Monitoring and Evaluation (M&E) Systems For Food Security Impact of Food Aid
Monitoring and Evaluation (M&E) Systems For Food Security Impact of Food Aid
Monitoring and Evaluation (M&E) Systems For Food Security Impact of Food Aid
Report On A
CARElGuatemala - IMPACT Workshop
Guatemala, November 6-10,1995
Monitoring And Evaluation (M&E) Systems
For Food Security Impact Of Food Aid
Anne J. Swindale
Joyce M. King
January 1996
This activity was carried out with support from the United States Agency for International
Development, Bureau for Global Programs, Field Support and Research, Office of Health and
Nutrition under the Food Security and Nutrition Monitoring Project (IMPACT)"with financial
support from the Bureau for Humanitarian Assistance, Office of Program and Policy
Evaluation, Contract No. DAN 5 110-Q-00-0014-00 Delivery Order 11.
1
Table of Contents
Page
1. Summarv of the utilitv of the worksho~for CARE Guatemala
1.1 Background
1.2. November 1995 Workshop
1.3. Next steps for CARE Guatemala
1.4. Evaluation of the workshop
2. Lessons learned from the worksho~
2.1. Data sources for indicators
2.2 Evaluation design methodologies
2.3 Diagnostic versus baseline data information needs
2.4. Indicator selection and definition
3. Worksho~details
3.1. Workshop objectives
3.2. Workshop methodology
3.3. Workshop participants
4. Contextual and methodoloeical presentations
4.1. USAID Food Security and Food Aid Policy -
4.1.1. Introduction
4.1.2. Policy Context
4.2. USAIDtGCAP Logical Framework and Title I1 Program
4.3. Results of LAC HNS Title I1 Cost-Effectiveness Study in Honduras
4.3.1. The Impact of Food Aid and Income Transfers on Health and Nutrition in
Honduras: An evaluation of the Mother-Child Health Cou~onand Food Aid
programs.
4.3.3.1. Results of the evaluation of the Mother-Child Health Coupon and Food
Aid programs in Honduras.
4.3.2. The Impact of School Feeding and Income Transfers on Education in
Honduras.
4.3.2.1. Results of the evaluation of the impact of school feeding and income
transfers on education in Honduras.
4.4. Monitoring and evaluation concepts 16
4.5. Operationalization of Indicators for CARE'S Final and Intermediate 20
Objectives
Appendix 1: Agenda
Appendix 2: List of Participants
Appendix 3: USAID food security conceptual framework
.1. Summan of the utilitv of the worksho~for CARE Guatemala
1.1 Background
CARE Guatemala has understood the need to consolidate its activities for some time.
Consolidation involves the complex task of integrating a variety of programs including MCH,
Food for Work (FFW), agricultural production and community banking under a Food Security
framework. CARE was not yet prepared to develop an M&E system, and only at the close of
the November workshop, appointed a task force to complete the steps needed to reach the
stage of developing an M&E system.
By the time CARE Guatemala presented its 1996 Development Project Proposal (DPP),
USAIDIG-CAP had greatly reduced the size of the geographic area where USAID is willing to
support activities. CARE'S 1996 DPP includes plans for further geographical shrinking and
progressively diminishing numbers of beneficiaries, or clients. USAID had urged, and CARE
also desired, to concentrate activities geographically. Further sources of recommendations for
CARE refocus had come from two recent studies. First, a rapid assessment in four
departments recommended integration of CARE'S program with those of other NGOs; the
creation, solidification and training of nuclei of community leaders; and the positioning of
agriculture as the pivotal point for the program, given the limited access and poor quality of
health services. Second, an MCH evaluation concluded that the project design was deficient in
that the objective of using food as an incentive for increased use of health facilities was
overcome by the greater disincentives of poor accessibility and quality of existing health
services; the evaluation reported, however, improved nutritional status of program children
compared with non-beneficiary children. CARE revised the food as incentive design,
accordingly.
The new 1996 DPP provides for more age targeting and limits on time in program for
households receiving food under the MCH program. However, the program falls short of
achieving a level of project concentration and project complementary that would create the
strongest prospects for ensuring impact on food security. Nevertheless, working within the
food security framework has caused CARE to make a constructive reanalysis of the different
project pieces and their placement in the framework under the appropriate headings of four
objectives: three dimensions of food security--availability, access, and utilization--and a
fourth, ovemding institutional objective of sustainability through community organization. In
the DPP,the intensity of project presence had been inventoried in each administrative division
of the country. This step, however, fails to solve the problem of highly diluted project
resources due to scattered programs within geographical zones working with different
populations (rural MCH,urban sanitation, e.g.). Further, intended institutional strengthening
is frustrated by differences in counterpart levels. The counterpart for the program with by far
the greatest coverage is at the ministerial level while smaller projects that could complement it
are at different lower administrative levels. Thus, CARE recognizes the need for further
internal review of future directions. This difficult evolution probably characterizes most of the
PVOs who took on high-coverage, essentially feeding programs that over time were converted
to MCH, at first in name only. Over the last 10 years, PVOs have tried to transform the
programs by adding nutrition education and growth monitoring/counseling for mothers and/or
health staff training, but they face constraints operating out of health ministries short on funds
and high on staff turnover. Earlier, these MCH feeding programs were run out of the food
distribution sections of PVO offices while smaller technical projects in agriculture, child
survival and sanitation might be run by sector offices of the PVO. The increasing integration
of food with technical projects has been a recent process and has been stepped up by the food
security framework and the more explicit USAID guidelines with respect to integration and
measurable impact .
1.2. November 1995 Workshop
The November 1995 workshop included a review of the new PL480 Title I1 guidelines and had
as primary objectives to develop and/or revise M&E systems for food security and to use the
process of developing guidelines for a specific PVO as the teachingllearning workshop
methodology. Specifically, the week-long effort was to review and refine objectives, and to
review and operationalize indicators for the three major food security dimensions: availability,
access and utilization. It was planned, and turned out to be true, that working this process
would serve as a teaching device for the other attending PVOs and that some of those attending
would bring their own experiences at operationalizing indicators into the process. In addition,
the process of reviewing objectives and indicators helped highlight deficiencies in the design of
CARE's DPP.
Working together during the workshop, the different CARE project -heads increasingly
perceived the inter-relationships (or lack of them) in their food security framework. Some
were only familiar with the section of the DPP pertaining to their program. Thus, gaining an
understanding of what the overarching goals and intermediate objectives should be, and how
they would be measured, for programs that were parts of the food availability, access and
utilization portions was a difficult exercise. What evolved was an awareness by the staff that
CARE's only large-scale program is a maternal health program, that the Title II program is
90% oriented to "health", but that the MCH program had few or no supporting components to
ensure attaining the objective of adequate biological utilization, the evaluation results
notwithstanding. Three days of the workshop were devoted to an attempt at operationalizing
the impactjgoal indicators and the objectives/intermediate effects and sub-objective indicators.
Other attending PVO staff members facilitated and enriched the effort by presenting their own
approaches to the process.
The principal next steps defined by CARE to move forward were: an appointed task force
comprised of sector chiefs and the M&E office would meet regularly to complete several tasks;
review of the Conceptual Framework and of the results in the Rapid Food Security Assessment
Survey to guide necessary program changes; integration of the overall project with the
activities of other organizations; revision of the DPP and the indicators; development of a
detailed implementation plan and M&E system; in support of which technical assistance and
other funding sources would be required. In sum, CARE and different project heads through
the process of indicator revision, saw the need to look again at the separate projects to see how
they contributed, or not, to likely impact on food security. Further it was clear that they
required stronger linkages, consolidation, and integration both within the CARE DPP and with
other PVOs and non-governmental organizations (NGOs) and USAID projects.
The workshop participants were pleased with the apportionment of time, though the oAginal
agenda in fact could not be completed. In retrospect, it was thought to have been too
ambitious, in the light of presenting new concepts to PVO staffs that require considerable
effort to gain "ownership" on their part. Those who benefited most were CARE technical
staff, other PVO technical and management staff from the country and region, World Food
Program and USAID staff members. Unfortunately the workshop was a missed opportunity
for counterpart Ministry staff and CARE management (with the exception of the MCH Sector
chief) who did not attended enough to participate in or profit from the process.
Several issues were discussed in the course of the workshop which may be of interest in
resolving problems faced by PVO elsewhere.
It was recognized that identifying data sources was a necessary first step prior to the selection
of feasible indicators. Would there be national studies or reports and surveys that would lend
themselves to serving as baseline or annual monitoring in the PVO project areas? Would new
studies have to be budgeted out of PVO resources? Should household food be measured by
availability or by consumption? Should the measurement be an average of household
consumption or be the measurement for the vulnerable members for whom increases are hoped
through project activities? Demographic Health Surveys (DHS) which coincide with baseline
years and are repeated in five year intervals were considered to be potentially useful for
programs with objectives to change or maintain levels of nutritional status in pregnantllactating
(P/L) women and preschool aged children, and to measure certain behaviors practices as they
normally include anthropometric measurements. Increasingly PVO needs should be taken into
consideration prior to the finalization of the DHS design. Project areas could be over-sampled
and a set of questions might be added that would clarify whether the respondent participated in
a Title 11-assisted program thereby dividing respondents into "program" and "control" groups.
In any case, it was thought that DHS data could often serve as baseline even if not 100%
coincidental with project startup.
Household consumption data, on the other hand, are not likely to be available through
national studies, though there might be special studies that might provide complementary
qualitative information. Household consumption surveys would be required to provide
baseline and final data to measure the impact goal of increasing calorie availability in the
household. The studies are expensive but provide high quality data and were considered cost-
effective by the group.
Qualitative information is vital and should complement quantitative data in order to explain
why quantitative data demonstrates the results that it does, and especially to provide the
viewpoints of clients and community leaders. Qualitative data can be collected at the same
time quantitative data are being collected, whether in the form of unstructured questionnaires,
interviews, rapid surveys or observation.
Quantitative information is essential for the credibility of a mid-termlfinal impact study, but it
can be gathered in a variety of ways depending on available human and financial resources,
and the needs of PVO management, donors, government officials or other stakeholders:
a) primary baseline data collected from control and program populations for
comparison with mid-term or final year data from control and program populations for the
highest level of scientific rigor; a control ,group can also be selected at the end of the project,
but the comparison does not prove project attribution because there is no data to indicate the
groups were similarly at project startup.
In undertaking impact evaluations, which do not have a baseline survey, evaluators have found
that it is difficult to find "uncontaminated" control groups for Title 11-assisted programs where
there are many PVOsfNGOs working in poorest areas.
The way indicators are defined has important implications for evaluation design. There is a
tendency to define indicators in terms of changes in the condition of a particular household or
individual. For example, an indicator of caloric adequacy is defined as " % of households
increasing caloric adequacy by 10%". This definition implies that the same households will be
tracked over time, in other words, that a panel study design is needed. The time, effort and
expense of implementing a panel study design for a project with a 5 year time frame can be
much greater than for a cross-sectional design. If the indicator were defined as " % of
households with greater than 80% caloric adequacy" or "average household caloric adequacy",
a cross-sectional study design could be used.
Baseline and problem analysis are often confused. Problem analysis precedes baseline and
identifies the nature and magnitude of the problem and separates causes and effects. In the
process (which includes quantitative and qualitative information, whether from formative
research, participatory community effort, or rapid field surveys), a PVO, often through
brainstorming techniques, takes a decision as to which cause will be attacked in its project(s);
many other causes have to go unattended by the PVO. A baseline survey, on the other hand,
identifies the condition(s) that are to be changed, and takes quantitative measurements that will
be used in a plan or system to evaluate changes in individuals, families, households and
communities.
Selecting Indicators for the Impact Goal. The most commonly tried and proved indicator for
measuring the three dimensions of food security is "x percent of households attaining 80-85-90
percent of their requirements". Household surveys provide information on household averages
of food consumption. In this instance the PVO is emphasizing desired change in intra familial
food distribution and vulnerable groups described as children under three years of age and
pregnant/lactating women. Thus, there is need to know more than household averages of
calorie consumption; to have individual assessments of vulnerable household members'
consumption. The latter, however, could not be followed up for impact in a subsequent
household consumption study because the vulnerable members will have changed in five years;
therefore special case studies would be needed to gather the final data on individual changes.
-
The other indicator, change in nutritional status of under-3 or under-5 year old children is
relatively straightforward, with a preference for weight/age because this anthropometric
measure is more useful to the growth monitoring education process, as well as likely to be
more accurately measured under field conditions. Because there are high levels of
malnutrition in the country, it was thought that using both cutoffs at < 2 Standard Deviations
(SD) from standard and < 3 SD might be useful to show more clearly "lives saved".
However, it was noted that the use of two indicators would complicate data analysis, since a
reduction in < 3SD malnutrition would result in an increase in <2 SD malnutrition.
Food for Work was viewed as primarily significant in terms of infrastructure. Thus if for
sanitation works, the project would fit into utilization rather than availability (commodities) or
access (income). If building roads to markets, it would more aptly fit the food access
objective.
The sustainability objective was untreated. Generally participants felt that there was a paucity
of guidance to indicate whether the question was with respect to institutional sustainability
(building community organizations that would eventually take on responsibilities) or economic
sustainability of activities (cost-recovery). CARE Guatemala treated the sustainability
objective as being achieved by strengthening institutions at all levels; this is in line with
specific guidance in the Food Security Policy Paper.
3. Worksho~details
General:
1) Support Guatemalan CS efforts to develop and review M&E systems for food security
impact
2) Establish guidelines for M&E of CARE/Guatemala1s Food Security and Nutrition
Project (FONUSEP)
3) Increase NGOs, government and other donor involvement: Use workshop to start this
process of closer cooperation, that is called for under reengineering (Objective added at
USAID/G-CAP request)
Specific:
1) Revise and refine CARE'S proposed objectives and indicators for FOMJSEP 1996-
2000, in the context of USAID's Food Security and Food Aid Policy
2) Operationalize FONUSEP's goal and objective level indicators
3) Define the data requirements for indicator measurement and design data collection
instruments
4) Define data collection and analysis methodology
5) Establish guidelines for the design of the baseline study
Workshop is to take advantage of IMPACT support and the experience of other NGOs,
to present a conceptual common ground and reach agreement on a common point of
departure.
Be able to define indicators of success in Aid and Food Security for CARE Guatemala.
It is understood that it will not be possible to complete an evaluation plan in a one week
workshop, but general guideline will be established.
Start to define the indicators and the level of success obtained.
3.2. Workshop methodology
4.1.1. Introduction
• The concern for demonstrating the food security impacts of Title II food aid programs
is based in U.S. Government policy. Enhancing the food security of the poor in developing
countries is the primary objective of U.S. food aid programs. According to the 1990 U.S.
Agricultural Development and Trade Act:
It is the policy of the United States to use its agricultural productivity to promote the foreign
policy of the United States by enhancing the food securin, of the develovina world through the
use of agricultural commodities and local currencies accruing under the Act to:
combat world hunger and malnutrition and their causes;
promote broad-based, equitable and sustainable development, including agricultural
development;
expand international trade;
develop and expand exportsfor United States agricultural commodities; and
foster and encourage the development of private enterprise and democratic
participation in developing countries.
While U.S. food aid policy emphasizes food security objectives, a 1993 review by the
U.S. General Accounting Office, at the request of the U.S. Congress, found that it was
difficult to document the food security impacts of past food aid programs. According to the
report, this is in part a result of a lack of operational guidance from the Agency to assist in the
identification of food security objectives and evaluation methodologies for food aid programs.
"...it is dzDcult to determine whether food
aid programs promote food security, in part
because USAID has not established a clear policy and operational guidance to assist program
managers in identzjjing food security objectives and evaluation methodologies for food aid
programs. "
In reaction to the GAO report, USAID has taken several steps. A first step was to
develop a food security definition for the Agency: When all people at all times have both
physical and economic access to suflcient food to meet their dietary needs for a productive and
healthy life.
By this definition, food security is a broad and complex concept which is determined
by the interaction of a range of agro-physical, socioeconomic and biological factors. Like the
concepts of health or social welfare, there is no single, direct measure of food security.
However, the complexity of the food security problem can be simplified by focusing on three
distinct, but inter-related dimensions of the concept, all of which are central to the attainment
of food security: food availability, food access and consumption utilization:
Dimensions of Food Security:
Food availability suflcient quantities of food from household production, other
domestic o q u t , commercial imports or food assistance.
Food access: adequate resources to obtain appropriate foods for a nutritious diet,
which depends on income available to the household, on the distribution of income
within the household and on the price of food.
Food un'lization: proper biological use of food, requiring a diet providing suflcient
energy and essential nutrients, potable water and adequate sanitation, as well as
measure on knowledge within the household of food storage and processing techniques,
basic principles of nutrition and proper child care and illness management.
Appendix 3 presents the food security conceptual framework for USAID. highlighting
the three dimensions of availability, access and utilization, the nature of their relationship to
one another, as well as a brief description of their determinants.
Food availability is a function of the combination of domestic food stocks, commercial
food imports, food aid, and domestic food production, as well as the underlying determinants
of each of these factors. Use of the term availability is often confusing, since it can refer to
food supplies available at both the household level and at a more aggregate (regional or
national) level. However, the term is applied most commonly in reference to food supplies at
the regional or national level. PVOs, however, are tending to apply the availability concept to
the issue of the agricultural production of food by the household.
Food access is influenced by the aggregate availability of food through the latter's
impact on supplies in the market and, therefore, on market prices. Appendix 3 indicates that
access is further determined by the ability of households to obtain food from their own
production and stocks, from the market and from other sources. These factors are, in turn,
determined by the resource endowment of the household which defines the set of productive
activities they can pursue in meeting their income and food security objectives.
Food access also is a function of the physical environment, social environment and
policy environment which determine how effectively households are able to utilize their
resources to meet their food security objectives. Drastic changes in these conditions, such as
during periods of drought or social conflict, may seriously disrupt production strategies and
threaten the food access of affected households. To the extent that these shocks often lead to
the loss of livestock and other productive assets, they also have severe implications for the
future productive potential of households and, therefore, their long-term food security.
To cope with those shocks and minimize potential declines in food access, households
typically adjust their consumption patterns and reallocate their resources to activities which are
more insulated from the influence of those shocks. In drought periods, for example,
households may shift their labor resources from crop production to non-farm wage
employment or sell-off small assets to ensure continued income. They may also adjust their
consumption patterns, reducing food intake and relying more on loans or transfers and less on
current crop production and market purchases to meet their immediate food needs. Over time,
as a crisis deepens, household responses become more costly, leading to the loss of productive
assets which can ultimately undermine future livelihoods and long-term food security status.
This corresponds to the component of protection in the livelihood security conceptual
framework of CARE.
Food utilization, which is typically reflected in the nutritional status of an individual,
is determined by the quantity and quality of dietary intake, along with high disease burdens.
Poor infant care and feeding practices, inadequate access to, or the poor quality of, health
services are also major determinants of poor health and nutrition. While important for its own
sake as it directly influences human well-being, improved food utilization also has feedback
effects, through its impact on the health and nutrition of a household members and, therefore,
on labor productivity and household income-earning potential.
In any given context, food security concerns may be due to either inadequate physical
availability of food supplies, poor access among a specific segment of the population, or
inadequate utilization. The conceptual framework in Appendix 3 suggests a hierarchy of
causal factors which ultimately influence the various dimensions of food insecurity: adequate
food availability at the aggregate level is a necessary, although not sufficient, condition to
achieve adequate food access at the household level, which, in turn, is necessary but not
sufficient for adequate food utilization at the individual level.
Another important step in developing an operational policy for the use of food aid by
USAID was the Food Securitv and Food Aid Policy Paper, which stresses the use of food aid
as an instrument for the achievement of food security.
According to Agency policy, the priorities for development food aid programs are:
Programmatic focus:
improving household nutrition, especially for children and mothers;
increasiny agricultural productivity to alleviate one of the leading causes of
hunger; and
increasinp income3 in rural and urban areas through economic and community
development and by promoting sound environmental practices.
Geographic focus:
Sub-Saharan Africa
South Asia
USAID will place particular priority to food aid programs that focus on improving
agricultural productivity and household nutrition in the most food insecure countries,
particularly in Sub-Saharan Africa and South Asia. However, USAID will continue to
approve new food aid activities in other regions of the world and' in other areas of the
program. The program and country priorities are not designed to prescribe arbitrary solutions
to the world's problems, nor to restrict the flexibility of program managers.
As a result of that finding, and in keeping with its mandate to employ performance-
based management methods, the Agency has shifted the oversight focus of food aid programs
from an emphasis on commodity monitoring and accountability, to one which stresses the food
security impacts of food aid programs on their intended beneficiaries. This new management
focus is laid out in the USAID Draft Interim Guidelines for FY 1996 PL 480 Title 11
Develo~mentPro-iect Proposals.
ynM- for results requires the definition of high level objectives that are achievable,
project outputs which support those objectives, and indicators of pe@ormance or achievement.
In the current environment of limited food aid resources, there is a need to focus and
streamline Title ZI development projects in order to demonstrate greater impact and to ensure
that appropriate monitoring and evaluation Vstems are established to document the results of
that impact.
This new focus requires that performance monitoring and evaluation systems be
introduced into Title I1 programs to permit USAID and Cooperating Sponsors to demonstrate
more clearly their programs' food security impacts. Approval for programs will depend upon
the success of field managers in demonstrating that food security impact.
USAlD will change its focus j?om commodity monitoring to a focus on the impacts of
food aid programs. Monitoring and Evaluation fistems will be implemented that permit
USALD and the PVOs to clearly demonstrate the impact that U.S.food aid programs have on
food security.
• Specific elements of the Guidelines include the following requirements for the F Y 1996
DPPs:
An external im~actevaluation of the project must be planned for in the DPP and
conducted no later than thefirst quarter of the final year of the project.
'litle DPP should describe the baseline data utilized and its source, state the
indicators developed for monitoring project-level progress during implementation and
discuss criteriafor assessing impact.
Criteria should be adequate to measure progress in annual reportina and
evaluation and should include benchmarks for activity completion and indicators of
project efectiveness.
The DPP should describe the information and data collection systems in place
or planned that will be used to monitor progress, including data reporting procedures
and mechanisms to analyze the data to direct fiture programming.
The emphasis on performance-based management and demonstrating the impacts of
Title 11 food aid programs on program beneficiaries is an important step forward in USAID
policy. The establishment of effective M&E systems will ultimately improve accountability as
well as program design and management. The information collected by M&E systems should
be of equal or greater importance to the PVOs.
While the guidelines provide clear direction on the role of M&E systems in food aid
programs and Agency decision-making, they leave much to the discretion of program
managers in terms of M&E system design, and offer an important opportunity for PVOs to
influence the definition of feasible and acceptable M&E reporting.
Previously, food aid was viewed as an unlimited resource, subject to impact reporting
and project design requirements that were less rigorous than for projects financed with DA
resources. This is no longer the case. FFP wants to be able to approve well-designed projects
for a five year period.
According to the guidelines, USAID Missions are intended to be close partners in
project planning, monitoring and evaluation and will submit comments annually for each Title
II project. In particular, the DPPs of Cooperating Sponsors, including M&E objectives,
benchmarks and indicators, will be subject to review and concurrence from USAID Missions.
Emphasis has also been placed on the importance of integrating food aid and other resources:
Food aid is most eflective when it is programmed in conjunction with finds for
technical assistance and local currencies for logistical support and grassroots development.
Food aid can also reinforce the positive impact of other development programs such as
nutrition education, family planning, child survival and community development projects.
"Food Aid should be better integrated with the other development resources USAID
programs. "
A DPP will have better possibilities of being approved when it can demonstrate that it
forms part of the USAID Mission's strategy.
4.3.1. The Im~actof Food Aid and Income Transfers on Health and Nutrition in Honduras:
An evaluation of the Mother-Child Health Coupon and Food Aid Drograms.
4.3.3.1. Results of the evaluation of the Mother-Child Health Coupon and Food Aid
programs in Honduras.
General results:
The MCH Ration program has positive impacts on health service utilization and on
food consumption by beneficiary households, women and children.
The MCH Feeding program has a positive impact on food consumption.
The MCH Bono program demonstrate little evidence of such impacts. It seems to
function more effectively as an income transfer mechanism than as a means to
improve the mothedchild situation.
Specific results:
All the programs are targeted towards the most vulnerable segments of the
population, in terms of level of income and malnutrition.
The programs represent 3 to 10% of household income for beneficiary households
in the bottom quintile.
Participation in the MCH Ration program increases the number of preventative
health center visits.
The quality of health services in the centers that are affiliated with the MCH Bono
and Ratio programs was not worse than in health centers not affiliated with any
program.
Families that participate in the MCH Ration and Feeding programs consume more
calories and protein than families not participating in any program.
Families that participate in the MCH Bono program show no difference in caloric
and protein consumption compared with families not participating in any program.
The two food distribution programs demonstrate a positive impact on caloric and
protein consumption by children under 5 years of age, adolescent girls and women.
The group that participates in the MCH Bono program shows no significant impact
on macronutrient consumption, with the exception of protein consumption by
children under 5 years of age.
The majority of mothers in all sample groups do not know of, or do not practice,
the most important actions that are needed in the areas of maternal health and child
survival. Mothers participating in the MCH Ratio program do have the highest
levels of KAP, and the beneficiaries of the MCH Bonos program have higher levels
of KAP than mothers not affiliated with any program. Although the differences in
KAP that are attributable to the programs are statistically significant, however, they
are small in relation to the desired objectives.
The MCH Bono program is the most cost-effective of the three programs.
• The cost-effectiveness results suggest that, if the principal objective of the programs is
income transfer, then the MCH Bono program is the most cost-effective. If a higher
priority is assigned to mother-child health and nutrition, however, the food distribution
programs, and especially the MCH Ration program, represent the best option.
4.3.2. The Im~actof School feed in^ and Income Transfers on Education in Honduras.
• The study compared the cost-effectiveness of two programs implemented in the schools
of Honduras:
School Income Transfer Program (School Bono)
* Distributes coupons worth 20 lempiras per month (approximately $2) two or
three times a year to the parents of children selected using socioeconomic
criteria.
* The children must be registered and actually attending school in order to receive
the coupon.
• School Snack Program (School Snack)
* Distributes a daily midmorning snack to children in approximately 3,700
primary schools in 9 of the poorest departments.
* The snack provides approximately 20% of daily caloric and 50% of daily .
protein requirements.
* The community makes a substantial contribution, in the form of time, fuel and
money.
4.3.2.1. Results of the evaluation of the impact of school feeding and income transfers
on education in Honduras.
The two programs are targeted more to the rural than urban areas. The School Snack is
distributed throughout the rural areas, while the School Bono program is more targeted
towards the rural west and south (the poorest areas of the country).
The two programs have positive impacts on several variables related to education.
These impacts were observed in all the children in schools with the programs, and not
only in children participating in the program.
The School Bono program impact is greater than the School Snack program for each of
the indicators of effectiveness measured, and four times greater in terms of years
gained, which is a useful summary indicator of education.
The School Snack program increases the rate of advance through school by a quarter
year; the School Bono program increased rate of advance by more than half a year.
The effect of the programs is greater in older children (10-13 years). Children 10-13
years old with access to schools with the Bono program gained almost a year, and older
children with access to schools with the Snack program gained almost a third of a year,
compared with children in schools with neither pragram.
The effects do not vary by sex or poor/nonpoor status of the child.
Neither of the programs has an impact on the probability of a child being registered at
school. This is probably due to the fact that school registration rates in Honduras are
very high (86% of 7-13 year olds are registered).
The School Snack program, and the combined program (schools with both the Bono
and Snack) increase the probability of not repeating the school year. The same effect
is observed with the School Bono program, but to a lesser degree.
The School Bono program has a highly positive impact on school attendance. The
availability of the Bono increased attendance by 6%. The School Snack has no impact
on attendance.
Neither of the programs are associated with systematic differences in academic
performance, as measured by Ministry of Education standardized tests.
Children in households that receive the benefits of the School Snack have higher levels
of adequacy for calories, protein and vitamin A. The snack does not substitute for
meals at home. Dietary adequacy is not higher for children in households that receive
the School Bono.
Neither the School Bono nor the School Snack program have the capacity, with the
current design, to overcome alone all the factors that negatively influence rates of
school registration, attendance and academic performance. Important needs still
remain; some of which can be addressed by the school systems while others depend on
the attention focused on some fundamental economic problems.
4.4. Monitoring and evaIuation concepts
Final Goal: To improve the food security of the most vulnerable populations in a
manner that is sustainable after project completion.
2a. Reduce moderate malnutrition (< 2 Standard Deviations from the Harvard
standard for weight for age) of children under five years of age by x percent.
2b. Reduce severe malnutrition ( < 3 Standard Deviations from the standard for
weight for age of children under five years of age by x percent.
(The percentage of change will be depend on baseline results--what household (and
child and vulnerable mother) the based on the results of baseline survey to measure
food in the household (and for child and woman) and anthropometry (weight and
height) all measures.)
Intermediate Goal 1. Increase the availability of staple foods and key sources of
vitamins and minerals in the most vulnerable households.
Indicator: Percent of households that increase expenditures for foods from the basic
food basket.
Indicators: 1) Percent of P/L women and children under five years of age who
increase their caloric consumption by x* percentage (*to be
operationalized when baseline data from the home consumption survey
are available) N.B., It was thought that this indicator might be moved
up to the Final Goal level.
November 6
November 8
November 10
SHARE Guatemala
Byron Flores
CRS Guatemala
Kristen Sample
Luis Alonzo
CARE Honduras
Gloria Manzanares
Georigina 0'Conner
I Social Environment