Multi-sectoral nutrition programming: exploring impact

This is a summary of a Field Exchange report summary that was included in issue 67. The original article summarised the following report: Ogada E, Bahwere P, Lelijveld N, Sessions N, Desplats G & Khara T (2021) Multi-sectoral nutrition programming – exploring impact. ENN, Oxford, UK. Available at: https://www.ennonline.net/mspexploringimpact

A greater understanding of how to monitor and evaluate the impact of multi-sector nutrition programmes (MSNPs) is needed, ensuring that:

- MSNPs are embedded in government structures and are implemented in a more coordinated way

- More guidance on effective and standardised MSNP evaluations is available, alongside better funding to support quality, large-scale evaluations

- Secondary nutrition outcomes are incorporated to allow for more realistic assessment of programme impact beyond stunting

Background

Multi-sector nutrition programmes (MSNPs) are increasingly emphasised as important strategies to prevent and tackle malnutrition. However, greater understanding of how to monitor and evaluate their impact is needed. This report presents findings from a systematic search of available evidence documenting the type and quality of monitoring and evaluation systems to measure the impact of MSNPs.

Findings

• Most evaluations were of the pre- and post-test design with no comparison group.
• Even rigorously designed evaluations noted difficulties in attributing impact to the intervention alone.
• Of the evaluations that included control groups, the majority demonstrated positive impacts on primary nutrition outcomes (child stunting, wasting, underweight or anaemia).
• Secondary nutrition outcomes were widely measured including household dietary diversity scores, food insecurity scores, indicators of infant and young child feeding (IYCF) and water, sanitation and hygiene practices, standardised measures of women’s empowerment and indicators of household finances. Many evaluations showed positive improvements in household dietary diversity and IYCF indicators.
• Few evaluations included coverage estimates.
• While all the reviewed evaluations covered multi-sector programmes, these were often not delivered in a coordinated way and were yet to achieve national scale.

Recommendations

• The implementation of MSNPs should be done in a more coordinated manner.
• More guidance is needed on effective and standardised methods for evaluating MSNPs.
• Greater availability of funding is required to support quality, large-scale evaluations.
• A minimum level of rigour should be set, allowing for the assessment of change in outcomes over time interpreted against the backdrop of secular trends.
• Secondary nutrition outcomes should be included as important and realistic indicators of impact beyond stunting.
• MSNPs should be embedded in government structures to improve scale-up.
• Indicators of programme coverage should be integrated into national information systems (within health, agriculture and education) and a more objective way of assessing programme convergence should be explored.