What Can We Learn From Nutrition Impact Evaluations
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What Can We Learn From Nutrition Impact Evaluations
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Author : The World Bank
language : en
Publisher: World Bank Publications
Release Date : 2010-08-27
What Can We Learn From Nutrition Impact Evaluations written by The World Bank and has been published by World Bank Publications this book supported file pdf, txt, epub, kindle and other format this book has been release on 2010-08-27 with Medical categories.
Evaluation Summary What Can We Learn from Nutrition Impact Evaluations? High levels of child malnutrition in developing countries contribute to mortality and have long-term consequences for children s cognitive development and earnings as adults. Recent impact evaluations show that many different interventions have had an impact on children s anthropometric outcomes (height, weight, and birth weight), but there is no simple answer to the question What works? to address the problem. Similar interventions have widely different results in different settings, owing to differences in local context, the causes and severity of malnutrition, and the capacity for program implementation. Impact evaluations of programs supported by the Bank, which are generally large-scale, complex inter-ventions in low-capacity settings, show equally variable results. The findings confirm that it should not be assumed that an intervention found effective in a randomized medical setting will have the same effects when implemented under field conditions. There are many robust experimental and quasi-experimental methods for assessing impact under difficult circumstances often found in field settings. The relevance and impact of nutrition impact evaluations could be enhanced by collecting data on service delivery, demand-side behavioral outcomes, and implementation processes to better understand the causal chain and what part of the chain is weak, in parallel with impact evaluations. It is also important to understand better the distribution of impacts, particularly among the poor, and to document better the costs and effectiveness of interventions. High levels of child malnutrition in developing countries are contributing to mortality and present long-term consequences for the survivors. An estimated 178 million children under age 5 in developing countries are stunted (low height for age) and 55 million are wasted (low weight for height). Malnutrition makes children more susceptible to illness and strongly affects child mortality. Beyond the mortality risk in the short run, the developmental delays caused by undernutrition affect children s cognitive outcomes and productive potential as adults. Micronutrient deficiencies vitamin A, iron, zinc, iodine, for example are also common and have significant consequences. Progress in reducing malnutrition has been slow: More than half of countries are not on track to achieve the Millennium Development Goal of halving the share of children who are malnou-rished (low weight for age) by 2015. The food price and financial crises are making achievement of this goal even more elusive. The World Bank has recently taken steps to ex-pand its support for nutrition in response to the underlying need and the increased urgency due to the crises. WHAT DO WE KNOW ABOUT REDUCING MALNUTRITION? The increased interest and resources focused on the problem of high and potentially increasing rates of undernutrition raises the question, what do we know about the causes of malnutrition and the in-terventions most likely to reduce it? The medical literature points to the need to inter-vene during gestation and the first two years of life to prevent child malnutrition and its consequences. It suggests that investments in interventions during this window of opportunity among children under 2 are likely to have the greatest benefits. Recently published meta-analyses of the impact evaluation literature point to several interventions found effective for reducing undernutrition in spe-cific settings. However, there are limitations to the generalizability of those reviews findings, particularly in the context of large-scale government programs most likely to be supported by the World Bank. The reviews tend to disproportionately draw on the findings of smaller, controlled experiments; there are few examples of evaluations of large-scale programs, over which there is less control in implementation. In reviewing a large number of studies, interventions, and outcomes, they tend to focus on average impacts. They generally do not explain the magnitude or variability of impacts across or within studies. Very few address the programmatic reasons why some interventions work or don t work, nor do they assess the cost-effectiveness of interventions. Objectives of the Review This paper reviews recent impact evaluations of interventions and programs to improve child anth-ropometric outcomes height, weight, and birth weight with an emphasis on both the findings and limitations of the literature and on understanding what might happen in a non-research setting. It further reviews in greater detail the experience and lessons from evaluations of the impact of World Bank-supported programs on nutrition outcomes. Specifically, the review addresses four questions. First, what can be said about the impact of different interventions on children s anthropometric outcomes? Second, how do these findings vary across settings and within target groups, and what accounts for this variability? Third, what is the evidence of the cost-effectiveness of these interventions? Finally, what have been the lessons from implementing impact evaluations of Bank-supported programs with anthropometric impacts? While there are different dimensions of child nutri-tion that could be explored, the report focuses on child anthropometric outcomes -- weight, height, and birth weight. These are the most common nutrition outcome indicators in the literature and the most frequently monitored by national nutrition programs supported by the World Bank. Low weight for age (underweight) is also the indicator for one of the MDGs. Methodology and Scope Forty-six nutrition impact evaluations published since 2000 were systematically reviewed. These evaluations assessed the impact of diverse interven-tions community nutrition programs, conditional and unconditional cash transfers, early child devel-opment programs, food aid, integrated health and nutrition services, and de-worming. All of the evaluations used research designs that compared the outcomes among those affected by the project to the counterfactual that is, what would have happened to a similar group of people in the absence of the intervention. About half used randomized assignment to create treatment and control groups, while the remainder used matching and various econometric techniques to construct a counterfactual. Among the 46 evaluations, twelve assessed the im-pact of World Bank-supported programs on nutri-tion outcomes in eight countries. While the broader review relies on the analysis of the published impact evaluations as the main source of data, for these twelve evaluations project documents and research outputs were reviewed and World Bank staff, country officials and the evaluators and re-searchers who conducted the studies were interviewed. Findings A wide range of interventions had a positive impact on indicators related to height, weight, wasting, and low birth weight. There were a total of 10 different outcome indica-tors for the four main anthropometric outcomes. A little more than half of the evaluations addressing a height-related indicator found program impacts on at least one group of children, and this was true for about the same share of interventions aimed at improving weight-related and wasting (low weight for height)-related indicators. About three-quarters of the 11 evaluations of interventions that aimed at improving birth weight indicators registered an impact in at least one specification, including five out of seven micronutrient interven-tions. There was no clear pattern of impacts across interventions in every intervention group there were examples of programs that did and did not have an impact on a given indicator, and with varying magnitude. Evaluations of the nutritional impact of programs supported by the World Bank, which are generally large-scale, complex, and implemented in low-capacity settings, show equally variable results. Even controlling for the specific outcome indicator, studies often targeted children of different age groups that might be more or less susceptible to the interventions. It is thus difficult to point to inter-ventions that are systematically more effective than others in reducing malnutrition across diverse set-tings and age groups. Differences in local context, variation in the age of the children studied, the length of exposure to the intervention, and differing methodologies of the studies account for much of the variability in results. Context includes factors like the level and local determinants of malnutrition, differences in the characteristics of beneficiaries (including their age), the availability of service infrastructure, and the implementation capacity of government. Outside of a research setting in the context of a large government program there are many things that can go wrong in either service delivery or the demand response that can compromise impact. Beyond this, there are social factors like the status of women or the presence of civil unrest that can affect outcomes. These findings underscore the conclusion that it should not be assumed that an intervention found effective in a randomized controlled trial in a re-search setting will have the same effects when im-plemented under field conditions in a different set-ting. They also point to the need to understand the prevailing underlying causes of malnutrition in a given setting and the age groups most likely to benefit in selecting an intervention. Further, impact evaluations need to supplement data measuring impact with data on service delivery and demand-side behavioral outcomes to demonstrate the plausibility of the findings, to understand what part of a program works, and to address weak links in the results chain to improve performance. There is scant evidence on the distribution of nutrition impacts who is benefiting and who is not or on the cost-effectiveness of interventions Just because malnutrition is more common among the poor does not mean that they will disproportio-nately benefit from an intervention, particularly if acting on new knowledge or different incentives relies on access to education or quality services. Only a third of the 46 evaluations looked at the distribution of impacts by gender, mother s education, poverty status, or availability of complementary health services. Only nine assessed the impacts on nutritional outcomes of the poor compared with the non-poor. Among the evaluations that did examine variation in results, several found that the children of more educated mothers or in better-off communities are be-nefitting the most. Bank-supported cash transfers, community nutrition, and early child development programs in six of eight countries had some impact on child anthropometric outcomes. Of the 12 impact evaluations of Bank support, all but one were of large-scale government programs with multiple interventions and a long results chain. Three-quarters found a positive impact on anthro-pometric outcomes of children in at least one age group, although the magnitude was in some cases not large or applied to a narrow age group. Most of the impact evaluations involved assessment of completely new programs and involved World Bank researchers. Most used quasi-experimental evaluation designs and two-thirds assessed impact after at most 3 years of program implementation. Only half of the evaluations documented the distribution of impacts and only a third presented information on the costs of the intervention (falling short of cost-effectiveness analysis). In two of the countries (Colombia and the Philippines) the evaluations likely had an impact on government policy or programs. Lessons A number of lessons for development practi-tioners and evaluators arose from the review of impact evaluations of World Bank nutrition support. For task managers: Impact evaluations of interventions that are clearly beyond the means of the government to sustain are of limited relevance. The complexity, costs, and fiscal sustainability of the intervention should figure into the decision as to whether an impact evaluation is warranted. Impact evaluations are often launched for the purpose of evaluating completely new pro-grams, but they may be equally or even more useful in improving the effectiveness of ongo-ing programs. There are methods for obtaining reliable impact evaluation results when randomized assignment of interventions is not possible for political, ethical, or practical reasons. For evaluators: In light of the challenges of evaluating large-scale programs with a long results chain, it is well worth the effort to assess the risks to disruption of the impact evaluation ahead of time and identify mitigation measures. The design and analysis of nutrition impact evaluations need to take into account the likely sensitivity of children of different ages to the intervention. For the purposes of correctly gauging im-pact, it is important to know exactly when delivery of an intervention took place in the field (as opposed to the official start of the program). Evaluations need to be designed to provide evidence for timely decision-making, but with sufficient elapsed time for a plausible impact to have occurred. The relevance of impact evaluations for po-licymakers would be greatly enhanced if im-pact evaluations were to document both the
World Bank Group Impact Evaluations
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Author : World Bank
language : en
Publisher: World Bank Publications
Release Date : 2013-03-12
World Bank Group Impact Evaluations written by World Bank and has been published by World Bank Publications this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-03-12 with Business & Economics categories.
Over the past decade the development community has focused more on measuring results, so the use of impact evaluations has expanded rapidly. IEG examines the relevance, quality, and influence of World Bank and IFC impact evaluations.
Multilateral Banks And The Development Process
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Author : Vinod Thomas
language : en
Publisher: Routledge
Release Date : 2017-07-05
Multilateral Banks And The Development Process written by Vinod Thomas and has been published by Routledge this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017-07-05 with Business & Economics categories.
A chain is only as strong as its weakest link. When the links in the chain represent development projects, if individual projects fail to achieve their purpose, the development program's effectiveness is compromised. When the chain's links are strong and well-connected, the results are improved for the sector, country, and region. The role of multilateral banks is crucial; they inform the impact of development operations and support policymakers in decision making. This volume emphasizes that some crucial links in development tend to be systematically overlooked. In these matters, preoccupation with the immediate exigencies seems to come at the expense of attention to enduring problems-at a great cost to society. Development practitioners should apply policies that have produced results over time, ensuring that the links in the chain are strong, but too often they overlook those links-because of myopia, complexity, tradition, or special interests. This book will help policy makers and practitioners focus on the links that measure progress, apply lessons, and matter for lasting results.
From Mines And Wells To Well Built Minds
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Author : Bénédicte de la Brière
language : en
Publisher: World Bank Publications
Release Date : 2017-05-17
From Mines And Wells To Well Built Minds written by Bénédicte de la Brière and has been published by World Bank Publications this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017-05-17 with Education categories.
Sub-Saharan Africa's natural resource-rich countries have poor human development. Children in these countries are more likely to die before their first birthday, more likely to be stunted, and less likely to attend school than children in other countries with similar income. Despite the current price downturn, extractives will remain an important part of Sub-Saharan Africa's growth story—using resource rents wisely remains a long term challenge. Governments must choose how to allocate resource rents between spending, investing in human or physical capital, or investing in global financial assets. The return to investing in physical and human capital will be high in countries where the capital stock is low. Moreover, higher levels of human capital make investments in physical capital more productive, which suggests that the optimal portfolio will involve investing in both. Human capital should be prioritized in many of Sub-Saharan Africa’s resource-rich countries because of the low starting point. Investing effectively in human capital is hard because it involves delivering services, which means coordinating a large number of actors and activities. Three dimensions of governance are key: institutions, incentives and information. Decentralization and leveraging the private sector are entry points to reforming institutional structures. Revenues from natural resources can fund financial incentives to strengthen performance or demand. Producing information, making it available, and increasing social accountability helps citizens understand their rights and hold governments and providers accountable. Improving the quality of education and health services is central to improving human capital. Two additional areas are promising. First, early child development—mother and newborn health, and early child nutrition, care, and education—improves outcomes in childhood and later on. Second, cash transfers—either conditional or unconditional—reduce poverty, increase household investments in child education, nutrition, and health, and increase the investment in productive assets which foster further income generation.
Pico Solar Electric Systems
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Author : John Keane
language : en
Publisher: Routledge
Release Date : 2014-04-03
Pico Solar Electric Systems written by John Keane and has been published by Routledge this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014-04-03 with Technology & Engineering categories.
This book provides a comprehensive overview of the technology behind the pico-solar revolution and offers guidance on how to test and choose quality products. The book also discusses how pioneering companies and initiatives are overcoming challenges to reach scale in the marketplace, from innovative distribution strategies to reach customers in rural India and Tanzania, to product development in Cambodia, product assembly in Mozambique and the introduction of ‘pay as you go’ technology in Kenya. Pico-solar is a new category of solar electric system which has the potential to transform the lives of over 1.6 billion people who live without access to electricity. Pico-solar systems are smaller and more affordable than traditional solar systems and have the power to provide useful amounts of electricity to charge the increasing number of low power consuming appliances from mobile phones, e-readers and parking metres, to LED lights which have the power to light up millions of homes in the same way the mobile phone has connected and empowered communities across the planet. The book explains the important role pico-solar has in reducing reliance on fossil fuels while at the same time tackling world poverty and includes useful recommendations for entrepreneurs, charities and governments who want to participate in developing this exciting and rapidly expanding market.
The Cash For Nutrition Intervention In Yemen Impact Evaluation Study
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Author : Kurdi, Sikandra
language : en
Publisher: Intl Food Policy Res Inst
Release Date : 2019-04-26
The Cash For Nutrition Intervention In Yemen Impact Evaluation Study written by Kurdi, Sikandra and has been published by Intl Food Policy Res Inst this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-04-26 with Political Science categories.
This evaluation of Yemen’s Cash for Nutrition intervention, a cash transfer program combined with nutritional trainings implemented by the Yemen Social Fund for Development (YSF), examines the program’s impacts on child nutrition indicators and related intermediate variables during a period of conflict. The decline in several indicators of welfare for the sample population that occurred after the beginning of the civil conflict in Yemen is also traced. Overall, the program decreased the share of children diagnosed with moderate or severe malnutrition and improved anthropometric indicators of nutritional status in children in the poorest third of households. The Cash for Nutrition program was funded by the World Bank through the United Nations Development Programme as part of the Yemen Emergency Crisis Response Project.
Impact Evaluation Of Home Grown School Feeding Programmes
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Author : Giunti, S., Aurino, E., Masset, E., Prifti, E.
language : en
Publisher: Food & Agriculture Org.
Release Date : 2022-03-25
Impact Evaluation Of Home Grown School Feeding Programmes written by Giunti, S., Aurino, E., Masset, E., Prifti, E. and has been published by Food & Agriculture Org. this book supported file pdf, txt, epub, kindle and other format this book has been release on 2022-03-25 with Technology & Engineering categories.
This publication seeks to support practitioners by providing methodological guidelines for conducting rigorous impact assessments of Home Grown School Feeding (HGSF) programmes. It presents an overview of the main technical issues to be addressed depending on the characteristics of the context and of the intervention itself. While these guidelines are mainly designed for monitoring and evaluation officers working for United Nations agencies, local governments or non-governmental organizations, its contents can be of interest to a wider audience of policymakers, researchers and practitioners interested in multi-sectoral, complex programmes linking agriculture and nutrition.
Economic Evaluation Of Sustainable Development
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Author : Vinod Thomas
language : en
Publisher: Springer
Release Date : 2019-04-16
Economic Evaluation Of Sustainable Development written by Vinod Thomas and has been published by Springer this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-04-16 with Business & Economics categories.
This book is open access under a CC BY 4.0 license. This book presents methods to evaluate sustainable development using economic tools. The focus on sustainable development takes the reader beyond economic growth to encompass inclusion, environmental stewardship and good governance. Sustainable Development Goals (SDGs) provide a framework for outcomes. In illustrating the SDGs, the book employs three evaluation approaches: impact evaluation, cost-benefit analysis and objectives-based evaluation. The innovation lies in connecting evaluation tools with economics. Inclusion, environmental care and good governance, thought of as “wicked problems”, are given centre stage. The book uses case studies to show the application of evaluation tools. It offers guidance to evaluation practitioners, students of development and policymakers. The basic message is that evaluation comes to life when its links with socio-economic, environmental, and governance policies are capitalized on.
Nutrition Sensitive Agriculture
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Author : Ruel, Marie T.
language : en
Publisher: Intl Food Policy Res Inst
Release Date : 2017-10-27
Nutrition Sensitive Agriculture written by Ruel, Marie T. and has been published by Intl Food Policy Res Inst this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017-10-27 with Political Science categories.
A growing number of governments, donor agencies, and development organizations are committed to supporting nutrition-sensitive agriculture (NSA) to achieve their development goals. Although consensus exists on pathways through which agriculture may influence nutrition-related outcomes, empirical evidence on agriculture’s contribution to nutrition and how it can be enhanced is still weak. This paper reviews recent empirical evidence (since 2014), including findings from impact evaluations of a variety of NSA programs using experimental designs as well as observational studies that document linkages between agriculture, women’s empowerment, and nutrition. It summarizes existing knowledge regarding not only impacts but also pathways, mechanisms, and contextual factors that affect where and how agriculture may improve nutrition outcomes. The paper concludes with reflections on implications for agricultural programs, policies, and investments, and highlights future research priorities.
Production Choices And Nutrition Related Implications In Ethiopia
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Author : Food and Agriculture Organization of the United Nations
language : en
Publisher: Food & Agriculture Org.
Release Date : 2018-04-11
Production Choices And Nutrition Related Implications In Ethiopia written by Food and Agriculture Organization of the United Nations and has been published by Food & Agriculture Org. this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018-04-11 with Medical categories.
The Improved Nutrition through Integrated Basic Social Services with Social Cash Transfer (IN-SCT) is a three-year pilot programme implemented by the Government of Ethiopia, with funding from UNICEF and Irish Aid. The programme started in the end of 2015 and currently covers two districts (woredas) in each of the following regions: Oromia and the Southern Nations, Nationalities, and Peoples' Region (SNNP). The IN-SCT is an integral part of the Productive Safety Net Programme (PSNP) in the latter’s fourth phase (2015-2018). The IN-SCT programme aims to enhance access to social services by fostering co-responsibilities for two groups of PNSP clients: Permanent Direct Support clients, receiving 12 months of transfers per year; and Temporary Direct Support clients, Public Works clients who are temporarily transitioning to the Direct Support components, based on certain circumstances, such as being pregnant or lactating or being a caretaker of a malnourished child, and are receiving six months of cash transfers with soft conditionalities. The IN-SCT programme expands the PSNP4 by offering an integrated package of multi-sectoral nutrition services. In SNNP, the programme supports the nutrition-sensitive interventions under PSNP and also undertakes activities to improve the quality of health services offered. In Oromia, a less intensive version of the IN-SCT programme is being implemented. This report aims to show how production choices are linked to nutrition and consumption behaviour. To do so, we first provide a snapshot of the rural livelihoods in the SNNP region by focusing on outcomes that allow us to gauge the economic and productive impacts of the IN-SCT, including agricultural production and other income-generating activities, labour supply, the accumulation of productive assets and access to credit and transfers. We then link some of these outcomes to indicators such as food consumption and household dietary diversity and study their patterns across the outcome distributions. We provide descriptive statistics from the baseline household survey conducted for the evaluation of the IN-SCT Pilot Programme in SNNP region. A baseline survey for the impact evaluation, including both quantitative and qualitative components, was conducted April–May 2016 in both SNNP and Oromia regions, though the sample for Oromia has not been included in the study, given the lack of a comparison group and the absence of nutrition-sensitive agricultural interventions.