Baseline Findings

Impact Evaluation of Sunaula Hazar Din- Community action for Nutrition Project

DIME, The World Bank

DOLPA

MUGU

JUMLA

KAILALI

BARDIYA

HUMLA

DOTI

SURKHET

NAWAL

PARASI

KAPIL-

BASTU RUPAN-

DEHI

DANG

BANKE

ACHHAM KALIKOT

JHAPA

MORANG

SIRAHA

SAPTARI

DARCHULA

BAJHANG

BAITADI

DADEL-

DHURA

KANCHAN-

PUR

BAJURA

PARSA

BARA RAUT-

AHAT

DHANUSA

MAHO-

TARI

SUNSARI

SARLAHI

DHADING

MAKAWAN-

PUR

CHITWAN

KASKI

TANAHU

PALPA

SYANGJA

PARBAT

ARGHAK

HACHI

GULMI

UDAYAPUR

SINDHULI

ILAM

BHOJ-

PUR

DHAN-

KUTA

TAPLEJUNG

OKHAL-

DHUNGA

TERHA-

THUM

KHOTANG

LALIT

BHAK

KATHM

SULUK-

HUMBU

DOLAKHA

SANKHUWA-

SABA

NUWAKOT

SINDHU-

PALCHOK

KAVRE

RASUWA

LAMJUNG

GORKHA

PYUT-

HAN

ROLPA

SALYAN

MYAGDI

DAILEKH

JAJARKOT

RUKUM

MUSTANG

MANANG

CHINA

INDIA

N

3

(+) Impact of the program

(+) Impact of other (external) factors

The Value of Control Group

0

2

4

6

8

10

12

14

16

Before After

Treatment Group

Control Group

Impact Evaluation

Rigorous impact evaluation uses a control group of similar individuals who are not exposed to the project

Randomization (usually) ensures that control group is a good proxy for treatment group

4

Three Components

Evaluation of Sunalua Hazar Din has three components: Overall Project Evaluation: Measures the effect of

SHD compared to control groups Expert Suggestions: Tests whether providing

communities with expert suggestions will improve outcomes

Female Leaders: Tests whether requiring female leadership will change goals and outcomes

5

Overall Evaluation Working in 282 out of 292 SHD VDCs

141 early treatment VDCs start project in 2014 141 late treatment VDCs start project in 2016.

The IE is working in the 1-2 most disadvantaged wards in each VDC

Impact of SHD will be determined from comparison of early starters to late starters before late starters begin operations

A number of outcomes will be studied

6

Sample 282 VDCs (out of 290 for SHD) Least developed 1 or 2 wards selected in each

VDC In each ward, household census was taken,

then a random sample of: Group 1: 15 households with a child under 2 Group 2: 10 households with a married woman

aged 15-25 Total sample of 7049 HHs

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Households in Group 1 were asked the entire questionnaire. Households in Group 2 were asked the Main Household Questionnaire and additional module on family planning.

Indicators on family planning come from Group 2, and are therefore representative of married women aged 15-25.

IE Design

9

282 IE VDCs

141 VDCs Early Starters begin project

in 2014

Standard RRNI Coaching

(70 VDCs)

Female Leadership

Requirement (35 VDCs)

No Leadership Requirement

(35 VDCs)

Coaches suggest

focus areas (71 VDCs)

Female Leadership

Requirement (36 VDCs)

No Leadership Requirement

(35 VDCs)

141 VDCs Late Stasrters begin project

in 2016

IE Activities Household survey of 7049 HHs was taken from

July-October 2013 Survey was undertaken by Full Bright

Consulting, under supervision from DIME, The World Bank

Overall Evaluation: Must be sure that late starter VDCs do not begin

until around 2016 Follow-up survey must be completed before late

starter VDCs begin

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Balance between Early Starters & Late Starters

11 Note: Standard Errors clustered at VDC-level and District fixed-effects included

Control (Late Starter) Treatment

(Early Starter) Balance

Test

N Mean SD N Mean SD P Value

Female headed Household (yes=1) 3512 0.09 0.29 3526 0.1 0.3 0.45

PDO 1: Unmet Family Planning Needs 820 0.32 0.47 821 0.31 0.46 0.72

PDO 2 : Pregnant Women taking IFA 2053 0.21 0.40 2042 0.21 0.40 0.87

PDO 3: Exclusive Breastfeeding 490 0.71 0.46 534 0.68 0.47 0.55

PDO 4: Minimum Acceptable Diet 1699 0.10 0.30 1685 0.09 0.29 0.34

PDO 5: Keeping Girls at School 3437 0.36 0.48 3446 0.38 0.49 0.31

PDO 6: Reducing Indoor Air Pollution 3439 0.35 0.35 3446 0.29 0.33 0.00***

PDO 7: Pregnant Women's Dietary Needs 2188 0.76 0.43 2192 0.74 0.44 0.16

Sample Breakdown

12

PresenterPresentation Notes90.3% of the household heads are male, while 9.7% of them are female. 71.3% of the households live in the Outer Terai, while 16.3% live in the Hill and 12.4% in the Inner Terai.

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Household Characteristics

Primary Occupation

14

Household Head Characteristics

15

Land and Livestock

16

Child Health and Nutrition

17

Malnutrition by Age

18

Malnutrition by Region

19

Breastfeeding by Age

20

Breastfeeding Practices I

21

Breastfeeding Practices II

22

Complementary Feeding Practices

23

Maternal Nutrition and Practices

24

Unmet Family Planning Need

25

Type of Contraception

26

Duration of taking IFA Supplements (during last pregnancy)

27

Maternal Nutrition (previous day)

28

Household Food Consumption over last week

29

Water and Sanitation

30

Source of Drinking Water

31

Toilet Facilities

32

Blue portion: Access to Toilet Red portion: No Access to Toilet

Feces Reported around House

33

Hand Washing Behavior

34

Community Attitudes 35

Families in this community send their daughters to school until at least 20 years of age

36

Attitudes towards Reducing Smoke Pollution

37

Should pregnant women eat at least 3 meals a day, including animal products?

38

39

Social Cohesion

Most people in this village can be trusted.

40

In the past year, have you worked with others in your village for the

benefit of the community?

41

What proportion of people in this village contribute time or money toward common development goals?

42

Differences that Most Often Cause Problem

43

To what extent do differences characterize your village?

44

Thank You!

45

Choice of Focus Groups

50% of VDCs were urged to select 3 suggested focus groups: 1. Increase Animal Protein 2. IFA/Deworming for Women 3. Breastfeeding or End Open Defecation

46

Appendix I: Project Development Indicators

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Appendix II: Definition of PDO

1. PDO 1: Percentage of women who do not want to become pregnant but are not using contraception

2. PDO 2: Percentage of pregnant women (15-49) taking iron and folic acid (IFA) supplements for 180 days

3. PDO 3: Percentage of children 0-6 months of age who are exclusively breastfed

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Appendix II: Definition of PDO

4. PDO 4: Proportion of children 6-23 months of age who receive a minimum acceptable diet 5. PDO 5: Community attitude towards the importance of keeping girls at school until age 20 6. PDO 6: Community attitudes towards the importance of reducing indoor air pollution 7. PDO 7: Proportion of women with children under 2 years who recognize the importance of eating 3 times a day including at least one animal-sourced food

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Appendix III: Focus Areas

1. Maintain adequate weight and regular eating among pregnant women and young children

2. Increase consumption of animal protein among pregnant women and young children

3. Practice proper and consistent breastfeeding 4. Use clan and safe water 5. Delay marriage and pregnancy for young girls 6. Regular de-worming and utilization of iron

supplements by young women

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Appendix III: Focus Areas

7. Extend education of young girls 8. Utilize family planning method to avoid

unwanted pregnancies 9. Practice proper and consistent hand washing 10. Ensure immunization of all children 11. End open defecation

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Appendix III: Focus Areas

12. Ensure prompt medical treatment of chest infection, fever, and diarrhea in young children 13. Improve school sanitation 14. Reduce workload of pregnant women 15. Reduce exposure to indoor smoke for

pregnant women and young children

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Baseline FindingsSlide Number 2The Value of Control GroupImpact EvaluationThree ComponentsOverall EvaluationSampleSlide Number 8IE DesignIE ActivitiesBalance between Early Starters & Late StartersSample BreakdownHousehold CharacteristicsPrimary OccupationHousehold Head CharacteristicsLand and LivestockChild Health and NutritionMalnutrition by AgeMalnutrition by RegionBreastfeeding by AgeBreastfeeding Practices IBreastfeeding Practices IIComplementary Feeding PracticesMaternal Nutrition and PracticesUnmet Family Planning NeedType of ContraceptionDuration of taking IFA Supplements (during last pregnancy)Maternal Nutrition (previous day)Household Food Consumption over last weekWater and SanitationSource of Drinking WaterToilet FacilitiesFeces Reported around HouseHand Washing BehaviorCommunity AttitudesFamilies in this community send their daughters to school until at least 20 years of ageAttitudes towards Reducing Smoke PollutionShould pregnant women eat at least 3 meals a day, including animal products?Slide Number 39Most people in this village can be trusted.In the past year, have you worked with others in your village for the benefit of the community?What proportion of people in this village contribute time or money toward common development goals?Differences that Most Often Cause ProblemTo what extent do differences characterize your village?Thank You!Choice of Focus GroupsAppendix I: Project Development IndicatorsAppendix II: Definition of PDOAppendix II: Definition of PDOAppendix III: Focus AreasAppendix III: Focus AreasAppendix III: Focus Areas