Community Supplementary Feeding Programme (CSFP) Evaluation in Zimbabwe

The first Field Exchange carried an article about the CSFP in Zimbabwe: Nutrition in commercial farms; finding the right plaster for the wound. Since then the findings of a MOH/UNICEF evaluation of the programme between 1995-6 following the severe drought of 1994-5, have been published. Before summarising these findings a brief description of this programme is in order.

The CSFP was started in 1982 in response to the 1981/2 drought and was re-introduced in 1992 following the 1991 drought. The programme has continued every year in some form since then. The overall objective of the programme is 'to maintain or improve the nutritional status of children under five in drought affected areas'. A daily supplement of maize, groundnuts and oil in the form of a porridge is given out at feeding points to children between the ages of one and five years old. This provides approximately 550 kcals per capita. The food is prepared by mothers and is eaten communally. Between 1995-6 up to 1.2 million children were fed including some children above 5 years not at school. An average of 81.4% of the under five population were registered nationally. Weights of children are recorded by village level feeding programme supervisors.

The programme is initiated in response to the effects of drought on crop production, with areas targeted on the basis of information on harvests compiled by AGRITEX (a branch of the Ministry of Agriculture). AGRITEX assesses agricultural production based upon rainfall and crop estimate data. Zones with the greatest shortfall in crop-production are classified as 'Red Zones' and have traditionally been immediately included in the CSFP. Areas of marginal harvests (yellow zones) are screened using Mid Upper Arm Circumference measurements (MUAC) and those where more than 15% of children aged 1-5 years have MUAC's of less than 13.5 cms are included in the programme. In addition to the supplement the CSFP also provides vitamin A supplementation to at-risk children and nutrition and health education delivered through feeding points.

The Effectiveness of Programme Implementation

The evaluation findings and recommendations were as follows.

Supply problems meant an absence of foods for several months at province level leading to long-term interruptions in the feeding programme during 1995-6. According to the evaluators, "the highly erratic supply of food was probably the main constraint to the success of the programme and would certainly have limited its ability to meet the primary objective which was to improve or maintain the nutritional status of children". The evaluators also argued that some of the problems experienced with food procurement and distribution could be reduced in future if purchase of maize is decentralised to provincial level.

Current targeting criteria are not sufficiently rigorous. AGRITEX data needs to be complemented by resource data, e.g. livestock and cash crop production, if the programme is to target efficiently on the basis of food insecurity. Donor governments believe that poor targeting contributed to over-estimation of numbers and undermined programme credibility. This in turn meant that resources were spread too thinly.

Daily on-site feeding creates large demands on caretakers of children who often have important competing demands upon their time. Some mothers said they would prefer dry take home rations but were worried about the pressure this might place on them to share the supplement with other household members. Attendance rates were between 60-100% on the days that the evaluation team visited centres, which they expected to be better particularly during the dry season. The team felt that this was due to competing carer demands.

The evaluators therefore recommended that a take home ration system should be piloted in place of the on-site feeding. This may be best implemented at clinic level. Such a system would have many advantages:

• it would target younger children who more frequently attend MCH clinics than older children
• it would have less opportunity cost for carers as collection of the food would not be every day
• it would also lead to improved growth monitoring as this is an activity which clinic staff are trained to carry out.

Trends in Child Growth and the Impact of the CSFP on Nutritional Status in Recent Years:

The percentage of children under weight (less than 2 S.D. Weight for Age) in Zimbabwe increased from 13% in 1988 to 17% in 1994. Rates of wasting (less than 2 S.D. weight for height) increased from 1-6% during the same period. However, levels of stunting did decrease from 30-22% over these six years. Possible reasons for the increase in levels of wasting, in spite of the CSFP, may have been the implementation of economic structural adjustment measures during this period. Other factors contributing to this trend might include irregular supplies of food to CSFP feeding points and poor deliveries of household general rations during food emergencies as well as the national increase in numbers of AIDS orphans and babies who are failing to thrive.

The CSFP probably fails to directly address the main nutritional problems as levels of malnutrition are highest amongst the 12-23 month age group yet most children attending the CSFP are 3-5 years old. Also, most of the rise in wasting in recent years is probably due to AIDS. Furthermore, stunting is the main nutritional problem in Zimbabwe yet this type of malnutrition is not efficiently addressed by an SFP.

Is there a Need for the CSFP in Zimbabwe?

In general the evaluation team found little enthusiasm among the donors for continued support for the CSFP who favoured instead programmes aimed at reducing chronic food insecurity.

Continuation of the CSFP may be appropriate in a scaled down/streamlined version with liberated resources instead being devoted to improving food security in non-drought periods.

The role of the CSFP Within the Context of Other Relief Programmes:

In Zimbabwe, emergency general rations (which have traditionally only provided a maize ration) are administered as a separate programme to the CSFP on declaration of a state of emergency by the government. This means that there is a duplication of operational cost with the CSFP including logistics such as transportation and distribution of supplies and monitoring and supervision of the programme. Also, separation of the programmes increases the likelihood that households may only receive one part of the relief package. There is a lot of previous experience of this when for example, emergency general ration provision was very erratic during the major drought programmes of 1992-3 and 1995-6 so that the CSFP effectively operated in the absence of an adequate general ration. As a result the CSFP ration was not really a supplement and probably served as a substitute meal for one that would have been given at home. This raises the issue of whether it is worth having a separate distribution system which aims, but often fails, to provide a supplement to children.

There is also the problem of beneficiaries having to organise themselves to participate in several emergency schemes (a third scheme introduced during the 1995-6 programme was a destitute feeding programme).

There are therefore clear arguments for greater linkage of the CSFP and emergency general ration programme. One approach may be to allocate an emergency 'family ration' only (which would include beans and oil) although this would have to include a strong education component to ensure that the nutritional needs of children are met by households. A proposal and costing for this needs to be put together as soon as possible ahead of the next drought. The National Nutrition unit should develop a proposal for use of family rations for drought relief which they can then submit to the National Drought Preparedness Committee for discussion.

The evaluators concluded by stating that there needs to be a timetable drawn up to review the operational and policy related finding of the evaluation in order to make decisions ahead of future drought programmes.

In summary, the evaluation identified the need to scale down the CSFP through initiatives like better targeting and introducing dry take home rations at clinic level. These approaches should be piloted and developed in the short term while the CSFP continues in non-emergency years. At the same time a proposal to merge the CSFP with emergency general ration provision, e.g. providing a family ration, should be formulated and considered by government as a matter of urgency before the next major drought.

A copy of the evaluation can be obtained from; Peggy Henderson, UNICEF, Harare, e-mail phenderson@healthnet.zw