FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT Prepared by Rebecca Copeland Timothy Frankenberger Eileen Kennedy Submitted by LTG Associates, Inc. and TvT Associates, Inc. Submitted to The United States Agency for International Development Under Contract HRN-I-00-99-00002-00, Task Order 2 Prepared for Office of Health and Nutrition Center for Population, Health and Nutrition Bureau for Global Programs, Field Support and Research U.S. Agency for International Development March 2002 Food and Nutrition Technical Assistance Project Assessment, was prepared under the auspices of the U.S. Agency for International Development (USAID) under the terms of the Monitoring, Evaluation, and Design Support (MEDS) project, Contract No. HRN-I-00-99-00002-00, Task Order No. 2, TD#43. The opinions expressed herein are those of the authors and do not necessarily reflect the views of LTG Associates, TvT Associates, or USAID. Information about this and other MEDS publications may be obtained from: Monitoring, Evaluation, and Design Support (MEDS) Project 1101 Vermont Avenue, N.W., Suite 900 Washington, DC 20005 Phone: (202) 898-0980 Fax: (202) 898-9397 jklement@medsproject.com www.medsproject.com ACKNOWLEDGMENTS We express our appreciation to United States Agency for International Development (USAID) staff in Washington and the Missions and Food and Nutrition Technical Assistance (FANTA) staff for their willingness to be interviewed at length, and for their insight, advice, and recommendations. We also appreciate the insight of other individuals in the international nutrition community. The organizations and individuals mentioned in this report are addressing the vitally important and difficult challenge of working to improve the nutrition and health status of populations, especially women and children, in developing countries. The team wishes to thank the Monitoring, Evaluation, and Design Support (MEDS) project staff, especially Symantha Holben and Muthoni Njage, for their attention and efforts in arranging the details of the review process. Their responsiveness and competence are appreciated. Rebecca Copeland Timothy Frankenberger Eileen Kennedy ACRONYMS ACC/SCN Administrative Committee on Coordination, Sub-Committee on Nutrition (United Nations) AED Academy for Educational Development AIDS Acquired Immune Deficiency Syndrome BHR Bureau for Humanitarian Response CMR Crude Mortality Rate CORE Child Survival Collaborations and Resources Group CRS Catholic Relief Services CS Cooperating Sponsor CSTS Child Survival Technical Support CTO Cognizant Technical Officer DCHA Democracy, Conflict, and Humanitarian Assistance DHS Demographic and Health Survey EGAT Economic Growth, Agriculture and Trade FAM Food Aid Management FANTA Food and Nutrition Technical Assistance project FFP/DP Food for Peace, Development Program FFP/EP Food for Peace, Emergency Program G/PHN Bureau for Population, Health and Nutrition (now the Bureau for Global Health) HIV Human Immunodeficiency Virus IFPRI International Food Policy Research Institute IR Intermediate Result ISA Institutional Support Agreement LAC Bureau for Latin America and the Caribbean MEDS Monitoring, Evaluation and Design Support Activity PPC Bureau for Program and Policy Coordination PPM Program, Planning, and Management PVC Private Voluntary Cooperation PVO Private Voluntary Organization REDSO/ESA Regional Economic Development Support Office/East and Southern Africa RNIS Refugee Nutrition Information Systems State/PRM State Department Bureau of Population, Refugees and Migration UNICEF United Nations Children’s Fund USAID United States Agency for International Development WFP World Food Programme CONTENTS ACKNOWLEDGMENTS ACRONYMS EXECUTIVE SUMMARY.............................................................................................. i I. Introduction ................................................................................................................. 1 II. General Framework .................................................................................................... 5 III. Support to USAID and Cooperating Sponsors; Nutrition and Food Security Program Development; Analysis, Monitoring, and Evaluation (IR.1) .......................................... 11 IV. USAID Global and Priority Country Mission Support in Policy and Strategy Development (IR.2)…................................................................................................... 19 V. Food Security/Nutrition Best Practices and Acceptable Standards (IR.3).................. 29 TABLES Table 1: Number of Persons Interviewed........................................................................ 3 Table 2: FANTA Funding and Expenditure to Date ....................................................... 6 Table 3: Priority Countries........................................................................................... 26 FIGURES Figure 1: FANTA Results Framework and Performance Indicators................................. 8 APPENDICES A. Assessment Scope of Work ..................................................................................... 37 B. FANTA Publications and Documents...................................................................... 43 C. Persons Interviewed................................................................................................. 49 D. Assessment Interview Questions ............................................................................. 53 E. Performance Indicator Report.................................................................................. 55 i EXECUTIVE SUMMARY OBJECTIVES OF THE ASSESSMENT: · To assess the appropriateness of the FANTA program strategy within the current USAID policy/programming environment. · To assess the degree to which FANTA has responded to the opportunities for improving food security/nutrition programming of USAID (Global Bureau for Population, Health and Nutrition (G/PHN), Bureau for Humanitarian Response/Food for Peace (BHR/FFP), Missions, Regional Bureaus) and its partners programs. · To recommend directions for the second five-year cooperative agreement. RECOMMENDATIONS: 1. The FANTA mandate continues to be relevant given the renewed focus on nutrition interventions in the Agency’s efforts to address unmet needs in maternal and child health and a strong emphasis on long-term, sustainable solutions. The broad consensus received in this assessment is that the FANTA project plays a unique and important role providing specialized technical assistance to a wide range of stakeholders involved in food security, nutrition and health. As USAID’s only multisector nutrition project, FANTA is well placed to make significant contributions in current and future policies and programs. 2. The performance of Academy for Educational Development (AED) has been satisfactory. There was a clear consensus that FANTA project activities over the last three years have led to substantial accomplishments in the three Intermediate Results (IRs) of their mandate for programming, policies and strategies, and best practices and acceptable standards. Overall, FANTA is a well managed and highly regarded project and the technical assistance they provide is viewed as high quality, useful, and responsive to stakeholder/partner needs. 3. The team therefore recommends that USAID exercise their option of continuing the FANTA project for a second five-year period. To build upon the successes of the first three years, the team has specific recommendations for the remaining one and a half years under the current agreement, and for the second five-year period. Support to USAID and Cooperating Sponsors, Nutrition and Food-security related Program Development, Analysis, Monitoring and Evaluation (IR.1) 4. FANTA needs to increase its support to food security issues that encompass agriculture and other food access measures. Despite the ongoing food security work being carried out by the International Food Policy Research Institute (IFPRI), Cornell University, and Tufts University, FANTA information in this FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT ii field did not equal the scope of technical assistance provided for nutrition and health. Better use of subcontractors like IFPRI, Cornell and Tufts is needed as well as additional linkages with the Bureau for Economic Growth, Agriculture and Trade (EGAT) and Michigan State University to share promising practices and facilitate better collaboration in this field. 5. FANTA needs to establish better ways of ensuring that technical needs of implementing partners are driving the selection of nutrition and food security promising practice efforts. Although FANTA has tried to be responsive to PVO needs, ways must be sought to insure that the focus of research and technical assistance is addressing the felt needs of implementing partners. Existing means of obtaining PVO input may need to be re-examined. Small, more frequent meetings could provide FANTA an opportunity to share the results of various activities they are carrying out that may not be readily available to PVOs indirectly engaged in the activity. 6. In the second five-year phase, FANTA needs to develop ways of scaling up its promising practices to its implementing partners and other organizations. FANTA’s connection to research institutions was acknowledged as vital, but several stakeholders stated that better ways of translating this information into operational modes need to be developed. Although FANTA has generated a number of useful guides for improving nutrition and food security programming, it is not clear that FANTA has an apparent strategy for scaling up promising practices. USAID, Global, and Priority Country Mission Support in Policy and Strategy Development (IR.2) 7. The level of in-country technical assistance needs to increase substantially in order to meet upcoming priority country technical assistance needs and to maximize the effectiveness of FANTA inputs in those country programs. Most of the priority country Missions stated that greater and more sustained in￾country technical assistance will make a "huge difference" in pushing through improvements to Title II programs and other Mission priorities that involve food security and health/nutrition strategic objectives. The imbalance between demand and available staff has inevitably caused some delay in program implementation and loss of momentum. A shift at this stage in program emphasis is both feasible and desirable. 8. Conduct a strategic review of priority countries to ensure maximum return on investments towards overall Project objectives, e.g. impact and lessons learned. This review should be the basis for planning in the second five year period. The team felt that a strategic review is required of the list of priority countries and the level of effort invested in each country. The links between priority countries and the four established criteria are not clear in project documentation. The level of effort expended and planned in the priority countries needs to be weighed against the established criteria and expected returns. EXECUTIVE SUMMARY iii Food Security/Nutrition Best Practices and Acceptable Standards (IR.3) 9. Output and results from the activities to document best practices and acceptable standards need to be better leveraged. Investments in IR.3 with subcontractors are medium- to long-term activities. For example, field validation studies on innovative food security measurements in Bangladesh and Burkina Faso will produce a wealth of data in years four, five, and beyond. FANTA needs to identify, a priori, how these data will be used, what kinds of additional analyses can be conducted, and which staff and institutions will be involved. 10. FANTA needs to be clearer about the specific products they want from IR.3 activities. Researchers working as subcontractors for FANTA do not have a comparative advantage in translating results to a wider audience. Given a major focus of IR.3 output is their use in training and technical assistance, increased attention should be focused on how results will be used. This is also an ideal time for FANTA to expand the client base reached by their materials. This would not only potentially expand the client base but also give increased visibility to FANTA. 11. A strategic plan for documenting best practices and acceptable standards needs to be developed. A systematic plan will help frame the ideas for upcoming investments in IR.3. The plan would specify high-priority topics, and would include a rationale for activities. A more methodical approach would address some of the perceived “chopping up of ideas” that has occurred in the first phase. A strategic plan could also be a very effective tool for training and advocacy. A rigorous, concise document would point out (1) what we know, (2) gaps in our knowledge, and (3) how and what FANTA will contribute to filling these gaps. 1 I. INTRODUCTION A. BACKGROUND The Nutrition Results Package is a ten-year program framework authorized in 1998. Under this authorization, The Food and Nutrition Technical Assistance (FANTA) project was awarded competitively in September 1998 to the Academy for Educational Development (AED) as the prime contractor, with Cornell University and Tufts University as subcontractors. The FANTA proposal included a memorandum of understanding with Food Aid Management (FAM)1 , a consortium of Private Voluntary Organizations (PVOs), referred to as Cooperating Sponsors (CS), implementing Title II food aid development and emergency programs.2 The overall purpose of FANTA is "improved food and nutrition policy, strategy, and program development". Three Intermediate Results (IRs) were identified to achieve this purpose: IR.1. USAID's and Cooperating Sponsors' nutrition and food security-related program development, analysis, monitoring, and evaluation improved, IR.2. USAID, host country governments, and Cooperating Sponsors establish improved, integrated nutrition and food security-related strategies and policies, and IR.3. Best practices and acceptable standards in nutrition and food security-related policy and programming adopted by USAID, Cooperating Sponsors, and other key stakeholders. The Cooperative Agreement states that the central activity of FANTA is to provide technical assistance to USAID, Title II PVOs, and host governments in planning and implementing cost-effective programs that can bring about measurable changes in the nutritional status of target populations. FANTA is unique in that it is charged with taking a broad approach to food security by assisting Missions and partners to examine how non-nutrition programs can be used to improve nutrition and to help ensure that investments in nutrition are focused on the best possible mix of interventions to achieve food security. The FANTA mandate is threefold: · To provide technical assistance to programs, · To lead or contribute to policy discussions, and · To identify and document promising practices and sponsor their dissemination. 1 Food Aid Management is a consortium of a number of private voluntary organizations that collaborate on technical and administrative issues related to food aid programming 2 The terms private voluntary organization (PVO) and cooperating sponsor are used interchangeably in this report. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 2 Technical assistance includes face-to-face meetings with program officials and staff to identify and solve problems; written materials such as technical updates, state-of-the-art guides on programming, and summaries of lessons learned; and formal reviews of Title II program proposals, implementation plans, program evaluations, and training activities. The primary partners in FANTA include the following: · Fifteen PVOs that design and implement more than 80 Title II development (non￾emergency) programs in 27 countries. PVOs carry out interventions across many sectors, particularly agriculture; natural resources; microfinance; education; water and sanitation; health; nutrition; and information, education, communications, and behavior change activities. · Global Bureau/Office of Population, Health and Nutrition (G/PHN), particularly for maternal health, child health, and HIV/AIDS teams and projects. · Bureau of Humanitarian Response (BHR) Food for Peace (FFP) Program. · USAID Missions and PVOs in 4–6 priority countries. · REDSO/ESA and Africa Bureau. · Tufts University, Cornell University, International Food Policy and Research Institute (IFPRI), World Health Organization (WHO), and Freedom from Hunger (FFH). B. ASSESSMENT SCOPE OF WORK Annex A contains a detailed scope of work. The assessment is meant to address the following points: 1. Progress made to date in three intermediate results: ü Programs. ü Policies and strategies. ü Best practices and acceptable standards. 2. The appropriateness and effectiveness of approaches, strategies, and activities by FANTA in achieving results to date, including operations/management, resource use, staff, communications, and collaborations. Recommend changes, if any, needed to improve these areas in the remainder of the current agreement. 3. Whether changes are needed to the FANTA project, objectives for the second five-year agreement to ensure relevance to the current USAID policy and programming environment, and to ensure that it meets emerging and future needs. This report is organized into four sections. The first is a review of the overall project operating environment and general findings and recommendations, followed by three sections that examine the three intermediate results. Each section contains a purpose, objectives, and expected results; a review of approaches and operations in project years 1–3; a summary of technical assistance and findings of the assessment team; and recommendations for the remainder of the current agreement and for the second five-year period. I. INTRODUCTION 3 C. METHODOLOGY The team first conducted a complete review of FANTA publications and documents (Annex B). The team then held meetings with key USAID/Washington program managers and senior staff, a majority of the FANTA project staff, and several PVO representatives whose offices are based in the Washington, DC area. The team also conducted telephone interviews with USAID Mission staff in priority countries, key subcontractors, and United Nations agency staff (Annex C). A list of interview questions (Annex D) was provided to the team by the FANTA Cognizant Technical Officer (CTO) for general guidance. The interviews were open-ended and usually took one hour. Most meetings were conducted by two or three members of the team, whereas telephone interviews were usually conducted by one team member who was assigned to that area. A total of 44 people were interviewed in person or by telephone (Table 1). FANTA staff were also interviewed (not shown in Table). Table 1 Number of People Interviewed for FANTA assessment by Organization USAID/W Global Health 7 DCHA 7 PPC 3 Africa Bureau 1 LAC Bureau 1 EGAT 1 USAID Missions REDSO/ESA 2 Ethiopia 1 Haiti 1 Honduras 2 India 1 Madagascar 1 Subcontractors Cornell 2 Tufts 2 IFPRI 2 UN Agencies UNICEF 1* WFP 1 Title II PVOs and others Africare 1 CARE 2 Save the Children1 World Vision 2 CRS 1 FAM 1 *The person contacted was formerly with G/PHN. CRS is Catholic Relief Services; FAM, Food Aid Management; LAC, Latin America and the Caribbean; UNICEF, United Nations Children’s Fund; WFP, World Food Programme. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 4 5 II. GENERAL FRAMEWORK A. OPERATING ENVIRONMENT Title II food aid programs represent approximately one third of the annual USAID budget and are therefore an important resource and platform for reaching undernourished women and children throughout the developing world. The 1998 request for applications stated: “The Program (FANTA) affords G/PHN an unprecedented opportunity to influence the quality and health impact of food aid programming, both through its role in providing direct assistance to Cooperating Sponsors, Missions and BHR/FFP, and through its role in facilitating technical exchange and cooperation with other ongoing G/PHN programs.” FANTA was envisioned to serve as a link between BHR/FFP and G/PHN through its activities in health and nutrition programming among Title II PVOs, and by integrating those activities within the food security strategies and population, health, and nutrition portfolios of 4–6 priority countries. Through this link, FANTA was to have compiled lessons and good field practices in order to guide the USAID food security and nutrition program strategy. Within G/PHN, FANTA was also seen as serving as a link among the divisions of maternal health, child survival, and HIV/AIDS. Whether FANTA was achieving its goal would be measured by assessing the percentage of programs in priority countries that report better nutrition among beneficiaries in a given year. Nine monitoring indicators have been defined for tracking how well the three intermediate results are achieved (see Figure 1). As a technical assistance project, FANTA results are primarily achieved through its partners and stakeholders. People interviewed by the team readily acknowledged that FANTA has operated within several constraints in trying to affect policies and programs, and to build linkages between the various stakeholders. These constraints include the following: · A general lack of knowledge and experience of Title II programs within G/PHN and country Missions. · Minimal internal demand for broad-based nutrition work within G/PHN, and a lack of consensus within USAID/Global Health about nutrition strategy. · The relatively limited base of global knowledge of nutrition program successes. This is particularly true for emerging areas of interest such as women’s nutrition, nutritional support and care for persons living with HIV/AIDS. · Title II PVOs (i.e., Cooperating Sponsors) are independent organizations and collaboration with FANTA on specific activities is a joint decision. These constraints have to some degree affected the approaches and activities by FANTA in all three intermediate results and the results achieved in each area. It has been widely acknowledged that prompting major change in the face of the constraints listed above is outside the manageable scope of FANTA. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 6 On the positive side, there is renewed interest and commitment from G/PHN leaders in bringing nutrition more fully into the G/PHN portfolio. “This may be nutrition’s moment,” said the office director. FANTA, as the only multi-sectoral nutrition project within USAID, is in an ideal position to make the most of this opportunity. B. FUNDING AND EXPENDITURES TO DATE The original funding ceiling for the cooperative agreement was $30 million; up to $10 million was to have come from G/PHN core funds and $20 million from field support or add-on funding over the initial five-year period. Four years into the five-year agreement, as of September 30, 2001, the FANTA project has received a total of $12,007,112 in authorized funding. This represents 40 percent of the original funding level. Slightly more than half the funds are from the G/PHN core budget ($6.4 million) and the remaining ($5.9 million) are field support funds from USAID bureaus (BHR, Africa, PPC), REDSO/ESA, and seven countries.3 Table 2 shows that only half (53 percent) of the $12 million obligated funds have been spent. Field support and core funds constitute 42 percent and 53 percent, respectively, of obligated funds. Table 2 FANTA authorized funding and expenditures as of September 30, 2001 Funding source Obligated (as of 9/30/01) Expended (% of obligated) G/PHN $6,420,147 $3,355,243 (53%) BHR $3,069,000 $1,968,704 (31%) Field support $2,517,965 $1,066,026 (42%) Subtotals $12,007,112 $6,389,974 (53%) According to the CTO, overall underspending is in the range of 10–15 percent. FANTA is expected to maintain a 13–15 month pipeline of project funds (approximately $1.2–1.5 million) at the beginning of the fiscal year due to delays in annual obligations. In addition, some vacancies within the FANTA project staff have not been filled in the last three years. C. STAFF FANTA staff has a mix of background, skills, and experience to reflect the multi-sectoral food security approach of nutrition, agriculture, food consumption, economics, emergencies, and public health. The current staff consists of the project director, 11 technical specialists (one of whom also serves as the deputy director), and three program associates/assistants. The core staff is supplemented with short-term consultants and one long-term advisor based in Nicaragua. Several positions have been vacant. Although these positions are now filled (some of them very recently), three vacancies indicate that some activities might have been affected by a lack of staff: · Communication specialist. 3 India, Honduras, Haiti, Guatemala, Nicaragua, Madagascar, Ethiopia. II. GENERAL FRAMEWORK 7 · Senior nutritionist. · Monitoring and evaluation specialist.4 A new staff vacancy for a second senior food security specialist is unfilled and recruitment efforts are underway. D. MONITORING AND EVALUATION The internal monitoring and evaluation system for FANTA, the Performance Measurement and Evaluation Plan (PMEP), is designed to provide data for monitoring indicators of the results framework (Figure 1). The definitions, data sources, and annual targets for each indicator were finalized in February 2001 after lengthy discussions with USAID. Not surprisingly, for experts in the field, the system is well designed and appears to be functioning smoothly for purposes of tracking activities and accomplishments. An annual performance indicator report is prepared for USAID. (See Annex E for the most recent report from project year 3.) One component of the project’s monitoring system is the biweekly reports prepared by technical staff on each intermediate result and all related activities, accompanied by supporting documents. The detail of the reports and how they are designed to mesh with specific monitoring indicators is impressive. Reports are compiled by the information staff and are used as the basis for the quarterly progress reports and annual reports for USAID. The financial reporting system is also well designed and tracks all expenditures against the 15 different funding sources, as well as intermediate results and all main activities. One USAID program manager commented, “FANTA is well managed and well monitored.” The internal monitoring systems examined as part of this assessment support that view. 4 The position was filled in September 2001 and will be vacant again shortly, when the person accepts another job in April 2002. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 8 FIGURE 1 FANTA Results Framework and Performance Indicators NTA Results Framework and Performance Indicators Strategic Objective Improved food and nutrition policy, strategy, and program development Intermediate Result One USAID’s and CS’s nutrition and food security-related program development, analysis, monitoring and evaluation improved Intermediate Result Two USAID, host country governments and CSs establish improved, integrated nutrition and food security-related strategies and policies Intermediate Result Three Promising practices and acceptable standards in nutrition and food security￾related policy and programming adopted by USAID, CSs, and other key Impact Indicator 1 Enhanced nutritional impact of FANTA-assisted nutrition and food security-related programs as demonstrated by decreased prevalence in stunting in the target populations in priority countries over the life of activities Monitoring Indicator 1 Percentage of programs in the priority countries reporting improvements in nutritional status among direct beneficiaries in a given year Monitoring Indicator 1.1 Percentage of CS food aid proposals assessed to satisfy agency review criteria in problem assessment, performance indicators, intervention design, and monitoring & evaluation plan Monitoring Indicator 1.2 Percentage of development food aid CS programs able to meet USAID’s reporting requirements including annual submissions, baselines, and evaluations Monitoring Indicator 1.3 Percentage of FFP/EP reporting positive change or maintenance of nutritional status Monitoring Indicator 1.4 Percentage of CSs able to meet FFP/EP reporting requirements Monitoring Indicator 2.1 Percentage of recommendations adopted by priority country CS programs Monitoring Indicator 2.2 Percentage of recommendations adopted by priority country USAID missions Monitoring Indicator 2.3 Number of recommended policies or strategies adopted by priority country host governments. Monitoring Indicator 3.1 Percentage of funding from other than G/PHN Monitoring Indicator 3.2 Number of promising practices and acceptable standards identified, produced, and disseminated by FANTA II. GENERAL FRAMEWORK 9 E. GENERAL FINDINGS AND RECOMMENDATIONS Following the completion of interviews with the various stakeholders and review of project background documents, progress reports and technical products, the team agreed on the following overall findings and recommendations: 1. The FANTA mandate continues to be relevant given the renewed focus on nutrition interventions in the Agency’s efforts to address unmet needs in maternal and child health and a strong emphasis on long-term, sustainable solutions. The broad consensus received in this assessment is that the FANTA project plays a unique and important role providing specialized technical assistance to a wide range of stakeholders involved in food security, nutrition and health. As USAID’s only multi-sector nutrition project, FANTA is well placed to make significant contributions in current and future policies and programs. 2. The performance of Academy for Educational Development has been satisfactory. There was a clear consensus that FANTA project activities over the last three years have led to substantial accomplishments in the three IRs of their mandate for programming, policies and strategies, and best practices and acceptable standards. Overall, FANTA is a well managed and highly regarded project and the technical assistance they provide is viewed as high quality, useful and responsive to stakeholder/partner needs. 3. The team therefore recommends that USAID exercise their option of continuing the FANTA project for a second five-year period. The following sections present the achievements to date under the three IRs and the findings and recommendations specific to each IR, for the period remaining under the current agreement and for the second five-year period. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 10 11 III. SUPPORT TO USAID AND COOPERATING SPONSORS; NUTRITION AND FOOD SECURITY￾PROGRAM DEVELOPMENT, ANALYSIS, MONITORING, AND EVALUATION (IR.1) A. PURPOSE, OBJECTIVES, AND EXPECTED RESULTS The overall purpose of the IR.1 is to improve food security and nutrition programming by supporting USAID/BHR/FFP and its Cooperating Sponsors. The aim of the intermediate result is to strengthen the capacity of stakeholders who analyze food and nutrition security problems, and who design projects and report their progress. Food aid programs are important because they provide nutrition directly to people, and because food aid programs are designed to complement other health and nutrition activities. Over the last few years the policy and strategy have shifted away from short-term programs that focused on meeting immediate needs through nutrition supplements to a longer-term, sustainable food security plan. As part of this shift, there has been an emphasis on using Title II development (nonemergency) resources to focus on improving agricultural productivity and nutrition for mothers and children. Humanitarian assistance is the focus of the Title II emergency program. The expected results have been defined in FANTA’s Results Framework and Performance Indicators (Figure 1): · Percentage of Cooperating Sponsor food aid proposals (FFP/DP) assessed to satisfy Agency review criteria in problem assessment, performance indicators, intervention design, and monitoring and evaluation plan. · Percentage of development food aid Cooperating Sponsor programs (FFP/DP) able to meet USAID’s reporting requirements, including annual submissions, baselines, and evaluations. · Percentage of FFP/EP reporting positive change or maintenance of nutritional status. · Percentage of Cooperating Sponsors able to meet FFP/EP reporting requirements. Much of the discussion in the following section is focused on the Title II development program. B. REVIEW OF APPROACH AND OPERATIONS IN PROJECT YEARS 1–3 The FANTA strategy is to promote a multidisciplinary approach in addressing food insecurity and malnutrition; to establish institutional linkages to support a broad-based approach; and to develop and use sound technical tools to assess problems, and design and implement solutions. Improved monitoring and reporting of results is an important component of the approach. FANTA provides technical assistance in these areas to the Title II development program, which has a portfolio of more than 80 projects in 27 countries implemented by 15 Cooperating Sponsors. The Food for Peace nonemergency FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 12 portfolio disburses $400 million annually in in-kind and monetized food commodities for a range of food security and nutrition activities. Activities as part of IR.1 are carried out with three primary partners, the Bureau of Humanitarian Response, the Office of Food for Peace Development Program and the Food for Peace Emergency Program division (BHR/FFP/DP and BHR/FFP/EP) and Bureau for Humanitarian Response, Program, Policy, and Management (BHR/PPM), as well as with Title II PVOs. In addition, FANTA works closely with the Office of Private Voluntary Cooperation (BHR/PVC) and its partners (the child survival PVOs) to ensure that technical improvements are shared with the wider community. C. SUMMARY OF TECHNICAL ASSISTANCE TO DATE AND FINDINGS This section contains an assessment of technical assistance activities provided by FANTA to each of the three primary stakeholder groups, and findings of the assessment team in the three areas. 1. BHR/FFP/DP FANTA provides ongoing support to the FFP/DP by reviewing Title II program concept papers, proposals, and results reports, and providing technical comments and recommendations. Last year, for example, FANTA completed technical reviews on 42 proposed Title II programs and 37 ongoing programs. These reviews focused on food security analysis, implementation strategies, and monitoring and evaluation. FANTA also participated in field reviews of Burkina Faso (in Mali), Haiti, and Nicaragua programs, and FANTA staff regularly participated in Washington-based review meetings with FFP and PVO staff. FANTA staff conducted several training workshops on problem assessment, nutrition interventions, program design, results reporting, and monitoring and evaluation for participants from USAID, Title II PVOs, host country government representatives, and other partners. FANTA staff also assisted FFP/DP to produce results reports for the development program, which forms the basis of the program’s results report and resource request (R4) submission. To further promote best practices and acceptable standards in food security and nutrition programming, the FANTA project has developed a package of materials for use by FFP staff and PVOs. These include eight indicator and measurement guides, nine technical reports, four training workshop materials and 12 technical notes (Appendix B) staff also created the Project web site (www.fantaproject.org) that contains technical guidance for FFP staff and Cooperating Sponsors. Section V of this report contains more details on the promotion of best practices and acceptable standards. The FANTA project has also contributed to the Commodity Reference Guide that contains information on ration design and commodity specifications. It has also participated in a USAID task force to explore the feasibility of using nonfat dry milk and associated blended commodities in food security programs. Input by FANTA staff has III. SUPPORT TO USAID AND COOPERATING SPONSORS; NUTRITION AND FOOD SECURITY PROGRAM DEVELOPMENT, ANALYSIS, MONITORING, AND EVALUATION (IR. 1) 13 contributed to the establishment of the FFP policy and guidelines on the use of nonfat dry milk and associated products in Title II programs. FANTA has played an important role in the development of the strategic plan for the FFP/DP. This year, FANTA staff completed the Report of Food Aid and Food Security Policy Assessment: A Review of the Title II Development Food Aid Programs, which was funded by FFP and PPM. The findings will be used to develop an updated strategy and results framework for the FFP/DP. From the perspective of the FFP staff, FANTA input has been invaluable in promoting technical improvements in the Title II development program. FANTA staff is viewed as technically competent, and their insights are critical to Title II program improvements. The multisectoral nature of the staff’s technical input is much appreciated, particularly their technical assistance on nutrition and performance indicators. In addition, the detailed knowledge of various countries by FANTA staff has helped FFP staff to better integrate Title II programs into USAID field programs. The rapport between FANTA staff and FFP staff is very good. FFP/DP staff are pleased with the work performed by FANTA staff and would like FANTA staff to continue to support Title II efforts. Given these positive responses, FFP staff cited several concerns regarding FANTA: · FANTA staff may be overextended. FANTA is currently trying to fill key positions in nutrition, maternal and child health, and food security programming. · Several FFP staff believed that the people who performed an assessment of the 1995 USAID Food Aid and Food Security Policy were not familiar enough with Title II programming to deeply probe the issues. FFP staff are still uncertain whether the assessment provides enough guidance and direction for the development of the next strategic plan. · More attention should be given by FANTA to agriculture and food access indicators and interventions. Despite the ongoing food security work being carried out by the IFPRI, Cornell University, and Tufts University, their information did not equal the scope of technical assistance provided for nutrition and health. · There is confusion among PVOs and Missions regarding whether FANTA recommendations are FFP or policy. Disconnects have occurred between FANTA recommendation and the position of the FFP on an issue. An example cited by FFP staff was the recommendation of shifting from individual rations to take￾home family rations in a particular program. Such a change had significant budget implications for the FFP program. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 14 2. Support to BHR/FFP/EP and BHR/PPM FANTA staff helped the FFP Emergency Program division (FFP/EP) develop guidelines for Title II programs in countries that are in transition from needing emergency assistance to development assistance. These guidelines present objectives, interventions, monitoring and evaluation activities, and formats for reporting transition activities. Key points in the guidelines were integrated into the annual FFP policy letter to PVOs. FANTA staff reviewed concept papers and proposals, and made comments and recommendations to improve rations, program strategies, and monitoring and evaluation plans and indicators. They also prepared results reports for Title II emergency and short￾term development programs. To help build capacity in emergency programming, FANTA staff have trained USAID staff and partners on emergency Title II program objectives, project design, problem assessment, monitoring and evaluation methods, and reporting requirements. Training has occurred at the annual course for USAID food aid managers. For the last three years, FANTA has had an important role in helping Food for Peace emergency program staff to develop a strategic plan, and in all likelihood, FANTA staff will be involved in developing a new emergency program strategic plan and results framework this year. FANTA helped refine the FFP/EP database for Title II emergency program results. The database is now better able to track indicators, targets, and annual progress for emergency activities funded by the FFP program. (A new FFP Institutional contractor is now responsible for maintaining the database.) The FANTA project has provided other emergency program activities, including the following: · Guidance to assess adult undernutrition in emergencies, in collaboration with the United Nations Administrative Committee on Coordination/Sub-Committee on Nutrition (ACC/SCN) working group on emergencies. · Guidelines for infant feeding in emergencies, with the LINKAGES project. · Technical support to promote standardized protocols and reporting tools for therapeutic and supplementary feeding programs during an emergency in Burundi. · An in-country review of the recent outbreaks of pellagra, possibly tied to food aid shipments. FANTA offered recommendations for appropriate interventions. · An assessment of the household food economy methodology developed by Save the Children–UK to investigate better practices for targeting food aid in complex emergencies. · A checklist to assist emergency food aid managers to design and implement food distribution operations. · A review of existing resource materials for emergency food managers and a descriptive bibliography of key documents. · Development of a ready-to-eat emergency ration bar to meet nutritional needs in emergencies. The bar provides essential nutrients and helps prevent malnutrition for up to 30 days. The National Academy of Sciences is reviewing III. SUPPORT TO USAID AND COOPERATING SPONSORS; NUTRITION AND FOOD SECURITY PROGRAM DEVELOPMENT, ANALYSIS, MONITORING, AND EVALUATION (IR. 1) 15 recommendations made by FANTA and will soon issue specifications that will form the basis for USAID to procure the bar. · Collaborated with the ACC/SCN to produce Refugee Nutrition Information System (RNIS) reports, which contain information on the nutritional status of refugees and displaced persons, and which are used to assess needs, track progress, and demonstrate results of USAID programs. · Worked with RNIS and the WHO Department of Emergency and Humanitarian Action to compile and analyze nutritional status (stunting) and crude mortality rate (CMR) data on refugees and displaced populations. These efforts resulted in USAID and the State Department Bureau of Population, Refugees and Migration (State/PRM) adopting a CMR as a humanitarian response performance indicator. BHR/FFP/EP and BHR/PPM representatives appreciated the support of FANTA in emergency programming. PPM staff praised the emergency nutrition support offered by FANTA staff as well as their additions to program reviews, results reports, and monitoring and evaluation indicators. Some BHR staff have concerns that may affect FANTA support to Title II emergency programming. For example: · FANTA may not have enough staff and resources to adequately provide the support needed by FFP/EP staff. There is concern that FANTA undertakes too many tasks, and that it may not be able to respond quickly when the emergency program division needs support. · Most of the FANTA staff have a development background rather than an emergency nutrition background. In general, experience in nutrition emergencies is much higher among Europeans. FANTA could rely on a cadre of European experts who have more experience. · FANTA may not have enough independence from FFP to perform unbiased and potential critical evaluations of USAID emergency programs. · USAID needs to use the technical support offered by a variety of organizations rather than rely on just one organization such as FANTA. 3. Support to Cooperating Sponsors in Title II Development and Emergency Programming When requested, FANTA provides guidance to PVOs in program design and development by reviewing concept papers and draft proposals, and by providing recommendations. After a formal proposal review, FANTA staff are available to provide technical support to PVOs on program design and implementation. FANTA guidelines, technical documents, training activities, and its project web site are also available to support PVOs, and in particular, on specific issues related to Title II programs. Much of the support is provided through electronic mail, telephone calls, and meetings. FANTA also provides guidance to the planning, interpretation and follow-up of evaluations of Title II development programs. Evaluation results have been used to improve existing programs and to design better programs in the future. As part of supporting FFP efforts to strengthen the abilities of its implementing partners, FANTA works with FAM, which is funded by an institutional support agreement, to FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 16 develop methods and guidance to improve Title II programs. FANTA is an active participant in the monitoring and evaluation working group and the local capacity building working group, which are involved in assessing existing indicators and identifying promising measurement practices. FANTA is also engaged in activities to increase collaboration between Title II PVOs and child survival PVOs. Working with the Child Survival Technical Support Project (CSTS), which is funded by BHR/PVC, FANTA facilitated a workshop on nutrition programming in collaboration with FAM and The Child Survival Collaborations and Resources Group (CORE). FANTA also reviewed proposals for new child survival programs that contain significant nutrition components. All PVO representatives acknowledged the value FANTA has contributed in strengthening Title II programs. It appears that everyone appreciates the technical guides produced by FANTA and, in particular, the technical assistance provided during monitoring and evaluation. Many PVO representatives stated that FANTA provides good technical advice on surveys, child feeding practices, and sampling. Staff in BHR/PVC support FANTA and have requested that FANTA staff continue to support child survival programming. Nevertheless, PVO staff expressed the following concerns about FANTA: · Many PVOs do not know the role FANTA plays and want to know what they can expect from its staff. For example, it is not clear how FANTA staff decide how much support they will provide to PVOs. One PVO representative stated, “we need to know what we can expect from them and what we can’t.” · The technical reviews by FANTA do not always consider realities in the field. Some PVO representatives said that the recommendations do not always contain the best solution given the realities. · Many PVO representatives believe that FANTA's technical support in developing and refining tools, manuals, and indicator guides could be more demand-driven than it currently is. For example, PVOs need support for agriculture interventions and indicators as well as food access measures. (The food access indicator tool kit being developed by the monitoring and evaluation working group is addressing this effort.) Although the TAG provides a forum for PVO input, it is unclear how much their input influences the documentation of best practices. Some PVOs believe that a conflict of interest exists when FANTA conducts assessment of the Food Aid and Food Security Policy, because FANTA is supported by FFP. · Because FANTA is funded by FFP, it is unlikely that FANTA can influence policy decisions. FANTA should focus more on program development and strategy. · FANTA does too many things. FANTA staff need to focus more on program development and providing technical assistance to the field. · FANTA wants generic evaluations of programs implemented by multiple Cooperating Sponsors in the same country. This strategy may not be wise if follow-up programs are to be implemented by different PVOs. · FANTA could better advise the process of developing exit strategies. III. SUPPORT TO USAID AND COOPERATING SPONSORS; NUTRITION AND FOOD SECURITY PROGRAM DEVELOPMENT, ANALYSIS, MONITORING, AND EVALUATION (IR. 1) 17 D. RECOMMENDATIONS 4. FANTA needs to increase its support to food security issues that encompass agriculture and other food access measures. Despite the ongoing food security work being carried out by the International Food Policy Research Institute (IFPRI), Cornell University, and Tufts University, FANTA information in this field did not equal the scope of technical assistance provided for nutrition and health. Better use of subcontractors like IFPRI, Cornell and Tufts is needed as well as additional linkages with the Bureau for Economic Growth, Agriculture and Trade (EGAT) and Michigan State University to share promising practices and facilitate better collaboration in this field. 5. FANTA needs to establish better ways of ensuring that technical needs of implementing partners are driving the selection of nutrition and food security promising practice efforts. Although FANTA staff have tried to be responsive to PVO needs, methods must be sought to insure that the focus of research and technical assistance is addressing the felt needs of implementing partners. Existing means of obtaining PVO input may need to be re-examined. For example, in addition to the TAG meetings, FANTA could have smaller meetings more often with several PVOs to elicit feedback and concerns. Although this is currently done on an ad hoc basis, this process could become more systematic. Such meetings could provide FANTA an opportunity to share the results of various activities they are carrying out that may not be readily available to PVOs indirectly engaged in the activity. 6. In the second five-year phase, FANTA needs to develop ways of scaling up its promising practices to it implementing partners and other organizations. FANTA’s connection to research institutions was acknowledged as vital but several stakeholders stated that better methods need to be developed for translating this information into operational modes. Although FANTA has generated a number of useful guides for improving nutrition and food security programming, it is not clear that FANTA has an apparent strategy for scaling up promising practices. For example, successful programs can be expanded by working through multiple institutions (quantitative scaling up). In addition to USAID and PVOs, FANTA could do a better job of sharing its work with the wider development community at strategically chosen international forums. Additionally, since FANTA is one of the only USAID multi-sector food and nutrition projects, it could demonstrate the value of combining multiple interventions to address nutritional problems for different contexts (functionally scaling up). Recent research supports the premise that broad-based nutrition programs focused on reducing general malnutrition could further gains in child survival than selective interventions. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 18 19 IV. USAID, GLOBAL, AND PRIORITY COUNTRY MISSION SUPPORT IN POLICY AND STRATEGY DEVELOPMENT (IR.2) A. PURPOSE, OBJECTIVES, AND EXPECTED RESULTS The overall purpose of the IR.2 is to ensure that Title II and population, health, and nutrition programs have a maximum effect on target populations, especially young children and women, by strengthening the relationship between USAID health, nutrition, agriculture, and food security interventions. In seven priority countries, FANTA has worked with USAID Missions and PVOs to strengthen food and nutrition security programs. It has done this by providing technical assistance on problem analysis, program design, and monitoring and evaluation of maternal and child health and nutrition interventions in Title II programs. FANTA also develops and revises Mission food security strategies and tries to more closely integrate food security and nutrition programs within the strategic framework of Missions. The expected results have been defined by the following indicators in the FANTA Results Framework and Performance Indicators (Figure 1): · Percentage of recommendations adopted by priority country Cooperating Sponsor programs. · Percentage of recommendations adopted by priority country USAID missions. · Number of recommended policies or strategies adopted by priority country host governments.5 B. REVIEW OF APPROACH AND OPERATIONS IN PROJECT YEARS 1–3 FANTA’s original mandate was to focus on creating guidance for policies and strategies. This was to shift programs: · “...from an exclusive focus on the treatment of severe malnutrition toward an emphasis on the prevention of mild to moderate malnutrition,” and · “…from an exclusive emphasis on promoting infant and child nutrition to one emphasizing adolescent girls’ and women’s nutrition, thereby recognizing the importance of life-cycle approaches and the intergenerational impact of nutrition.” Within this overall framework, FANTA policy and strategy recommendations must reflect local policies and operational realities of Missions and PVOs. Whereas, for example, FANTA strongly maintains the policy of shifting food aid so that it benefits all children under two years of age rather than malnourished children younger than age five, implementing this may not be feasible due to conflicting national policies and programs 5 Although the second intermediate result states that recommendations and strategies will be adopted in “host countries,” to date, FANTA has had few direct relationships with ministries of health or other government representatives. Primary in-country partners are Missions and PVOs. This leads to the question whether it is realistic to hold FANTA accountable—or conversely, to give it credit for—changes in national-level policies and strategies when there is little contact with the so-called change agent. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 20 in some countries. FANTA also continues to promote women’s nutrition, although currently, few activities focus specifically on women’s nutrition. Activities are carried out at two levels: in the seven priority country missions, and in USAID/Washington with G/PHN and the Bureau of Humanitarian Response. FANTA policy activities are covered primarily in IR.1 and IR.3. The following discussion examines the work that has been carried out in priority countries. According to program documents, FANTA prioritizes country requests for technical assistance using the following criteria:6 · High impact countries or those where joint USAID programs exist. · Larger food security programs are given priority, as are requests to solve problems of more general relevance. · Cooperating Sponsors with strong interest in assistance are considered ahead of those with less interest. · Assistance is offered where it will be relevant to the larger development audience, and where it will have a multiplier effect with other Title II PVOs, host governments, and local nongovernmental organizations. Individual staff members are assigned to cover specific countries. From Washington, they are responsible for reviewing proposals and maintaining regular communications with overseas counterparts. Although specific individuals in FANTA may be the primary contact, other FANTA staff are available to respond to queries as needed. Annual work plans and budgets are developed on the basis of specific scopes of work written by Mission counterparts. An approved work plan must be in place for overseas travel to occur. Work plans are revised and updated as needed during trips. Detailed trip reports are written in a standard format following the consultancy. Outside consultants are used to supplement core FANTA staff, although their use has been minimal. The CTO reviews and approves scopes of work and travel as part of the annual work approval process. The 2002 budget (program year 4) shows major increases in almost all technical assistance areas, with $4.8 million budgeted for the year compared with $6.1 million spent in the first three years. The fourth-year budget includes substantially more spending in priority countries, presumably for in-country technical assistance. The annual work plan does not contain a planned level of effort for specific countries or activities. Although individual country plans show specific activities and estimated costs, neither they nor the annual work plans describe more staff or other possible means for the higher spending levels. In Ethiopia, for example, the FY 2002 budget is $179,000, the same amount that was spent in the previous three years. This same pattern appears in the Haiti budget. Only the 2002 budget for Madagascar remains at a similar level as expenditures in previous years, at $94,000 (compared with $204,000 for the previous three years). 6 The criteria were established through a consultative process between USAID and PVOs. Priority countries are also determined by field support funds from Missions. Because it is a centrally funded project, FANTA cannot work without an endorsement from a Mission. IV. USAID, GLOBAL, AND PRIORITY COUNTRY MISSION SUPPORT IN POLICY AND STRATEGY DEVELOPMENT (IR. 2) 21 Over the past three years, the core staff has spent relatively little time providing direct, in-country technical assistance to priority country Missions and Title II development PVOs. Core staff spent 29 person months (750 days) providing in-country technical assistance, or roughly 10 person months each year.7 Of the total, more than 75 percent (584 days) of staff time was spent in three countries, Ethiopia, Haiti, and Madagascar, with much of it provided by one individual from the core staff. Minimal use is made of U.S.-based or local consultants to provide short-term, in-country assistance. C. SUMMARY OF TECHNICAL ASSISTANCE AND FINDINGS BY COUNTRY This section contains a summary of the technical assistance provided by FANTA in each priority country. The summaries are based on the review of project documents and responses by USAID Mission and REDSO staff who were interviewed for this assessment. The findings of the assessment team are presented separately for each country. The primary focus of FANTA assistance in the field has been the following: · Revision of Mission food security strategies. · Developing and revising PVO monitoring and evaluation systems and indicators for food security, particularly health and nutrition. · Integrating Title II program activities and results reporting into the overall Mission framework. · Sponsoring training sessions and workshops for Mission and PVO staff on key food security and nutrition strategies and interventions. The budget for the Title II development program in 2001 and level of effort in person days expended for each country by core FANTA staff are reported in parentheses where appropriate. Ethiopia ($34 million; level of effort, 249 person days) The assistance provided to USAID/Ethiopia and eight Title II PVOs is the most comprehensive of all priority countries. It offers a good overview of what FANTA can do in one country using minimal resources. In November 1999, the Mission requested FANTA assistance in food security and health/nutrition strategic planning because the nutrition situation was becoming worse. FANTA organized two PROFILE8 workshops with government representatives, other donors, nongovernmental organizations, and Title II PVOs. This resulted in recommendations for nutrition intervention. FANTA is planning a follow-up policy gap analysis, and work is ongoing to conduct secondary analysis of 2000 Ethiopia Demographic and Health Survey (DHS) data to document improved analysis and reporting on infant and child-feeding indicators (by IFPRI and Macro International). 7 These level-of-effort figures do not include “technical support” that was provided by core staff to PVOs and Missions in nonpriority countries from the Washington office. This totaled 272 person days. The Nicaragua figure also does not include the level of effort of the resident food security advisor, who has been in place since program year 3. 8 PROFILES is an analysis and presentation software program that uses current scientific and epidemiological data to associate malnutrition with four main functional consequences: child mortality, morbidity, intelligence loss, and lower productivity. These consequences have been calculated for the period 2000–2005 using United Nations demographic data, demographic and health survey data, other national surveys, and ministry of health reports. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 22 FANTA worked with PVOs to ensure that Title II food aid programs reflect Ethiopia PROFILE recommendations and best practices in nutrition and health programs. PVO staff were also trained in designing and implementing information systems to monitor health and nutrition interventions, and monitoring and evaluation indicators were revised to support the Mission’s results reporting framework. FANTA also provided technical information in all stages of a Title II program evaluation conducted by a local contractor. Within the Mission, nutrition was elevated to a “cross-cutting theme,” and nutrition now receives more attention from all strategic objectives in the Mission. FANTA performance was rated high by Mission counterparts: “FANTA has been great. The workload has been substantial and their time limited, which makes their input even more valuable.” Title II PVOs have benefited substantially; according to the Mission, “they understand . . . appropriate activities and the need for technical assistance.” Although it is still too early to assess whether better programs have contributed to better nutrition for target populations, a program evaluation scheduled for April 2002 will help answer the question. Better nutrition policies are needed at central and regional levels in order to achieve the widest program impact, but creating better policies requires more in-country technical assistance. The Mission has a heavy workload, and according to Mission staff, FANTA needs to offer more assistance over the next year and a half to “help with the programs, approaches, and training,” including preparing for the mid-term Mission evaluation, promoting better use of HIV/AIDS assistance, assessing national food security policies, and developing a sentinel site system to allow joint programs and household food security monitoring. “We want and need an exclusive deal” with FANTA, said one Mission staff member. The Ethiopia Mission and other country technical assistance requests are summarized in Table 3. Madagascar ($6.5million; level of effort, 209 person days) The Title II program is three years old, and since August 1999, FANTA has helped to improve management, programming, and monitoring and evaluation of the program. FANTA helped develop indicators to cover all aspects of food security (e.g., soil quality improvement, rice production, breast feeding/complementary feeding, and nutritional status) for use by the Mission in reporting results on food security. Using recommendations made by FANTA, the Mission created a new Food Security/Disaster Response Unit, which will help to rationalize planning and to integrate activities. FANTA prepared a food security situation analysis, which the Mission is supposed to use in its new strategic plan for the period 2003–2007. Efforts were also made to initiate an “Information for Action” network on food security among all key players in the country. According to the Mission counterpart, “FANTA’s money has been used wisely,” and has had noticeable results. The food security situation analysis report “has been very valuable” and is being used by the Mission as a reference. The work of FANTA on PVO monitoring and evaluation systems results can now be shared through results reporting and in presentations to other Mission offices. FANTA helped “the education process within the Mission” by promoting the Title II program, and links with other programs will be evident as the new Mission country strategy is developed. The Mission counterpart stated that as the program matures, FANTA may be needed to perform data collection and to refine food security indicators, particularly in agriculture. The Mission IV. USAID, GLOBAL, AND PRIORITY COUNTRY MISSION SUPPORT IN POLICY AND STRATEGY DEVELOPMENT (IR. 2) 23 also needs more guidance in reviewing the next round of development assistance proposals. It appears that FANTA can continue to influence the direction of this program. Regional Economic Development Services Office/East and Southern Africa (REDSO/ESA) ($374 million) Support to REDSO/ESA is part of strategic objective seven, “Enhanced Regional Capacity to Improve Health Systems.” Accordingly, FANTA technical assistance is directed toward improving the institutional capability of REDSO regional partners. FANTA has been working with nutrition coalitions in three countries (Kenya, Tanzania, and Uganda). FANTA activities focus on HIV/AIDS and nutrition; specifically, technical assistance to support national guidelines in HIV/AIDS nutritional care and support. Work is carried out in collaboration with a local expert and the Regional Center for Quality of Health Care. FANTA organized a workshop in November 2001 to develop national guidelines based on the document HIV/AIDS: A Guide for Nutrition, Care and Support, which was developed by FANTA. Follow-on assistance continues. REDSO has a network of partners that can be used to disseminate information to a wide arena, such as the Commonwealth Regional Health Community Secretariat. REDSO individuals were very pleased with FANTA and believe FANTA technical assistance has been “outstanding [and] very collaborative.” The next six-month work plan is now being reviewed and discussed with FANTA. More frequent and longer in-country visits were requested as a way to maintain the momentum of activities. Because the REDSO staff has a large workload, communications may be slow. REDSO staff mentioned that activities could speed up if a FANTA person was present for on-the-spot discussions. The option of setting up a regional office was discussed, with one REDSO staff member saying, “It all depends upon how much work there is. This isn’t easy because of their unusual business.” One problem is that food security and health/nutrition programs “are basically separate.” Nutrition and the link between health and nutrition is a high priority in REDSO and the HIV/AIDS focus is important in the foreseeable future. One individual in USAID/Washington spoke about the value of HIV/AIDS guidelines that are the focus of FANTA work in the region, noting, “FANTA put together absolutely fantastic HIV/AIDS feeding guidelines.” There seemed to be less certainty about its work in emergency activities, and this is under discussion. Field support funds are available ($480,000), and because a positive working relationship exists, it is clear that FANTA could make important gains in specific areas. Haiti ($28 million; level of effort, 126 person days) FANTA work has focused on standardizing monitoring and evaluation indicators, and better integrating the Title II program and results reporting into the overall Mission strategic framework. The Title II portfolio was evaluated and findings were used to redirect the Mission portfolio of activities. FANTA supported two studies in the country, the results of which are potentially important to the wider nutrition community. The first study was on methods to evaluate Vitamin A status in pregnant women. In 2002, for the second study, IFPRI and Cornell University began to assess the effectiveness of targeting food rations to all children under two years of age instead of targeting malnourished children under age five. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 24 FANTA technical assistance was rated high, as it was by other countries. “They have been so responsive and forth coming. It is first rate. They are able to pick up issues that are important to the Mission, . . . and understand them.” According to the Mission staff person interviewed for this assessment, an important FANTA effort is the study of the effectiveness of a new targeting approach. Documenting and disseminating the study findings could be important to the overall FANTA program and will answer local concerns about the new approach. The Mission wants more technical assistance. This will be necessary if FANTA wants to support the Mission in a PROFILE advocacy effort with immediate partners and, ultimately, to engage the Government of Haiti in generating consensus in nutrition programming priorities. The government will be initiating new nutrition guidelines and programs in the near future, and thus timing is crucial if FANTA is to influence this process. Honduras ($5.1 million; level of effort, 50 person days) FANTA has assisted one PVO, with the main effort being the redesign of the maternal and child health and nutrition component of Title II activities to incorporate all children under age two in the project area, rather than only malnourished children under age five. This target is different from that of the Ministry of Health, and results from the up coming program evaluation will be useful in discussions on the relative effectiveness of the approach. FANTA provided technical assistance to the local contractor who finalized indicators, and created a study design and an analysis plan. FANTA has been asked to update the Mission’s food security strategy in the coming months. Mission staff said that the methodology and lessons learned from the Honduras Title II program evaluations (baseline, mid term, and final) make Honduras a valuable case study, and the lessons can be shared within the region. The best practices in this small country should be documented and shared. As these tasks are completed, Honduras could graduate from the priority country list. If the tasks are not completed, the continued status of Honduras as a priority country (with its low level of effort) should be justified in terms of its service to the overall FANTA program. Nicaragua Over the last year and a half, a resident food security specialist has provided technical assistance to the Mission and PVOs to improve the Title II program as part of the Hurricane Mitch Relief and Rehabilitation special objectives. Training and technical assistance was also given to help PVOs make the transition to a long-term assistance program. This specialized activity will end in March 2002, and FANTA will offer no further in-country technical assistance. India ($108 million; level of effort, 71 person days) FANTA technical assistance has been minimal. Two PVOs implement the Title II programs. The majority of their interventions address maternal and child health and nutrition problems. At the request of the Mission, FANTA prepared Enhancing Child Survival: Impact of PL 480 Program in India using core funds, and reviewed and made recommendations to the Mission’s results framework for child survival and nutrition. FANTA staff aided in developing the scopes of work for the final evaluations of the PVO IV. USAID, GLOBAL, AND PRIORITY COUNTRY MISSION SUPPORT IN POLICY AND STRATEGY DEVELOPMENT (IR. 2) 25 development programs conducted in 2001. New Title II programs are scheduled to begin in 2002. According to the Mission, FANTA has been helpful in reorienting the focus of the Title II program from one of direct food aid to one that addresses child survival. A report produced by FANTA “has been very useful.” However, almost a year has passed since the development assistance proposal reviews were conducted, with little if any in-country activity from FANTA. “Although FANTA has always been responsive whenever we needed them, they have not kept abreast of the program and needs.” FANTA is trying to address this gap and is working with the Mission to develop a plan of activities. In the next few years, the Mission wants to use FANTA assistance to help develop an exit strategy for the Title II program food aid component, which is to be phased out over the next 10 years. FANTA can help in the “research, experimentation, and documentation of best practices” in the area where CARE works, by examining non-food models that could be expanded to a wider area (from one covering seven million people to one for 28 million people). The Mission sees this as something to start preparing now with work to continue over the next 5–10 years. “We want to find a good, clear niche for FANTA.” India should be made a priority by FANTA in the remaining time under this agreement and in the next five-year period. The initial difficulty in developing and obtaining Mission approval for a work plan is being addressed. Given the importance of having an approved work plan, it is important that FANTA make every effort to work with the India Mission to ensure that a work plan is in place and updated as needed. Table 3 summarizes the status of in-country technical inputs, available Mission funds, and priority country Mission requests for the remaining period under the current agreement. Table 3 FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 26 Priority Country Technical Assistance, Plans, Mission Requests, and Recommendations to date Priority country Total TA days by core staff to￾date Field support funds available as of 10/2001 Status of FY 2002 country work plan (or LOE planned if available) Mission preference for mode and level Review team Recommendation Nicaragua 45 $50,503 LOE, 6 months Close-out March ‘02 Remove from priority country list Honduras 50 $35,928 On-request basis Continue by task request Graduate and remove from priority country list Haiti 126 $72,580 Work plan available, updated as needed by trip Two to three month TDYs. Pursue options for longer TDYs Madagascar 209 $94,408 Work plan available, updated as needed by trip More than current 2–3 times a year. Pursue options for longer TDYs Ethiopia 249 $172,655 Work plan available, updated as needed by trip Resident advisor for 18 months Pursue options to place resident advisor India 71 $494,345 Work planning in process with Mission More TA, continue short-term mode Increase frequency of TDYs and communications REDSO/ESA 374 $480,260 Work planning in process with Mission More TA, more frequent Increase frequency of TDYs TA indicates technical assistance; LOE, level of effort; TDY, temporary duty travel. D. RECOMMENDATIONS 7. The level of in-country technical assistance needs to increase substantially in order to meet upcoming priority country technical assistance needs and to maximize the effectiveness of FANTA inputs in those country programs. Most priority country Mission staff noted that greater and more sustained in-country technical assistance will make a “huge difference” in pushing through improvements to Title II and other programs that involve food security and health and nutrition. The imbalance between demand and available staff has inevitably caused some delay in program implementation and a loss of momentum. A representative comment from field staff is, “There is only one problem. They are in very high demand and they cannot give us all that we need. If they had an office here, they could really move a lot of things here.” A shift in program emphasis is feasible and desirable. With the evident and hopefully sustainable improvements in Title II programming and routine reporting, monitoring, and evaluation, FANTA can shift more of its attention to priority countries, where it will see the “biggest bang for the buck.” Consolidating and moving forward the IV. USAID, GLOBAL, AND PRIORITY COUNTRY MISSION SUPPORT IN POLICY AND STRATEGY DEVELOPMENT (IR. 2) 27 impressive gains already made in the priority countries will contribute to the aims of IR 1 and IR 3. The assessment showed considerable room to increase the total level of effort to priority countries as well as to distribute the workload more evenly among the core staff, as appropriate. FANTA will face barriers. The project director and the CTO have cited financial complications as well as difficulty in finding appropriately qualified personnel to allow for increased in-country technical assistance. To do so is not impossible, however, and a concerted effort should be made to increase level of effort of in-country assistance. Efforts made now will position FANTA for the next five-year period. As seen in Table 3, the mode, level, and duration of more technical assistance will differ according to Mission requirements. After a strategic review of the priority countries (see recommendation 8 below), FANTA should discuss with each Mission ways to update work plans, determine needed levels of effort, and agree on the mode of operations to satisfy technical assistance needs. FANTA needs to organize a recruiting campaign to attract long￾term and short-term consultants, and it could begin to mobilize additional field mission funds. It is unclear how much money will be necessary to fulfill technical assistance needs in the time remaining under the current cooperative agreement. India, for example, currently has approximately $500,000 in unspent obligated funds. This may be sufficient. 8. Conduct a strategic review of priority countries to ensure maximum return on investments toward overall Project objectives, e.g. impact and lessons learned this review should be the basis for planning the second five-year period. A strategic review of priority countries and levels of effort invested in each country are required. Links between priority countries and the four established criteria are not clear in project documentation. Levels of effort expended and planned in priority countries need to be weighed against established criteria and expected returns. For example, an assessment could be made of which programmatic returns have been realized for the 209 person days in Madagascar by spending $6.5 million in Title II monies. Further questions and issues that FANTA should review are: · Determine what to do with closed-out countries such as Guatemala and Nicaragua e.g., a final report of activities and achievements, documentation of “promising practices” for sharing, a list of possible venues and methods to disseminate information where their value will be greatest. · Determine when and how to “graduate” other countries. Honduras, for example, should be graduated, given the high demand for FANTA expertise elsewhere and its low level of effort in Honduras. There should be some minimum scale to qualify as a priority country. Some level of technical assistance could be provided by short-term consultants instead of core staff, who could provide follow-up technical assistance for refining and maintaining gains for a specified period after graduation. · Identify new priority countries as soon as possible, such as Mozambique, Rwanda, and Uganda, which are mentioned in the fourth program year annual plan. FANTA staff may decide that it is not advisable to add new countries to the list in the remaining period under this agreement. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 28 · Identify how more technical assistance can influence other intermediate results, thereby maximizing the gains from field activities. For example, “best practice” research should as much as possible be done in priority countries. Ethiopia and India are important and large programs with large potential across a number of program areas. 29 V. FOOD SECURITY AND NUTRITION BEST PRACTICES AND STANDARDS (IR.3) A. PURPOSE, OBJECTIVES, AND EXPECTED RESULTS IR.3 is meant to ensure that best practices, and acceptable standards in nutrition and food security policy and programming are adopted by USAID, Cooperating Sponsors, and other key stakeholders. This section will assess the achievements to date, but it is important to emphasize that each of the three intermediate results are linked. The original FANTA concept had three objectives for meeting this intermediate result: · Assist the Global Bureau in fulfilling a primary function of global leadership in promoting the use of best practices in maternal/child health and nutrition. · Conduct priority research in programmatic issues and expand the capacity of stakeholders to assess, design, implement, monitor, and evaluate effective food security and nutrition policies and programs. · Evaluate the impact of Title II programs on maternal/child health and nutrition. IR.3 is measured primarily by two monitoring indicators (Figure 1): percentage of funding from sources other than G/PHN, and the number of promising practices and acceptable standards identified, produced, and disseminated by FANTA. In the original program description, the second broad indicator was subdivided into subintermediate results to include: · Priority program issues in nutrition and food security are identified and analyzed, alternatives are tested, and the results are appropriately disseminated. · Training, materials, and technical assistance are provided. · Exchanges occur between Cooperating Sponsors and other ongoing USAID projects. · Meta-analyses of maternal and child health and nutrition issues are conducted and disseminated in the context of food security programs. B. REVIEW OF APPROACH AND OPERATIONS IN PROJECT YEARS 1–3 FANTA activities have been conducted primarily by three subcontractors, Cornell University, Tufts University, and IFPRI. The FFH, a fourth subcontractor, has been involved to a lesser extent in some related activities. The original FANTA program description stressed the importance of research, indicating a “ …need [for a] firm technical basis for approaching selected aspects of food security and nutrition.” Programs designed without a solid scientific basis will not achieve their expected results. Indeed, the FANTA proposal explicitly states that interventions that work well have a limited history. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 30 Activities in IR.3 are intended to fill gaps in: · Identification of issues and subjects for best practices. · Development of those practices and standards. · Dissemination of the practices and standards. · Advocacy for their application. Staff time and financial resources have been allocated to address these four areas. Progress has been made in each. FANTA has used a demand-driven approach to identify research, analysis, and monitoring and evaluation activities. Most of the specific activities relate to the articulated needs of stakeholders. The TAG meeting has been a prime mechanism for soliciting input from clients. The process with the TAG has been consultative and iterative. C. SUMMARY OF ACTIVITIES AND FINDINGS One example of a demand-driven, highly successful research output has been the analysis by Dr. David Pelletier of the malnutrition/child mortality work. This was an extension of earlier work and it provided the opportunity, through additional analyses, to examine the broad implications of child malnutrition. Even though a final report has not yet been published, the analyses from the research have been widely used throughout USAID. Indicator guides, best practices publications, and research on development of more appropriate food security and nutrition indicators are principal outputs of this intermediate result. (See Annex E for list of FANTA publications and products.) A major stakeholder is Title II and PVO implementers. Therefore, a number of publications emerging from FANTA work are indicator guides. In response to stakeholder requests, the sampling guide was translated into French and Spanish. The recently completed Food for Education Indicator Guide provides a framework for indicators that can be used to measure the educational outcomes of the Food for Education Program. The guide provides a list of potential indicators and includes a discussion of calculation, interpretation, methods of data collection, and data use. Work on the guide emerged because of specific requests from PVOs, USAID, and the WFP. FANTA has made a significant investment in developing and testing new approaches for measuring household and individual access to and consumption of food. Two tandem projects in Burkina Faso (by Africare and Cornell University) and Bangladesh (by World Vision and Tufts University) are helping to develop and adapt qualitative food security measurement instruments. If these new food security measurement tools are successful, they could allow a more “user friendly” means of evaluating food security status. This work builds on earlier research at Cornell University, which resulted in a new food security measurement scale in the United States. This multiyear project should result in the development of a generic protocol that could be replicated in other countries. IFPRI has been testing the feasibility of diet diversity indicators to measure access to and consumption of food at the household level. The appeal of the indicators is their relative V. FOOD SECURITY AND NUTRITION BEST PRACTICES AND STANDARDS (IR. 3) 31 ease of data collection and analysis methodologies, if they hold up to closer scrutiny. This activity has used extant data from six countries. Research was initiated by FANTA under the auspices of IFPRI and Cornell University in Haiti to examine the effects of universal targeting of programs to children under the age of two. As one researcher commented, “while it’s conventional wisdom that targeting children under two is cost-effective, there is virtually no research in a real-life setting that has tested this assumption.” The results from this work may have a significant effect on the design of Title II and other maternal and child health and nutrition programs. This is a clear example of research looking at important aspects of preventive nutrition. Some newer areas have been added to the overall FANTA portfolio under IR.3. Specifically, women’s nutrition, HIV/AIDS, and measurement of infant and child feeding. However, few people interviewed were aware of the specific details of this work. Whereas these new research areas have a potentially high payoff, several respondents indicated that FANTA needs to identify the project’s comparative advantage as activities are added. The general conclusion from people interviewed for this assessment is that the work is high quality, responsive to client needs, and relevant. Most people emphasized that if FANTA did not exist, that USAID would not have achieved its food security and general nutrition goals over the past three years. Specific examples of how the project has made a major contribution include the following: · FANTA served as the stimulus for more and better communications on food security issues within USAID, as well as between USAID and PVOs. Better communication has resulted in parties using the same "language" to discuss food security issues. · The importance of food security has been upgraded for PVOs. · FANTA activities have brought humanitarian assistance and economic development closer together in USAID programs. · FANTA research activities are relevant because they are practical and provide clear guidance. The food aid/maternal and child health work in Bolivia and Peru are two examples of this. · FANTA products such as the indicators guide are realistic and based on science. Some comments indicated that improvements could be made in FANTA programs. For example: · Use of the Technical Advisory Group (TAG). A common sentiment is that the subcontractors have not collaborated; this is a missed opportunity. Although the TAG is seen as providing a venue for interaction among representatives of the subcontractors, recent participation by the subcontractors has declined. The separation of TAG meetings into general and technical meetings may have exacerbated this trend. Indeed, participation in general at the TAG meetings has declined. TAG meetings are often set up at short notice, and given the competing FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 32 demands of staff, it has been difficult for the subcontractors to amend their schedules to participate. The subcontractors bring expertise to the food security and nutrition arena. Additional efforts are needed to increase their interaction and to enlist a broader group of professionals from each subcontractor. In general, the tendency has been to rely only on subcontract staff listed on a particular task order, yet the subcontractors have many multitalented people whose talents could be beneficial to FANTA. It would be easy to use general task orders to structure a focused discussion with a broader range of colleagues from each subcontractor. This in-depth dialogue could follow a regularly scheduled technical advisory group meeting and would minimize the number of trips to Washington, D.C. More dialogue among the subcontractors and TAG members would avoid the “chopping up of ideas”, a comment from a respondent that was meant to reflect the sense that activities as part of IR.3 are often specific to a task order, and that an overall synthesis of activities is missed. · Visibility. Those who know FANTA activities rank FANTA highly. However, the project is not well known outside the USAID/PVO circle, including the research and best practices work sponsored by FANTA. Given the strong base of high-quality documentation of best practices and acceptable standards, USAID and FANTA should use this as a platform for increasing awareness of FANTA. FANTA needs to map out a specific strategy for identifying forums at which to engage broader food security and nutrition issues. · Staffing. FANTA has done a good job matching staff and other resources to requests; however, with expected higher demand for documenting best practices and acceptable standards, FANTA needs to reassess its staffing requirements. It is reasonable to assume that in the next two years and beyond, more requests will emerge from stakeholders. USAID staff indicate that general nutrition issues and food security will have higher visibility in the coming years. For example, plans are underway to set up a nutrition division within the Global Health Bureau. At the moment, FANTA staff has only one nutritionist who holds a Ph.D. This person is also the project director and thus needs to spend a significant amount of time on management issues. With the increasing complexity of multi-sectoral programming for nutrition and food security and the need to interact more explicitly with subcontractors, many people interviewed said that a senior nutritionist would be an asset to FANTA. D. RECOMMENDATIONS It is clear that much of the payoff from an investment in research and best practices will accrue in the next two years and beyond. Given the strong foundation that has been established, the team offers the following recommendations. 9. Output and results from activities to document best practices and acceptable standards need to be better leveraged. Investments in IR.3 with subcontractors are V. FOOD SECURITY AND NUTRITION BEST PRACTICES AND STANDARDS (IR. 3) 33 medium- to long-term activities. For example, field validation studies on innovative food security measurements in Bangladesh and Burkina Faso will produce a wealth of data in years 4, 5, and beyond. FANTA needs to identify, a priori, how these data will be used, what kinds of additional analyses can be conducted, and which staff and institutions will be involved. A part of this leveraging process must emphasize the development of a streamlined set of indicators that are easy to use, relevant, and universal. PVOs need simple ways to monitor and measure food security and nutrition. At the moment, a smorgasbord of indicators exist, and the list is overwhelming. FANTA has extensive experience in this area and can help refine the work already in progress. Related to this is the need for defined cutoff points for each indicator, based on solid scientific data. 10. FANTA needs to be clearer about the specific products it needs from IR.3 activities. Researchers working as subcontractors for FANTA do not have a comparative advantage in translating results to a wider audience. Because a major focus of IR.3 is their use in training and technical assistance, more attention should be given to how research results will be used. This is also an ideal time for FANTA to expand the client base that uses its materials. For example, short, 1- or 2-page briefs that summarize what we know from cutting-edge research would be valuable to policy makers and project implementers in developing countries. This has begun to happen in FANTA, but technical briefs needed to be more aggressively advertised. 11. A strategic plan for documenting best practices and acceptable standards needs to be developed. A systematic plan will help frame the ideas for upcoming investments in IR.3. The plan would specify high-priority topics, and would include a rationale for activities. A more methodical approach would address some of the perceived “chopping up of ideas” that has occurred in the first phase. A strategic plan could be an effective tool for training and advocacy. A rigorous, concise document would point out 1) what we know, 2) gaps in our knowledge, and 3) how FANTA will contribute to filling these gaps. The document would help address the perception that “we know everything about best practices.” Indeed, a master plan would help chart new directions for FANTA. For example, there is a general perception that a solid science base for nutrition interventions for women exists, but there are major gaps in the science. The plan would specify what is known and how gains in information will be achieved through activities to achieve intermediate results. Such a plan could be used to educate a wider audience and could be the basis for generating more interest and funding for important food security and nutrition issues. The strategic plan should be the focus of a meeting at which stakeholders have an opportunity to offer comments, and a meeting would be a specific way to engage the TAG. Ideally, individual subcontractors would use the meeting as a venue to provide updates on on-going activities and as a forum for focusing on future needs. Involving researchers and program managers in these meetings should foster a rich discussion. The team believes that activities related to best practices will continue to be an essential component of FANTA. One person interviewed said that best practices are FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 34 often a smoke screen, the implication being that many people assume that a large knowledge base is available from the existing research than is actually the case. Thus, in future work by FANTA, the team recommends that greater attention be paid to educating stakeholders about what is known. Development of a strategic plan would provide an opportunity to stress the links between food security and health and nutrition. At the moment, food security (availability, access, and utilization) and health and nutrition issues are almost entirely separate within USAID and many PVOs. For many people within USAID and the PVO community, nutrition and health issues go beyond a food focus. Activities as part of the IR.3 afford an extraordinary opportunity to document these links. This has not yet happened. 35 APPENDICES A. Assessment Scope of Work ...................................................................................... 37 B. FANTA Publications and Documents....................................................................... 43 C. Persons Interviewed.................................................................................................. 49 D. Assessment Interview Questions .............................................................................. 53 E. Performance Indicator Report ................................................................................... 55 FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 36 FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 37 APPENDIX A ASSESSMENT SCOPE OF WORK FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 38 I. Title Activity: Assessment of the Food and Nutrition Technical Assistance (FANTA) Project, HRN-A-00-98-00046-00. Contract: Monitoring, Evaluation and Design/Assessment Support (MEDS) HRN-I-00-99- 00002-00 Task Order 2, Technical Directive 43. II. Objectives of the Assessment 1. To assess the appropriateness of the FANTA program strategy within the current USAID policy/programming environment. 2. To assess the degree to which FANTA has responded to the opportunities for improving food security/nutrition programming of USAID (G/PHN, BHR/FFP, Missions, Regional Bureaus) and its partners programs. 3. To recommend directions for the second five-year cooperative agreement. III. Background The Nutrition Results Package is a ten-year program framework authorized in 1998. Under this authorization, the FANTA project was awarded competitively in September 1998 to the Academy for Educational Development (AED) as the prime with Cornell and Tufts Universities as subcontractors. The FANTA proposal also included a Memorandum of Understanding with Food Aid Management (FAM), a consortium of private voluntary organizations, referred to as Cooperating Sponsors, that implement Title II food aid development and emergency programs. The overall purpose of FANTA is “Improved food and nutrition policy, strategy and program development." Three intermediate results (IRs) were identified to achieve the above purpose: IR 1. USAID Cooperating Sponsors nutrition and food security-related program development, analysis, monitoring and evaluation improved. IR 2. USAID and its counterparts establish improved, integrated nutrition and food security strategies and policies. IR 3. Best practices and acceptable standards in nutrition and food security-related policy and programming adopted by USAID, Cooperating Sponsors, and other key stakeholders. The request for applications stated that the cooperative agreement would provide support for 5 years. USAID anticipated up to $10,000,000 in G/PHN core funds and up to an additional $20,000,000 in field support or add-on funding for the FANTA activity over the initial five-year period at the total estimated funding for the cooperative agreement of $30,000,000, subject to the availability of funds. The request for applications also stated that USAID may choose to non-competitively award a second five-year cooperative agreement based on agency priorities and satisfactory performance of the recipient of the first five-year agreement. APPENDICES 39 Four years into the five-year cooperative agreement, as of September 2001, the FANTA project has received $6,420,147 from the G/PHN core funds, consisting of SO2 (maternal survival) $2,207,000 SO3 (child survival) $3,888,147 SO4 (HIV/AIDS) $325,000 And field support funds come from USAID bureaus (BHR, Africa, PPC), seven countries (India, Honduras, Haiti, Guatemala, Nicaragua, Madagascar, and Ethiopia), and RESDO/ESA, and total $5,900,965. This represents 52% of the total project allocation from G/PHN Core and 48% from field support funds thus far. IV. Assessment Scope of Work The assessment should address the following: 1. Describe progress made to-date in FANTA’s three Intermediate Results areas: · Programs (IR.1) · Policies and strategies (IR.2) · Best practices and standards (IR.3) 2. Assess the appropriateness and effective of FANTA’s approaches/strategies and activities in achieving results to date, including operations/management, resource utilization, staffing, communications, and collaborative relations. Recommend changes, if any, needed to improve these areas in remainder of the current agreement. 3. Assess if /what changes are needed to FANTA project objectives for the second five-year agreement to ensure relevance to the current USAID policy and programming environment and to ensure it meets emerging/future needs. Audience The audience for this assessment includes USAID staff involved in the management of the FANTA program and FANTA staff. Recommendations made by the team will be considered jointly by USAID and FANTA and used as a guide to the second five-year agreement/modifications. V. Methods and Procedures The assessment Team will: 1. Review relevant project documents, such as the program description section of the request for applications, FANTA project cooperative agreement, FANTA work plan (project year 4), and various FANTA publications and others as appropriate (CTO and the FANTA staff will provide these documents). FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 40 2. Develop a questionnaire to conduct interviews in consultation with the CTO and FANTA staff. 3. Conduct interviews with FANTA project staff in Washington, D.C. 4. Conduct interviews with FANTA clients—key USAID/Washington and Mission staff (in person, via phone, or e-mail) and other relevant stakeholders (a list of suggested contacts is attached). 5. Prepare a draft report outlining the key findings and recommendations. 6. Conduct a debriefing for USAID on the findings. 7. Complete the assessment report by incorporating the comments from USAID and FANTA staff. VI. Products The expected outcome will be a written report not exceeding 40 pages. The report will address the assessment areas specified under the objectives, and will present a clear and concise summary of its findings, and any recommendations to USAID. Report outline: Executive Summary I. Introduction A. Purpose of assessment/SOW B. Methodology II. PVO Programming (IR.1) C. Purpose, objectives, and expected results D. Summary of technical assistance inputs and results to date E. Review of strategy/approach, operations, activities in project years 1–3, and recommendations for the remainder of the current agreement F. Recommendations for the next, second five years (project years 6–10) III. USAID, Global, BHR (DCHA), and Priority Country Missions Support in Policy and Strategy Development (IR.2) G. Purpose, objectives, and expected results H. Summary of technical assistance inputs and results to date by country I. Review of approach, operations, and activities in project years 1–3, and recommendations for the remainder of the current agreement J. Recommendations for the second five years (project years 6–10) IV. Food Security/Nutrition best practices and standards (IR.3) K. Purpose, objectives, and expected results L. Summary of activities and results to date M. Review of approach, operations, and activities in project years 1–3, and recommendations for the remainder of the current agreement N. Recommendations for the second five years (project years 6–10) APPENDICES 41 V. APPENDICES VII. Timeline 1. The assessment should begin on or about January 30, 2002 for a three-week duration, and be completed by February 20, 2002. 2. Reviewing relevant documents will occur prior to beginning the assessment. 3. Developing interview questionnaire and conducting interviews/discussions and other data gathering should occur during the first two weeks of the assessment. 4. A debriefing should be conducted during the third week of the assessment. 5. The final report should be submitted to USAID no later than April 9, 2002. VIII. Team composition The assessment team should consist of three individuals with the following mixture of expertise and experiences: · A person (or persons) with an in-depth understanding of the intricacies of managing a Global Bureau–funded technical assistance project with a field support orientation. The person should have experience in food security and the population, health, and nutrition sector. Knowledge of USAID and its procedures is essential. · A person with technical knowledge of the issues that address food security and nutrition in the field today, especially as they relate to Title II development and emergency programs. · A person with experience managing food security and/or maternal and child health field activities. The individual should have first-hand understanding of the challenge of working to achieve the objectives of the Global Bureau, USAID Missions, and other partners when the objectives may be inconsistent. IX. Funding and Logistical Support All funding and logistical support for the FANTA assessment will be provided through MEDS. Activities that will be covered will include recruitment the assessment team; payment of team members for five-day work weeks; support for all expenses related to the assessment; logistical support, and limited distribution of the draft and final report. FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 42 FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 43 APPENDIX B FANTA PUBLICATIONS AND DOCUMENTS FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 44 FANTA Assessment Briefing Book 1 TABLE OF CONTENTS I. Request For Application – (Selection Criteria, Program Description) II. Technical Activity Description III. FANTA Staff IV. Project Year Four Work Plan V. Performance Measurement and Evaluation Plan (PMEP) VI. Project Annual Reports: Project Years 1-3 VII. Stakeholder Survey FANTA ASSESSMENT BRIEFING BOOK 2 TABLE OF CONTENTS FANTA’S INTERMEDIATE RESULTS 1. Products in Support of IR1: USAID’s and Cooperating Sponsors (CS) nutrition and food security –related program development, analysis, monitoring, and evaluation improved 1.1. Support to improve development programming · FFP-DP Strategic Objective 2 Results Report Fiscal Year 2000 1.2. Support to improve emergency and transition programming · FFP-EP Strategic Objective 1 Results Report Fiscal Year 2000 · Quarterly Report on the Nutrition of Refugees and Displaced Person July 2001 (Earlier reports available upon request) · A Study of Emergency Relief Foods for Refugees and Displaced Persons · The Derivation of the Proposed Nutritional Composition of an Emergency Relief · Food for Refugees and Displaced Persons · Enhancing the Nutritional Quality of Relief Diets: Workshop Proceedings, Washington, DC April 28-30, 1999 1.2.2 Technical Support to Cooperating Sponsors and USAID Field Missions · Report of an investigation into recurrent epidemics of Pellegra in Kuito Angola · Therapeutic And Supplementary Feeding Programs · Kenya Drought Emergency Operation-Food Aid And Nutrition: Key Findings And Lessons Learned APPENDICES 45 1.3. Priority Country Trip Reports 1.3.1. Ethiopia · Trip report 10/26/99 - 11/09/99 · Trip report 08/20/00 - 09/01/00 · Trip report 10/30/00 - 11/11/00 · Trip report 04/19/01 - 05/05/01 · Trip report 09/10/01 - 09/25/01 1.3.2. Madagascar · Trip report 08/11/99 – 08/28/99 · Trip report 05/16/00 - 05/26/00 1.3.3. Guatemala · Trip report 06/04/00 – 06/18/00 · Trip report 11/27/00 - 12/08/00 · Trip report 02/19/01 - 03/02/01 1.3.4. Haiti · Trip report 03/14/99 – 03/18/99 · Trip report 06/23/99 – 06/28/99 1.3.5. Honduras · Trip report 04/12/99 – 04/23/99 · Trip report 11/06/00 – 11/11/00 · Progress report FY 2000 · Progress report 2001 & Workplan 2002 1.3.6. Nicaragua · Trip report 03/22/99 – 03/26/99 · Trip report 04/14/99 – 05/07/99 2. Products in support of IR2: USAID and its counterparts establish improved, integrated nutrition and food security-related strategies and polices 2.1. Define and implement strategies for improving women’s nutrition · Strategies, Policies and Programs to Improve the Nutrition of Women and Girls 2.2. Improve the food security framework – Food Aid and Food Security Assessment (FAFSA) · FAFSA: A Review of the Title II Food Aid Program 2.3. Review health and nutrition in emergencies · ACC/SCN Session on Assessment of Adult Undernutrition in Emergencies · Summary Report (Nairobi Conference) FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 46 2.4. Support food security strategy development with Missions · Food Security in Madagascar: A Situation Analysis Prepared for USAID Mission in Antananarivo 2.5. Support the Greater Horn of Africa Initiative (GHAI) · Household Food Economy Interviews: How Well Do They Monitor Food Security and Food Aid Use in Camps of Persons Displaced by Protracted Emergencies? · Resources for Emergency Food Aid Managers · Reference Documents and Training Curricula for Emergency Food Aid Managers · GHAI Assessment/REDSO Partner meeting, Kenya, Tanzania, and Uganda TDY February 18-28, 2001 2.6. Develop Credit with Education program advocacy piece and monitoring and evaluation measurement guide · Credit with Education: A Promising Title II Microfinance Strategy · Background Paper on Applicability of Lot Quality Assurance Sampling (LQAS) to Credit with Education 3. Products in support of IR 3: Best practices and acceptable standards in nutrition and food security-related policy and programming adopted by USAID, Cooperating Sponsors, and other key stakeholders 3.1. Title II Indicator Guides · Anthropometric Indicators Measurement Guide · Food for Education Indicator Guide · Measuring Household Food Consumption: A Technical Guide · Sampling Guide (available in French & Spanish) · Water and Sanitation Indicators Measurement Guide 3.2.1. Improving the Use of Food Rations in Maternal and Child Health and Nutrition (MCHN) Programs Guide · Improving the Use of Food Rations in Title II Maternal/Child Health and Nutrition Programs Selecting Children under 3 Years of Age as Beneficiaries – Summary of findings from a literature review · Summary Report: The Use of Food Rations in Maternal and Child Health and Nutrition Title II Programs · Food Use in Maternal Child Health and Nutrition Programs: Background Report · Improve agriculture - consumption - nutrition linkages · Increasing the Nutritional Impacts of Agricultural Interventions · Improving the Nutrition Impacts of Agriculture Interventions: Strategy and Policy Brief 3.4. Measuring improved household access to food 3.4.1. Dietary diversity APPENDICES 47 · Dietary Diversity as a Food Security Indicator 3.4.2. Adaptation of the U.S. Household Food Security Scale approaches in developing country contexts · Cornell Household Food Security Measurement Tool Burkina Faso Proposal · Building Household Food Security Measurement Tools From the Ground Up · Development and Results of a Questionnaire-Based Tool to Measure the Food Security of Production Units in Zondoma for Africare’s Baseline Survey · Cultural Perspectives for Understanding Food Security among the Mossi · Interview Guide for In-depth Understanding of Food Security in Zondoma Province, Burkina Faso · Report on the Analysis of the In-depth qualitative data: Revision of the Initial Food Security Measurement Tool · Tufts Food Insecurity Measurement and Validation Study in Bangladesh Research Proposal · Scope of Work/ Memorandum of Understanding World Vision￾FANTA/Tufts Collaboration Bangladesh Research · Food Insecurity Measurement and Validation Study: A Report on the Formulation of the Core Food Security Module, and Experiences in its Implementation in Bangladesh · Tufts Food Insecurity Measurement and Validation Study a Report on the first round of data collection relating to WVB’s FSEI activities in Bangladesh 3.4.3. Measuring infant and child feeding behaviors · A Positive Deviance Approach to Studying Child Feeding Practices and Care in Accra, Ghana · A Multiple-Method Approach to Studying Childcare in an Urban Environment: A Case of Accra, Ghana · Assessing Care: Progress Towards the Measurement of Selected Childcare and Feeding Practices, and Implications for Programs 3.5. The use of food to strengthen household and community response to HIV/AIDS · The Potential Role of Food Aid for AIDS Mitigation in East Africa: Stakeholder Views. · Potential Uses of Food Aid to Support HIV/AIDS Mitigation Activities in Sub-Saharan Africa · HIV/AIDS: A Guide for Nutrition, Care and Support · Uganda Trip Report 09/10/01 – 09/24/01 · Uganda, Kenya and Tanzania Trip Report 11/08/01 – 11/21/01 · Rwanda Trip Report 11/20/01 11/24/01 3.6. Estimating changes in child mortality from changes in child malnutrition using secondary data · Child Survival in Developing Countries: Malnutrition Does Matter · Malnutrition and Child Mortality: Findings from Longitudinal and Cross￾Sectional Analyses at Population Level FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 48 3.7. Measuring the Impact of Nutrition Programs · Preliminary Review of the Impact of Programs on Child Nutritional Status 3.8. Training Workshops (Partial List) · Title II Monitoring and Evaluation Workshop Bamako, Mali, May 29 – June 2, 2000 · Data Analysis Workshop for Title II Development Program Managers Nairobi, Kenya, November 6 10, 2000 · M&E Training Workshop for ADRA Title II Development Programs August 6 – August 10, 2001 · Nutrition Works Training · Sampling Workshop Agenda (Materials available upon request) · Conceptual Framework for M&E Systems · Food Aid: Issues and Applications 3.9. Information Sharing and Communications · African Journal of Food and Nutritional Sciences August 2001 3.10. Comparison of Prevention vs. Recuperative food ration approaches in Haiti · Review of Health and Nutrition Education Messages and Delivery System Currently Used in Haiti, and Recommendations for Further Research · IFPRI Proposal: Prevention Or Cure? “A Comparison Of The Effectiveness Of Targeting Food Supplements To Malnourished Children Compared To Universal Targeting of Children Under Two in Haiti” FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 49 APPENDIX C PERSONS INTERVIEWED FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 50 USAID/Washington and Missions Betsy Brown, office director GH/HIDN Richard Greene, acting deputy director GH/HIDN Eunyong Chung, FANTA CTO GH/HIDN Mary Ellen Stanton, SO2 team leader GH/HIDN Al Bartlett, SO3 team leader GH/HIDN Frances Davidson, MOST CTO GH/HIDN Kate Crawford GH/HIV/AIDS Emmy Simmons, AA EGAT Lauren Landis, director DCHA/FFP Jeannie Markunus, deputy director DCHA/FFP Tom Oliver, previous director DCHA/AA Richard Newberg, division chief DCHA/FFP/DP Jon Brause, division chief DCHA/FFP/EP Tom Marchione DCHA/PPM Peter Morris DCHA/OFDA Rene Berger, previously with FFP PPC Bill Renison and Anne Ralte PPC/PDC Holly Fluty-Dempsey AFR/SD Bobbie Van Haeften LAC/RSD Pedro Carrillo USAID/Madagascar Ashi Asturia USAID/India Leslie Perry and Alix Grubel REDSO/East & Southern Africa Tim Shortley USAID/Ethiopia Carrell Laurent USAID/Haiti Marta Larios and John Rogosch USAID/Honduras SUBCONTRACTORS David Pelletier Cornell University Edward Frongillo Cornell University Bea Rogers Tufts University Patrick Webb Tufts University Lawrence Haddad IFPRI Marie Ruel IFPRI APPENDICES 51 COOPERATING SPONSORS Mara Russell Food Aid Management Judy Bryson Africare Kathy McCaston CARE Thoric Cederstrom Save the Children Dorothy Scheffel World Vision Anwer Aquil Catholic Relief Services Bob Bell CARE Margaret Schule World Vision UN AGENCIES Robin Jackson World Food Programme Miriam Labbok UNICEF FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 52 FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 53 APPENDIX D ASSESSMENT INTERVIEW QUESTIONS FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 54 Interview Questions: (Global Health, DCHA/Food for Peace, Missions, CSs) 1. From your perspective, are the FANTA mandates/objectives still relevant and needed in the current USAID policy and programming environment? 2. Would you suggest any changes to FANTA project objectives to make them ore relevant to current and future needs? 3. From your viewpoint, is FANTA’s approach effective in achieving the project objectives? 4. Would you suggest any changes in FANTA’s implementation approaches? 5. Has FANTA been responsive to your needs? Has the type of assistance provided by FANTA been appropriate to your needs? 6. What suggestions do you have for emerging technical and program areas in which FANTA could be of assistance? FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 55 APPENDIX E PERFORMANCE INDICATOR REPORT FOOD AND NUTRITION TECHNICAL ASSISTANCE PROJECT ASSESSMENT 56 INDICATOR TYPE INDICATOR DESCRIPTION DATA SOURCE TIMING BASE LINE (FY98) FY99 YEAR ONE: TARGET YEAR ONE: ACTUA L FY00 YEAR TWO: TARGE T YEAR TWO: ACTUAL FY01 YEAR THREE: TARGET YEAR THREE: ACTUAL FY02 YEAR FOUR: TARGET YEAR FOUR: ACTUAL FY03 YEAR FIVE: TARGET YEAR FIVE: ACTUAL LOA FINAL RESPONSIBLE PERSON(S) FOR DATA COLLECTION/ ANALYSIS SO: Improved food and nutrition policy, strategy and program development impact enhanced nutritional impact of FANTA-assisted nutrition and food security related programs as demonstrated by decreased prevalence in stunting in the target populations in priority countries* R2s, mid￾term and final evaluation s baselin e, final 0* 1 1 2 3 TBD by individual program lead country person; M&E specialist monitoring percentage of programs in the priority countries reporting improvements to nutritional status among direct beneficiaries in a given year** SO tracking table; CS and Mission document ation annual N/A 50% 80% 60% 100% 70% 73% 75% 80% 70% lead country person; M&E specialist IR1: USAID's and Cooperating Sponsors' (CS) nutrition and food security-related program development, analysis, monitoring and evaluation improved. IR1.1: monitoring percentage of CS development food aid proposals assessed to satisfy Agency review criteria in problem assessment, performance indicators, intervention design, and monitoring and evaluation plan core elements of DAP Review scoring system; IR1 tracking system annual 36% 40% 36% 40% 18% 50% 25% 55% 60% 60% M&E specialist IR1.2: monitoring percentage of development food aid CS programs able to meet USAID's reporting requirements including annual submissions, baselines and evaluations FFP R2 tracking system; R2 review annual 88% 90% 88% 90% 88% 90% 95% 95% 95% 95% ME&A; M&E specialist IR1.3: monitoring percentage of FFP/ER programs reporting change or maintenance of nutritional status FFP R4; R2s and other annual reports; tracking system annual N/A 55% 53% 60% 66% 65% 85% 65% 65% 65% ER specialist; M&E specialist IR1.4: monitoring percentage of CSs able to meet FFP/ER reporting requirements FFP R4: R2s and other annual reports; tracking system annual N/A 60% 57% 50% 50% 60% 45% 45% 45% 45% ER specialist; M&E specialist APPENDICES 57 IR2.3: monitoring number of recommended policies or strategies adopted by priority country host governments IR2 results matrix annual 0 0 0 0 0 2 7 2 3 3 lead country person: M&E specialist IR3: Best practices and acceptable standards in nutrition and food security-related policy and programming adopted by USAID, Cooperating Sponsors, and other key stakeholders IR3.1: monitoring percentage of funding from sources other than G/PHN/HN financial tracking annual 28 25 11.5 35 42 45 47% 55 65 65 financial manager IR3.2: monitoring Number of promising practices and acceptable standards identified, produced and disseminated by FANTA highlights; product tracking table annual 0 3 1 3 3 3 4 3 3 13 information specialist *The SO impact indicator (stunting) is reported by 10 out of 23 programs in the seven priority countries. None of those has mid-term or final values yet. As of FY98, there are no results reported to be compared with baseline values. **The SO monitoring indicator is reported by 15 out of 23 programs in the seven priority countries. 1) Baseline calculated for all variables from FY98. FANTA was signed in the last weeks of FY98 and received its first funding in that fiscal year, but operations only began in FY99. 2) Indicators where targets are constant take into account the changing population of Title II cooperating sponsors. 3) While targets reflect incremental increases, each value (except SO impact indicator) is calculated annually based on changing populations and proportionately different levels of effort. IR2: USAID, host country governments and Cooperating Sponsors establish improved, integrated nutrition and food security-related strategies and policies IR2.1: monitoring percentage of recommendations adopted by priority country CS programs IR2 results matrix annual 0 100% 100% 90% 78% 90% 90.40% 95% 100% 100% lead country person; M&E specialist IR2.2: monitoring percentage of recommendations adopted by priority country USAID missions IR2 results matrix annual 0 100% 100% 90% 100% 90% 86.40% 95% 100% 100% lead country person: M&E specialist