Planning an integrated agriculture and health program and designing its evaluation: Experience from Western Kenya

Cole, Donald C.; Levin, Carol; Loechl, Cornelia; Thiele, Graham; Girard, Aimee Webb; Sindi, Kirimi; Low, Jan

doi:10.1016/j.evalprogplan.2016.03.001

Cited by 35 publications

(49 citation statements)

References 38 publications

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“…Our results corroborate with previous findings regarding economic benefits of interventions in QPM (Gunaratna, Groote, Nestel, Pixley, & McCabe, ), OFSP (Cole et al, ), biofortified iron beans (Murekezi et al, ), bananas (Shimwela et al, ), crop‐livestock integration (Mottet et al, ), improved livestock breeds (Argent et al, ) and farmer capacity building (Davis et al, ) to sync sowing time with rainfall (Mottet et al, ), investments in sustainable soil and water management (Shikuku et al, ) and greater participation of non‐state actors (Shin et al, ).…”

Section: Conclusion and Policy Recommendationssupporting

confidence: 91%

Sustainable development in East Africa: impact evaluation of regional agricultural development projects in Burundi, Kenya, Rwanda, Tanzania, and Uganda

Warinda

Nyariki

Wambua

et al. 2020

Natural Resources Forum

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Investments in agricultural technologies, capacity building and policy harmonization are needed to support sustainable development across Africa. Regional development projects can facilitate the adoption of agricultural technologies and innovations across nation‐state borders and generate benefits for shared prosperity. This paper uses panel data from 1,160 smallholder households including beneficiaries and non‐beneficiaries from five countries in East Africa ‐ Burundi, Kenya, Rwanda, Tanzania, and Uganda. From a pool of over 90 projects implemented over a span of 15 years, 23 regional projects are included in this study. The major economic benefits to smallholder participants are higher crop productivity and income, access to adaptable technologies, access to markets, higher livestock and milk production, gender equality, enhanced food security, resilience and capacity building for uptake and scaling up of future innovation platforms. For example, the adoption of low‐cost tissue culture banana by the beneficiaries increased their incomes by 15% in Rwanda while the adoption of appropriate land and water management technologies increased the potato yields from 2.8 tons (USD 2,840/ha) to over 7.5 tons (USD 7,410/ha) in Kenya. The beneficiaries ensured value added to commodities like bananas (for export) and orange‐fleshed sweet potatoes (a nutrition‐sensitive intervention for enhancing domestic intake of vitamin A) in Burundi, Kenya, Rwanda and Uganda. Additionally, milk production increased from 6 to 11 L per cow per day in Uganda and from 6 to 8 L per cow per day in Tanzania, with increases in sales generating USD 115 per cow per month above the non‐beneficiaries. These results are supported by previous studies on technology adoption, investments in agriculture and well‐being outcomes. Our findings with the higher farm income Difference‐in‐Differences (DiD) estimator for the female beneficiaries compared to male beneficiaries might have important implications for investing in regional development projects that will close the gender gap in agricultural productivity in Africa. Regional projects can also support post‐conflict development efforts for food security and peace in fragile contexts such as in Burundi. Our findings might serve as an input to the African Union's Comprehensive Africa Agriculture Development Programme, localization of the United Nations Sustainable Development Goals related to food security and agriculture in Africa and an input to monitoring, evaluation and learning.

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Section: Conclusion and Policy Recommendationssupporting

confidence: 91%

Sustainable development in East Africa: impact evaluation of regional agricultural development projects in Burundi, Kenya, Rwanda, Tanzania, and Uganda

Warinda

Nyariki

Wambua

et al. 2020

Natural Resources Forum

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“…Like ours, other studies have identified breakdowns in the pathway between training and effective application of its contents, including the volume of content to be absorbed, the skills and attributes of trainers, logistical and human challenges to adequate supervision, and the considerable and perhaps unrealistic demands placed on community agents (Kim et al, ; Mbuya, Menon, Habicht, Pelto, & Ruel, ). Such research has documented exposure to the intervention (Avula et al, ; Rajaraman et al, ) as well as gaps in delivery (Mbuya et al, ) and has deepened understanding of the complexities of such multisectoral public health undertakings (Cole et al, ; Harris et al, ). In our study, although master trainers evinced good understanding of the ENA concepts, there was considerable loss through the cascade to OWL/HC and then mothers, which led us to increase the frequency of refresher training and supervision and reinforce communication skills.…”

Section: Discussionmentioning

confidence: 99%

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

Nielsen

Olney

Ouedraogo

et al. 2017

Maternal & Child Nutrition

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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.

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“…The impact pathway and subsequent monitoring and evaluation strategy covered all major areas of inputs, actions, and outcomes including the following: knowledge and attitudes; diet, nutrition, and health; seed systems; production practices; and cross-sectorial (horizontal) integration (5). However, the implementation of Mama SASHA faced several challenges.…”

Section: Discussionmentioning

confidence: 99%

“…Through community and health facility platforms, the project targeted households with PLW with enhanced nutrition education by using inputs in the form of vouchers for OFSP planting materials and enhanced agricultural extension (5). Demographic and Health Survey data available just before program development indicated undernutrition and low coverage with VA supplementation programs as public health concerns for young children and women of reproductive age in Western Kenya (6).…”

Section: Introductionmentioning

confidence: 99%

Promotion of Orange-Fleshed Sweet Potato Increased Vitamin A Intakes and Reduced the Odds of Low Retinol-Binding Protein among Postpartum Kenyan Women

Girard

Grant

Watkinson

et al. 2017

The Journal of Nutrition

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Background: Orange-fleshed sweet potato (OFSP) improves vitamin A (VA) status of young children; research with pregnant and lactating women is limited.Objective: We examined the effectiveness of the Mama SASHA (Sweetpotato Action for Security and Health in Africa) program to improve nutrition knowledge, diets, and nutritional status of pregnant and lactating women (PLW) in Western Kenya.Methods: Eight health facilities were allocated to the Mama SASHA intervention or comparison arms. PLW in intervention facilities received enhanced nutrition counseling at health clinics, were linked with community-based maternal support groups, and received vouchers for OFSP vine cuttings. Control PLW received clinic-based nutrition counseling only. A total of 505 women in early and midpregnancy, attending their first antenatal care visit, and with no previous engagement in project activities were enrolled from the 8 facilities. Nutrition and health-seeking knowledge, food security, dietary patterns, and anthropometric measurements were collected at 4 time points at ≤9 mo postpartum. VA intakes were assessed with multipass 24-h recalls in a subsample of 206 mothers at 8–10 mo postpartum. VA status was assessed by using serum retinol-binding protein (RBP). Impacts were estimated with multilevel mixed models adjusted for clustering and differences at enrollment.Results: At enrollment, 22.9% of women had RBP <1.17 μmol/L. By 9 mo postpartum, intervention women had significantly higher intakes of VA [adjusted difference = 297.0 retinol activity equivalent (RAE) units; 95% CI: 82, 513 RAE units; P = 0.01; n = 206], greater consumption of VA-rich fruit and vegetables in the previous 7 d (difference-in-difference estimate: 0.40 d; 95% CI: 0.23, 0.56 d; P < 0.01), and a 45% reduction in the odds of RBP <1.17 μmol/L (OR: 0.55; 95% CI: 0.33, 0.92; P = 0.01).Conclusion: Promotion of OFSP to PLW through health services is a feasible strategy to improve women’s nutrition knowledge, VA intakes, and maternal RBP.

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Planning an integrated agriculture and health program and designing its evaluation: Experience from Western Kenya

Cited by 35 publications

References 38 publications

Sustainable development in East Africa: impact evaluation of regional agricultural development projects in Burundi, Kenya, Rwanda, Tanzania, and Uganda

Sustainable development in East Africa: impact evaluation of regional agricultural development projects in Burundi, Kenya, Rwanda, Tanzania, and Uganda

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

Promotion of Orange-Fleshed Sweet Potato Increased Vitamin A Intakes and Reduced the Odds of Low Retinol-Binding Protein among Postpartum Kenyan Women

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