutrition. However, NSA interventions have a lesser impact on nutritional status. NSA interventions lead to nutrition outcomes through 5 key pathways: food production, nutrition-related knowledge, agricultural income, women's empowerment, and strengthening of local institutions. We emphasize the need to carefully design, implement, and evaluate interventions with consideration for factors affecting impact pathways. Future research should focus on the effect of interventions combining multisector components, and pathways through non-food-production-related income, women's empowerment, strengthening of local institutions, food prices at intervention level, and expenditure on health care.

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Project description:BackgroundIn 2019, Burkina Faso was one of the first countries in Sub-Saharan Africa to introduce a free family planning (FP) policy. This process evaluation aims to identify obstacles and facilitators to its implementation, examine its coverage in the targeted population after six months, and investigate its influence on the perceived quality of FP services.MethodsThis process evaluation was conducted from November 2019 through March 2020 in the two regions of Burkina Faso where the new policy was introduced as a pilot. Mixed methods were used with a convergent design. Semi-directed interviews were conducted with the Ministry of Health (n = 3), healthcare workers (n = 10), and women aged 15-49 years (n = 10). Surveys were also administered to the female members of 696 households randomly selected from four health districts (n = 901).ResultsImplementation obstacles include insufficient communication, shortages of consumables and contraceptives, and delays in reimbursement from the government. The main facilitators were previous experience with free healthcare policies, good acceptability in the population, and support from local associations. Six months after its introduction, only 50% of the surveyed participants knew about the free FP policy. Higher education level, being sexually active or in a relationship, having recently seen a healthcare professional, and possession of a radio significantly increased the odds of knowing. Of the participants, 39% continued paying for FP services despite the new policy, mainly because of stock shortages forcing them to buy their contraceptive products elsewhere. Increased waiting time and shorter consultations were also reported.ConclusionSix months after its introduction, the free FP policy still has gaps in its implementation, as women continue to spend money for FP services and have little knowledge of the policy, particularly in the Cascades region. While its use is reportedly increasing, addressing implementation issues could further improve women's access to contraception.

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Process evaluation improves delivery of a nutrition-sensitive agriculture programme in Burkina Faso.

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Process evaluation improves delivery of a nutrition-sensitive agriculture programme in Burkina Faso.

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