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Home-grown school feeding: assessment of a pilot program in Nepal.

ABSTRACT: BACKGROUND:The Nepal School Meals Program reached 600,000 schoolchildren in basic education in 2017 and plays a key role in the government's strategy to increase children's academic and nutritional outcomes. A large part of the program is implemented through cash transfers with schools responsible for the school meal delivery. Home-grown school feeding, an approach in which local communities are given greater control over the school meals program and part of the food is sourced locally, may strengthen local ownership and improve meal quality, but there is a lack of evidence for impact. METHODS:This study piloted home-grown school feeding in 30 schools reaching nearly 4000 children in Sindhupalchok and Bardiya districts in Nepal with the aim to assess operations and outcomes in comparison to the regular cash-based school meals program. The study used a one-time post evaluation with a mixed methods approach. Qualitative data were collected through 12 focus group discussions and 28 key informant interviews with government and school staff, parents, cooks, cooperative members, World Food Programme representatives and other stakeholders involved in the pilot program. The quantitative part applied a quasi-experimental design and used cross-sectional data collected from 1512 children in 30 pilot and 30 control schools. RESULTS:The quantitative data indicated that children in the pilot schools had a significantly higher provision of midday school meals (+?19%; p?

SUBMITTER: Shrestha RM

PROVIDER: S-EPMC6950908 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Home-grown school feeding: assessment of a pilot program in Nepal.

Shrestha Rachana Manandhar RM Schreinemachers Pepijn P Nyangmi Mamta Gurung MG Sah Manoj M Phuong Judy J Manandhar Shraddha S Yang Ray-Yu RY

BMC public health 20200108 1

<h4>Background</h4>The Nepal School Meals Program reached 600,000 schoolchildren in basic education in 2017 and plays a key role in the government's strategy to increase children's academic and nutritional outcomes. A large part of the program is implemented through cash transfers with schools responsible for the school meal delivery. Home-grown school feeding, an approach in which local communities are given greater control over the school meals program and part of the food is sourced locally, ...[more]

PMID: 31914980

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Project description:Community health workers (CHWs) are essential to primary health care systems and are a cost-effective strategy to achieve the Sustainable Development Goals (SDGs). Nepal is strongly committed to universal health coverage and the SDGs. In 2017, the Nepal Ministry of Health and Population partnered with the nongovernmental organization Nyaya Health Nepal to pilot a program aligned with the 2018 World Health Organization guidelines for CHWs. The program includes CHWs who: (1) receive regular financial compensation; (2) meet a minimum education level; (3) are well supervised; (4) are continuously trained; (5) are integrated into local primary health care systems; (6) use mobile health tools; (7) have consistent supply chain; (8) live in the communities they serve; and (9) provide service without point-of-care user fees. The pilot model has previously demonstrated improved institutional birth rate, antenatal care completion, and postpartum contraception utilization. Here, we performed a retrospective costing analysis from July 16, 2017 to July 15, 2018, in a catchment area population of 60,000. The average per capita annual cost is US$3.05 (range: US$1.94 to US$4.70 across 24 villages) of which 74% is personnel cost. Service delivery and administrative costs and per beneficiary costs for all services are also described. To address the current discourse among Nepali policy makers at the local and federal levels, we also present 3 alternative implementation scenarios that policy makers may consider. Given the Government of Nepal's commitment to increase health care spending (US$51.00 per capita) to 7.0% of the 2030 gross domestic product, paired with recent health care systems decentralization leading to expanded fiscal space in municipalities, this CHW program provides a feasible opportunity to make progress toward achieving universal health coverage and the health-related SDGs. This costing analysis offers insights and practical considerations for policy makers and locally elected officials for deploying a CHW cadre as a mechanism to achieve the SDG targets.

Project description:PURPOSE:This study aimed to assess the feasibility of a Home-based, Individually-tailored Physical activity Print (HIPP) intervention for African American women in the Deep South. METHODS:A pilot randomized trial of the HIPP intervention (N = 43) versus wellness contact control (N = 41) was conducted. Recruitment, retention, and adherence were examined, along with physical activity (7-d physical activity recalls, accelerometers) and related psychosocial variables at baseline and 6 months. RESULTS:The sample included 84 overweight/obese African American women 50-69 yr old in Birmingham, AL. Retention was high at 6 months (90%). Most participants reported being satisfied with the HIPP program and finding it helpful (91.67%). There were no significant between-group differences in physical activity (P = 0.22); however, HIPP participants reported larger increases (mean of +73.9 min·wk (SD 90.9)) in moderate-intensity or greater physical activity from baseline to 6 months compared with the control group (+41.5 min·wk (64.4)). The HIPP group also reported significantly greater improvements in physical activity goal setting (P = 0.02) and enjoyment (P = 0.04) from baseline to 6 months compared with the control group. There were no other significant between-group differences (6-min walk test, weight, physical activity planning, behavioral processes, stage of change); however, trends in the data for cognitive processes, self-efficacy, outcome expectations, and family support for physical activity indicated small improvements for HIPP participants (P > 0.05) and declines for control participants. Significant decreases in decisional balance (P = 0.01) and friend support (P = 0.03) from baseline to 6 months were observed in the control arm and not the intervention arm. CONCLUSIONS:The HIPP intervention has great potential as a low-cost, high-reach method for reducing physical activity-related health disparities. The lack of improvement in some domains may indicate that additional resources are needed to help this target population reach national guidelines.

Dataset Information

Home-grown school feeding: assessment of a pilot program in Nepal.

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Home-grown school feeding: assessment of a pilot program in Nepal.

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