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Title Perils of scaling up: Effects of expanding a nutrition programme in Madagascar.
Full text https://escholarship.org/uc/item/65h992zg
Date 2019
Author(s) Weber, Ann; Galasso, Emanuela; Fernald, Lia
Abstract Scaling up integrated nutrition programmes from small, targeted interventions or pilot studies to large-scale government-run programmes can be challenging, with risks of changing the nature and quality of the interventions such that effectiveness is not sustained. In 1999, the Government of Madagascar introduced a nationwide, community-based, growth-monitoring and nutrition education programme, which was gradually scaled up throughout the country until 2011. Data from three nationally representative surveys, administered pre- and post-programme implementation, in participating and non-participating communities, were used to evaluate the effectiveness of the programme to reduce malnutrition in children under 5 after two phases of expansion (1999-2004 and 2004-2011). In our analyses, we compared original communities, who had initiated the programme during the first phase, and new communities, who initiated the programme during the second phase. Original communities demonstrated a significant effect on mean weight-for-age and on the prevalence of underweight by 2004; this effect was sustained at a reduced level through 2011. In contrast, new communities showed no benefits for any childhood nutritional outcomes. An explanation for these findings may be that community health workers in the new communities reported lower motivation and less use of key messages and materials than those in the original communities. Frontline workers reported increased workload and irregular pay across the board during the second phase of programme expansion. Our findings underscore the risk of losing effectiveness if programme quality is not maintained during scale-up. Key factors, such as training and motivation of frontline workers, are important to address when bringing a programme to scale.
Subject(s) community-based programme; difference in differences; impact evaluation; integrated nutrition programme; scale-up; Child Nutrition Disorders; Child; Preschool; Community Health Services; Government; Health Education; Health Promotion; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant; Newborn; Madagascar; Nutritional Sciences; Nutritional Status; Program Evaluation; Surveys and Questionnaires
Publisher eScholarship, University of California
Type of publication article
Format application/pdf
Source Maternal and Child Nutrition, vol 15 Suppl 1, iss Suppl 1
Rights public
Identifier qt65h992zg
Repository Berkeley - University of California
Added to C-A: 2023-05-30;10:09:57