Global Nutrition Innovation Lab Africa...

Feed the Future Food Security Innovation Labs: Collaborative Research Programs

Global Nutrition Innovation Lab

Africa Asia

Shibani Ghosh

Associate Director

Tufts University


Who we are (US Partners)


Research and Capacity Building

Global Nutrition Innovation Lab

Leader with Associates award (Tufts as ME)

Deep-dive research: Nepal and Uganda Associate Awards: Malawi, Mali, exploring

others in Asia

Human and Institutional Capacity Building Degree programs, skills trainings, research

symposia, research to policy interactions


G-NIL Research Emphasis

1. Delivery Science – ‘the how’, not just ‘the what’

2. Filling knowledge gaps that meet national priorities

3. Defining essential actions that link agriculture to nutrition and health

4. Translate knowledge from research into practice

5. Engage with policymakers and planners from the start

6. Document processes and effectiveness not just impact


G-NIL Research Approach

Operational focus Wrap around integrated programs (but wider lens) Not RCTs, but using rigorous epidemiological study

designs: e.g. randomized site selection with counterfactuals/pre-post, observational longitudinal birth cohorts

Focus on country-ownership (supporting research that informs local priorities AND policy decisions).

Link with country missions, implementers and local Govt. Larger grants at scale (not myriad small grants).


G-NIL Partners in Country

USAID Missions in Uganda, Nepal, Mali, Malawi

Academia

Government

Planning authorities, line ministries, local departments of development, district departments

UN agencies

UNICEF, World Food Programme, Food and Agriculture Organization

International and Local NGOs


Agriculture-Nutrition Pathways

N/CRSP Research Foci

Program Impact Pathways

Integrated Programming Pathways

1

2

3

Greater clarity on cause-and-effect (agric.-nutrition)

What design/processes support success at scale? How? What is the effect of external factors on program success

What combinations of interventions work best, in what context? What efficiency gains of integration (and costs)?


1

2 2

3


World Bank “The logic of the transmission mechanisms between agricultural production and nutritional outcomes is not…clear.”

John Newman, World Bank Patrick Johnson, Booz | Allen |Hamilton

South Asia Food and Nutrition Security Initiative May 2011

Greater clarity on cause-and-effect (agric.-nutrition)

Agriculture-Nutrition Pathways 1


Community Connector

programme

Maternal/Child Nutrition

ENA and EHA

Agricultural and post harvest Technologies

Risk management, Micro-credit

Savings

Service Quality

Income, Health

Diet Quality

? ?

Gender approaches

Sectoral coordintn

1. Transmission Pathways for Integrated Programmes

?

Makerere

Harvard School of Public Health

Tufts

IFPRI


Baseline Survey • Objectives

– To examine the relationship between key agricultural, livelihood, food security, nutritional, health, and gender outcomes in vulnerable households and populations To provide a baseline for

evaluating the CCP (and other programs/interventions)

To inform future interventions and policy

12


• Survey households in six Phase I CC districts

• Within households, the focus is:

• Women of childbearing age

• Children under two years

13


Observational Birth Cohort study

• Assess impact of CC implementation on nutrition and health outcomes

• Continuous perspective on outcomes

– Maternal nutrition

– Pregnancy and birth outcomes

– Infant and young child nutritional status

• Continuous perspective of program exposure, uptake and utilization


Better maternal health and nutrition during pregnancy, less anemia, Higher Birth Weight

More Exclusive Breastfeeding Better Maternal Nutrition Better morbidity status because of water /sanitation/WASH behaviors, health-sector access, malaria prevention Improved maternal knowledge/practices Higher household incomes

Improved Complementary Feeding More diverse foods for mother, child Less stunting and underweight since nutrition better, and less illness which can sap nutritional status

3 6 9 12 15 18 21 Age in MONTHS

Periodic biochemical sampling to complement anthropometric data

CC District, CC sub-district- contingent on exposure

CC District, no CC subdistrict

non CC District

He

igh

t fo

r ag

e Z

sco

re


Program Impact Pathways

“A major obstacle to program success is the nearly complete lack of information on the cost, effectiveness and process of scaling up interventions.”

Darmstadt, et al. (2008) Health Policy and Planning. 23:101–117.

2

What design/processes support success at scale? How? What is the effect of external factors on program success


Mountain sites

Hill sites

Valley (Terai) sites


SUAAHARA TRAINING Package

District

Orientation &

Planning in

collaboration DHO

Master Training of Trainers

(MTOT)

Core Trainers/Managers

Suaahara team/Govt officials

District Training of Trainers (TOT)

District Trainers/Managers

Village/HF Level Training

HF Staffs

Field Trainers/Supervisors

NGO Staff

Community Level Training

FCHVs

Mothers group members

Ward Level Training

Mother Group members

ENA+

CB-GMP

ENA+

SAM

IMCI for newly

recruited HWs

Village Model Farms

ENA+

GMP-CB

IMCI for newly recruited

FCHVs

ENA+

Homestead

gardens/poultry

ENA/EHA

HTSP, SBMR

CB-GMP

IMCI training for

private pract/newly

recruited HWs

Training of Trainers (TOT)

NTAG Trainers Team

Training

Organization/Manage

ment

ENA+ includes optimal infant and young feeding practices, optimal nutrition for women,

essential hygiene behaviors and healthy timing and spacing for pregnancy.

NTAG in

partnership with

health facility staff

will conduct the

training

Local NGOs in

partnership with

VHW/FCHVs will

conduct the

training

What was learned?

Effective transmission?

Fidelity of transmission?

Effective integration?

Effective transmission?

What was learned?

Effectively applied?


G NIL program impact pathways research

1. Central policy level (government policy decision process, donor processes, implementing partner management).

2. District level (fidelity of program implementation, incentives for inter-ministry cooperation, value-added of multisector investment).

3. Facility level (enhanced quality and fidelity of service delivery, best practices and protocols, new products).

4. Community level (effectiveness and coverage of health/nutrition services; reduced discrimination and inequity by gender, caste, ethnicity).

5. Household level (exposure to/uptake of program elements, intensity of program interaction, frequency of program engagement, intrahousehold dynamics around behaviour change, demand for services, resource use).


Integrated programming 3

“The effectiveness and cost-effectiveness of large scale interventions that target nutrition. Both single and packaged interventions that affect general nutrition and micronutrient intake should be assessed for their effect on stunting.”

Lancet series on Maternal and Child Undernutrition (2008)


ENA/EHA Agriculture

Health Delivery Training Activities

Model Farms Project Management

Income growth

Inputs and Activities

Seeds, fertilizer, model farms (IR4)

BCC, health service delivery (IR4)

Service usage (IR2)

Outputs

Impacts

Outcomes

Crop diversity

Changed behaviors (IR1)

Diet diversity (IR3) Better birth outcomes, health status, micronutrient status

Child Stunting (SO)

Mothers’ Nutrition (SO)

Data collection foci on Integrated Programming

Tufts

JHU

IFPRI

Harvard

Implementation team M&E

Purdue


Suuahara FTF program

Diet Quality

Maternal/Child Nutrition

Behavior change

Home gardens

Agric. Extension

Service Quality

New seeds

Irrigation

Diet Quantity

(and Quality)

Rural finance

? ?

Poultry, goats

Sectoral coordintn

?


• Publishing and disseminating research findings – Larger academic community – In country policy makers, global policy thinking

• Development of core metrics for understanding • Support to Mission and implementing partners

– Indicator reporting to USAID Uganda and NGO implementing Community Connector

– Providing support on the development of tools and technology used for data collection

Outputs


‘Deep Dive Research ‘ G NIL

Delivery Science

Empirical evidence base for agr and nutr


G NIL Capacity Building

1. Mentorship between local collaborators and U.S. universities

2. Training at all levels, in person and via distance learning

3. Networking travel to build international communities of practice


Stakeholder Engagement and Capacity-Building

Short term training and conferences Long term in country training Long term training at a US university Short term training and professional opportunities to faculty Development of short courses on food technology and food

safety (for delivery in country) Development of training modules on the production and

marketing of nutrient rich complementary foods (targeting agribusiness employees, managers or entrepreneurs.


First Dietetics program (accredited) in Malawi (Bunda College of Agriculture)

Food Composition table development in Malawi

Policy level engagement in reviewing and modifying medical school curriculum in Malawi

High level stakeholder fora (Uganda and Nepal) Setting of research priorities

Linking research to policy



Annual scientific symposia Forum for local scientists to present research in nutrition, health and

agriculture

Workshops and Trainings in country Research Methods (Epidemiology and Econometrics)

Grant Writing workshops

Positive Deviance

Evaluation Research Methods



Thanks

Management Entity Team Patrick Webb, Director and PI, Asia Jeff Griffiths, Director and PI, Africa

Eileen Kennedy, Co-PI, Asia and Africa Shibani Ghosh, Associate Director, Asia and Africa

Elizabeth Marino-Costello, Program Manager, Asia and Africa Edgar Agaba, Coordinator, Africa Diplav Sapkota, Coordinator, Asia

Global Nutrition Innovation Lab Africa...

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