PLENARY SESSION: REGIONAL PERSPECTIVES ON NUTRITION AND HEALTH OUTCOME - Case Study, Frederick Grant, , Helen Keller International (HKI)
Nutrition and Health Outcomes in Helen Keller International's Enhanced Homestead Food Production (EHFP) program: Findings from cluster-randomized impact evaluations in Nepal and Burkina Faso
HKI's nutrition-sensitive agriculture strategy has evolved to incorporate elements that evidence suggests show the greatest promise for achieving nutritional impact: the integration of nutrition education with technical assistance for improved, diversified production of both plant and animal-source foods; the empowerment of women with training and skills; a model farm serving as a demonstration site for agricultural training, nutrition education and input supplies; facilitating replication of all activities at the household level; and, linkages with government partners. The nutrition behavior change strategy is the Essential Nutrition Actions (ENA) framework which targets practices that influence maternal, infant and young child nutrition and health during the first 1,000 days of life.
Between 2008 and 2012, HKI implemented the program in two food insecure settings using cluster-randomized assignment to treatment or control conditions. In Burkina Faso, the program followed a cohort of children 3-12 months longitudinally between February 2010 and February 2012; in Nepal, the program used a cross-sectional design to evaluate impact of exposure between August 2009 to August 2012 on children < 2 years and women of reproductive age. In both settings, significant impact was documented on all impact pathways comparing treatment to control communities: maternal nutrition knowledge of optimal ENA practices; nutrition practices among women and their children 0-24 months of age; production of an increased variety and quantity of vitamin-A rich plant and animal foods; and, income benefits likely attributable to improved food production. In Nepal, impact was also seen on perceived food security. Neither site found significant improvements in child anthropometry, but showed modest impact on child hemoglobin concentration; the lack of findings are likely due to complexity of the intervention and the limited exposure period constrained by funding cycles. In Nepal, there were significant and important improvements in women's underweight and anemia, which merit further exploration.
Project timelines of 3-4 years are inadequate for assessing impact in complex programs such as EHFP. In future longitudinal designs, the baseline survey will be conducted just before implementation is ready to launch; it is likely that an important proportion of the children included in Burkina's baseline study were beyond the age for maximum growth benefits before program activities began. Research is also being designed to investigate impact in more mature programs, where production has been established and the impact on new birth cohorts can be assessed. Lastly, more detailed dietary intake data will be collected on women to generate stronger evidence for the contributions of EHFP to women's improved nutritional status.