Presented at the Nutrition Research Dissemination Conference 2018.

1. Participants’ Perceptions of the
Feed the Future Integrating
Nutrition in Value Chains Program
in Malawi
Valerie L. Flax1,2; Agatha K. Bula3,4; Ryan Seguin2,4;
Gustavo Angeles2
1RTI International; 2MEASURE Evaluation, University of North Carolina at
Chapel Hill; 3Centre for Public Health Research and Development; 4UNC
Project-Malawi
Nutrition Research Dissemination
Conference 2018

2. Mixed-methods evaluation
 Program impact measured through
population-based household surveys
 Overall question: Is an integrated value
chain + nutrition program more effective
in improving nutritional status of children
< 3 years than a value chain alone?
 Program implementation measured, in part,
through Most Significant Change (MSC)
stories
Background
Integrating Nutrition in Value Chains, 2012–2016
Target
Districts

3. Nutrition and Health Investments
Improved diet
and feeding/care
practices
Increased legume
production
Increased Food
Security
Increased
household income
Demonstrations:
Gardens/Cooking
Improved Nutrition
Reduced chronic
malnutrition among
children U3
Impact
Community Care
Groups
Training care group
volunteers on:
 Health screening
and services
 Essential nutrition
actions (ENA) and
scaling up nutrition
(SUN)
 Food production,
processing, and use
Agriculture Value Chain Investments
Agricultural Inputs:
• Improved Seed
• Technology
• Fertilizers
• Irrigation
Agricultural
Practices:
• Diversification
• Conservation
farming
• Demonstration
farms & gardens
Processing &
Marketing:
• Storage
• Processing
• Aggregation and
Distribution
• Retailing
Increased farm
income
Increased Food
Diversity
Increase Use of
Health ServicesNutrition Screening
& Service Referrals
Improved nutrition
knowledge
Nutrition Education:
ENA and SUN

4. DAI - Prime
Univ of Michigan -
partner
Save the Children -
partner
NASFAM FUM CADECOM MMPA
Nkhoma
Synod
AG Technical Service Providers
Nutrition Technical
Service Provider
Farmer’s
Assoc.
Farmer’s
Assoc.
Farmer’s
Club
Farmer’s
Club
Farmer’s
Club
Lead Farmer
supports Club
Soy
Grp
GN
Grp
Gender, Nutrition,
HIV Group
CCGCCG
Volunteer
Leader
Volunteer
Leader
Volunteer
Leader
INVC Integration Model
HH: U5
& PLW
HH: U5
& PLW
HH: U5
& PLW
HH: U5
& PLW
HH: U5
& PLW
HH: U5
& PLW
Community
Care Group
(CCG) Nutrition
Promoter (120)
1 Promoter
supports 3 CCGs
(360 CCGs)
Mentors 12 HH
1 CCG=12
Volunteer Leaders
(4320 volunteers)
Mentors 12 HH Mentors 12 HH
District Coord. (3)
Nutrition Asst. (6)
Soy
Grp
Soy
Grp
Chili
Grp
Farming /
Marketing Groups
Group Action Committees
Farmer Farmer Farmer Farmer
Farmer Farmer Farmer
Farmer’s
Assoc.
Assoc. Field Officers
train Lead Farmers
GVH/GACVillageDistrict
Integration point
of entry

5. Davis, Rick and Jess Hart (2005). The ‘Most Significant Change’ (MSC) Technique: A Guide to its
Use. http://www.mande.co.uk/docs/MSCGuide.pdf.
Photo: Elizabeth T. Robinson/MEASURE Evaluation
From participants’ perspective:
 What aspects of the integrated program had the
biggest impact on their lives?
 What aspects of the program could be improved?
Methods
Most Significant Change Stories

6.  26 nutrition promoters in
Lilongwe and Kasungu
districts trained to collect
stories
 Each promoter collected one
MSC story per month
 Promoters met quarterly to
review stories, select most
significant, and document
reasons selected
 Data collected for
one year (total 277 stories)
 Data coded in Dedoose
Methods

7. Benefits of INVC
Improved
household
health status
(78%)
Improved
nutrition
knowledge
(56%)
Improved
farming
practices
(22%)
Economic
benefits
(34%)
Improved
hygiene and
sanitation
(23%)
Improved infant
and young child
feeding practices
(39%)
Results

8. “Even though my wife is the group
member, I can still see changes in
our family. Our child is healthy and
we use soya to make milk and
snacks. We also have porridge each
morning that is making us healthy.
In the past, we didn’t know much
about soya and used to just sell
Now we use it for nutrition and
child is healthy.”
Improved health status
and improved nutrition
knowledge and practices
Results

9. “I am able to practice what
I have been trained and my
child doesn’t get sick. This
has enabled us to use the
money from the sales of
the harvest to do some
developments—unlike in
the past, when it was
mostly used to pay hospital
bills.”
Economic benefits
Results

10. “This year I managed to
do groundnut farming, a
thing I have never done
in my life…
I gained knowledge of
groundnut planting,
caring, and harvesting.”
Improved Farming
Practices
Results
Source: CGIAR

11. “Before I didn’t know when
to wash my hands. Now I
do. Now I wash my hands
before I feed my child and
before I prepare food.
What has changed most
that I never used to wash
hands after changing the
child’s nappy, but now I
do.”
Improved Hygiene and
Sanitation
Results
Source: New Food Magazine

12. Suggestions for Improving INVC
Distribution
of inputs:
seeds, loans,
animals
(77%)
Better
monitoring
and
supervision
(44%)
More
outreach and
training
(22%)
Results

13. “There is a need to help with
more soya seed as well as
groundnut seed on loan…This
is because people lack seed
and can’t improve their
habits. They want to be able to
farm the necessary food and
sell some to earn money to buy
more food so that they can
provide the six food groups to
their families.”
Provision of inputs
Results

14. “The program should take a
step by visiting us, so we could
explain how we have benefitted
through the program and the
problems we are facing. We
always tell the lead mother in
our group to explain to the
promoter, so that he should tell
their leaders. But we have
never seen any single person
coming to visit us in our
village.”
Better monitoring and
supervision
Results

15. “It would be good for these
groups to be teaching every
member in the evening at
home, so that men should be
available… It can be good
sometimes if chiefs are told to
encourage or motivate men to
participate in these groups,
because a lot of men do not
take part in these teachings.”
More outreach and
training
Results

16.  Participants benefitted from INVC through improved
health and improved nutrition knowledge and practices
 We found some linkages between the agriculture and
nutrition components of the project
 Participants reported gaps in the program in terms of
availability of inputs, especially seeds and loans, and
frequency of outreach and training
 Some issues with implementation could have been
avoided with more regular monitoring and supervision
Conclusions

17. This presentation was produced with the support
of the United States Agency for International
Development (USAID) under the terms of
MEASURE Evaluation cooperative agreement AID-
OAA-L-14-00004. MEASURE Evaluation is
implemented by the Carolina Population Center,
University of North Carolina at Chapel Hill in
partnership with ICF International; John Snow,
Inc.; Management Sciences for Health; Palladium;
and Tulane University. Views expressed are not
necessarily those of USAID or the United States
government.
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