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Evaluation of Nutrition-sensitive Programs

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Nutrition and Health in a Developing World

Part of the book series: Nutrition and Health ((NH))


The current global evidence base regarding the nutritional impacts of nutrition-sensitive programs, including popular ones such as social safety nets and agriculture development programs, is generally limited because of poor targeting, design and implementation of programs, and equally important, sub-optimal evaluation designs. Although there is a consensus regarding the need to invest in nutrition-sensitive programs in order to address the underlying causes of undernutrition and to improve the effectiveness, reach, and scale of both nutrition-specific interventions and nutrition-sensitive programs, the evidence of what works, how and at what cost is extremely limited. Thus, building a strong body of evidence from rigorous, theory-based comprehensive evaluations of different nutrition-sensitive program models that bring together interventions from a variety of sectors (e.g., health, education, agriculture, social protection, women’s empowerment, water, and sanitation) is essential to provide the needed guidance for future investments for improving nutrition. This chapter provides this type of guidance, focusing on how to design and carry out rigorous process, cost, and impact evaluations of complex nutrition-sensitive programs; and it aims to demystify some of the perceived insurmountable challenges that have prevented investments in rigorous evaluations of such programs in the past. By doing so, we hope that the evidence gap in nutrition-sensitive programming, which has characterized the past decades of development, will quickly be filled and that future investments will benefit from a strong body of evidence on what works to improve nutrition, how it works, and at what cost.

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  1. 1.

    The extent to which adherence can be reliably measured varies. For instance, adherence to vitamin A supplementation, which is provided twice a year under strict supervision, is considerably easier than for micronutrient powders which are consumed at home on daily basis.

  2. 2.

    Outcomes may be attributed to the program if a probability design is used to assess them.

  3. 3.

    Outcomes may be impacts in different studies, depending on the study design, objectives, and selected measures of success.

  4. 4.

    Impacts can only be assessed if a probability study design is used and a valid counterfactual has been established.

  5. 5.

    Note that difference-in-difference estimation is also used to estimate impact on experimental studies.


  1. Ruel MT, Alderman H. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet. 2013;382. doi:10.1016/S0140-6736(13)60843-0.

  2. Olney DK, Rawat R, Ruel MT. Identifying potential programs and platforms to deliver multiple micronutrient interventions. J Nutr. 2012;142(1):178S–85S. doi:10.3945/jn.110.137182.

    Article  CAS  PubMed  Google Scholar 

  3. Webb-Girard A, Cherobon A, Mbugua S, Kamau-Mbuthia E, Amin A, Sellen DW. Food insecurity is associated with attitudes towards exclusive breastfeeding among women in urban Kenya. Matern Child Nutr. 2012;8(2):199–214. doi:10.1111/j.1740-8709.2010.00272.x.

    Article  PubMed  Google Scholar 

  4. Leroy JL, Frongillo EA. Can interventions to promote animal production ameliorate undernutrition? J Nutr. 2007;137(10):2311–6.

    CAS  PubMed  Google Scholar 

  5. Rawat R, Nguyen PH, Ali D, Saha K, Alayon S, Kim SS, Ruel M, Menon P. Learning how programs achieve their impact: embedding theory-driven process evaluation and other program learning mechanisms in alive and thrive. Food Nutr Bull. 2013;34(3 Suppl):S212–25.

    Article  PubMed  Google Scholar 

  6. Leroy JL, Ruel MT, Verhofstadt E. The impact of conditional cash transfer programmes on child nutrition: a review of evidence using a programme theory framework. J Dev Effectiveness. 2009;1(2):103–29. doi:10.1080/19439340902924043.

    Article  Google Scholar 

  7. Rabin BA, Brownson RC, Haire-Joshu D, Kreuter MW, Weaver NL. A glossary for dissemination and implementation research in health. J Public Health Manag Pract. 2009;14(2):117–23. doi:10.1097/

    Article  Google Scholar 

  8. Habicht JP, Gretel P, Lapp J. Methodologies to evaluate the impact of large-scale nutrition programs. Washington DC. 2009.

    Google Scholar 

  9. Habicht JP, Victora CG, Vaughan JP. Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact. Int J Epidemiol. 1999;28(1):10–8. USA: Division of Nutritional Sciences, Cornell University.

    Google Scholar 

  10. Rossi PH, Lipsey MW, Freeman HE. Evaluation: a systematic approach, vol. 7th. Thousand Oaks, CA: Sage Publications; 2004.

    Google Scholar 

  11. Olney DK, Vicheka S, Kro M, Chakriya C, Kroeun H, Sok L, Talukder A, Quinn V, Iannotti L, Becker E. Using program impact pathways to understand and improve program delivery, utilization, and potential for impact of Helen Keller International’s Homestead Food Production Program in Cambodia. Food Nutr Bull. 2013;34(2):169–84.

    Article  PubMed  Google Scholar 

  12. White H. Theory-based impact evaluation: principles and practice. J Dev Effectiveness. 2009;1(3):271–84. doi:10.1080/19439340903114628.

    Article  Google Scholar 

  13. Gertler PJ, Martinez M, Premand P, Rawlings LB, Vermeersch CMJ. Impact evaluation in practice. World Bank Publications. 2010.

    Google Scholar 

  14. Khandker SR, Koolwal GB, Samad HA. Handbook on impact evaluation: quantitative methods and practices. Washington DC: World Bank Publications; 2010.

    Google Scholar 

  15. White H. An introduction to the use of randomised control trials to evaluate development interventions. J Dev Effectiveness. 2013;5(1):30–49. doi:10.1080/19439342.2013.764652.

    Article  Google Scholar 

  16. Baker JL. Evaluating the impact of development projects on poverty: a handbook for practitioners. World Bank Publications. 2000.

    Google Scholar 

  17. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–60. doi:10.1016/S0140-6736(07)61690-0.

    Article  PubMed  Google Scholar 

  18. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51. doi:10.1016/S0140-6736(13)60937-X.

    Article  PubMed  Google Scholar 

  19. Gibson RS. Principles of nutritional assessment. Oxford University Press. 2005.

    Google Scholar 

  20. Coates J, Swindale A, Bilinsky P. Household food insecurity access scale (HFIAS) for measurement of food access: indicator guide (v.3). Washington D.C.: Food and Nutrition Technical Assistance Project (FANTA)/Academy for Educational Development; 2007.

    Google Scholar 

  21. FAO (Food and Agriculture Organization of the United Nations), and IRD (Institut de Recherche pour le Développement). Defining a standard operational indicator of women’s dietary diversity: the women’s dietary diversity follow-up project. Contributors: Martin-Prével Y, Allemand P, Wiesmann D, Arimond M, Ballard TJ, Deitchler M, Dop MC, Kennedy G, Lee WTK. Rome; Montpellier. 2014.

    Google Scholar 

  22. Alkire S, Meinzen-Dick R, Peterman A, Quisumbing A, Seymour G, Vaz A. The women’s empowerment in agriculture index. World Dev. 2013;52:71–91. doi:10.1016/j.worlddev.2013.06.007.

    Article  Google Scholar 

  23. WHO. Indicators for assessing infant and young child feeding practices part 2: measurement. Geneva: World Health Organization; 2010.

    Google Scholar 

  24. Olney DK, Dillon A, Pedehombga A, Ouédraogo M, Ruel MT. Using an agricultural platform in burkina faso to improve nutrition during the first 1,000 days. In: International Food Policy Research Institute (IFPRI), editors. Global nutrition report 2014: actions and accountability to accelerate the world’s progress on nutrition. Washington D.C: International Food Policy Research Institute; 2014. doi:10.2499/9780896295643.

  25. Nguyen PH, Menon P, Keithly SC, Kim SS, Hajeebhoy N, Tran LM, Ruel MT, Rawat R. Program impact pathway analysis of a social franchise model shows potential to improve infant and young child feeding practices in Vietnam. J Nutr. 2014;144(10):1627–36. doi:10.3945/jn.114.194464.

    Article  CAS  PubMed  Google Scholar 

  26. Fiedler JL, Villalobos CA, De Mattos AC. An activity-based cost analysis of the honduras community-based, integrated child care (AIN-C) programme. Health Policy Plann. 2008;23(6):408–27. doi:10.1093/heapol/czn018.

    Article  Google Scholar 

  27. Margolies A, Hoddinott J. Costing alternative transfer modalities. J Dev Effectiveness. 2015;7(1):1–16. doi:10.1080/19439342.2014.984745.

    Article  Google Scholar 

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Correspondence to Deanna K. Olney .

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Olney, D.K., Leroy, J.L., Ruel, M.T. (2017). Evaluation of Nutrition-sensitive Programs. In: de Pee, S., Taren, D., Bloem, M. (eds) Nutrition and Health in a Developing World . Nutrition and Health. Humana Press, Cham.

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  • Print ISBN: 978-3-319-43737-8

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