1. Presented by: Deanna Olney, PhD* October 19, 2016
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)
Feb.-May
2010
15 villages randomly assigned
Older Women Leader (OWL) BCC 512 baseline households
15 villages randomly assigned
Health Committee (HC) BCC
514 baseline households
25 villages randomly assigned
Control group
741 baseline households
Apr.-May
2011
15 Villages
75 Women
60 KI
14 Villages
70 Women
58 KI
15 Villages
75 Women
Mar.-June
2012
443 households
400 women
395 children
15 villages
75 Women
75 Men
75 KI
441 households
407 women
376 children
14 Villages
70 Women
70 Men
58 KI
597 households
565 women
511 children
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
Stunting prevalence, children aged 3-12 mo at baseline
Wasting prevalence, children aged 3-12 mo at baseline
Diarrhea 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 at baseline
Anemia prevalence, children aged 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. How did 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
HC members more knowledgeable about anemia and more likely to elicit support from other family members to support adoption of optimal practices
Beneficiaries in HC villages also tended to feel more supported in adopting new practices compared to those in OWL villages

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: Abdoulaye Pedehombga, Marcellin Ouedraogo, Hippolyte Rouamba, Olivier Vebamba, Ann Tarini, Dr. Jean Celestin Somda and 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!!