Assessing Impact and Impact Pathways of a Homestead Food Production Program on Household and Child Nutrition in Cambodia

Abstract

Cambodia's homestead food production program increased household production and consumption of micronutrient-rich foods and maternal and child intake (or frequency of intake) of some of these foods. Weaknesses in the evaluation design (e.g., lack of comparability between groups at baseline, failure to control for self-selection of households into the intervention, and collection of baseline and endline data during different seasons) prevent drawing firm conclusions about the program impacts. Analysis of impact pathways also shows that household-level benefits from the program did not translate into significant improvements in maternal and child health and nutrition. A careful redesign and rigorous assessment of the program using a program theory framework would help unleash its true potential to improve maternal and child health and nutrition outcomes.

The politics of reducing malnutrition: building commitment and accelerating progress

“…A process convened by the New York Academy of Sciences and WHO for setting of research agendas in nutrition emphasises crucial gaps and a framework to undertake implementation research in nutrition. 102 Examples of such research have been emerging in the form of feasibility studies and formative research, [103][104][105][106] operations research and process evaluations, [107][108][109][110][111] and costing studies. [112][113][114] However, the scientifi c literature about implementation through delivery platforms, such as community-based or health-facility-based programmes, is more developed than is that of the use of mass media or market-based approaches to scale up interventions.…”

“…Solid guidance now exists to bring rigour to evaluations of nutrition programmes. 52,100,[124][125][126] This guidance is needed to create solid ground for evaluation of the progress, and pathways to progress, of nutrition interventions, 110,127,128 with theory-driven and qualitative evaluations exploring the whys and hows of progress and the extent. 100,129 Analyses of eff ectiveness and operational evaluations of innovations that are introduced into scaled-up programmes, or of the process of scale up of innovative programmes from small-scale pilots to a large scale, are essential, but challenging.…”

Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?

“…This fi nding is consistent with results from an impact-pathway focused assessment of a homestead food production system in Cambodia, which showed no eff ect on child anthropometry or anaemia despite eff ects on household production, consumption, and dietary diversity. 60 Despite explicit targeting of women in many agricultural programmes, few studies have measured specifi c aspects of women's empowerment as a pathway to improved nutrition, and results are mixed. Assessments of home stead food production systems in Bangladesh and Nepal report positive eff ects on women's income, control over resources, or infl uence in decision making on a range of issues.…”

Agricultural research for nutrition outcomes – rethinking the agenda

“…The impact pathway shows the links between program interventions and the series of outcomes leading ultimately to nutrition impact (Avula et al 2013;Kim et al 2011;Olney et al 2009;Rawat et al 2013). Impact pathways inform program design and implementation by ensuring that there are no gaps in the intervention logic and that all activities believed necessary to achieve the expected outcome are anticipated and included in the program.…”

“…Over several years, IFPRI has worked closely with Concern Worldwide and Helen Keller International in detailed impact and implementation evaluations of nutrition interventions Olney et al 2009;Spielman and Pandya-Lorch 2009). An important partnership question is how to extend the reach of this type of research -implementation partnership to a broader group of non-governmental and even governmental partners.…”