2010 Kenya: Evaluation of the Emergency Blanket Supplementary Feeding Programme (BSFP) in Five Districts of Northern Kenya
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The Arid and Semi Arid Lands (ASAL) of Kenya constitute approximately 80% of the land mass and pastoralism serves as the main source of livelihood. The ASAL regions are among the poorest in Kenya, where poor infrastructure, widespread insecurity, frequent droughts and limited livelihood options keep many residents in conditions of poverty and vulnerability. Recurring shocks and insecurity have created pockets of protracted relief operations that raise concerns about dependency on external assistance. Because population densities in the ASAL are low, the government in the past, has paid relatively little attention to the particular challenges that confront residents of the ASAL regions and thus to policies necessary to sustain and improve their livelihoods. The new coalition government in it’s vision 2030 recognizes the need to develop the ASALs if the country is to achieve economic development and the creation of the Ministry of development of Northern Kenya is a step in the right direction to develop policies and strategies
geared towards development of these regions.
It is due to this vulnerability in ASAL areas that a number of Donors and NGOs have focused special attention to this area. However, despite the humanitarian efforts including many years of food aid, levels of acute malnutrition have continued to remain high above the 15% emergency thresholds (WHO). During periods of food insecurity such as the drought experienced in 2008/09, the Arid and Semi Arid (ASAL) districts saw very high levels of acute malnutrition >30% (<-2 Z scores and oedema) in some districts. Whilst the high malnutrition rates in the ASAL regions may be due to food insecurity as a result of the weakened livelihoods, the poor health infrastructure, low literacy levels, poor water and sanitation and poor child caring practices all play a significant role in maintaining the high levels of acute malnutrition hence the emergency food aid and therapeutic feeding programmes have not managed to bring these levels down over the years.
A number of NGOs and development partners have in the recent past been discussing new ways of addressing the chronically high levels of acute malnutrition and especially during the hunger gap period when malnutrition levels peak. The drought experienced in 2008/09 coupled with very high food prices severely affected the ASAL areas hence calling for a more effective response. The European Commission Humanitarian Aid (ECHO) together with partners in the nutrition technical forum (NTF) considered it an opportune time to pilot blanket supplementary feeding programme (BSFP) targeting 5 severely affected districts of Marsabit, Samburu, Turkana, Mandera and Wajir.
To prevent a peak in the incidence of malnutrition during the hunger gap (January – April 2010) a consortium of NGOs in collaboration with WFP implemented a blanket supplementary feeding programme funded by ECHO targeting all pregnant and lactating women and children less than 5 years old in 5 districts in Northern Kenya. The aim of this blanket feeding programme was to protect the nutritional status of the most vulnerable people (children, pregnant and lactating women) during the peak drought period.
Using both qualitative and qualitative methods, this evaluation was aimed at assessing the implementation of the BSFP and generating plausible evidence that would demonstrate that the BSFP achieves its objective.
The BSFP was implemented for a period of 4 months from 21st January to 31st May 2010. The target of the blanket feeding programme was an estimated 441,465 children and women in five districts. Each beneficiary was entitled to receive 250 g of corn-soya blend (CSB) and 25g vegetable oil per day to provide approximately 1,225 Kcal. In addition to the distribution of rations a complementary health package was administered.
A significant positive change in the anthropometric status of the young children was observed during the period of implementation. While qualitative data showed that the ration played a role in improving the nutritional status of children, no firm conclusions can be made on the level of attribution.
The coverage, functioning and quality of the programme proved to be supportive of the programme’s objectives, however proper planning and stronger coordination at all stages of the programme cycle is imperative for the BSFP to achieve it’s objectives.
The BSFP proved to be supportive of other existing health and nutrition interventions. This can further be strengthened by proper and timely planning, monitoring and evaluation.
A smaller pilot study should be implemented in one of the districts during the next hunger gap. This will be aimed at accessing the extent to which we can attribute change in nutritional status to the blanket supplementary rations. A cost benefit analysis is also imperative BSFP is a very expensive intervention.
BSFP can be implemented during the hunger gap as a way to scale up and strengthen the existing health programmes especially immunization, vitamin A supplementation, IMAM and WATSAN.
Given the dearth of information available on blanket supplementary feeding programmes an implementation and evaluation toolkit or manual should be developed in collaboration with the MOPHS to guide future interventions. This will facilitate knowledge and capacity transfer to partners involved in the implementation of BSFP.
A significant positive change in the anthropometric status of the young children was observed during the period of implementation. This change could either have been due to a change in food security due to higher than expected rainfall or it could have been due to the BSFP.
The coverage, functioning and quality of the programme proved to be supportive of the programme’s objectives, however better coordination at all stages of the programme cycle needs to be considered in the next implementation phase and the targeting needs to improve to ensure that the right beneficiaries get and consume the rations.
The BSFP supported other existing health and nutrition interventions. This can further be strengthened by proper and timely planning, monitoring and evaluation.
Lessons Learned (optional):
The blanket supplementary feeding programme was well received by communities in the five districts and, as an intervention, it was appreciated by the local authorities and partners implementing the programme alike. A blanket supplementary feeding programme in the context of chronic food insecurity and a high prevalence malnutrition may not only be used to address food gaps but also as an opportunity to strengthen existing health and nutrition programmes.
Functioning of BSFP
A high level of coordination is essential both at national and district levels for the successful implementation of a multi-agency programme. Effective, appropriate and clear arrangements for communication between the stakeholders should be arranged and started before any programme begins. Also each partner should fully understand their roles and responsibilities before implementation starts. Sufficient lead time prior to start of the implementation of the BSFP should be given to allow for proper planning and timely communication to all stake holders.
The use of mixed criteria might have supposedly given the mothers a reason not to be honest about their child’s age so that a ration could be obtained. This meant that the data on anthropometric indices based on age were unreliable. In future it would be better, for the purposes of any evaluation at least, to allow all children <110 cm entry to the programme, whatever their age, so that there is a consistent, easily determined and transparent basis for getting a ration that promotes honesty. This should be widely advertised so that mothers know. The implication is that the needs of any evaluation should be considered by the programme when it is being designed, not just traditional and arbitrary practice, and that if this is not done the consequences for the quality of data from any attempt to assess the impact of a blanket feeding programme should be appreciated by programme administrators.
Both the quantitative and qualitative data indicate that food was mostly shared within households and was not used solely to feed the child beneficiary. This indicates that it would be better to target the whole household with children less than 5 years rather than just young children ie a blanket feeding programme.
BSFP complementary activities
The BSFP complementary activities proved to be very supportive of the existing programmes. The BSFP could be used as a way to strengthen existing programmes. However, proper planning, coordination, monitoring and evaluation are imperative.
There should be a greater linkage between the BSFP monitoring systems and existing data collection systems. This will ensure that the contribution of the BSFP to support existing programmes is captured and reported comprehensively.
The BSFP was aimed at preserving the nutritional status of children during the hunger gap. However, the rains came earlier than expected and hence the hunger gap might not have been as severe as expected. The timing of the intervention is thus crucial to ensure that it is most effective.
It will never be possible to obtain data to prove that a blanket feeding programme is effective without having untreated controls, something that is not feasible in a humanitarian crisis. Nevertheless it should be possible to collect good data to provide several strands of plausible evidence of an impact, assuming that there is no major change in food security at the same time as the programme. To obtain high quality data several things are necessary. Data should be collected by monitoring and evaluation teams who are separate from programme implementers and ideally from an independent agency. The evaluators should be adequately trained in research methods. As there was strong evidence that many children at the fifth distribution were not the same as the children who were enrolled, which may be a particular problem in pastoral communities, Personal Digital Assistants (PDAs) with finger-print readers could be used to confirm children’s identity at each encounter. This would also serve to minimise data recording and entry errors by providing range checks. It would also be useful to have periodic nutrition surveys, in times of adequate food security as well as when it is poor, to help understand the degree of fluctuation in anthropometric and nutritional status throughout the seasons in the arid lands of Kenya. Such data may be available, but they are not easily accessible or reported. A central coordinating unit to standardise survey methods and aggregate data on nutrition and health could serve such a purpose.
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