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The essential focus of IFAD is to expand the range of opportunities for the rural poor - primarily through improved agricultural production, rural finance and local capacity-building. Progress in any or all of these endeavours should result in reduced malnutrition. Some of the most promising work in the area of food security and nutrition involves the use of rapid nutrition surveys to measure malnutrition among young children.
"...ultimately the only criterion by which the value of the Fund can be properly judged is its impact, particularly with regard to food security and nutrition, on the circumstances of the rural poor." - IFAD Annual Report, 1998
Rapid nutrition surveys can reinforce project monitoring and evaluation systems by establishing benchmarks that can be used to estimate project impact during mid-term reviews and completion evaluations. These surveys also enable IFAD's contribution to reaching global targets for poverty alleviation and the elimination of hunger to be demonstrated more easily.
IFAD's position on nutrition assessment dates back to 1984, when it published 'Guiding Principles for the Design and Use of monitoring and Evaluation in Rural Development Projects and Programmes', which stated: "At the very least, monitoring and evaluation systems for rural development programmes should incorporate one or more of the commonly accepted indicators of general nutritional status." IFAD's corporate strategies for 2000 and 2001 have recently repeated the call for benchmarks on child malnutrition in IFAD project areas.
There are three indicators of nutrition status based on anthropometry (physical measurements):
- Chronic malnutrition (also called "stunting") is a measure of height relative to age. It is perhaps the most relevant indicator for IFAD-assisted projects and for the overall well-being of a community. High levels of chronic malnutrition reflect deprivation over a period of months or years. Children who are chronically malnourished may suffer irreversible disability in mental and physical development, causing poor performance in school and reduced physical productivity for the rest of their lives.
- Acute malnutrition (or "wasting") is a measure of weight relative to height. It is associated with temporary shocks, such as famine or episodes of illness.
- Underweight is a measure of weight relative to age. It is most often used to monitor the nutrition status of individual children.
All three anthropometric indicators are gender-sensitive and appropriate in multicultural contexts. The indicators are determined separately for girls and boys, and there is solid consensus that ethnic or racial differences in growth patterns are not observable among children under the age of five years (although such ethnic or racial differences may begin to appear in later childhood or early adolescence). For these reasons, the indicators are particularly valuable for comparing the impact of different projects across different countries and regions.
Case Studies
Two projects were selected for field-testing the feasibility and relevance of rapid nutrition surveys - the Rural Development Project in the Mountain Zones of Al-Haouz Province in Morocco and the Qinling Mountain Area Poverty Alleviation Project in China. Sample sizes were calculated to provide sufficient statistical power using multi-stage sampling methodology (sample sizes are normally in the range of 600-900 children); corresponding series of villages were randomly selected.
In
Morocco, the nutrition survey was conducted during the project formulation
mission. The survey team (eight doctors and nurses) weighed and measured
750 children during five days of fieldwork. Minimal initial training
was required, as the Ministry of Health staff were already familiar
with anthropometric measurements. Data entry, analysis and reporting
took another five working days.
Results from Morocco indicated that levels of chronic malnutrition in the project area were significantly higher than the national average for rural areas. This finding also supported the conclusion that the project location had been selected appropriately to serve a population vulnerable to continued food insecurity.
In
China, the nutrition assessment was field-tested as part of a more
comprehensive baseline survey. The survey team (22 project staff and
maternal and child health nurses) completed a sample of 600 children
in six days of intensive training and fieldwork. Unseasonably cold
weather greatly complicated the fieldwork, although well-planned logistical
support mitigated some of these difficulties. Four days were spent
on data entry, analysis and reporting. Results confirmed that chronic
malnutrition was a serious concern in the project area. Noteworthy
features of the work in China were the excellent level of cooperation
between IFAD and the World Food Programme, and the ability of project
staff to absorb the training and successfully carry out a similar
survey in a neighbouring province without external assistance.
Neither survey cost more than USD 1 000 in the field. Factoring in the expense of an international consultant (when necessary) and the purchase of measuring equipment, the average cost for a complete survey would be roughly USD 10 000.
The benchmark data from both countries will be complemented by repeat surveys during the mid-term review and the completion evaluation. Changes in the level of malnutrition can be measured at intervals of three years for six-year projects and of five years for ten-year projects.
Overall, the survey work in Morocco and China demonstrated that nutrition assessments are feasible, rapid and inexpensive and that they can produce relevant benchmark indicators. While no single set of quantitative data can provide all of the information required, IFAD-generated experiences have shown the relative simplicity and potential value of using measurements of malnutrition as anchor indicators for estimating project impact.
Household Food Security and Gender Memory Checks |Practical Anthropometry 101 and 102 | Rapid Nutrition Surveys for Estimating Project Impact | Manual for Bottom-up Approach in Food Security Inverventions | Comprehensive Participatory Planning and Evaluation | Household food Security: Concepts, Indicators and Measurements
