A case for integrated development: pathways to improve child well-being

ABSTRACT

Economic strengthening interventions may increase income, assets, and food security. Donors and implementers see the potential for improvements in child well-being. This article presents lessons learnt from the implementation of two economic strengthening interventions. It finds missed opportunities with regard to child nutrition, and recommends: (1) integrating economic strengthening interventions with complementary development activities; (2) deep formative assessment to inform programme design; and (3) the use of community-based feedback loops. Development practitioners, funders, policymakers, and researchers must take every opportunity to improve the lives of children as young as possible to build healthy families, communities, and nations.

Les interventions de renforcement économique peuvent avoir pour impact l’augmentation des revenus, des actifs et de la sécurité alimentaire. Les donateurs et les responsables de la mise en application des politiques y voient un potentiel pour l’amélioration du bien-être des enfants. Cet article présente les leçons apprises lors de la mise en application de deux interventions de renforcement économique. Il révèle des occasions manquées en rapport avec la nutrition de l’enfant, et recommande: (1) l’intégration des interventions de renforcement économique à des activités complémentaires de développement; (2) une évaluation formative en profondeur pour orienter l’élaboration des programmes; et (3) un retour communautaire d’informations. Les praticiens du développement, les donateurs, les décideurs politiques et les chercheurs doivent saisir toutes les opportunités d’amélioration de la vie des enfants dès leur plus jeune âge afin de contribuer à la fondation de familles, de communautés et de nations.

Las intervenciones orientadas a fortalecer ciertos aspectos económicos pueden derivar en ingresos más elevados, en el aumento del número de activos y en mayor seguridad alimentaria, lo que determina que tanto los donantes como los operadores vean su potencial para mejorar el bienestar de los niños. El presente artículo da cuenta de los aprendizajes surgidos a partir de la implementación de dos intervenciones enfocadas en ciertos aspectos económicos. Al respecto, se detectaron oportunidades no aprovechadas en términos de la nutrición de los niños. Por ello el artículo recomienda: (1) integrar las intevenciones para fortalecer la economía mediante la realización de actividades de desarrollo complementarias; (2) realizar un profundo análisis formativo destinado a orientar el diseño de programas; y (3) hacer uso de circuitos de retroalimentación comunitarios. Los operadores de desarrollo, donantes, formuladores de políticas e investigadores deben aprovechar cualquier oportunidad que se presente para mejorar la vida de los niños desde su más tierna edad a fin de potenciar la existencia de familias, comunidades y naciones sanas.

KEYWORDS:

• Aid – Aid effectiveness, Monitoring and Evaluation
• Environment (built and natural) – Agriculture, Food security

Introduction

Interest is growing in international development for integrated programming across sectors and target populations, as such programmes may yield greater results for development programme participants, their families, communities, and beyond. One such promising combination of development approaches includes economic strengthening programming with the explicit intent to improve children’s well-being. Economic strengthening programmes are interventions that seek to help individuals, families, and communities reduce their economic vulnerability and empower them to protect and/or generate all types of assets (James-Wilson et al. 2008; PEPFAR 2012). Child well-being as used here includes all domains of child welfare, including physical, psychological, and social (Ben-Arieh, 2000, Ben-Arieh et al. 2014). Components of the physical domain, for example, include health, food security and nutrition, and safety. In order for economic strengthening providers to include child well-being in their integrated programme design, they must work across sectors relevant to child well-being.

This viewpoint argues that integrating child well-being objectives into economic strengthening programmes is essential, because improving children’s well-being may minimise the transfer of poverty from one generation to another (Esping-Andersen and Sarasa 2002; PEPFAR 2012; Sinclair et al. 2013). Success would mean poverty reduction, thereby achieving an essential development goal.

In light of the above logic, and since economic strengthening programmes typically focus on household welfare, they should seek to increase the welfare of everyone in the household in order to achieve sustainable change over time. Existing evidence supports this view, as analyses show a correlation between household economic welfare and child well-being (Akwara et al. 2010; Campbell et al. 2010). How and when improved household economic welfare contributes to greater child well-being, however, are not well understood. Moreover, the prevailing assumption that successful household economic strengthening programmes will contribute to the well-being of children in the absence of child-focused design may be false, at least in the short-term (two to three years) in which most evaluations take place. Thus, the potential contributions of economic strengthening programmes to greater child well-being remain somewhat elusive (Sinclair et al. 2013).

Background

This article draws on lessons learnt from implementing value chain strengthening in Liberia and savings groups in Mozambique under the Supporting Transformation by Reducing Insecurity and Vulnerability with Economic Strengthening (STRIVE) project. Funded by USAID’s Displaced Children and Orphans Fund and implemented by FHI 360, STRIVE examined the effects of economic strengthening initiatives on micro- and small-sized enterprises (MSEs), households, and children to fill current knowledge gaps on effective approaches to reducing the vulnerability of children and youth. To narrow the focus of child well-being, we examine the results from quasi-experimental impact evaluations of two economic strengthening interventions on one specific aspect of child well-being that is critical to proper growth and development: nutrition. While the programme in Mozambique had a child-focused component by targeting mothers with children under the age of two years with nutrition training, the Liberia programme targeted rural agricultural farmers and provided ad hoc nutritional messaging during farmer-group meetings. The value chain intervention facilitated linkages between farmers and others in the supply chain of goods and services, such as farm inputs and sales outlets. In both cases, the population relies on agriculture.

Figure 1 illustrates the hypothesised intervention causal pathway toward improved child nutrition based on these two cases. The model comprises three steps. The first step postulates that value chain and savings groups (SGs) support increased agricultural production leading to increased income and assets. Step two assumes that through enhanced production and increased income, families will have better availability of, and access to, food (food that is grown and/or purchased). The third step presumes that with better access to food, households will be able to mitigate periods of food scarcity and to eat a more diverse diet thereby improving nutrition for all household members including children.

Figure 1. Causal pathway from economic strengthening to child nutrition.

In both Liberia and Mozambique, economic strengthening interventions were implemented in rural contexts characterised by subsistence farming, with limited opportunities for other economic strategies and little to poor integration into national, regional, and global economies. In Liberia, the Agriculture for Children’s Empowerment (ACE) programme focused on strengthening smallholder vegetable farmers in Bong and Nimba counties, promoting linkages with input suppliers and buyers, and teaching modern farming techniques to increase their engagement in the horticulture value chain. By establishing the perception of farming as a business and the increased production due to the linkages and use of modern farming, ACE expected to see improved household economic welfare (farm income and household assets) and stimulate investments in children’s well-being, including improved child nutrition.

STRIVE Mozambique promoted and facilitated the formation of savings groups in Nampula Province. Savings groups are self-managed and capitalised microfinance programmes in which members save in regular cycles and can borrow from the pooled savings, repaying with interest. At the end of each cycle, accumulated savings and interest from loans are shared out among members in proportion to each member’s deposits. By improving access to financial tools, the intervention was intended to help largely agrarian households acquire more food through production or purchase and to make investments that could in turn lead to greater benefits. A complementary programme (SANA) included nutritional education to mothers of young children, which was meant to contribute to improved child nutrition.

Results from the evaluations of both projects, reported elsewhere, provide support for the first two steps of the causal model. Both evaluations show improvements in income from crop sales. STRIVE Mozambique found increased asset ownership among savings group participants (Brunie et al. 2016; Rutherford et al. 2016). The ACE evaluation also found a positive effect on access to, and availability of, food, while the Mozambique evaluation showed improvements in months of household food sufficiency (Brunie et al. 2014; Rutherford et al. 2016).

Results at the child level are mixed. In Liberia (Rutherford et al. 2016), evaluation findings show a decrease in the number of meals missed for children living in ACE households, but the difference between treatment and comparison groups was not statistically significant. The ACE evaluation also found a decrease over time in the diversity of foods eaten by children in all groups, which qualitative findings suggest may have to do with environmental reasons such as increased wildlife scarcity. In Mozambique (Brunie et al. 2014), participation in savings groups was found to increase children’s individual dietary diversity scores; however, these scores were low at baseline and remained low at endline. There was no significant effect for anthropometric outcomes (weight-for-age). Qualitative findings revealed that although parents appeared to be aware of the particular nutritional needs of children, they continued to face financial constraints and were not systematically able to meet these needs. Another potential gap was also identified in relation to organisational duties within the household: women managed food choices, but men remained the financial gatekeepers.

Lessons learnt

Mixed-method evaluation findings and experiences from STRIVE in two countries supported the identification of several areas of missed opportunities for a greater contribution of economic strengthening interventions to child nutrition. Recommendations to improve the programme design and impact of this specific integrated development approach include:

• Engage local partners for multi-sector interventions. Integrated development approaches hold the potential to improve the well-being of children. As seen in the cases described above, economic strengthening activities alone were largely insufficient to drive sustainable increases in children’s nutrition despite improvements in access to and availability of food. Complementary interventions with local organisations with child nutrition expertise to provide nutrition messaging may have increased children’s nutrition. So may have engaging communities and other stakeholders, like health workers, teachers and village leaders, in a discussion about children’s nutrition to promote awareness of the issue. In Liberia, the programme was initiated in schools, with agricultural demonstration plots to teach children and their families about modern farming techniques. The advantages of this include produce for school meals and hands-on nutritional education. Unfortunately, it was less successful in quickly reaching farmers and fomenting behavioural change on their farms, so the activity was dropped in lieu of direct outreach to farmers. It may be that long-term behavioural change requires both integrated programme design and longer implementation periods.

• Conduct a deep formative assessment to understand the needs, challenges, and values of the multiple potential programme stakeholders including direct and indirect beneficiaries. Assessment requires deep engagement with communities and leads to better understanding of the context in which we work, resulting in better programme design, collaborative definitions of success and measurement, and opportunity to take advantage of learning in real time, including uncovering why there may be no observable child-level effects and how to mitigate harm to children (Rutherford, Carmichael, and Christopherson 2015). Formative assessments are critical for any development initiative, but are particularly important for integrated approaches, in order to understand the complex, interrelated dimensions between the various sectors (Cheung, Rutherford, and Burke 2016). In the Mozambique case, had the implementer understood the gender dynamics affecting food selection before the programme started, the nutrition messaging might have been targeted equally at men and women, since women prepare food, but men hold the financial decision-making authority.

• Incorporate fast, flexible feedback loops in child-sensitive monitoring systems and evaluation design. This approach to monitoring and evaluation is essential to understanding how programmes may be affecting children by capturing short-term and intermediate results, the analysis of which produces opportunities to redirect programming to enhance children’s well-being. This is especially important when the effects are harmful or little-to-no effects are observed, as in the Liberia case where no changes in eating habits were observed by staff, which was only captured at the child level when dietary diversity was measured with an endline survey. Effective feedback loops require time for programme staff and stakeholders (including direct and indirect beneficiaries) to review and discuss results from data analysis, so that they may co-create meaning and generate ideas to improve programme effectiveness and mitigate any discovered harmful outcomes.

Given the assumption that children play an integral role in economic development over time and that poorly fed children are less well equipped to fulfil that role, it would behove economic strengthening projects to take steps to improve children’s nutrition. In this case, ACE dropped early school-based garden and financial education activities to focus resources on the economic farm activities in order to meet its primary goals. This may have been “penny wise and pound foolish”, which was only recognised with the benefit of hindsight.

The recommendations above from two different economic strengthening approaches in two countries build some confidence in their generalisability and salience for other contexts. While the cases formulated here are in the context of child nutrition, their relevance should also be considered in applying economic strengthening plus child well-being programmes for improving other aspects of child well-being. Research findings from these cases and others recently led to the conclusion that a rising tide does not lift all boats (Carmichael and Rutherford 2015; Rutherford, Carmichael, and Christopherson 2015; Sinclair et al. 2013).

Practitioners and donors work to solve complex development problems that are multi-sectoral in nature. Increasingly, they use integrated programme designs to address complex problems. There is some evidence to suggest that taking an integrated approach may result in better outcomes for target populations and amplify and generate sustainable impact. Testing integrated programming is necessary to understand the potential impact on the populations we serve.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Diana D. Rutherford is a Senior Research and Evaluation Specialist at FHI 360, Washington, DC, USA.

Jessica Bachay is a Project Manager at FHI 360, Washington, DC, USA.

Additional information

Funding

Funding for STRIVE was provided by the US Agency for International Development (USAID) under the terms of associate agreement DFD-AA-00-07-00251-00, the Supporting Transformation by Reducing Insecurity and Vulnerability with Economic Strengthening (STRIVE) project. The contents of this article are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government.