Evaluating Impact:

Turning Promises into Evidence

Main Uddin Khandaker, Parveen Akhter, Gana Pati Ojha, NazmulAhsan, Bushra Alam, Tania Dmytraczenko, Karar Zunaid Ahsan

Moderator: Gloria Rubio Soto

Kathmandu, Nepal

February 2010

National Nutrition Program

(NNP), Bangladesh

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1. Background

The Bangladesh National Nutrition Program (NNP) started in 2004.

The objective of the NNP is to achieve sustainable improvements in birth weights and in the nutrition status of vulnerable groups through behavioral change and nutrition interventions.

The NNP services include Behavior Change Communication (BCC) for appropriate caring, feeding practices, etc.; growth monitoring and promotion (GMP), supplementary feeding, micronutrient supplementation, and promotion of exclusive breast feeding and infant and young child feeding (IYCF) for target groups (under-two children, pregnant/ lactating mothers, adolescent girls).

Currently NNP covers 172 upazilas (sub-districts), around 35% of the country. NNP is periodically scaled up with the aim to nationwide coverage.

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2. Results Chain

Inputs Activities Outputs OutcomesLong-term

Outcomes

1. Fund available through sector wide program HNPSP (Health, Nutrition and Population Sector Program) under Ministry of Health and Family Welfare (MoHFW).

1. Contracting out NGOs through competitive bidding to carry out NNP activities

2. Training for NGO’s field level staffs to provide effective services

3. NGOs provide the following activities:

a) Awareness building to change traditional food habit

b) Behavior change communication (BCC) targeted towards the disadvantaged and hard-to-reach population groups

c) Promote sanitation, hygiene, and safe drinking water

4. Supervision and monitoring of NGO activities by NNP.

1. Improved health condition of the target populations (U5 children, pregnant and lactating women).

1. Increase in infant and young child feeding (IYCF) and exclusive breastfeeding.

2. Reduced neonatal and under-5 malnutrition

3. Reduced micronitruientdeficiencies (anemia, night blindness, etc.) among u5 children, pregnant and lactating women

4. Reduced helmenthisis among U5 children and adolescents (deworming).

1. Growth monitoring and promotion (GMP) system established for children

2. Provide supplementary food for severely malnourished children and pregnant women

3. Micronutrients package received by target groups

4. Deworming received by children and adolescents.

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3. Primary Research Questions

Has NNP reduced the rate of low birth weight (LBW)?

Has NNP lowered malnutrition rates among under-five children?

Has NNP increased rate of exclusive breastfeeding upto 6 months?

Has NNP increased the rate of complementary feeding for young children?

Has NNP reduced the prevalence of helmenthisis among under-five

children?

Assessment of adequate consumptions of supplementary foods,

micronutrients, and deworming by the target groups (qualitative

component).

Has NNP lowered micronutrient deficiencies among pregnant and lactating

women?

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4. Outcome Indicators

Birth weight

Stunting (under-five and under-two children)

Wasting (under-five and under-two children)

Underweight (under-five and under-two children)

Rate of exclusive breastfeeding upto 6 months

Rate of proper complementary feeding among children age 7-24 months

Prevalence of helmenthisis among under-five children.

Blood Hemoglobin (Hb) level of pregnant and lactating women, and under-

two children

Prevalence of night blindness among children and pregnant/lactating

women

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5. Identification Strategy/Method

The challenges we faced to evaluate impact of NNP are:

The evaluation will be retrospective in nature over a long time

NNP was scaled up non-randomly duirng 2004-2009

2004 NNP baseline had treatment and comparison areas which needscomparability checks

Out of 172 upazilas, 48 treatment upazilas (and 16 control upazilas) can be used in the analysis

The method employed is Difference-in-Difference (DD).

The anallysis plan would be as follows:

If 2004 NNP baseline treatment and comparison areas a) are notcomparable, b) have inadequate sample size, c) do not have the requiredindicators , the impact evaluation exercise will not be carried out.

Year Treatment Control

2004 48 uz 48 uz

2012 16 uz 16 uz

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6. Sample and data

For evaluating impact of NNP, a representative cross-sectional survey willbe conducted.

The treatment group will consist of sampled under-five children, and mothers who have delivered a child in last five years.

For data collection, structured questionnaire will be used. Hemacues willbe used to measure blood Hb and retinol binding protein to measurevitamin A deficiency, and height/weight scales to measureanthropometrics.

The data collection tools will follow standard MEASURE DHS approach toensure comparability with existing rounds of the Bangladesh Demographicand Health Surveys (BDHS).

The baseline sample size was XXX (for each target groups) and theendline sample size will be estimated with reasonable power.

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7. Time Frame/Work Plan

Weeks

1 2 3 4 5 6 7 8 91

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11

21

31

41

51

61

71

81

92

02

12

22

32

42

52

62

72

82

93

0

Baseline analysis

Contracting evaluator

Questionnaire development

Submission of inception report

Field implementation

Data processing and analysis

Submission of draft report

Submission of final report

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8. Sources of Financing

The financing for the impact evalaution is budgeted in theoperational plan of NNP.

Thank you

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