Completed Research

This report presents the findings for the first stage of the 1000 Most Critical Days Programme process evaluation. The National Food and Nutrition Commission (NFNC), in coordination with several donors, including the Department for International Development (DFID, developed a bundled, multisector programme called The First 1000 Most Critical Days (MCDP) in order to address Zambia’s child undernutrition. CARE, in conjunction with the NFNC, coordinates the implementation and delivery of the programme through several ministries. American Institutes for Research (AIR) was contracted by DFID Zambia in 2014 to conduct a two-year evaluation of the MCDP. The evaluation includes three components: a rapid qualitative assessment, a process evaluation, and an impact evaluation. This report presents the findings from the first process evaluation study, with a focus on implementation experiences, including communication and coordination, monitoring and reporting, financial flows, and successes and challenges in implementing each of the MCDP priority intervention areas.  
In both Chipata and Mbala, we found that higher (District, WNCC) levels of actors had a good conceptual understanding of the implications of the multisectoral paradigm and co-ordinated approaches to implementation. This understanding diminished, however, further down the programme chain. Furthermore, although some coordination in activity planning and implementation (chiefly in the area of sensitisation) was under way (particularly in Mbala), this was limited by the overall slowness of activity roll-out. In terms of planning and communication, we found challenges particularly along the vertical axis, in particular between the WNCCs and their respective DNCCs: In both districts, WNCC members felt that they did not have particularly good communication with their DNCCs and that their role had been limited to simply carrying out the orders of the DNCC. We heard calls for greater ownership and autonomy. Finally, moving up a level, we note that line ministry focal points on the DNCC in Chipata reported poor communications with CARE, in which repeated requests for funding carry-over went unanswered. 
Respondents we spoke to at the central, district, and ward levels indicated that monitoring processes are not being consistently or systematically carried out. Although a new, harmonised monitoring and evaluation plan was recently created, it is not yet operational. Because a unified monitoring tool for the MCDP is lacking, programme implementers improvise to extract relevant data from their respective line ministries to monitor activities. Using existing ministry registries creates an additional burden for those responsible with the task of reporting. Although the programme targets and would therefore report only on children of ages 0–2, ministry registries focus on children 0–5 years old, meaning MCDP staff must spend time extracting only the children of ages 0–2 from the registries. Furthermore, confusion over which activities are SUN- funded and which would occur without the MCDP continues to be a challenge for reporting. The lack of clarity in which activities can be attributed to the programme raises reliability problems in what is reported.  
Financial processes and the flow of funds pose perhaps the most significant obstacle to MCDP implementation. There appears to be a fundamental mistrust of accountability over finances between the central, district, and ward levels, causing significant challenges in communication and coordination of financial reporting and approval procedures. Delays in funding 
 
American Institutes for Research  Zambia’s 1000 MCDP: Results From the 2016 Process Evaluation—ix 
disbursements pose substantial problems to implementation of several intervention activities which are time-sensitive, reducing their effectiveness. In addition, when districts need to ‘carry over’ funding from one quarter to another, the procedures necessary to request this approval cause further delays on interventions. Inconsistent funding also causes programming gaps, leading many to forget earlier activities which they may have been a part of, ultimately preventing MCDP processes from being institutionalised by implementers.  
Findings highlighted many successes and ongoing challenges experienced by implementers delivering the programme’s priority interventions. In Chipata, IFA, vitamin A, and deworming activities occur regularly, and respondents noted that they have sufficient tablets to distribute. Most respondents felt that SUN funds had not significantly added to existing IFA, Vitamin A, and deworming activities, though some explained that the MCDP has been successful in routinising the activities. MCDP activities in breastfeeding also have systematised a focus on appropriate breastfeeding practices. In Chipata, a separate breastfeeding mothers’ group has been established, and sensitisation occurs frequently with pregnant women to encourage and educate them on feeding. Respondents in Mbala reported a shift in dialogue about child feeding as a result of the MCDP. Some respondents we spoke with in Chipata described a training they had received on IYCF, explaining how valuable it was, but others within the same ward revealed they had not yet had an opportunity to attend this training, highlighting perhaps inconsistent targeting efforts for trainings. Resource challenges also were mentioned by ward-level MCDP implementers, who expressed a need for additional resources, particularly for cooking demonstrations and community training activities. 
Respondents provided mixed opinions on the ways in which the MCDP has added to growth- monitoring activities. Though plans exist to train growth promoters and growth monitoring volunteers, trainings have not occurred in either district as a result of funding constraints. In addition, in Chipata, insufficient growth monitoring and IMAM inputs have been provided, causing problems with conducting adequate sensitisation to malnutrition and inhibiting growth- monitoring activities. At the same time, in Chipata, implementers emphasised that because of the MCDP, they sensitise a great deal more on stunting, and pregnant and breastfeeding women consequently understand the link between malnutrition and stunting.  
A number of SUN activities in dietary diversity have been completed in Chipata and Mbala. Respondents mentioned several sensitisation activities which have been integrated into regular ministry functions, as well as cooking demonstrations in Mbala, both of which target farmers and women’s groups. Respondents in Chipata reported more challenges in carrying out activities because of a lack of funding, and the trainings which have been provided were reported as too superficial. In contrast, in Mbala, the district office has conducted training and multiple cooking demonstrations, and by conducting fewer and targeted trainings they managed to distribute agricultural inputs systematically.  
We also found significant variations between the districts in WASH activities, likely because Mbala is already a pilot district for a Ministry of Education and UNICEF-funded community-led total sanitation intervention. In Chipata, this intervention area largely focused on chlorination of wells and orientation of pump menders, and in Mbala activities served to reinforce previous activities done under the UNICEF CLTS project. WASH activities require substantial coordination between multiple ministries and other NGOs conducting relevant activities. 
 
American Institutes for Research  Zambia’s 1000 MCDP: Results From the 2016 Process Evaluation—x 
Although it is too early to assess the success of ministerial coordination, respondents indicated that the MCDP has not been in contact with other NGOs to ensure that efforts are appropriately targeted and not duplicated.  
Although community sensitisation to MCDP priority intervention areas is ongoing, the rollout of formalised nutrition messaging is still limited. The IEC materials which respondents did mention had been developed centrally and were in English, and consequently not as effective as they could have been because the target recipients of these materials do not read English. Respondents expressed a clear need for tailored messaging appropriate to the localised traditions and customs which perpetuate poor IYCF practices.  

 


This rapid assessment was conducted in December, 2008 to ascertain the levels of malnutrition in Lusaka urban. It was a cross-sectional descriptive survey that was aimed at establishing factors that have led to an increase in under five year old malnutrition admission rates at the University Teaching Hospital.

The study was undertaken following reports that during the period of August-October, 2008, the case load of severe malnutrition admissions to the University Teaching Hospital (Ward A07) had gone beyond seasonal trend with an average of 15 admissions daily making. This situation had resulted in overcrowding of the ward leading to children sharing beds (cots); on average 2-3 children shared a cot. In addition, the mortality rates among these admitted children were reported to be as high as 40-50 percent.  

A desk assessment into this situation revealed that the majority of the admitted children were referred from Kamwala, Kanyama, Matero Reference, and Chawama Health Centres. Based on this, the National Food and Nutrition Commission and partners conducted this rapid assessment to ascertain the nutrition situation in these source areas of Lusaka urban as well as the factors that had led to this high increase in admissions.


The overall objective of the NNSS is to provide timely and accurate nutrition information relevant for informing policies and programmes that lead to improved food and nutrition situation among the majority of the Zambian population.

The 2009 National Nutrition Surveillance System (NNSS) is part of the National Food and Nutrition Commission (NFNC) nutrition surveillance that were initiated in 2007 and mainly focus on the nutritional status of children and women in Zambia. It was designed to collect nutrition indicators and relevant nutrition programmatic information that is needed by policy makers, planners and program officers to make informed decision on effective and efficient interventions aimed at improving the nutritional status of the Zambian population.

The findings also provide a comprehensive overview of the overarching nutrition situation of children and women in Zambia, down to the district. It highlighted areas of progress as well as challenges that need to be overcome in order to attain an acceptable level of nutrition status for the population, especially vulnerable groups such as women and children. It also further highlights the need for continued support and strengthening of food nutrition programmes by the Government of the Republic of Zambia (GRZ) and its cooperating partners.


The main objectives of the survey were (1) to measure urinary iodine concentration in school children, and (2) estimate the coverage of adequately iodated salt in their households.

The survey showed that Zambia has maintained the remarkable progress achieved since the introduction of Universal Salt Iodization. Only 14% of the individuals had low urinary iodine concentration, which confirms that iodine deficiency is not a significant public health problem in Zambia.


The overall study was aimed at fully understanding which transfer mechanism (cash or food) ensures adequate nutrition improvement for those initiating ART treatment, and increases adherence to ART in a more effective way. The study was conducted in Eastern Province of Zambia, Katete District, at St. Francis Mission Hospital. This was an intervention study focusing on HIV positive individuals initiated on ART.


This baseline survey was conducted in October 2013 prior to the commencement of the maize meal fortified school feeding. The purpose of the project          was to assess the relationships associated with school attendance, nutrition wellbeing, and health status of learners under the Home Grown School Feeding Programme (HGSFP).  This survey was conducted in 16 districts across the 22 districts implementing the HGSFP national wide. It was cross-sectional in nature which employed both quantitative and qualitative methods of data collection. 

This survey focused on the dietary patterns of school children in the rural areas. The results provide some useful insights to guide those interested in promoting healthy eating behaviour among school children.  The survey also showed that, a general view of school meals was important in enhancing regularly attendance of learners in school. The survey indicates that school meals help improve school attendance and reduce absenteeism in schools. This was stated to be very helpful especially to children that come from poor families. The results of this survey can therefore be used to refine the school feeding programme in terms of design and targeting.


The Zambia Food Consumption Survey was undertaken to provide the critical body of evidence that policy makers and program designers need in order to make informed decisions about effective investments to reduce deficiencies of vitamins and minerals in Zambia. Such decisions will result in substantial contributions to efforts being made to assist Zambians in achieving the Millennium Development Goals. The survey was carried out in Northern and Luapula Provinces.

Food consumption was measured using the 24-hour recall method with duplicate measurements on a subset of the sample to allow estimation of usual intake. The survey also included an interview to collect background information on dietary habits, socio-demographic status and lifestyle, and the collection of a blood sample to assess haematological and biochemical indices of nutritional status.  


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