Mobile Value Added Nutrition Extension Services and Women Economic Empowerment (WEE-Care) in Mchinji and Lilongwe Districts

Chimwemwe Jemitale

EXTENSION WEEK FOR THE MaFAAS Friday 29th July 2016

WE-Care Programme – Hewlett Foundation

Phase 1• Where: Malawi, Uganda, Ethiopia, Zimbabwe, Colombia, Philippines• When: October 2014 – March 2016• What:

Develop and test innovative research methodologies (RCAs, HCS, RCTs, Effectiveness Reviews). Implement research and learn about outcomes of change strategies. Influence Development Policy and Practice

Phase 2• Where: 3 African Countries• When: April 2016 – December 2017• What:

Deepen the evidence base, and strengthen influencing capacity on WEE and unpaid care;Develop and test a variety of influencing resources, strategies, and approaches Capture and disseminate learning about effective influencing for policy change on WEE and unpaid care

Unpaid Care WorkIs the provision of services for family and community members outside of the market

Child careElderly care

Care of ill or disabledCare of community members

CookingCleaning

Washing, mending, ironing clothesFetching water

Collecting firewood

WE-Care Programme – What do we mean by Care?

Care is a ‘social good’, not a

‘burden

• Improved care of people has a widespread, long-term, positive impact on wellbeing and development

• Care is a ‘social good’, not a ‘burden’• Care provision is critical to address inequality and vulnerability, both for care providers

and receivers

Investing in Care is Important

Care Responsibility

Women face heavy and unequal care responsibilities which not only impede efforts to promote women's equal enjoyment of human rights but also has devastating effects on her and her children nutritional status.Woman “Looking after children can be a burden because we postpone doing other things like going to the field in order to prepare them for school but sometimes, during farming season, women neglect the children as they want to concentrate on farming activities”

CORE CONSIDERATIONS

Example of Mitundu, Lilongwe: hours per week spent

Oxfam, Dec. 2014

• Recognise care work• Reduce difficult, inefficient tasks• Redistribute responsibility for care

more equitably - from women to men, and from families to the State/employers

• Represent carers in decision making

The 4 Rs – Transforming Care

mNutrition in Malawi (mAgri + mHealth)Managing Donor:Lead Partner GCP:

Content Agri

M&E Agri:

National Content Development Committee• Min of Ag & Food Security• Dept of Extension Services…

SMS

IVRGroups

Individuals

Con

nect

ing

to O

xfam

Pro

gram

mes

Content Health

Technical Working Group• Min of Health• DNHA•…

M&E Health:

Mobile ServiceHealth + Agri Content Data Base

Other Organisations•Save the Children•UNICEF…

WE-Care

Donor:

212 mChikumbe / 321 Platform

Global Content Partner:

Is the daily allocation of time to non-paid care work different between women small-holder farmers that access mNutrition services (health and agriculture) through a mobile phone vs women SH farmers who do not access mNutrition services?

The RCT in a Nutshell•Who: 160 Participants – 80 Control & 80 Treatment•Where: Mitundu (120 participants) and Mchinji (40 participants)•When: December 2015 – March 2016•What:

o Treatment: 24 messages (12 Health & 12 Agriculture)o Control: 12 messages

RCT Steps:•Baseline: April 2015•RCT implementation•Endline: March 2016

RCT Steering Committee:•3 Ministries: Agriculture, Health and Gender•1 Private Company: Airtel Malawi•2 NGOs: HNI and Oxfam

Randomised Control Trial

Randomised Control Trial Design - Messages

Treatment Group - 24 Messages Control Group - 12 Messages

Breastfeed your baby more often when they are sick. It will give strength to fight the illness, avoid weight loss, and recover more quickly.

Wash, peel, grate and dry sweet potato. Store grates in a cool dry place. The grates should be pounded or milled into flour for use in different products.

Weed at 2 weeks after planting and subsequently when weeds appear. Delay in weeding can cause significant reduction in soya bean yields

Bre

astfe

edin

g

Coo

king

Agr

onom

ic P

ract

ices

Directly Related to Unpaid Care Work Directly Related to Income Generating Activities

Lake Malawi is very beautiful and it is the only lake in the world where you can find the tasty Chambo fish

Inte

rest

ing

fact

s an

d gr

eetin

gs

Not related to Care Work or Income Generating Activities

Findings - RCT End-line

Baseline mean (n=594) Treatment mean (n=80) Control mean (n=78)

Primary Care HoursNumber of hours spent on care as a primary activity.(Women) 5.30 5.27 5.40Primary/Secondary care hoursRespondent 6.04 6.06 6.23

Hours for income generating activitiesRespondent 1.7 2.6 1.5Sleep hoursRespondent 10.8 8.67 9.26

How often does the husband do specific care activities each week1.11 1.78 1.60

Activities undertaken by respondents and other household members in a 24 hour period with regard to care:

• No significant difference in total primary care hours between control and treatment groups and when compared to the baseline.• There is an increase of over 70% in the time allocated to income generating activities in the treatment group compared

to the control group.• Overall there is a significant reduction in the sleep hours of the treatment group, which is in line with findings from other

WE-Care countries where Oxfam analysed the impact of Oxfam's livelihoods programmes on time allocation.

Findings - RCT End-line

Preliminary findings point to a low uptake of messages that are directly related to care work activities (e.g. cooking or breast-feeding), showing no significant difference in the total care hours between control and treatment groups and when compared to the baseline. However, there is a deprioritization of certain care work activities in the treatment group.

The analysis points to an early uptake of those messages related to income generating activities, resulting in an overall increase of time dedicated to these activities in the treatment group.

Overall there is a significant reduction in the sleep hours and personal care of the treatment group, which is in line with findings from other WE-Care countries where Oxfam analysed the impact of Oxfam's livelihoods programmes on time allocation.

An increment in the time dedicated to income generating activities could potentially lead to increased nutrition levels through access and consumption of higher quantities of nutritious foods. However, the deprivation of sleep can have negative effects on health and nutrition levels of the beneficiaries.

Findings - RCT End-line – Implications for mNutrition

The overall goal of the mNutrition programme is to increase the nutrition levels of women and children, and this is more directly achieved through the food messages and health practices. The agricultural messages aim to directly influence the income levels of the recipient household and indirectly result into increased nutrition levels of women and children.

If both types of messages are received simultaneously, this study points to a prioritisation of those messages directly related to income generating activities in detriment of those directly linked to health and food practices.

Need for new approach to promote uptake of health and food messages as well as agriculture and for parallel intervention to reduce the amount of time dedicated to unpaid care work, which could level the negative impact of the messages in sleep hours of the recipients.

Frequency of the messages•Only 4 messages in the first 1.5 months•Messages sent daily since Feb 16th

Challenges during implementation of the RCT

Information Spillovers:•Some people in the treatment group sharing messages with control group•Individual vs village randomisation

Challenges with the handsets:•Availability of electricity•Batteries•Mobiles damaged or lost

END

Communication Materials•WE-Care Programme Report (RCAs, RCT and findings)•RCA toolkit

LINKING UNPAID CARE WORK AND MOBILE VALUE ADDED SERVICES IN MALAWIWE-Care Programme