Multi-sectoral programs are essential for addressing nutrition problems among pregnant women and their infants in many poor areas of lower income countries. Yet designing appropriate evaluations, to respond to different disciplinary cultures of evidence, remains a challenge. We describe the context, program development process, and evaluation design of the Mama SASHA project using a biofortified orange-fleshed sweetpotato (OFSP).
A multi-disciplinary team used needs assessments, stakeholder consultations, and a round of implementation evaluation of a pilot to develop a program theory of change and resulting impact pathway describing what aspects of the program would be monitored and how. Program monitoring and regular feedback meetings informed mid-course corrections in implementation. To measure health impact, we conducted a quasi-experimental allocation by health facility catchment area, repeat village surveys across intervention and control areas, and individual mother-child pair tracking longitudinally. We collected resource use and costs to assess affordability, cost-effectiveness and sustainability.
The benefits of multi-sector programs outweigh the challenges. Working across sectors and disciplines resulted in a robust program theory and impact pathway that guided the monitoring and evaluation strategy. Substantial time is needed for planning, pilot testing, and re-designing based on preliminary findings. Coordinating multiple evaluation components is associated with increased staff burden.
Managing mixed methods evaluation involved trade-offs but was essential for responding to agriculture, nutrition and health sector stakeholders, program funders and disciplines concerned about nutrition of populations in lower income countries.