12. COMMUNITY-BASED ASSESSMENT AND IMPACT OF NUTRITION PROGRAMMES

A community-based participatory evaluation of the nutrition education programme to assess its impact on the farmers was conducted between December 2004 and February 2005. Participatory methods such as farmers’ seminars, focus group discussions and a SWOC/T (strength, weaknesses, opportunities and constraints or threats) analysis were used.

12.1. Farmers’ seminars

Eight farmers’ seminars were organized in as many selected HDTC areas involving farmers covered by the project and stakeholders such as DAE district officials, extension staff, members of the project management and experts. Discussions covered:

1. knowledge of food-based nutrition gained by the farmers
2. application of this knowledge at family level
3. implementation of lessons learned from the nutrition programme
4. farmers’ suggestions to improve the nutrition activities

The objective of the seminars was to determine the areas in which the project had benefited the farmers, the lessons learned and the possible long-term impact on the farmers’ livelihood.

12.1.1. Development of the evaluation process and methodology

The primary method and process of the assessment was designed by the project’s national and international nutrition specialists together with the FAO Nutrition Backstopping Officer and the National Project Coordinator. The primary methodology was field-tested in Pabna and Natore towns by a team including the National Nutrition Education Specialist, the Participatory Training Specialist and the UNDP Nutrition Intern. The findings were reviewed by the NPD, NPC, training, monitoring and nutrition specialists and necessary changes made to the methodology.

Focus group discussions (FGDs) were held at the village level with farmers as participants. The SWOC/T analysis was organized at the HDTC level, involving farmers and other stakeholders like DAE officers, extension staff, health officials and NGOs.

Guiding questions were used during the FGD to obtain information and the findings were put in a broad format during the SWOC/T analysis. Farmers and other stakeholders from 15 HDTCs in project areas were chosen to ensure participation by a representative cross-section of actors. Health Department representatives and local NGOs also took part in the seminar. A total of 408 people participated in the seminar, including 366 farmers, 26 HDTC officers, other stakeholders and 19 extension and field staff personnel (see Table 30).

Involvement of different project stakeholders was essential in view of their roles at various levels in supporting community participation and leadership. Each farmer group selected two members. About 50 farmers and selected stakeholders from the DAE, district health department and NGO took part.

The project team facilitating the seminar included the National Nutrition Education Specialist, Participatory Training Specialist, Socio-economic Monitoring and Evaluation Specialist and theUNDP Nutrition Intern. Logistical support at HDTC and village-level seminars was provided by HDTC staff.

Table 30. Participation of district officials and farmers in the seminar

12.1.2. Focus group discussions

Eight FGDs were organized in as many project villages involving 25 farmers from each village. The objectives of the discussion were to identify benefits of the nutrition intervention as experienced by the farmers; determine its possible long-term impact on their food pattern and nutrition behaviour, elicit farmers’ suggestions and identify areas for improvement.

The discussions were facilitated by the National Nutrition Education Specialist with inputs and support from other specialists, the Nutrition Intern, HDTC officer in-charge and the Horticulture Overseer. In some cases, farmers were asked additional questions. They were also requested to explain their views in detail. The discussions were held in a friendly atmosphere to encourage full involvement of the farmers. Qualitative information was obtained and the seminars’ findings and observations were summarized. After the discussion on each aspect, a farmer leader summarized the discussion and main points for consideration (see Table 31).

Table 31. Outline of FGD findings

12.1.3. Nutrition knowledge and practices

• The farmers were fully aware of the importance of nutrition and the human body’s need for nutritious food. They could explain the nutritional importance of different vegetables and fruits in terms by vitamin and mineral content and referred to nutrition and income benefits from the home garden.
• They knew how to clean, cut and cook vegetables to conserve nutritive value such as washing before cutting, cutting into big pieces, using just enough water for cooking, covering with a lid while cooking, using light heat and cooking leafy and yellow-orange vegetables in a little oil for vitamin A absorption.
• As part of the participatory nutrition activities, some farmers prepared nutritious recipes like mixed vegetables soup, mixed vegetables, kochu pata pitha (steamed colocasia leaves snack). They explained preparation methods for sobuj bhath, sobuj ruti, vegetables, hotchpots (soft cooked mixture of rice and lentil), mushroom chop, carrot halwa, and complementary food for children.

12.1.4. Access to vegetables and fruits

• The farmers said that all of them had a home nutrition garden where they grew different vegetables and fruits.
• They bought vegetables and fruits in the market during the off season or if they could not produce in the home garden.

12.1.5. Vegetable and fruit consumption

• The farmers ate vegetables almost every day and fruits two days a week depending on availability. The findings were similar to those of the Dietary Assessment Study¹⁰³ in collaboration with the Institute of Nutrition and Food Science.
• A typical meal included four to five types of vegetables every other day. Red amaranth, Indian spinach, spinach, pumpkin, colocasia leaves, green papaya, potato, brinjal, cabbage, cauliflower, broccoli, bottle gourd and tomato (as salad) were commonly eaten vegetables. This practice of having four to five vegetables every day was in keeping with the nutrition message given to the farmers by the nutrition education programme.

12.1.6. Preparing recipes learned from project

• Mixed vegetable soup, sobuj ruti, sobuj bhath, drumstick leaves pakura, kochu pata pitha, mushroom curry and chop, as well as complementary food for children were commonly prepared recipes.
• The farmers cooked mixed vegetables soup and sobuj ruti at least three times a month. Recipes like sobuj bhath, pakura and pitha had been prepared only once.
• Recipe preparation depended on the availability and price of the vegetables.
• Most participants had tried and tasted only once or twice, the recipes learned during the project training at the HDTC or at village-based demonstration.

12.1.7. Food preparation knowledge and practices

• The farmers spoke of various food preparation and cooking tips, showing their confidence and application of the knowledge learned.
• The change in practice included washing vegetables before cutting, cutting into large pieces, stir frying leafy and yellow-orange vegetables, avoiding prolonged boiling, boiling and frying at right temperatures, avoiding smoking of oils and cooking in a covered pan.

12.1.8. Preparation and feeding of complementary food

• Most group members, who were mothers with infants or young children, prepared complementary food and said that their children demanded it.
• They could also describe the steps in preparing the complementary food.
• The mothers prepared and stored the complementary food and used it regularly.

12.1.9. Health, sanitation and hygiene practices

• Other practices included washing hands with water and soap before cooking and eating, taking care¹⁰⁴ of children, especially small ones, clipping children’s nails in time, using slippers in the toilet, and washing hands with soap or ash after visiting the toilet.
• The farmers also explained the care for pregnant women and lactating mothers, the food given to them and the right attitude shown by elder family members.
• They emphasised the importance of regular visits to health centres, particularly by pregnant women and young children. They knew of the vital importance of antenatal care during pregnancy and the need for health and related care for sick family members.

12.1.10. Possible impact on life and economy

• The farmers understood very well that their changed practice would result in nutritional benefits and good health for the family.
• They believed that regular use of the knowledge given to them by the project would make their children healthy and free from disease. They were taking children less often to the doctor and themselves needed medical care less frequently than before.
• They felt that participation in the nutrition activities had and would continue to improve the household economy. Following the nutrition knowledge and practices learned from the project had helped them reduce health care costs.

12.2. SWOC/T analysis

A SWOC/T analysis of the project’s nutrition activities began with participants being briefed about the objectives, methods, time required and responsibilities. Four groups were formed and supported by HDTC officers and extension staff. The farmers identified and reviewed key areas of nutrition learning, highlighting strengths, weaknesses and threats or constraints, and opportunities for improvement. Each group presented the outcome of its discussion to the others. In some instances, the groups debated among themselves, especially when elderly women were present.

12.2.1. Findings

Strengths

• Farmers felt empowered with the information and skills obtained from the nutrition programme.
• They found the nutritional training and demonstrations highly useful in daily food, nutrition and hygiene management at home.
• Awareness of the nutritional value of vegetables and promotion of the fruit varieties by the project had improved their dietary choices.
• Preparation of new and nutritious recipes from locally available vegetables and fruits had diversified monotonous household diets.
• They knew about the daily consumption requirement of vegetable and fruits for good nutrition and could prepare nutritious recipes from a variety of vegetables and other food.
• Mothers and other child carers had benefited from the training for horticulture-based complementary food preparation for infants and small children together with the pictorial flip charts given to households.
• The knowledge given by the project, including nutritional value of vegetables and fruits, diet for children, adolescent girls and pregnant women, preparation of nutritious recipes and complementary food, and the importance of health care for children, adolescents and pregnant women, was of great importance to them.
• The sharing of nutritional knowledge in village group meetings¹⁰⁵ was an excellent opportunity to review, renew and expand learning and experiences.

Weaknesses

• Written instructions were not given after the training and demonstration sessions, making it difficult to put these in practice.
• Inadequate information on care for pregnant women and diet for children over two years of age.
• Farmers not covered by all training and demonstration sessions; requested more training, specifically in nutrition and care of pregnant women and children between two to five years old.

Constraints

• Not enough land for home nutrition garden as most farmers had less then 0.5 acre.¹⁰⁶
• Seasonal availability of vegetables needed for recipes.
• Lack of participation by males; conservative social and family attitudes.
• Superstitious beliefs, especially on the fotoa (fatwa) given by village religious leader that mushroom is a haram (unholy) food.
• Financial problems including lack of funds for new initiatives and recipes.

Opportunities/suggestions for improvement

• Provide more nutrition training and demonstrations to group members.
• Give more recipes and recipe options with vegetables and fruits for adolescents and adults.
• Teach more food preservation techniques.
• Facilitate supply of improved seasonal vegetable seeds.
• Ensure more practical and hands-on support in all training and demonstration.
• Organize community-level cooking and recipe competitions.

12.3. Observation and lessons learned

The seminars indicated that the project offered collaborative learning opportunities and resulted in unanimous participation by the farmers who discussed almost everything they had learned in the project nutrition activities. Younger farmers took the lead in almost all areas of discussion and a lively debate took place among the groups during the presentation of their work outputs to the plenary session.

12.3.1. Inter-sectoral stakeholder participation

The DAE officers, health officials and NGO representatives actively facilitated the farmers’ working groups and took part in the discussion during the plenary session where they explained their role in the nutrition activities. The active collaboration of NGOs and health partners was considered essential for strengthening and smooth implementation of nutrition activities. All stakeholders expressed readiness for involvement in project nutrition activities as and when needed.

12.3.2. Changes in practice and behaviour

The farmers revealed that an outcome of the intervention was that the attitude of older women family heads towards younger or newly-wed women had started changing. The older woman farmer, who is often the family head, had become generous towards the young or new daughter-in-law with regard to food distribution and health care. In Pabna, an elder group member said she was more responsive and dutiful to her daughter-in-law during the latter’s pregnancy and lactation as a result of the knowledge gained from the project.

12.3.3. Empowerment

Women farmers from far away places participated confidently in the seminar, discussing cooking ingredients and methods. They showed solidarity in planning food-based activities and promoting horticultural food consumption for household nutritional improvement.

The farmers identified the strengths, weaknesses, opportunities and constraints of the project nutrition interventions from their perspective, proving their ability to debate various aspects among themselves. They presented their findings confidently in the plenary session in the presence of government officials.

12.3.4. Idea generation

The farmers identified issues and areas for future training and demonstration such as food for the elderly, food distribution among family members, relation between food and gender, and new recipes for teenagers. They pinpointed factors affecting the application of the nutrition knowledge in their lives. These mainly related to traditional pregnancy dietary beliefs such as eating less for fear of having a big baby and difficulties during birth, as well as lesser male participation.

12.3.5. Traditional attitudes

Farmers had typical traditional attitudes towards learning, such as requesting longer project duration, more training and demonstrations, and more material inputs. At the same time, this manifested the often-seen dependency of resource-poor communities.

12.3.6. Community adoption and replication

During the farmers’ group discussions, older females acted as resource persons and motivators to spread nutrition information and messages among the community. This also strengthened the link between the Sub Assistant Agriculture Officer and the community and was in keeping with the project’s community-based approach needed for longer-term sustainability and impact.

12.3.7. Overall outcome and impact

The findings of the community-based assessment appeared to be consistent with those of the food consumption and dietary survey. The change in practice found during the seminar and the farmers’ commitment to apply the knowledge, were positive aspects of the intervention.

The application of the knowledge and skills learned from the project was picking up and its continuation depends on opportunity and accessibility of resources. However, it takes long to bring about changes in behaviour in terms of nutrition and food management at the household level.

While the quantitative dietary survey provided appropriate estimates of the impact and efficiency of the nutrition intervention, the community-based assessment had implications for programme design and monitoring. Community-based assessments of other project components can help link nutrition-related project outputs with specific horticultural inputs under other technical components of the project.

Further documentation of case studies is needed, highlighting the activities of both successful and unsuccessful farmers in project areas and these should be made available to the stakeholders.

¹⁰³ INFS. 2004. Food Consumption and Dietary Assessment: Evaluations from FAO-UNDP-GoB IHNDP. Dhaka, Institute of Nutrition and Food Science, Dhaka University, Bangladesh.

¹⁰⁴ This was explained in terms of concern for their children, time spent with them and taking care of their affection needs.

¹⁰⁵ Farmers’ group meetings were held regularly in the village as part of farmer group activities.

¹⁰⁶ 2.37 acre = 1 ha