1. www.FSNNetwork.org How data can help us: Analysis of participation in multi-sectoral food security programs that achieve reductions in stunting -- A look at Honduras, Mozambique and Bangladesh. September 22, 2016 The TOPS Program 1

2. CARE Honduras Food Security Program FY1996 to FY2000 Statistically significant reduction in stunting: BL 54.9% FE 47.2% Control FE 65.8%

3. 3 CARE Honduras Food Security Program FY1996 to FY2000 HOGASA: Maternal-child health, nutrition and WASH with preventive ration to <2 and PLW EXTENSA: Increased agriculture production and diversified production PODER: Food for Assets

4. VariableCoefficient Participation in any 1 intervention (reference)1.0000 Participation in 2 interventions1.1115 Participation in all 3 interventions0.3441* 4 Effect of household participation in interventions of the CARE Food Security Program on child stunting, age 24-59 months * Regression analysis with controls for SES; significant at 0.01

5. CARE Mozambique Viable Initiatives for the Development of Agriculture (VIDA) FY1997 to FY2001 5 NAMPULA PROVINCE Started as agriculture production / agribusiness program At midterm found statistically significant increases in household income but no reduction in stunting Added nutrition education component through women’s groups, with some linkages with farmer groups

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7. Results: Trend in reduction of severity of stunting Z score Height-for-age Baseline 1997Survey 2002 n%n% Mild or none (>-2 sd)35240.034141.0 7

8. Results: Trend in reduction of severity of stunting Z score Height-for-age Baseline 1997Survey 2002 n%n% Severe (<-3 sd)30434.521025.3 Moderate ( -3 sd)22425.528233.9 Mild or none (>-2 sd)35240.034141.0 TOTAL880100.0831100.0 8

9. Cross-tabulation of chronic malnutrition with participation 9 Household participation in VIDA Project activities Height-for-Age < -2 s.d. N% Any project activity18156.9 No participation22564.1 Agriculture only7749.3 Nutrition only8662.7 Agriculture and nutrition18*72.0 No participation22564.1 * Further investigation showed that fully integrated activities as planned were not prioritized – instead referrals from nutrition groups to agriculture support were made for children in malnourished condition -- a “curative” focus vs. prevention intention. Strategies were reviewed and preventive focus strengthened.

10. CARE Bangladesh SHOUHARDO-I FY1998 to FY2010 10 In 18 districts, including peri-urban and rural communities in North Char, Mid Char, Haor and Coastal areas. Reduction in stunting: BL 51.9% FE 36.4%

11. Participation at the household level 11 Program Group Activities% of household participation Core Occupational Group (ag/IGA)72.2% Mothers’ Group94.8% Additional analysis (regression) IMPORTANCE OF INTEGRATION AT THE HOUSEHOLD LEVEL ! p-value NUMBER OF INTERVENTIONS households participated in over the previous year and CHILD STUNTING 0.013 **

12. Core Occupational Group interventions COG Intervention% of household participation Agriculture22.5 CHD: Vegetable production30.9 CHD: Fruit production8.2 CHD: Livestock20.2 IGA: Non agriculture12.9 IGA: Agriculture11.0 IGA: Livestock10.6 Fisheries9.1 ANY COG INTERVENTION72.2 12

13. WALA Project: FY2009-FY2014 Reduction in stunting: BL 42.4% FE 37.1%* Statistically significant at p<0.01 13

14. Nutrition / WASH / Agro-economicsBLFE Minimum adequate diet12.3%20.0% * Improved hygiene (latrine, handwashing, bed nets)6.1%26.0% * Average Household Dietary Diversity Score4.294.50 * 14 Positive Results in IPTT Indicators in Multiple Sectors *Statistically significant at p<0.01

15. Percentage of Households Participating in X Number of WALA Project Activities NUMBER OF WALA PROJECT ACTIVITIES % HH at FE 0 ACTIVITIES13.2 1 to 3 ACTIVITIES37.4 4 to 6 ACTIVITIES29.5 7+ ACTIVITIES19.9 15

16. The TOPS Program was made possible by the generous support of the American people through the United States Agency for International Development (USAID) Office of Food for Peace. The contents of this presentation do not necessarily reflect the views of USAID or the United States Government.