Presented by: Deanna Olney, PhD* October 19, 2016

1. Lessons Learned from the Evaluation of Helen Keller international’s Enhanced Homestead Food Production (EHFP) Program Presented by: Deanna Olney, PhD* October 19, 2016 * Olney, Dillon, Ruel, Nielsen. Lessons learned from the evaluation of Helen Keller International’s Enhanced Homestead Food Production Program. AOTR

2. Background • The agriculture sector can improve nutrition especially through integrated agriculture and nutrition programs. • Consistently improve agriculture production and dietary diversity (Leroy et al. 2008, Girard et al. 2012). • Also posited to improve nutrition outcomes by simultaneously addressing the direct and underlying causes of undernutrition (Ruel et al. 2013). • However, limited documented evidence exists about their impacts on nutrition outcomes and how impacts are achieved. • Rigorous, comprehensive evaluations that include impact and process evaluations are needed to generate this evidence.

3. Enhanced-Homestead Food Production (EHFP) program in Burkina Faso • Program enhancements: • Targeted to mothers with children 3-12 mo of age • Increased focus on women • Improved behavior change communication (BCC) strategy Distribute agriculture and zoological inputs Establish Village Model Farms Establish home gardens Increase production Increase income & assets Improve maternal & child health & nutrition outcomes Provide agriculture training Increase consumption Provide nutrition and health-related training Improve nutrition, health and hygiene practices

4. Study design for HKI’s EHFP program in Burkina Faso 2009 55 eligible villages (water + population criteria) 2010 Feb.-May 15 villages randomly assigned Health Committee (HC) BCC 514 baseline households 15 villages randomly assigned Older Women Leader (OWL) BCC 512 baseline households 25 villages randomly assigned Control group 741 baseline households 2011 Apr.-May • 15 Villages • 75 Women • 60 KI • 14 Villages • 70 Women • 58 KI • 15 Villages • 75 Women 2012 Mar.-June 597 households 565 women 511 children 443 households 400 women 395 children 441 households 407 women 376 children • 15 villages • 75 Women • 75 Men • 75 KI • 14 Villages • 70 Women • 70 Men • 58 KI • 15 Villages • 75 Women • 75 Men

5. What impact did the EHFP program have on children’s and women’s nutritional status and women’s empowerment?

6. 2 y impact on children’s stunting, wasting and diarrhea Diarrhea prevalence, children aged 3-12 mo at baseline Stunting prevalence, children aged 3-12 mo at baseline Wasting prevalence, children aged 3-12 mo at baseline * P<0.01, ** P<0.05 Olney et al., Journal of Nutrition 2015

7. 2 y impact on children’s anemia Anemia prevalence, children aged 3-12.9 at baseline Anemia prevalence, children aged 3-5.9 at baseline * P<0.01, ** P<0.05 Olney et al., Journal of Nutrition 2015

8. 2 y impact on mother’s underweight and body mass index (BMI) Change in the prevalence of underweight among women1 Change in women’s body mass index (BMI) by underweight status at baseline1 ** P<0.05 for DID estimates, * P<0.10 for interaction. Olney et al., Journal of Nutrition 2016

9. 2 y impact on women’s overall empowerment, decision-making and social capital • Significant impacts on meeting with other women, purchasing and health care decisions • No impact on spousal communication, social support, family planning decisions or infant and young child feeding decisions. ** P<0.05 for DID estimates. Olney et al., Journal of Nutrition 2016

10. Howdid the EHFP program work to improve children‘s and women’s nutritional status and women’s empowerment?

11. Production – consumption pathway: What worked? • Process evaluation • Improved knowledge of optimal agriculture practices and adoption of some key practices • Perceived increases in production of chickens, eggs and vegetables • Impact evaluation • Beneficiary women owned more chickens • Beneficiary women produced more micronutrient-rich foods

12. Production – consumption pathway: What needed improvement? • Process evaluation • Water constraints • HKI worked to decrease water constraints through a variety of methods such as creating new wells and boreholes, repairing existing water sources, using drip irrigation kits, etc. • Perceived inadequacies in supplies • Motivation and compensation of local implementers • Timing and duration of the program • Impact evaluation • Impact on household level production

13. Production – income pathway: What worked? • Process evaluation • Positive changes in men’s and women’s opinions about women’s ability to own and use land changed • Beneficiary women maintained control over their gardens, food produced and income generated • Impact evaluation • Beneficiary compared to non-beneficiary women: • Owned more agriculture assets • Owned more chickens • Produced more micronutrient-rich foods

14. Knowledge – adoption of optimal health and nutrition practices pathway: What worked? • Process evaluation • Knowledge of some optimal health, hygiene and nutrition practices improved • Impact evaluation • Knowledge and adoption of some key practices improved • Mothers’ intake of micronutrient-rich foods increased • Children’s dietary diversity increased

15. Knowledge – adoption of optimal health and nutrition practices pathway: What needed improvement? • Process evaluation • Home visit frequency • Motivation of local level program implementers • Technical abilities and quality of program implementation by OWLs • Understanding of BCC topics related to prevention and treatment of anemia • HKI retrained nutrition trainers and in turn beneficiaries in the topics related to the prevention and treatment of anemia • Impact evaluation • Further improvements in knowledge and adoption of some of the promoted practices

16. Conclusions • The EHFP program improved child and maternal nutritional status and maternal empowerment • Further reductions in anemia, diarrhea and stunting are needed • Possible ways to achieve this are: • Intervening earlier and for longer • Improving delivery and utilization of some program components • Re-examining issues related to motivation and compensation of program implementers • Including additional interventions designed to address some of the other causes of undernutrition such as water, sanitation and hygiene (WASH) interventions or the provision of a fortified complementary food for children 6-24 mo of age

17. Acknowledgements • Study participants in Burkina Faso • Helen Keller International (HKI) • HKI Burkina Faso: AbdoulayePedehombga, MarcellinOuedraogo, HippolyteRouamba, Olivier Vebamba, Ann Tarini, Dr. Jean Celestin Somdaand Fanny Yago-Wienne • HKI headquarters: Victoria Quinn, Jennifer Nielsen • Local implementing non-governmental organizations (NGOs) • Burkina Faso - Association d'Appui et de Promotion Rurale du Gulmu(APRG) • Research team at the International Food Policy Research Institute (IFPRI) and Michigan State University • IFPRI and Michigan State: Andrew Dillon • IFPRI: Marie Ruel, Mara van den Bold, Elyse Iruhiriye, Lilia Bliznashka, Julia Behrman, Esteban Quiñones and Jessica Heckert • Funding: • The Office of U.S. Foreign Disaster Assistance (OFDA) of the U.S. Agency for International Development (USAID) • Gender, Agriculture, and Assets Project (GAAP), supported by the Bill and Melinda Gates Foundation • European Commission (EC) • CGIAR Research Program on Agriculture for Nutrition and Health (A4NH) led by the International Food Policy Research Institute (IFPRI)

18. THANK YOU!!