MERCY USA FOR AID AND DEVELOPMENT  
EMERGENCY NUTRITION AND WASH SUPPORT PROGRAM FOR GARISSA COUNTY
(15th March 2011‐ 15th March 2012)
END OF PROGRAM EVALUATION
Final Report
March 2012
i 
TABLE OF CONTENTS
LIST OF FIGURES ...............................................................................................................III
LIST OF TABLES ................................................................................................................. III
ACRONYMS AND ABBREVIATIONS ................................................................................ IV
ACKNOWLEDGEMENT ...................................................................................................... VI
EXECUTIVE SUMMARY .................................................................................................... VII
1.0 INTRODUCTION ....................................................................................................... 11
1.1 BACKGROUND INFORMATION ........................................................................................................................ 11
1.2 PURPOSE OF THE EVALUATION ..................................................................................................................... 12
1.2.1 Broad Objective ........................................................................................................... 12
1.2.2 Specific Objectives ...................................................................................................... 12
1.2.3 Focus Areas: ................................................................................................................. 13
2.0 METHODOLOGY ...................................................................................................... 14
2.1 STUDY POPULATION ........................................................................................................................................... 14
2.2 SAMPLING METHOD AND SAMPLE SIZE DETERMINATION ................................................................ 14
2.3 HOUSEHOLD INTERVIEW ................................................................................................................................. 16
2.4 SELECTION OF HOUSEHOLDS ......................................................................................................................... 16
2.5 KEY INFORMANT INTERVIEWS (KII) ............................................................................................................ 17
2.6 FOCUSED GROUP DISCUSSIONS (FGD) ......................................................................................................... 17
2.7 OBSERVATION ....................................................................................................................................................... 17
2.8 DATA COLLECTION TOOLS .............................................................................................................................. 18
2.9 ENUMERATORS SELECTION AND TRAINING ............................................................................................ 18
2.10 DATA CLEANING ............................................................................................................................................... 18
2.11 DATA ANALYSIS ................................................................................................................................................ 19
3.0 FINDINGS AND ANALYSIS ...................................................................................... 19
3.1 DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS ............................................................. 19
3.2 RELEVANCE OF PROJECT OBJECTIVES AND ACTIVITIES TOWARDS MEETING THE NEEDS 
IDENTIFIED ...................................................................................................................................................................... 20
ii 
3.2.1 Relevance of Program Components ............................................................................. 20
3.2.2 Approaches Being Used to Identify the Beneficiaries ................................................. 20
3.2.3 To what extent does the program address the needs of beneficiaries? ........................ 21
3.2.4 Relevance of the Approach .......................................................................................... 22
3.2.5 Coverage of the program activities: were specific needs to be addressed met? .......... 22
3.2.6 Reasons for defaulting (Non Attendance) .................................................................... 23
3.3 COHERENCE OF PROGRAM IN RELATION TO OTHER INTERVENTIONS IN THE 
GEOGRAPHICAL AREA OF IMPLEMENTATION .................................................................................................. 23
3.4 THE IMPACT OF THE PROJECT ON ITS WIDER ENVIRONMENT ........................................................ 24
3.5 THE SUSTAINABILITY OF THE PROJECT ACTIVITIES AND LIKELIHOOD OF CONTINUATION 
OF THE BENEFITS PRODUCED BY THE PROJECTS TO THE BENEFICIARIES .......................................... 25
3.6 THE EFFICIENCY OF THE NUTRITION SUPPORT AND WASH PROGRAM ....................................... 25
3.6.1 Cost Effectiveness ........................................................................................................ 25
3.7 THE EFFECTIVENESS OF THE CONTRIBUTION FROM THE PROJECT RESULTS AND HOW 
ASSUMPTIONS HAVE AFFECTED THE PROJECT ................................................................................................ 26
3.7.1 How assumptions have affected the project ................................................................. 26
3.8 KAP ON IYCN .......................................................................................................................................................... 27
3.8.1 Breastfeeding ............................................................................................................... 27
3.8.2 Pre lacteal feeding practices ......................................................................................... 28
3.8.3 Practices of feeding infants with colostrum ................................................................. 28
3.8.5 Knowledge on Initiation of Complimentary Foods/ Weaning ..................................... 29
3.8.6 Practices of Initiation of Complimentary Feeding/Weaning ....................................... 29
3.8.7 Twenty four hour recall on fluids given to children aged 6 to 24 months. .................. 29
3.8.8 Household Food consumption and Dietary diversity ................................................... 31
3.8.9 Health Seeking Behaviour ........................................................................................... 32
3.8.10 Knowledge of feeding sick child ................................................................................. 32
3.8.11 Level of knowledge of causes of diarrhea in children ................................................. 33
3.8.12 Intake of Vitamin A ..................................................................................................... 34
3.8.13 Iron-folate uptake ......................................................................................................... 35
3.8.14 Prevalence of Acute Malnutrition ................................................................................ 35
3.9 WATER, SANITATION AND HYGIENE (WASH) ........................................................................................... 36
3.9.1 Access to water ............................................................................................................ 36
3.9.2 Time taken to nearest water source .............................................................................. 36
3.9.3 Practices of water treatment ......................................................................................... 37
3.9.4 Knowledge on water safety .......................................................................................... 37
3.9.5 Access and types of toilets ........................................................................................... 38
3.9.6 Child faeces disposal methods ..................................................................................... 39
3.9.7 Household solid waste disposal methods ..................................................................... 39
3.9.8 Hand washing practices ............................................................................................... 40
3.9.9 Methods of hand washing ............................................................................................ 40
3.9.10 Dish Rack ..................................................................................................................... 40
4.0 CONCLUSION ........................................................................................................... 42
5.0 RECCOMENDATIONS .............................................................................................. 43
6.0 REFERENCES .......................................................................................................... 44
iii 
7.0 APPENDICES ................................................................................................................45
Appendix 1: Evaluation Tools ........................................................................................................................................... 45
Appendix 2: Map of Garissa County ............................................................................................................................... 31
Appendix 3: List of Supervisors and enumerators for the Garissa County Evaluation 29th-7th March 2012 ...... 32
Appendix 4: Summary of expected tasks, information required, sources of information and methods and tools . 33
LIST OF FIGURES
FIGURE 1: HOUSEHOLD MEMBER’S AGE BY SEX ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 20
FIGURE 2: REASONS FOR DEFAULTING NON ATTENDANCE. ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 23
FIGURE 3: TIME TAKEN BEFORE BREASTFEEDING THE CHILD AFTER BIRTH ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 27
FIGURE 4: PRE‐LACTEAL FEEDING ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 28
FIGURE 5: PRACTICES OF FEEDING INFANTS WITH COLOSTRUMS ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 29
FIGURE 9: 24 HRS RECALL ON SOLID FOOD GIVEN TO THE CHILD ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 30
FIGURE 10: FREQUENCY OF MEALS GIVEN TO THE CHILD PER DAY ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 31
FIGURE 11: IMMUNIZATION COVERAGE BY ANTIGEN ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 32
FIGURE 12: REPORTED ILLNESS AMONG CHILDREN UNDER 5 YRS ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 33
FIGURE 13: KNOWLEDGE ON THE CAUSES OF DIARRHEA ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 33
FIGURE 14: VITAMIN A UPTAKE ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 34
FIGURE 15: IRON‐FOLATE  UPTAKE AMONG PREGNANT WOMEN ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 35
FIGURE 17: TIME TAKEN TO THE NEAREST SOURCE OF WATER ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 36
FIGURE 18: HOUSE HOLD WATER TREATMENT METHODS ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 37
FIGURE 19: RESPONDENTS VIEW ON THEIR DRINKING WATER SAFETY ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 38
FIGURE 20: TYPE OF HOUSEHOLD TOILET ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 38
FIGURE 21: CHILD FAECES DISPOSAL METHODS ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 39
FIGURE 22: HOUSEHOLD SOLID WASTE DISPOSAL ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 39
FIGURE 23: CAREGIVER’S HAND WASHING PRACTICES ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 40
FIGURE 24: AVAILABILITY OF DISH RACK ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 41
LIST OF TABLES
TABLE 1: RESULTS FROM THE SMALL‐AREA SURVEYS OF THE SQUEAC........................................................................................... 22
TABLE 2: REASONS FOR NOT INITIATING BREASTFEEDING ............................................................................................................ 27
TABLE 3: TABLE SHOWS TWENTY FOUR HOUR RECALL ON FLUIDS GIVEN TO CHILDREN AGED 6 TO 24 MONTHS ........................................ 29
TABLE 4: HH FOOD CONSUMPTION AND DIETARY DIVERSITY....................................................................................................... 31
TABLE 5: ACUTE MALNUTRITION BASED ON WEIGHT‐FOR‐HEIGHT Z‐SCORES .................................................................................... 35
TABLE 6: DISTRIBUTION OF ACUTE MALNUTRITION AND OEDEMA BASED ON WEIGHT‐FOR‐HEIGHT Z‐SCORES........................................... 36
iv 
ACRONYMS AND ABBREVIATIONS
ANC   Ante‐Natal Clinic
ASAL   Arid and Semi‐Arid Lands  
BSFP   Blanket Supplementary Feeding Program  
CSB     Corn‐Soya Blend  
CTC Community Therapeutic Care  
DNOs   District Nutrition Officers  
ENA     Emergency Nutrition Assessment
FGDs     Focused Group Discussions  
GAM   Global Acute Malnutrition  
GFD   General Food Distribution  
HDDS     Household Dietary Diversity Score  
IYCF     Infant and Young Child Feeding  
KII   Key Informant Interview
MUAC   Middle Upper Arm Circumference  
NGOs     Non‐governmental Organizations  
OFDA   USAID Office for Foreign Disaster Assistance  
OTP   Outpatient Therapeutic Program
SC     Stabilization Centre  
SFP     Supplementary Feeding Program
SMART   Standardized Monitoring and Assessment in Relief and Transition  
WFH     Weight for Height
WFP     World Food Program
WHO   World Health Organization  
ALRMP   Arid Lands Resource Management Project
CSAS   Centric Systematic Area Sampling  
v 
MERCY USA PROGRAM DISTRIBUTION MAP KENYA
Areas in Yellow are active program sites as of March 2012
This End of Program Evaluation of Garissa County’s Integrated Nutrition and WASH Program Area
was commissioned by Mercy‐USA for Aid and Development   
The Consultants:
 Lead Consultant ‐  Ms. Fatuma Hussein
 Co‐ consultant ‐ Mr. Jack Bwong  
vi 
ACKNOWLEDGEMENT
Many people contributed to the success of the evaluation. Special appreciation goes to the staff of
Mercy USA, the staff of the MoMS and MoPHS for technical, logistical and physical support while
in the field.
We would like to express our appreciation to all those interviewees who took their time to answer
questions at the targeted households and all other groups who contributed their views during the
qualitative data collection.
The assessment team would like to give particular thanks to the staff of the Hiddig Hotel in Garissa
town whose services during the training also contributed to making our work successful.
We hope the study findings will be useful in planning and executing similar interventions in the
future.
vii 
EXECUTIVE SUMMARY
Mercy USA has been implementing an Emergency Nutrition and WASH Program in Garissa County,
North Eastern Province in Kenya for a period of 1 year since March 2011 to March 2012. Mercy‐
USA, initiated an emergency response on the ground supporting both facility and community‐
based interventions to enable a holistic approach in curative and preventive nutrition
rehabilitation interventions for the targeted beneficiaries and improve access to water and
sanitation facilities for school going children. The program proposed to expand existing coverage
and outreach activities to enable the delivery of services to a wider population currently in need of
nutrition support within this County. The MoMS/MoPHS capacity to provide nutrition
rehabilitation services within its health facilities are limited hence this program had been designed
to strengthen existing ministries of health systems to adequately provide nutrition support to
vulnerable groups within the community. The main focus areas of this program was to address
management of moderate and severe acute malnutrition through the Integrated Management of
Acute Malnutrition (IMAM) approach, building capacity of the MoMS/MoPHS staff through
training, supervisory support and mentoring of health workers, promotion of behaviour change at
the community level through nutrition and hygiene promotion education sessions and improving
access to water and sanitation facilities.
The main responsibility of the consultant was to conduct an assessment of the Nutrition and
WASH projects in Garissa, Ijara, Fafi, Balambala and Lagdera Districts within Garissa County.
The Specific objectives of the assessment were: To establish the relevance of project objectives
and activities towards meeting the needs identified within the community; establish coverage of
the program activities; assess the coherence of the program in relation to other interventions in
the geographical area of implementation; establish efficiency; assess the impact of the project on
its wider environment, assess the effectiveness of the contribution from the project results and
sustainability of the project activities and likelihood of continuation of the benefits produced by
the projects to the beneficiaries.
Methodology and tools  
There were two levels of sample size calculation, one for the SQUEAC methodology (Semi‐ 
Quantitative Evaluation of Access and Coverage where 324 households with children under the
age of 5 were sampled) and the other for the household assessment on the Infant and Young Child
viii 
Feeding Practice where 400 households were sampled. The first level of the sample size was for
the small sample surveys for the SQUEAC and uses a two‐stage screening test model which
involved the hypothesis generation and thereafter testing the hypotheses through the small area
surveys.
Findings  
On average the coverage and access to nutrition services were satisfactory at >50%
(Recommended by Sphere Standards) in four of the five districts of Garissa, Lagdera, Balambala
and Ijara. Only Fafi was unsatisfactory at 45%.  Highest coverage was in Lagdera at 71.4%. A large
number of children had been admitted and treated during the project cycle whereby IMAM
services had been integrated into the health system in Garissa County. However, due to the
persisting drought, the GAM rates still remained high in March 2012 as compared to April 2011 as
the baseline. The over 20% GAM in March 2012 was also attributed to poor access of health care
services which meant no or late treatment of acute malnutrition and diseases such as diarrhoea,
malaria and respiratory diseases. As compared to April 2011, these conditions had aggravated.
There are also inadequate fully functioning health facilities in the project area. In those that are
functioning, there is high staff turn‐over even for those already trained in the Integrated
Management of Acute Malnutrition.
As a result of strengthening the health system (a key objective of the program), the overall child
morbidity declined and deworming coverage improved the same period of between April 2011
and March 2012.  
Comparison of baseline findings (April 2011) and Evaluation findings (March 2012)
April 2011  Baseline % March 2012 (end line)
Nutritional Status and morbidity
% Global Acute Malnutrition (GAM)‐ ALL 16.2 21.0
% Global Acute Malnutrition (GAM)‐ BOYS 17.2 22.4
% Global Acute Malnutrition (GAM)‐ GIRLS 15.1 19.6
% Moderate Acute Malnutrition (MAM) 13 17.7
% Severe Acute Malnutrition (SAM)‐ WHZ <‐3 3.2 3.3
% Severe Acute Malnutrition (Oedema) 0.5 0.2
ix 
Overall child morbidity   46.1 38
Deworming   46.7 48
Infant and Young Child Feeding
Initiation of breastfeeding within one hour   40.6 51
Given Colostrum 83.3 85
Exclusive breastfeeding  for 6 months   75.7 85
Still breast feeding   77.2 78
Ever breastfed 93.7 95.6
Food Aid  received in  household   51.7 62.4
Pregnant and lactating women MUAC <23cm 10.8 8.9
WASH indicators
Access to clean water   48.6 51
Access to proper sanitation   45.4 18
Practice proper hand washing   38.7 34
There was also improvement in all IYCN indicators as shown in the Table above. This was
attributed to the increased caregiver education and awareness during the program period.
Nutrition education was conducted both at health facility and community level. While access to
clean water improved, rates of access to proper sanitation and appropriate hand washing did not
– and this may have been partly due to difference in the sampling method for WASH indicators
between the baseline and end line surveys. Other reasons to explain the difference are due to the
increased mobility (due to drought and insecurity) which limits the use of toilets for those moving
and lack of water for hand washing.
It was found that the program supported the provision of the needed (and thus relevant) services
in the program area, focusing on the High Impact Nutrition Interventions (HINI). The approaches
used to achieve these were appropriate and responsive to the challenges of health care system.
The main approach was to scale‐up integration of nutrition services into the existing ministries of
health systems through support to DHMT and on the job training. The emergency nutrition needs
at the time of drought (during the program) were also addressed with  total of 8,724 children in
SFP, 3,464 in OTP and 5,042 pregnant and lactating women  reached as at March 2012.  
Other programmatic achievements were:
x 
1. Decentralization of management of acute malnutrition from the district hospital to health
facility and community
2. Recovery rates, death rates and default rate for both management of severe and moderate
malnutrition were all within the sphere standards at end line.
For even greater impact, it is recommended that:
1. The community mobilization and awareness strategy be extended beyond community
volunteer training and leader sensitization meetings, to include creative events such as
theatre and jingles, among others.
2. The number of health facilities must be increased in order to ensure that the population
has adequate access to treatment. It will therefore be vital to supporting health facility
teams to improve service delivery.
11 
1.0 INTRODUCTION
This is a report on an end of program evaluation for the Emergency Nutrition and WASH Support
Program in Garissa County, Kenya.  The program was launched in March 2011 and ran for a period of
one year. The main responsibility of the consultant was to conduct an assessment of the Nutrition
and WASH projects in Garissa Ijara, Fafi, Balambala and Lagdera District of Garissa County. Garissa
County is within ecological zones V and VI, which fall within the arid and semi‐arid lands (ASALs) in
Kenya. The ASAL is home to the poorest segments of the population who are trapped in a drought
plagued and hostile environment often marginalized from the mainstream of economic activity with
issues in the livestock sub sector that include low pastoral production and weak service delivery. This
is attributable to unpredictable weather patterns, droughts, and floods  that have direct effect on
livestock feed and water supply and consequently the quality and quantity of production; forcing drop
out of pastoralist who in turn created new settlements of slums where majority live in absolute
poverty.
1.1 BACKGROUND INFORMATION
Mercy USA proposed the implementation of the Nutrition and WASH support intervention in Garissa
County with primary funding from OFDA. This was initiated in 2011 as an emergency response on the
ground supporting both facility and community‐based interventions to enable a holistic approach in
curative and preventive nutrition rehabilitation measures and WASH interventions for the targeted
beneficiaries. The program proposed to expand existing coverage and outreach activities to enable
the delivery of services to a wider population currently in need of Nutrition and WASH support within
these districts. Additionally, the program provided support to the Ministry of Medical services
(MoMS) and Ministry of Public Health and Sanitation (MoPHS) in the district through training of
health workers and other community volunteers. The MoMS and MoPHS capacity to provide nutrition
rehabilitation services within its health facilities is limited, hence this program had been designed to
strengthen existing health systems to adequately provide nutrition and WASH support to vulnerable
groups within the community.  
The main focus areas of the Nutrition program was to address integrated  management of moderate
and severe acute malnutrition, support to the MoMS and MoPHS at the district level through training,
12 
supervisory support and mentoring of health workers, and the promotion of behaviour change at the
community level through nutrition education activities. WASH interventions focused on; conducting
hygiene promotion at community and school levels, providing safe water to school children through
construction of rainwater harvesting tanks, installation of sanitation facilities which included hand
washing stations and pit latrines.
1.2 PURPOSE OF THE EVALUATION
The purpose of the evaluation was to conduct a summative assessment of the Nutrition and WASH
projects in Garissa, Ijara, Fafi, Balambala and Lagdera district within Garissa County. The evaluation
was based on the program objectives.  
1.2.1 Broad Objective
The goal of this project is to provide access to nutrition rehabilitation services for vulnerable children
<5 and Pregnant and Lactating Women (PLW), as well as WASH interventions for children in selected
schools.
1.2.2 Specific Objectives
1. To establish the relevance of project objectives and activities towards meeting the needs
identified within the community
2. To establish coverage of the program activities; whether specific needs to be addressed were met.  
3. To assess the coherence of the program in relation to other interventions in the geographical area
of implementation.
4. To establish efficiency (the cost, speed and management efficiency with which inputs and
activities were converted into results and the quality of the results achieved)
5. To assess the impact of the project on its wider environment.  
6. To assess the effectiveness of the contribution from the project results and how assumptions have
affected the project  
7. To assess the sustainability of the project activities and likelihood of continuation of the benefits
produced by the projects to the beneficiaries.
8. To assess IYCN practices and knowledge gaps in the target communities  
9. To assess the coverage of WASH interventions   
13 
1.2.3 Focus Areas:
1. Conduct a coverage assessment of the nutrition and WASH activities in line with recommended
methodology.
2. Assess the prevailing knowledge, attitude and practice of the target community pertaining to
nutrition education and IYCN focus areas such as exclusive breastfeeding, complementary feeding,
feeding of sick or malnourished child, health seeking behaviour, micronutrient supplementation,
WASH etc.
3. Assessment of processes and systems used by Mercy USA program staff to ensure effective
implementation of the program inputs to achieve the desired outcome.
4. Assessment of involvement of all the stakeholders, particularly women, youth and minorities in
design, planning, implementation and monitoring stage.
5. Evaluate the integration of cross cutting issues into program activities; gender relations,
protection mainstreaming, infrastructure rehabilitation, capacity building/training.  
14 
2.0 METHODOLOGY
This was a cross sectional descriptive evaluation study involving both quantitative and qualitative
methodologies. There was a desk review of program documents such as program proposal, reports
and literature search to inform the quality improvement approaches and applications to such
programs. Quantitative methods were used to determine whether the project has achieved
sustainable outcomes and impacts. This involved the household survey for the IYCF and the SQUEAC
methodology (Semi‐Quantitative Evaluation of Access and Coverage) to evaluate access and coverage.
The qualitative methods were employed to assess the quality of the program, efficiency and
effectiveness of the program. It also gave the perception and views of the beneficiaries about the
Nutrition and WASH program. Furthermore, this evaluation provides recommendations for
consideration during the continuation or scale up for other related programs.  
2.1 STUDY POPULATION
The study population for the evaluation included care providers, mothers with children under five
years of age, pregnant and lactating women. However the unit of analysis was the households with
children under five years in the five districts. The survey targeted children 0‐59 months and women of
reproductive age (15‐49 years). The care givers of the children who were not covered in the program
were also interviewed to give their reasons for the child’s non‐attendance. For the WASH program,
the schools were sampled as the population and focus was on; the provision of safe water, hand‐
washing practices and the change in behaviour with regard to water, hygiene and sanitation.
2.2 SAMPLING METHOD AND SAMPLE SIZE DETERMINATION
The SQUEAC (Semi‐Quantitative Evaluation of Access and Coverage) methodology was used. The data
collected from routine program data and anecdotal data, when combined, provided information
about coverage as well as the likely barriers to service access and uptake that exist within a program.
This information can be considered as a set of hypotheses that can be tested. The SQUEAC method
uses small‐area surveys to confirm or deny these hypotheses. The SQUEAC small‐area survey was
determined by the coverage of the samples areas. For the satisfactory areas, 10% sample was used
while for the unsatisfactory areas 50% was covered.
15 
There were two levels of sample size calculation one for the SQUEAC methodology and the other one
for the household survey on the Infant and Young Child Feeding Practice (IYCF). The first level of the
sample size was for the small sample surveys for the SQUEAC (Semi‐ Quantitative Evaluation of Access
and Coverage) and uses a two‐stage screening test model.
STAGE 1: Identification of areas of probable low and high coverage and reasons for coverage failure
using routine program data readily available. Quantitative and anecdotal data was collected with little
additional work.  
STAGE 2: Confirmation of the location of areas of high and low coverage and the reasons for coverage
failure identified in Stage 1 using small‐area surveys. SQUEAC small‐area surveys use the same in‐
community sampling and data‐collection methods as CSAS surveys. Cases were selected using an
active and adaptive case‐finding method. Whenever a case is found the caregiver was asked whether
the child is already in the program. A short questionnaire was administered if the malnourished child
was not already in the program. The criteria for assessing coverage was that it had to be regarded as
below the SPHERE minimum standard for coverage of therapeutic feeding programs in rural settings
of 50% due to:
a) A mismatch between the program's definition of malnutrition (i.e. anthropometric criteria and
problems of food security) and the community's definition of malnutrition (i.e. as a
consequence of illness, particularly diarrhoea with fever).
b) Patchy coverage of outreach services particularly with regard to the on‐going follow‐up of
children with marginal anthropometric status.
c) Distance to OTP sites and other opportunity costs.
A small‐area survey was undertaken in this area to confirm this hypothesis. This survey involved using
active and adaptive case‐finding in all villages in the area identified in and the application of a
questionnaire similar to caregivers of non‐covered cases found by the survey. Analysis of the collected
data confirmed that coverage in the identified area is likely to be below 50%.
The second level of sample size calculation was for the household survey on the Infant and Young
Child Feeding (IYCF), which employed the following formulae to determine sample size for the study.  
                           (Eqn 1)
16 
Where;
n=the desired sample size  
N= the population size (Estimated number of children under 5 years in Garissa County ‐66,267)
e=the level of precision (5%)
 398
05.0267,661
267,66
2  
n             (Eqn 2) (Households for the IYCF and other qualitative
assessment information)
n=398 which was rounded off to 400 to address any absenteeism, transfers and any form of attrition
(Yamane 1967). The survey targeted 724 households with mothers 15‐49 years of age with at least
one child under 5 years of age. The 724 households were proportionately distributed in the five
districts. The households were selected from the catchment of randomly selected health facilities.
The household survey sample was 398 rounded off to 400 and the 324 was the SQUEAC sample
adding up to 724 households.
The qualitative sampling method and techniques that were involved were mainly purposive sampling
and involved KII and FGDs methodologies. Using the Lot Quality Assurance Sample (LQAS) from the 5
districts, the average coverage assessment of 64 children per district giving a total of 324 children
This survey used cluster sampling. The various villages formed the clusters within a sub‐location,
villages were listed and 36 clusters were randomly selected from the list. The total number of
households targeted per cluster was 20.
2.3 HOUSEHOLD INTERVIEW
Structured questionnaires were administered to 724 randomly sampled households with caregivers
15‐49 years old who have children under the age of 5. The aim of household interviews was to collect
information on the quality of nutrition and health services provided, intervention strategies
implemented, perceived impact of activities, success stories and the achievements, gaps and
limitations of the activities as well as existing opportunities for action.
2.4 SELECTION OF HOUSEHOLDS
Each survey team moved to the centre of the assigned cluster. At the centre, a pen was span to
determine the direction to be followed to identify households to be surveyed. The selection of the
17 
first household was random and from this, successive households were picked by random walk until
20 households were covered.  
2.5 KEY INFORMANT INTERVIEWS (KII)
The aim of the qualitative interviews was to assess the quality of the program, efficiency and
effectiveness of the program.  A total of seventeen (17) KIIs were done, 5 KII with District Nutrition
Officer (DNOs), 3 KII with Head Teachers/committee members, 4 KII with the MOH staff especially the
catchment health facilities and 5 KII with Mercy USA staff supporting this program.
2.6 FOCUSED GROUP DISCUSSIONS (FGD)
An FGD guide was used to collect data in the FGDs. A total of 18 FGDs were conducted with caregivers
and mothers. The discussions explored views regarding the quality of Nutrition, WASH and Health
services provided by the program and their recommendations for improvement.
2.7 OBSERVATION
On site observation was done with the aid of a checklist. The observation was based on the physical
appearance especially of the children, service delivery at the health facility, water points provided in
the schools and the records at the health facilities. The assessment was carried out at different levels
as shown in the sample size table.
Sampling frame  
`Districts Divisions Health
facilities
KII FGD Household
Interview
5 10 5 5DNO
3H/Teacher/ Committee
4 MOH
5Mercy USA  staffs  
18 with
caregivers
724 mothers  with
children under 5  
5 10 5 17KIIs 18 FGDs 724 Households
18 
2.8 DATA COLLECTION TOOLS
Data to be derived from this survey focused on anthropometric measurements and other indicators
relevant to nutrition status such as IYCN, household food security, morbidity and other High Impact
Nutrition Interventions (HINI). Data collection tools included structured and semi‐structured tools
that were pre‐tested by the consultant. Data was triangulated by both source and method. Data from
anecdotal sources and methods was also triangulated with routine program data and data from
previous baseline survey.  
2.9 ENUMERATORS SELECTION AND TRAINING
The plan for data collection started immediately with the identification, selection and training of
enumerators. We had 8 members in each team consisting of 2 supervisors, 1 team leader 5
enumerators for each of the 5 districts. The enumerators were recruited from the community and
trained to ensure quality data. The criterion for selection was that enumerators had to be locals who
understood the local Somali language and also had technical knowledge in health. They included
nutritionists, nurses and Public Health Officers with fluency in both English and local language. The
District Health Management Team (DHMT) was also involved in mobilization for quality data
collection. The participatory 2 day training culminated in a return demonstration of the data
collection exercise amongst the enumerators in order to identify some of the challenges expected and
also to assess the level of success of the training.
The pre‐test was done on the third day at Bula Iftin which was out of the target survey area. The
successful trainees were then considered for data collection exercise with supervision to ensure
maintenance of quality and consistency.  
2.10 DATA CLEANING
Data was cleaned in two phases. The first cleaning was done immediately from the field where the
data collection tools were cleaned on a daily basis. The tools were sorted out according to their
categories. The questionnaires were checked for completeness, clarity and the right coding. The
second phase of cleaning was done after quantitative data had been entered in the computer.
19 
2.11 DATA ANALYSIS
Quantitative data was analysed using Statistical Package for Social Scientists (SPSS) software (version
19.0, Chicago, Illinois, USA). ENA for SMART 2010 was used to analyse anthropometric data, other
data sets and variables collected especially from the IYCF were analysed through the SPSS Version 19.
Manual analysis of qualitative data from KIIs and FGDs included coding, summarizing, categorizing,
direct quoting, comparisons and manually by theme and sub themes.  
3.0 FINDINGS AND ANALYSIS
3.1 DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS
A total of 724 households were surveyed with total of 3,735 household members. Each household
had an average of 5 household members. Majority 89.8 % (650) of the household heads respondents
were male, only 10.2 % were female. Most of the respondent 83 % had no education; only 4.3 % and
2.8 % had some primary incomplete and primary complete education respectively.  
Majority of the household members were children under 5yrs 38.2 %. This was the general population
covered by the survey in the 724 households. Only 39.9 % of the household members had some form
of income as compared to 60.1 % (2244) who were under 24 years indicating a high dependency ratio
in households . Fig. 1 below illustrates the household members age by sex.  
20 
Figure 1: Household member’s age by sex
3.2 RELEVANCE OF PROJECT OBJECTIVES AND ACTIVITIES TOWARDS MEETING THE NEEDS
IDENTIFIED
The involvement of all the stakeholders, particularly women, youth and minorities in design, planning,
implementation and monitoring stage made the project relevant as these provided an opportunity for
their inputs in design in their own perspective.
3.2.1 Relevance of Program Components
The program primarily targeted children under 5 years of age and pregnant and lactating women (15‐
49 years). The Health and Nutrition intervention services package offered to the children with
nutritional needs include Outpatient Therapeutic Programs, Supplementary Feeding Program,
Inpatient Program(SC),Micronutrient supplementation (iron and folate for pregnant women, Vitamin
A supplementation, Zinc), de worming, immunization, growth monitoring, IYCN through individual
counselling and community nutrition and health education. Referral systems for children with
nutritional needs were done in the community by the Community Health Workers to the health
facility. Feedback documentation is done at the health facility. No payments are charged for referrals.
3.2.2 Approaches Being Used to Identify the Beneficiaries
The identification of beneficiaries at the outreach sites and in health facilities was guided by the
program guidelines under the IMAM and HINI approach, which define admission criteria for
beneficiaries and other groups to be reached by the interventions. It was observed that there was an
21 
integration of nutrition services with Primary Health Care (PHC) services at government health
facilities.
The CHWs identifying beneficiaries in their area were trained to apply the criteria and procedures in
accordance with the established IMAM and HINI guidelines. Malnourished children were referred to
the health facilities and verified by the health workers through facility assessment (anthropometric
measurements and clinical observations). At facility level Mercy USA supported the MoPHS in the
provision of accessible health care through different approaches. One of them was through the
community outreaches. A total of 60 outreaches were identified and supported in consultation with
the District Health Management teams (DHMTs), 12 outreaches per district for the 5 districts. The
organization had provided on the job training for the health workers at the health facilities, training
them on HINI. This included 76 health workers and 84 CHWs.  
Mercy USA supported joint supervision with the DHMTs. Mercy USA also supported the facility to
engage 2 CHWs at each of the health facilities in Garissa County to help in implementation of the
nutrition program. Quarterly review meetings were held in each facility. This was quite relevant in
strengthening the functionality of the district health care system at community level.
3.2.3 To what extent does the program address the needs of beneficiaries?
The program managed to reach a vast number of households with children in need of nutrition
support. As at the end of March 2012, a total of 8,724 children in SFP, 3,464 in OTP and 5,042
pregnant and lactating women in SFP were reached with nutrition interventions. A total of 3,200
children attending school in Early Childhood Centres (ECD) were also reached by the interventions.  
While most OTP sites seemed to be well and convincingly rooted in their communities and familiar
with the needs and those most in need (observations by evaluators), explicit evidence of needs
assessments was presented and noted by the evaluators from the desk review of the program records
and verification  during the field visits.
The Nutrition and the WASH projects are quite relevant. They met the needs of the community
especially in addressing malnutrition among the under 5 years of age and also improving accessibility
of water and sanitation facilities in schools. In the four schools visited it was noted there was
improved hygiene practices and the increased access to clean and safe water.
22 
3.2.4 Relevance of the Approach
This approach was chosen based on a previous study (baseline survey 2011) acknowledging the
existence of local responses. The baseline survey found out there was a need for capacity building for
health workers to effectively provide nutrition and health services to the vulnerable groups. There is
apparently a continued need of strengthening local responses to nutrition care and support, through
capacity building of CHWs and the health facility staff.
3.2.5 Coverage of the program activities: were specific needs to be addressed
met?
The program addressed the immediate needs of the beneficiaries. The beneficial interventions
included; health education, micronutrient supplementation, outpatient therapeutic program,
supplementary feeding, screening, de worming, immunization and WASH interventions (supply of
safe water, provision of sanitation facilities and hygiene promotion).
Access and coverage of Nutrition services
Table 1: Results from the small‐area surveys of the SQUEAC
Results from five small‐area surveys from the first SQUEAC use
OTP Site True
Coverage
Cases
Found
(n)
Covered
Cases
(c)
D c/nx100 Is c >
d?
Classified
Coverage
Comments on
coverage
Garissa > 50% 14 8 7 57 Yes > 50% Satisfactory
Lagdera > 50% 7 5 2 71.4 Yes > 50% Satisfactory
Mbalambala < 50% 15 8 7 53 Yes > 50% Satisfactory
Fafi < 50% 20 9 11 45 No < 50% unsatisfactory
Ijara > 50% 6 4 2 66.7 Yes > 50% Satisfactory
On average the coverage and access to nutrition services was satisfactory in all the four districts apart
from Fafi district based on the sphere minimum for the rural population which is 50%.
23 
3.2.6 Reasons for defaulting (Non Attendance)
The mothers/care givers of the children were asked about the reasons for the non‐attendance. The
responses are depicted in the figure below. The caregivers of children who had not attended were
asked to give a view of their perspective with regard to their non‐attendance.  
Figure 2: Reasons for defaulting Non Attendance.
The majority of the care givers (75%) had expressed mainly three reasons for their non‐attendance.
Those who expressed difficulty with child care were 25.4% while some expressed that they did not
have time or were too busy to attend(24.3%) and 24.5% said that they could not travel with more
than one child.
3.3 COHERENCE OF PROGRAM IN RELATION TO OTHER INTERVENTIONS IN THE
GEOGRAPHICAL AREA OF IMPLEMENTATION
Coherence is the integration of relief activities to policy and practice changes needed to address root
causes. This refers to the integration of cross cutting issues into program activities; gender relations,
protection mainstreaming, infrastructure rehabilitation, capacity building/training.
All Key Informant interviews (KIIs) done with the MoMS/MoPHS reported they had been trained on
HINI though classroom training and on job training by different organizations including Mercy USA in
collaboration with MoPHS.
24 
The integration of the interventions has been coherent as was outlined in the program proposal in
2011. The implementation of Nutrition and WASH services, Capacity Building / Training and the
community involvement complimented each other well.
The direct beneficiaries of nutrition interventions were children under the age of 5. A total of 15,560
children were reached with both Nutrition and WASH interventions. The main focus was to address
their current state of malnutrition, reduce levels of malnutrition and prevent future incidences of the
same among this vulnerable group through various curative and preventive approaches outlined in
HINI. WASH activities at school level were also found to be complimentary to this approach.
With regard to Capacity Building / Training, Mercy‐USA provided training to health workers on key
areas of nutrition included in HINI and WASH (Participatory Hygiene and Sanitation Training – PHAST)
and linked this to IMCI protocol which was also integrated well through the HINI approach. This has
improved the capability of health workers to effectively carry out program activities and to provide
reflective and accurate reporting on the same.
An integral part of the project was to build the capacity of local communities through training in
health and nutrition issues so that they are able to reinforce best practices at the home and
community level. Mercy USA staff has been conducting quarterly nutrition and WASH education
sessions at facility level which was the main mechanism for community education. At least 3
community sessions were conducted in majority of facilities covered. It was however noted from
information through KIIs that there were some challenges especially insecurity in some locations that
made it difficult to execute these sessions.
This program has enhanced linkages with CCC, MCH, ANC and other outpatient clinics within the
hospitals and health centres that have enabled early nutrition support to the targets, providing them
with nutrition education services. From the KII with the DHMTs, they acknowledged this support
through the capacity building component of the program to health workers which in turn improved
case management at facility level.
3.4 THE IMPACT OF THE PROJECT ON ITS WIDER ENVIRONMENT
The program has integrated well with other stakeholders particularly the community and MoPHS and
MoMS. In terms of gender the CHWs training has empowered women, youth and minorities in design,
25 
planning, implementation and monitoring stage. From the KIIs, the key impacts attributed to the
program included promotion of health education, promotion, adaption and improved hygiene and
sanitation practices in the community as well as reduced malnutrition in the community.  
3.5 THE SUSTAINABILITY OF THE PROJECT ACTIVITIES AND LIKELIHOOD OF
CONTINUATION OF THE BENEFITS PRODUCED BY THE PROJECTS TO THE
BENEFICIARIES
From all the KIIs, informants stated that the nutrition services can be sustained.  
The challenges mentioned by the KII included; increased workload to the health workers, inability to
meet the target coverage, lack of mobilization and integrating the nutrition with other programs like
WASH and HINI.    
Capacity building the health workers and hiring a nutritionist would enhance sustainability. Providing
more bicycles would also enhance sustainability by improving the means of transporting during the
outreaches. Adhering to the MoMS/MoPHS policy and involving the DHMT during the program
implementation process.  
3.6 THE EFFICIENCY OF THE NUTRITION SUPPORT AND WASH PROGRAM
The efficiency element compares the cost, speed and management of resources with which inputs
and activities were converted into results and the quality of the results achieved. This section reflects
on the processes and systems used by Mercy USA program staff to ensure effective implementation
of the program inputs to achieve the desired outcome. The KII stated that the cost of running the
services was fairly expensive in all aspects in terms of material, personnel and logistics. The time
allocated for the program is not enough.
3.6.1 Cost Effectiveness
The financial management report gives details of the variability of cost effectiveness among Mercy
USA program activities, with several examples. The evaluation found that the following factors
influenced cost effectiveness:  
 Longer term presence; this was evident by the engagement with already existing government
structures,  
26 
 Slow scale up; the integration of the nutrition and PHC services was done well, few
expatriates, local implementation partners and existing relationships and knowledge of
environment.
 Active partners and technical competence.
 The last factor, technical competence, is an important one that is only indirectly referred to in
the financial management report.  
3.7 THE EFFECTIVENESS OF THE CONTRIBUTION FROM THE PROJECT RESULTS AND HOW
ASSUMPTIONS HAVE AFFECTED THE PROJECT
This section focused on the knowledge, attitude and practice of the target community pertaining to
Nutrition education and IYCN focus areas such as breastfeeding and complementary feeding, feeding
of sick or malnourished children, health seeking behaviour, Water Sanitation and Hygiene promotion
and micronutrient supplementation.
3.7.1 How assumptions have affected the project
The main assumptions upon which this project was implemented were that:  
 UNICEF and WFP were to continue providing supplies for the nutrition services and no
interruption in the delivery of supplies was to be experienced.  
 During the project period, no new natural calamities of significant effect that could influence
the outcome of the project as planned would be experienced, thus the expected outcomes
and benefits would be achieved.  
 The impact of the current climatic and food security disaster on the target population would
not be compounded by further disasters related to natural elements.
 There was to be adequate funding, human resources, facilities and supplies in the sites
throughout the program period to ensure timely service delivery to the intended beneficiaries.  
Some of the assumptions affected negatively or positively the achievement of results, for instance,  
 Mercy USA received additional funding during the implementation of the program that
enabled scale up of activities such as outreaches.  
27 
 There was heightened insecurity especially from the Al shabaab threat that resulted in
suspension of activities in some locations towards the end of 2011 that slowed down progress.  
 Natural calamities such as rains made some places inaccessible for service delivery due to
impassable roads.
3.8 KAP ON IYCN
3.8.1 Breastfeeding
Practices of initiation of Breastfeeding  
Slightly more than half of the caregivers 51.3 % indicated that the child was put on breast milk within
half an hour after birth.  
Figure 3: Time taken before breastfeeding the child after birth
Table 2: Reasons for not initiating breastfeeding
Reasons for not breastfeeding Percent %
No milk 51.3
Did not want to/child refused 19
Traditional beliefs 6.3
medical advice 9.5
mother died 4.8
The child was sick 9.1
28 
Of the mothers who never breastfed their children (51.3%) indicated that it was because of lack of
milk while 19% said they (children) just did not want to breastfeed. (Multiple response question)
3.8.2 Pre lacteal feeding practices
Figure 4: Pre‐lacteal feeding
The study revealed that 61% of the caregivers gave other feeds to new‐born babies before initiating
breastfeeding, 38% did not give pre‐lacteal feeds and 1% did not know whether the children had been
given pre‐lacteal feeds.
3.8.3 Practices of feeding infants with colostrum
The study revealed that 92% of mothers fed the infants with colostrum, 7% did not feed the infants
with colostrum while only 1% did not know.  
Pre‐lacteal Feeding
No ‐ 38%
Yes ‐ 61%
Don't know ‐ 1%
29 
Figure 5: Practices of feeding infants with colostrum
3.8.5 Knowledge on Initiation of Complimentary Foods/ Weaning
Majority of the caregivers, 53% said weaning should start at six (6) months, 36% said at 1 year, 4%
said it should start at 3 years and 7% did not know.  
3.8.6 Practices of Initiation of Complimentary Feeding/Weaning
The survey found out that 51% of the caregivers initiated complimentary feeding / weaning when the
child was six months old, 32% of them started weaning at two years , with 12% at three years and 5%
did not know.
3.8.7 Twenty four hour recall on fluids given to children aged 6 to 24 months.
Table 3: Table shows twenty four hour recall on fluids given to children aged 6 to 24 months
Supplementary feeding Percent %
Infant formula 5.8
Other  milk 75
Sweetened flavoured juice 18.5
Oral rehydration salt 8.3
Tea/coffee 7.7
Plain water 53.3
Thin Porridge 43.9
Yes ‐ 92%
No ‐ 7%
Don’t Know ‐ 1%
30 
Chicken/egg soup 7.8
Enriched porridge 67.8
67% of young children aged 6 to 24 months were fed with porridge in the last 24 hour recall period.
The study also revealed that about 91.2% of these children were not given infant formula while 3%
did not know. 75% of the children were fed with other milk like animal and reconstituted powdered
milk. Only 18.5% were given flavoured juices.  
3.8.7.1 Twenty Four Hour Recall on Solid Foods Given To Children Aged 6 to 24 Months
The study found that only 32% of children aged 6‐23 six months were fed on eggs, 33% had been fed
on meat, 78% of them did not feed on grains and tubers which are sources of carbohydrates, 63%
were also not given vitamins, 75% were not given vegetables and 34% of these children were given oil
and fats.
Figure 6: 24 hrs. recall on solid food given to the child
3.8.7.2 Meal Frequency (No Of Meals per Day)  
Majority of the children (60%) were fed 4 times in a day while 12% was fed 3 times.  Only 4% were fed
6 times.
31 
3.8.8 Household Food consumption and Dietary diversity
Table 4: HH Food consumption and Dietary Diversity
Type of foods Yes No Don’t Know
Cereals and cereal products (e.g. anjera, sorghum, maize, spaghetti,
pasta, anjera, rice, bulga wheat, bread)
94.0 6.0 0
Vitamin A rich vegetables and tubers: Pumpkin, carrots, yellow fleshed
sweet potatoes   
62.7 37.3 0
White tubers and roots: White tubers, white potatoes, white yams ,
cassava or foods from roots, white sweet potatoes,
81.3 18.5 0.3
Dark green leafy vegetables: Dark green leafy vegetables such as
cassava leaves, pumpkin leaves, cowpeas leaves, sukuma wiki, spinach,
41.5 58.5  
Organ meat, (Iron rich): Liver, kidney, heart or other organ meats or
blood based foods , spleen
24.4 74.2 1.4
Flesh meat, Meat, poultry, offal ( goat, camel, beef, poultry) 72.4 27.6 0
Eggs 53.6 46.4 0
Fish, Fresh or dried fish or shell fish or smoked , salted, fried 8.5 91.5 0
Milk and milk products, (e.g. goat , camel, fermented milk , powdered
milk )
89.7 10.3 0
Oil/fats, ( e.g. cooking fat or oil, butter , ghee, margarine 83.4 16.2 0.4
Meal frequency
0
2
4
6
8
10
1 2 3 4 5 6 7 8 910 11 12 13
4% 
4% 
1% 
0% 0% 0% 0% 0% 0% 
1% 1% 
29% 
60% 
Figure 7: Frequency of meals given to the child per day
32 
Sweets, Sugar, honey, sweetened juice, soda/sugary foods such as
sweets, glucose
79.4 20.6 0
Condiments, spices and beverages  like royco, garlic, dhania, tangawizi, 77.9 22.1 0
Most respondents, 94% consumed cereal based food items as compared to Iron rich products like
animal organs which only accounted for 24 %.
3.8.9 Health Seeking Behaviour
3.8.9.1 Immunization coverage
There was a marked improvement in the immunization coverage particularly in the PENTA 1 and
PENTA 3 as compared to the KDHS 2008/2009, from 85.9% and 57.7% to 91.2% and 86.7% for PENTA
1 and PENTA 3 respectively.  
Figure 8: Immunization coverage by Antigen
3.8.10 Knowledge of feeding sick child
Diarrhoea was reported to be the leading (16.5 %) cause of morbidity among the children under five
years, as compared to the least (3.8 %) which was skin infections.
33 
Figure 9: Reported illness among children under 5 yrs.
3.8.11 Level of knowledge of causes of diarrhoea in children
The study showed that majority of the caregivers (83%) were aware of causes of childhood diarrhoea
while only 17% were not aware.
Figure 10: Knowledge on the causes of Diarrhoea
The respondents further mentioned the possible causes of diarrhoea as eating contaminated food at
44.2 % as compared to contaminated hands 15.4 %.  
Fig. 13 Respondents view on the causes of Diarrhoea.
Knowledge onthe causesof diarrhea
Yes ‐ 83%
No ‐ 17%
34 
3.8.12 Intake of Vitamin A
Figure 11: Vitamin A uptake
Overall, 37% of children aged 6‐35 months received vitamin A supplementation once and 26 % of
children aged 6‐59 months received a vitamin A supplementation twice in the six months preceding
the survey.  
35 
3.8.13 Iron‐folate uptake
Figure 12: Iron‐folate uptake among pregnant women
Nearly half (48.8 %) of the women had received iron tablets as compared to 36.5 % who had not
received.
3.8.14 Prevalence of Acute Malnutrition
Due to the persisting drought, the GAM rates still remained high in March 2012 as compared to April
2011 as the baseline. The over 20% GAM in March 2012 was also attributed to poor access of health
care services which meant no or late treatment of acute malnutrition and diseases such as diarrhoea,
malaria and respiratory diseases. As compared to April 2011, these conditions had aggravated.
Table 5: Acute malnutrition based on weight‐for‐height z‐scores
All
n = 508
Boys
n = 268
Girls
n = 240
Prevalence of acute malnutrition  
(<‐2 z‐score and/or oedema)
(107) 21.0 %
(17.5  ‐  24.6 95%
C.I.)
(60) 22.4 %
(17.4  ‐  27.4
95% C.I.)
(47) 19.6 %
(14.6 ‐ 24.6 95% C.I.)
Prevalence of moderate malnutrition  
(<‐2 z‐score and >=‐3 z‐score, no
oedema)  
(90) 17.7 %
(8.3  ‐  19.7 95%
C.I.)
(50) 18.7 %
(10.4  ‐  20.2
95% C.I.)
(40) 16.6%
(9.9 ‐ 18.3 95% C.I.)
Prevalence of severe malnutrition  
(<‐3 z‐score and/or oedema)  
(17) 3.3 %
(2.4 ‐ 7.7 95% C.I.)
(9) 3.4 %
(3.5  ‐  5.7 95%
C.I.)
(8) 3.3 %
(2.1 ‐ 6.8 95% C.I.)
36 
Based on the WHO 2006 growth standards, Acute Malnutrition is defined as <‐2 z scores weight‐for‐
height and/or oedema while Severe Acute Malnutrition (SAM) is defined as <‐3z scores weight‐for‐
height and/or oedema).
Table 6: Distribution of acute malnutrition and oedema based on weight‐for‐height z‐scores
<‐3 z‐score >=‐3 z‐score
Oedema present   Marasmic kwashiorkor
No. 1
(0.2 %)
Kwashiorkor
No. 0
(0.0 %)
Oedema absent   Marasmic
No. 51
(10.0 %)
Normal
No. 457
(90.0 %)
Children were also classified as acutely malnourished based on the presence of oedema. For those
with oedema, 0.2% had a combination of marasmus and kwashiorkor while none had kwashiorkor
only. The prevalence of oedema had reduced from 0.5% in 2011 to 0.2%
3.9 WATER, SANITATION AND HYGIENE (WASH)
3.9.1 Access to water
The findings of the survey revealed that, 25.9% of the respondents got water from the river through
water vendors, and 35% got water from dams.  
3.9.2 Time taken to nearest water source
Figure 13: Time taken to the nearest source of water
37 
The findings also showed that majority of the respondents (35.4%) took less than 30 minutes to reach
to the water point, 33.8% took between 30 minutes to 1 hour, 20.8% took more than 2 hours and
10.0% took between 1 and 2 hours.
3.9.3 Practices of water treatment
Majority of the caregivers (51%) treated water for drinking by boiling. However, 21% did not treat
water for drinking. 20% use chemical treatment and 7% do filtering and settling. The treatment was
due to the fact that many 92 % caregivers did not feel the water was safe.  
3.9.4 Knowledge on water safety
HH water 
21 51
1 6
20
1
0
20
40
60
80
None Boiling Filtering Setling Chemical
treatment
Others specify
Figure 14: House hold water treatment methods
38 
92.8% said the water they use is not safe for drinking while only 6.5% indicated that the water was
safe for drinking.
3.9.5 Access and types of toilets
Figure 16: Type of household toilet
Only 18.8 % of households had a toilet as compared to 81.2 % who did not have a toilet and who had
most probably adopted open defecation as way of faecal waste disposal. For those who had toilets,
traditional pit latrine was the most commonly used toilet type at 75%. Use of bush as alternative to
toilet was found to be the second popular type at 16 %.  
6.5%
92%
1.5%
0
750 
Yes No DNK
Knowledge on water safety
Figure 15: Respondents view on their drinking water safety
39 
3.9.6 Child faeces disposal methods
Figure 17: Child faeces disposal methods
The survey found out that close to half (44%) of the respondents disposed of children faeces
hygienically (through burning and in compost pit) while54% dumped the faeces in the nearby garbage
and 1% just left it scattered in the compound (open defecation).
3.9.7 Household solid waste disposal methods
Figure 18: Household solid waste disposal
54% of the caregivers disposed HH waste by crude dumping, 34% disposed by burning, 10% by
compost pits, 1% by scattering in the compound and 1% disposed by other methods.
40 
3.9.8 Hand washing practices
Figure 19: Caregiver’s hand washing practices
Most of the caregivers (35%) only washed their hands during ablution for prayers, 34% of them
washed before eating food, 26% washed their hands after eating and 5% washed their hands after
changing baby.  
3.9.9 Methods of hand washing
Majority of the caregivers, 60.5% wash their hands with only water in a basin, 34.2% use water
poured from a container to wash their hands, 5.3% use running water from taps to wash their hands.
3.9.10 Dish Rack
About 75% of the households served did not have a dish rack, as compared to 11% who had a dish
rack and in use.
41 
Figure 20: Availability of dish rack
42 
4.0 CONCLUSION
The program coverage and access of services to the target community is satisfactory in four districts
in the project area of Garissa County, indicating the achievement of the program. The program
reached those who are acutely malnourished impacting on children under‐fives and pregnant and
lactating mothers as further shown by the recovery rates, death rates and default rates which are all
on acceptable Sphere Standards limits. Access to clean water has also improved and the decline in
proper sanitation and hand washing could be due to differing assessment methodologies at baseline
and end line. The over 20% GAM in March 2012 was also attributed to poor access of health care
services which meant no or late treatment of acute malnutrition and diseases such as diarrhoea,
malaria and respiratory diseases. There are also inadequate fully functioning health facilities in the
project area. In those that are functioning, there is high staff turn‐over even for those already trained
in the Integrated Management of Acute Malnutrition.
It was found that the program supported the provision of the needed (and thus relevant) services in
the program area, focusing on the High Impact Nutrition Interventions (HINI). The approaches used to
achieve these were appropriate and responsive to the challenges of health care system. However, the
nutrition status has not improved due to the persisting drought and household practices such as
those linked to infant feeding and hygiene. There is need to continue education and awareness on
infant feeding practices. Also, only two‐thirds are receiving food aid and there is need to continue
advocating for increased food aid.  
It has been learnt that there is more need for community sensitization, awareness and education on
appropriate infant and young child feeding practices including those on hygiene and sanitation to
improve on children nutrition status. There is also need to increase the number of active health
facilities to promote access to health and nutrition services.
43 
5.0 RECCOMENDATIONS
The number of health facilities must be augmented in order to ensure that the population has
adequate access to treatment. It will therefore be vital to work with health facility teams to improve
service delivery. This may involve provision of double rations, organizing more than one day a week
for follow‐up or other modifications as may be provided by the health workers themselves.   
It is important that the planning and implementation in improving interface is done jointly, in close
partnership with health facility teams, to ensure ownership of the adaptations they identify.
Thus, the community mobilization and awareness strategy must be further elaborated beyond
community volunteer training and leader sensitization meetings, to include creative and
unforgettable events, such as theatre, jingles, as well as stronger sensitization of alternative key
stakeholders, such as traditional healers.
There is need to hire a nutritionist at the health facility, involving the local key persons and the MOH
personnel to take a key lead to oversee and support nutrition and WASH program and improve
coordination of the program.
44 
6.0 REFERENCES
 Government of Kenya National AIDS Control Council (2003) National Program Guidelines on
Orphans and other Children made Vulnerable by HIV/AIDS  
 Government of Kenya. Ministry of Health Kenya AIDS Indicator Survey 2007
 Kenya Demographic and Health Survey (2008‐2009), Kenya Demographic and Health Survey,
NCPD, CBS, and Ministry of Planning and National Development Final report
 Mercy USA proposal 2011, for Emergency Nutrition and WASH Support Program for Garissa
County Submitted to USAID Office for Foreign Disaster Assistance USAID/OFDA. Proposed
project site: Garissa, Ijara, Lagdera and Fafi districts in Garissa County, Kenya.  
 Mercy USA  Garissa County site quarterly reports 2011
 Ministry of Health March 2007. Reversing the trends the Second national Health strategic plan
of Kenya
 Myatt M. et al  (2006) SMART METHODOLOGY  Measuring Mortality, Nutritional Status, and
Food Security in Crisis Situations Institute of Ophthalmology and VALID International Inc.
 NACC (2009) National Aids Control Council Kenya National Aids Strategic Plan 2009/10 –
2012/13 Delivering on Universal Access to Services November 2009
 Richter, Ralph et al. The Community Health Worker: A Resource for Improved Health Care
Delivery. A.J.P.H. 1974; 64:1056‐1061
 UNICEF and MOH (2011)Report Garissa County Nutrition and Food Security Survey May 2011
 USAID 2008; Improving Performance of Community‐Level Health and Nutrition Functionaries:
A Review of Evidence in India
 USAID (2005) Policy Project In support of the OVC RAAAP Initiative‐    Rapid Country
Assessment, Analysis, and Action Planning (RAAAP) Initiative On Behalf of Orphans and Other
Vulnerable Children in Sub‐Saharan Africa
 WHO Study Group. Strengthening the Performance of Community Health Workers in Primary
Health Care. Geneva, World Health Organization, 1989.
45 
7.0 APPENDICES
Appendix 1: Evaluation Tools
ANNEX 1: a) 
 
 
Government of Kenya 
Ministry of Health 
Mercy- USA for Aid and Development 
INTERIM ASSESSEMENT OF EMERGENCY NUTRITION SUPPORT PROGRAM FOR 
GARISSA COUNTY 
HOUSEHOLD QUESTIONNAIRE-IYCF KAP 
 SECTION A: Introduction and Consent 
Hallo, my name is ____________________________. I am among a team in this area carrying out an 
evaluation on Nutrition and WASH Program being supported by Mercy USA. Your household has 
been selected by chance from all households in the area. I would like to ask you some questions related 
to the life and health of your household members. Whatever you tell me will be kept completely 
confidential. If there are some questions that you do not wish to answer, just tell me and we will skip 
them. 
Information you provide will be useful to find out the status of quality of life in your community and 
will be used for planning future programs in this area Do you have any questions? 
 If yes kindly clear the issues before proceeding with the interview. 
Do you agree to participate? Yes/No… ……. [__]. If No end interview and thank the interviewee 
Name of
Location
Name of
Village
Household
Number
Name of
supervisor
Name of
Interviewer
Date of Interview
(dd/mm/yy)
        
46 
SECTION B: Socio Demographic Information 
Household data 
1.1.1How many people live in this household together and share meals? (Household size)
HH Socio demographic information 
1.1.2. 1
Person’s
code
1.1.2.2
Person’s
Name
1.1.2.3
Approx.* Age
Enter months
for children up
to 24 months
and years for
over 2 yrs.
Verify age by
1=Health card
2=Birth
certificate/
Notification
3=Recall
1.1.2.4
Sex
1= Male
2= Female
1.1.2.5
Relationship to HH 
Head 
1. Head 
2. Spouse 
3. Child by Birth 
4. Grand child 
5. Other children by 
relation 
6. House help 
7.Others specify
1.1.2.6
Education Level
1= None 
2=Some Primary. 
3= Completed Primary 
 4=Some secondary 
 5=Completed Secondary. 
6=College/University/Grad
uate 
7=Adult Education 
8=Other (Specify) 
1.1.2.7
Marital Status
1= Married. 2= 
Single. 3=Divorced. 
4= Widowed. 
5=Separated. 6= 
Others specify. 
7. NA 
1.1.2.8
Religion
Muslim
Christian
Other
1.1.3 Income and Livelihood
Source of income 
1.1.3.1 Whatwereyoursourcesofincomethelastthreemonths(pleaseindicatethethreemostimportantinorderofpriority) 
1=Sale of livestock,2=Sale of livestockproduct,3=Sale of rationfood,4=Sale of owncrop,5=Wagelabor,6=Remittance, 
7=Charcoal/firewood,8=Basketweaving,9=Pettytrade,10=Others(specify) 
47 
1.1.3.2 Inthelast3months,whatwasyourMAINexpenditure?1=Food,2=Clothing/HHItems,3=Rent,4=SchoolFees,5=PurchaseofLivestock, 6=Others(Specify) 
Livelihood 
1.1.3.3 What is the MAIN source of livelihood for the household? 
1=Pastoralism,2=Agro-pastoralism,3=petty-trading,4=Agriculture,5=Formalemployment,6=Informalemployment7=naturalresourcedependents 
1.3.4 StatusoftheHousehold:1=Resident2=IDP3=Temporaryresident4=Resettled5=Refugee 
1.1.4: Food Aid
1.1.4.1 Has your HH received 
food aid in the last three (3) 
months? 
1= Yes 
2=No 
1.1.4.2 If Yes, 
what were the 
sources? 
1=M-USA 
2=Government 
3=Redcross 
4=Others(specify) 
1.1.4.3 What food 
commodities were received 
1=CSB(„Uji‟)
2=Oil 
3=Pulses 
4=Maize/Maize Meal 
5=Rice/Wheat/Sorghum 
6. Others (specify) 
1.1.4.4 Of the food aid received for 
what purpose was it used?(multiple 
answers allowed) 
1=Resold in the market 
2=Bartered for other item 
3=Shared with kin 
4=Saved for seed 
5=Consumed by the HH members 
6=Fed the Animals (Goats/Cow) 
7=Other 
1.1.4.5 How many days on average 
did the food commodities last? 
1=1Week 
2=2weeks 
3=3weeks 
4=4 weeks and more 
1.1.5 Respondent (Primary Caregiver) code 
1.2 Data on Children aged 0 – 24 months and Immunization 
48 
 Anthropometric status of the women: 
1.2.2
Child
Nam
e
1.2.
3
Im
mu
niza
tion 
card
: 
1.Pr
ese
nt 
2. 
Not 
pres
ent 
1.2.4
Child
’s age 
in 
mont
hs 
1.2.5
 Sex 
1= 
M 
2= F
1.2.6
MUAC
(0.1C
M)
1.2.7
Oedema
in both
feet
1.2.8
Weigh
t
(0.1kg
)
1.2.9 
Height 
(0.1 
cm) 
1.2.10 
Currentl
y 
enrolled 
feeding 
program 
(confirm 
by card) 
1=Yes 
2=No 
1.2.11
BCG 
(Injection 
on left 
arm, 
leaves a 
scar 
1=given 
2=not
given
3= DK
1.2.12
Polio 
(Drop 
from 
bottle 
given) 
1=give
n 
2=not 
given 
3= NA 
1.2.13
 PENTA 
VALEN
T 
(Injection 
on the 
thigh) 
1=given 
2=not 
given 
3= NA
1.2.14
Has the
child
received
measles
immunizat
ion?
(enter
code)
(U2 only)
1=Yes
2=No
3=Don’t
know
4= N/A
1.2.15
Has 
[NAME
] already 
received 
Vitamin 
A 
supplem
entation 
in the 
last 6 
month 
(show 
the 
capsule) 
1=Yes
2=No
3=Don’t
know
4= N/A
(if yes
proceed
to 1.2.16)
1.2.16
How many
times did
the child
receive
Vitamin A
the last six
months?
(U2 only)
(Show the
mother the
capsule so
that she
recalls or
understand
)
Indicate
the
number of
times the
child has
received
0=Not
taken
1= Once
2= Twice
1.2.17 
Has any under
five in this fam
suffered from 
disease in the p
one month 
1. Diarrheal 
diseases 
2. Typhoid 
related fevers 
3. Eye infectio
4. Malaria 
5. Skin infecti
6. Others spec
49 
Measure MUAC of the child’ caregiver 
Caregiver must be female between 15 and 49 years of age 
If there are multiple caregivers, interview only the one who is a primary caregiver 
61. What is the woman’s current physiological status? ( ask carefully and circle) 
1. Pregnant 3. Breastfeeding (6-23 months child) 
2. Breastfeeding ( < 6 months child) 4. Pregnant and breastfeeding ……………………………………………...
62. MUAC:_______________cm 
63. Is the woman currently enrolled in a feeding program: 1. SFP 2.GFD…………3. No 
SECTION C: NUTIRTION 
2.0 INFANT AND YOUNG CHILD FEEDING (IYCF) (This section will only be filled in if there are children 0 to 23 months). 
2.1 Infant and young child breastfeeding information 
Make every effort to speak with the mother. If she is not available, speak with the primary caregiver responsible for feeding of the child. Take 
the child number from the table above. For every question use the child (Name) 
Background Information Infant Breastfeeding information
2.1.1 2.1.2 2.1.2 2.1.4 2.1.5 2.1.6 2.1.7 2.1.8 2.1.9 2.1.10 2.1.11 2.1.12 2.1.13 2.1.14 2.1.15 2.1.16 2.1.17
Child’s
code
Child’s
date of
Birth:
dd/mm/y
y
Source of
birth date
(Record
the approp.
code)
1 = CARD
2= RECALL
3 = DNK
Age
of
child
in
mont
hs
Sex of
child
1 = M
2 = F
How long after
birth do you
think a child
should be put
on the breast?
See code
below for the
answers
How long
after birth
did you put
(child’s
name) on
the
breastfeed
? See code
below for
the
answers
If
Never,
why?
See
code
below
for the
answe
rs
If yes,
How long
after birth
did you
put
(name) on
the
breast?
See code
below for
the
answers
During the first
3 days after
delivery, did
you give
(Name) the
fluid/liquid that
came from
your breasts
(Dambar)?
1= Yes,
2= No,
3= DNK
If no,
why was
the
colostru
m not
given to
[NAME]?
During the
first 6
months after
delivery, did
you give
(Name)
anything to
drink or eat
other than
breast
1.Yes
2.No
3. DK
If fluids
were given
during first
6 months,
why were
they given?
(To
understand
the
knowledge
or attitudes
on EBF)
If yes,
what did
you give
(Name of
child)
See codes
below for
answers
Are you
still
breastfe
eding
(Name)?
1= Yes
2= No
3= DK
If yes, 
how 
many 
times 
in a 
day do 
you 
breastf
eed 
(Name)
? 
Normally up to 
what age of a 
child should one 
stop 
breastfeeding? See
code below for
the answers
1 
Question 2.1.6: 1= Less than 1 Hr ; 2= 1 hr ;3=1 day 4= 1 week; 5= Don’t know; 6= Others specify 
Question 2.1.7: 1= Less than 1 Hr ; 2= 1 hr ;3=1 day 4= 1 week; 5= Don’t know; 6= never, 7= Others 
specify 
Question 2.1.8: 1= No milk; 2= Did not want to breast feed;3=Traditional beliefs ( specify) 4= 
Medical advice 5= Mother died 6. Other; 
Question 2.1.9: 1. Less than 1 hr, 2. Less than 24 hrs, 3. More than 24 hrs, 4. DK, 5. Others specify 
Question 2.1.11: 1. Dangerous for child 2. Traditional 3. Don’t know 4. Other:
Question 2.1.12: 1. Nothing, 2. Plain water; 3. Sugar water or glucose water; 4. Powdered milk 
(name), Fresh milk, 5. Infant formula (name), 6. Gripe water; 7. Other (specify) 
Question 2.1.13:1.Thirsty 2. Helps colic/constipation 3. Helps to get out meconium 4. Tradition/cultural 5.
Makes baby healthy 6. Told by the health worker 7. Baby was hot 8. Baby not breastfeeding 9. Don’t know 10.
Other
Question 2.1.15: 1. Less than 1 month; 2. 6 months; 3. 1year, 2years; 4. Don’t know; 5. Others 
specify 
Question 2.1.16: 1. Less than 1mnth, 2. 6mnths, 3. 1 yr. 4. Still breastfeeding 
 Question 2.1.17. 1= No milk; 2= Did not want to breast feed; 3= Beliefs (specify) 4= Medical advice 
5= Mother died 6. Other specify 
1 
2.2 Complimentary Feeding information 
Since this time yesterday (day and night), has [NAME] received (FOOD/LIQUID)? (Ask the 
mother /caregiver response to mention all foods given to the child and record as mentioned in 
the appropriate category)Note: Please wait for the mothers response after asking the questions 
other than reading out the various foods 
Child’s code 2.2.1 2.2. 2.2.3 2.2.3 2.2.4 2.2.5 2.2.6 2.2.7 
Breast 
milk 
Only 
one 
answer 
coded 
as 
below: 
1. Yes 
2. No 
3. 
DNK 
Infant 
formula 
 ( S26, 
Nan) 
1. Yes 
2. No 
3. DNK 
Other milks: 
- animal 
milk, 
 - 
reconstituted 
powdered 
milk,(Hilwa, 
Milki, Nido, 
Safari land, 
Hayat, 
Coast) 
- Sour milk. 
1. Yes 
2. No 
3. DNK 
Sweetened 
flavoured 
juices 
(Quencher, 
Juice for you, 
Zeitun, 
Altuza, 
Mushakil, 
vimto, 
Ananas, 
Savannah,) 
Soda 
1. Yes 
2. No 
3. DNK 
ORS 
1. Yes 
2. No 
3. 
DNK 
Tea/Co
ffee 
1. Yes 
2. No 
3. DNK 
Plain 
water 
1. 
Yes 
2. No 
3. 
DNK 
Thin 
porri
dge 
1. 
Yes 
2. No 
3. 
DNK 
codes               
At what age               
2 
Childs
code
2.2.18 2.2.19 2.2.20 2.2.21 2.2.22 2.2.23
Child’
s code 
2.2.8 2.2.9 2.2.10 2.1.11 2.2.12 
 
2.2.13 2.2.14 2.2.15 2.2.1
6 
2.2.17 
Eggs 
1. 
Yes 
2. 
No 
3. 
DN
K 
Porridge 
made 
from 
CSB/ 
Unimix/ 
millet/ 
sorghum/ 
maize 
flour 
Use the 
correct 
code. 
Only one 
answer. 
1. Yes 
2. No 
3. DNK 
Flesh 
Meats 
(Chicken
, beef, 
Goat, 
Kidney,
Liver, 
Mutton, 
Camel, 
Donkey, 
Fish,) 
1. Yes 
2. No 
3. DNK 
Legumes 
and Nuts 
(Beans, 
Groundn
uts, 
Cowpeas, 
Lentils, 
Green 
Grams) 
1. Yes 
2. No 
3. DNK 
Dairy 
Products 
(Milk, 
cheese, 
Ghee, 
fermente
d milk ) 
1. Yes 
2. No 
3. DNK 
Grains, 
Roots 
&Tubers 
(Pasta, 
rice, 
bread, 
potatoes, 
biscuits, 
mandazi, 
chapatti, 
anjera, 
ugali) 
 1. Yes 
2. No 
3. DNK 
Vitamin A 
Rich fruits 
& 
Vegetable
s 
(pawpaw, 
 melon, 
Sukuma 
wiki, 
carrots, 
cowpea 
leaves, 
spinach, 
Avocado) 
1. Yes 
2. No 
3. DNK 
Other 
Fruits and 
Vegetable
s ( onions, 
tomatoes, 
cabbage, 
Oranges, 
bananas 
Okra, wild 
fruits) 
1. Yes 
2. No 
3. DNK 
Oil 
(Sala
d oil), 
fats, 
Zeitz
un, 
simsi
m, 
(came
l fat) 
1= 
Yes 
2= 
No 
3= 
DNK 
Yester
day 
(Durin
g the 
day 
and at 
night). 
How 
many 
times 
did 
you 
feed 
(Name
) solid 
and 
semi￾solid 
foods? 
 No. of 
times 
child 
was 
given 
food 
to 
make 
it full. 
Codes                   
At
what
age
                  
                    
3 
Other 
water-based 
liquids ie. 
Broth 
1.Yes 
2. No 
3. Don’t 
know 
Fresh or 
dried fish, 
shellfish? 
1.Yes 
2. No 
3. Don’t 
know 
Any sugary 
foods such 
as sweets, 
pastries, 
cakes or 
biscuits? 
1.Yes 
2. No 
3. Don’t 
know 
Condiments 
for flavor 
such as 
chillies, 
spices, herbs? 
1.Yes 
2. No 
3. Don’t 
know 
CSB? 
1.Yes 
2. No 
3. Don’t 
know 
Plumpy nut? 
( Show one 
packet) 
1.Yes 
2. No 
3. Don’t 
know 
Codes          
At what
Age
         
            
We would like to know at what age these foods were introduced (Fill in the table above) 
2.2.24. Are there foods you believe children are not to be given and 
why?................................................. 
2.2.25. Did (Name) drink anything from a nipple?1=yes 2=No 
2.2.26. When [NAME] is sick, how much was he given to drink? 
Same as usual 
Less than usual 
More than usual
Don’t know 
2.2.27. When [NAME] is sick, how much was he given to eat? 
Same as usual 
Less than usual 
More than usual
Don’t know 
2.2.28 What can a woman do to have more breast milk? 
Increase frequency of child suckling 
Reduce stress or not worry 
Eat special foods/soup/drinks Increase quantity of food/liquids 
Massage breasts 
Rest 
Don’t know 
Other:________________________ 
4 
2.2.29 Why should caregivers introduce complementary foods to infants? 
Breast milk is not sufficient anymore 
To make him/her strong 
He/she is hungry 
Don’t know 
Other:__________________________ 
2.3 Household Food Consumption and diet diversity  
Twenty four hour and seven day recall for food consumption in the households. The interviewers 
should establish whether the previous day and night; seven days and nights were usual or normal for 
the households. If unusual feasts, funerals or most members absent, then another day should be selected 
2.3.1. Food group consumed 
Type of food 
2.3.2. Did any member of 
your household consume 
any food from the groups 
in the last 24 hrs 
1. Yes 
 2. No 
2.3.3. If yes 
how many time 
was the food 
consumed in 
the last 7 days? 
Cereals and cereal products (e.g. sorghum, maize, spaghetti, pasta,
anjera, rice, bulga wheat, bread)
  
Vitamin A rich vegetables and tubers: Pumpkin, carrots, yellow
fleshed sweet potatoes  
  
White tubers and roots: White tubers, white potatoes, white yams ,
cassava or foods from roots, white sweet potatoes,
  
Dark green leafy vegetables: Dark green leafy vegetables including
wild ones + locally available vitamin A rich leaves such as cassava
leaves, pumpkin leaves, cowpeas leaves, sukuma wiki, spinach,
  
Other vegetables (e.g. tomatoes, egg plant, onions, cabbages)   
Vitamin A rich fruits: Ripe mangoes , papayas + others locally
available like watermelon,
  
Other fruits like   
Organ meat (Iron rich): Liver, kidney, heart or other organ meats or
blood based foods , spleen
  
Flesh meat and offal’s: Meat, poultry, offal ( goat, camel, beef,
poultry)
  
Eggs   
Fish: Fresh or dried fish or shell fish or smoked , salted, fried   
Pulses legumes or nuts (e.g. beans , lentils, green grams, cowpeas,
dried peas,
  
Milk and milk products (e.g. goat , camel, fermented milk , powdered
milk )
  
Oils/ fats ( e.g. cooking fat or oil, butter , ghee, margarine)   
Sweets: Sugar, honey, sweetened juice, soda/sugary foods such as
sweets, glucose
  
Condiments, spices and beverages  like royco, garlic, dhania,   
5 
tangawizi,
SECTION D: FOOD SECURITY 
2.4.0 Food Shortage Coping Strategies 
In the previous month, has the household done any of the 
following? Tick as appropriate
Tick Below 
2.4.1 Reduction in the number of meals per day
2.4.2 Skip food consumption for an entire day
2.4.3 Reduction in size of meals
2.4.4 Restrict consumption of adults to allow more for children
2.4.5 Feed working members at expense of non‐working
2.4.6 Swapped consumption to less preferred or cheaper foods
2.4.7 Borrow food from a friend or relative
2.4.8 Purchase food on credit
2.4.9 Consume wild foods (normal wild food)
2.4.10 Consume immature crop
2.4.11 Consume decomposed food
2.4.12 Send household members to eat elsewhere
SECTION E: WATER, SANITATION AND HYGIENE 
3.1 HH Water 
3.1.1 What is 
your main 
current water 
source for 
household use? 
(Probe for the 
Main source) 
1= River 
2=Lake 
3= Water tap 
4=Borehole 
5= 
Unprotected 
well 
6= Protected 
well 
7= Public pan 
8= Water tanks 
9= Dam 
10= Laga 
11= Other 
3.1.2How 
long does it 
take to go to 
the main 
source of 
water, fetch 
and come 
back (in 
minutes) 
( In case you 
approximate 
in hours 
kindly note 
(Hrs)) 
3.1.3 How 
much do 
you pay for 
a 20lt 
jerrican 
(enter zero 
if water is 
free) 
3.1.4 On 
average, 
how many 
LITRES 
of water 
does the 
household 
use per 
day? 
3.1.5 
Based on 
your own 
perception 
is water 
from the 
primary 
source 
safe for 
drinking? 
1.YES 
2.NO 
3.DK 
3.1.6 If
No, what
action do
you take
to make it
safe  
0. None 
1. 
Boiling 
2. 
Filtering 
3. 
Settling 
4Chemic
altreatme
nt 
5. Others 
specify 
3.1.7Doe
s your
househol
d store
water?
1.Yes
2. No
3.1.8 (If 
yes) 
what 
type of 
storage 
facilities 
do you 
have? 
1. 
Overhea
d tank 
2. 
Undergr
ound 
tank 
3. 
Ordinar
y iron 
tank 
4. 
Drum/Je
rricans 
5.  Other,
specify
6 
 
3.2 HH Sanitation 
3.2.1 
Does your 
household have 
access to a 
toilet/ latrine 
facility? 
1=Yes 
2=No 
3.2.2 If yes, what 
type of toilet 
facility do you 
have? (Please 
observe)1=Bucket 
2=Traditional pit 
latrines 
3=Ventilated 
improved pit 
latrine 
4=Flush toilet 
5=Other Specify 
3.2.3 If No, 
where do you 
go/use? (probe 
further) 
1= Bush 
2=Neighbour’s 
toilet 
3=Open field 
4=Near the river 
5=Behind the 
house 
6=Other ( 
specify) 
3.2.4 How is 
children’s faeces 
disposed (Probe and 
OBSERVE) 
1=Disposed of 
immediately and 
hygienically in the 
latrine 
2= Disposed of 
immediately in the 
nearby bushes 
3= Not disposed 
(scattered in the 
compound) 
4= Use of dogs 
3.2.5 How do you 
dispose off your 
household solid 
waste? (Ask for 
the main method) 
1=Burn 
2=Rubbish pit 
3=Compost pit 
4=Scattering 
5=Others (Specify 
3.2.6 Is the 
compound 
clean?(By 
observation) 
( No visible
faeces near
the house, No
Rubbish all
over )
1 = Yes 
2 = No 
 
7 
3.3 HH Hygiene 
3.3.1 When do 
you wash your 
hands 
(Probe – 
without reading 
alternatives) 
1.Before eating 
2. After toilet 
use 
3. After 
changing baby 
4.Before 
feeding young 
children 
5. Ablution 
6. before food 
preparation 
7. Others 
Specify 
3.3.2 How 
do you 
wash your 
hands? 
1.Using 
running 
water 
2.Using 
running 
water with 
soap 
3.Using 
water in a 
basin 
4.Using 
water in a 
basin with 
soap 
5.Others 
(Specify) 
3.3.3 How 
often do 
you 
practice 
the 
following 
activities? 
a) 
Washing 
fruits 
before 
eating 
b)Coverin
g cooked 
food 
1. Always 
2.Never 
3. DK 
4. Others 
specify 
3.3.4 How 
do you 
clean baby’s 
feeding 
utensils 
1. water 
only 
2. Water 
and soap 
3. Boil to 
sterilize 
3. DK 
4. Others 
specify 
3.3.5 Please 
observe/ask 
presence of 
dish rack 
1. Present in 
use 
2.Present 
not in use 
3.Absent 
3.3.6 Are 
you aware 
of the 
causes of 
childhood 
diarrhoea? 
1. Yes 
 2. No 
3.3.7 If 
yes, what 
are the 
causes? 
1. 
Drinking 
dirty 
water 
2. Eating 
contamina
ted food 
3. 
Contamin
ated hands 
4. Others 
(specify) 
3.3.8 What 
preventive 
and control 
measure 
against 
diarrhoea 
are you 
aware of? 
1. Boiling 
drinking 
water 
2. Use of 
toilets to 
dispose of 
human 
faecal 
matter 
3. Cover 
cooked 
food and 
drinking 
water 
4. Wash 
hands after 
using toilet 
and before 
eating 
5.Wash
hands
before food
preparation
with soap
6.Wash
child’s’
hands  
before and
after
feeding with
soap
7.Wash 
hands with 
soap after 
attending 
to a child 
who has 
8 
SECTION F: HEALTH SEEKING BEHAVIOUR 
4.0GENERAL HOUSEHOLD MORBIDITY AND HEALTH SEEKING BEHAVIOUR 
4.1 Has anyone been ill in this household in the last two weeks? 
Yes 
No 
If yes enter all of them in the table below. 
4.1.1 4.1.2 4.1.3 4.1.4 4.1.5 4.1.6 4.1.7 4.1.8 4.1.9 
Enter the 
complete 
individual 
number, 
(Cluster, 
HH, No., 
individual 
code)
Duration 
of illness 
1.Less 
than 4 
weeks 
2.4 weeks 
or more 
Type of 
illness 
encountered 
1. Malaria 
2. ARI 
3. Diarrhoea 
4. AIDS 
related 
5. Pregnancy 
related 
6. Don’t know 
7. Others, 
specify 
If s/he had 
diarrhoea 
was any of 
these 
fluids 
given 
1.Afluide 
from a 
special 
packet 
called 
oralite 
(ORS) 
2.home￾made sugar 
salt 
solution 
3.another 
home-made 
liquid such 
as porridge 
soup, 
coconut 
water 
4.zinc 
5.others 
(specify) 
Freque
ncy of 
illness 
1. Daily
2.weekl
y 
3.mont
hly 
4.Quate
rly (4 
months
) 
5. 
Yearly. 
7. N/A 
Where was 
treatment 
sought 
1. No 
treatment 
2. Health 
facility 
3CHW/refe
rral/extensi
on 
treatment 
4. Self 
medication 
5.Tradition
al healer 
6. Faith 
healing 
7. 
Counsellin
g 
8. Others, 
specify 
What 
was the 
outcom
e 
1. 
Recove
ry 
2. Still 
sick on 
treatme
nt 
3.Still 
sick not 
on 
treatme
nt 
4. 
Others 
specify 
How 
much 
was 
paid for 
treatme
nt 
0=No 
cost 
1. Less 
100/= 
2. 100-
500/= 
3. 501-
1000/= 
4. Over 
1000/= 
5.Don’t 
know 
6. 
Others 
specify. 
Time taken to 
walk to 
 nearest facility 
1.less than 30min 
2.30 min-1hr 
3.More than 1hr 
 
defecated. 
8.Exclusively
breastfeed
up to first 6
months
9.Don’t
know
10.Other
 
9 
4.2 SUPLEMENTATION 
4.2.1 In your last pregnancy, did you take 
Any of the following 
1.Ironpills 
2.Ironsyrup–Haematon 
3.Injection–Inferon 
4 .Sprinkles with iron 
5.Noneoftheabove 
4.2.2 Ask the 
Breastfeeding/lactating mothersonly. 
“Have you received any vitamin A supplements?”
1. Yes 
2. No 
3. Don't know 
4.2.3 Deworming 
Has the child taken any drug for intestinal worms in the last six months? (Show tablet or syrup) 
Yes 
No 
Don’t know 
4.2.4 Salt Iodization 
Is the salt consumed at home iodized? Please request for a packet of the salt, if they don’t have it, ask 
for the brand name of the salt they use or show them a sample of salt in packets 
Where do you get your salt; (market, shop etc)? 
Did you buy the salt in a packet 
Do you store the salt in a sealed container? 
4.3.1 Mosquito Control/ Bed net use and treatment 
SECTION G: IMPACT 
3.5.1. What changes /benefits have you experienced from the M-USA project? (Individual, household 
and community) 
3.5.1.1 Individual- level 
4.3.1. Does this 
household have a 
mosquito net? 
1 = Yes 
2 = No 
(IF NO, GO TO 
9.1) 
4.3.2 Where did 
you get it from: 
1 = A Shop 
2 = An agency 
3 = Ministry of 
Health 
4= Others 
(specify)______ 
4.3.3. If you got it 
from the shop, 
have you ever 
treated your net 
(soaked or dipped 
it in dawa or 
chemical to repel 
mosquito or 
insects)? 
1 = Yes 
2 = No 
 3. DK 
4.3.4. If YES, 
When did you last 
treat it? (Enter 
code) 
Less than one 
month ago 
Between one and 
six months ago 
More than six 
months ago 
Cannot remember 
4.3.5. Who slept under 
the mosquito net last 
night? 
(Probe - enter all 
responses mentioned) 
Everybody 
Children less than 2 
years 
Children over 2 years 
Pregnant woman 
Mother 
Father 
Nobody uses 
10 
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
---------------------------------------- 
3.5.1.2. Household level 
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
---------------------------------------- 
3.5.1.3 Community level 
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
---------------------------------------- 
3.5.2. Do you have any general suggestions andrecommendations regarding M-USA Activities? 
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------- 
------------------------------------------------------------------------------------------------------------------- 
 Thank you 
11 
ANNEX 1: b) 
CLASSIFICATION OF COVERAGE IN INDIVIDUAL CLINIC/OTP CATCHMENT AREAS 
# Name of
Clinic
Name of clinic
catchment
area
OTP
Site
1=Yes
2=No
Sample size or
cases found (n)
Number of
covered
cases (c)
Threshold
level
d=[n/2]
Classification (Classified
coverage = 50%)
c < d c>d
                
ANNEX 1: c) 
TOOL F1: FGD GUIDE FOR MOTHERS
Do you face any challenges in giving care to your children?
           {If yes probe for them, causes and possible solutions}
………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………..
What do you know about M‐ USA as an organization working in this community (probe for
programmes and target group, when it was started?)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How are mothers involved in these programs?
Nutrition
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
WASH
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
12 
What are beneficial things that you can remember since the Program started?      
………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………..
How has your ability to care for children improved as a result of this Program? {If not probe on
specific services received}  
What problems/challenges does the community have regarding
Nutrition
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
WASH
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How have you benefited from the project in addressing these challenges?
Nutrition
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
WASH
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What other types of care and support are most needed by parents and guardians in this community?
………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………
2.0 Establishment of Rural Community Support Centers, providing information, education and
Referral  
Are you aware of community support centres established by M‐ USA to provide information and
referral for nutrition and WASH issues?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How has the setting up of these centres helped the community in improving Nutrition and WASH?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Of what benefit are the centres to mothers and children in particular (probe for services or support a
particular group gets from the centres
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What are your opinions on access, relevance, and sustainability of the centres?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
13 
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How do you rate the public awareness about Nutrition and WASH now as compared to the past
(probe for community’s perception and participation
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………
2.0 Improvement of the Skills and capacity of the community in Nutrition and WASH
What types of support and services does the program offer towards improving of Nutrition and
WASH?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How is the support provided (probe for channels of service delivery such as home visits,)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How is the support/services channeled to reach mothers/guardians?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How have your nutritional skills improved in handling care and support to children under your care?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What training, support, assistance is available?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What changes are there due to the above?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What are the impacts of these activities on the community
Nutrition programme
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
WASH
14 
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
4.0 Enhancement of the sustainability of community activities through training in income generation  
What are your sources of income (IGA, Salary, external support, farming e.t.c?) (probe where support
is gotten)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Have you received any training or support from M‐ USA on Microfinance Management?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
If yes, how has it helped you improve your household income and in particular on Nutrition and
WASH?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
5.0 Establishment of mother to mother services
What is your opinion on the mother to mother services introduced by M‐ USA programme on?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How have they helped change the lives of children under your care and others in the community?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How sustainable are these programmes?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What would you like done differently to achieve higher results
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
6.0 Facilitation of raising levels of awareness in the community
15 
How do you rate the public awareness about Nutrition now as compared to the past (probe for
community’s perception and participation)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
In your opinion what is the prevalence rate of malnutrition as compared to two years ago (probe for
frequency of deaths, symptoms associated with)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
7.0 General Improvements, Networking and Best Practice
How has life of children changed in terms of:
Their Health
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Children accessing schooling
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
For the time M‐ USA has been working what positive impacts have you seen in terms of Nutrition and
WASH (probe for indicators)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What can the community do/contribute to ensure the Program will continue to assist the family?
Which other groups are working in the area towards nutrition and WASH?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
………………………………
Are there groups specifically for children?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
…………
If yes, how do there collaborate with M‐ USA?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
16 
………………………………………………………………………………………………………………………………………………………………
………………………………
If no, do you feel there is need for these groups and why?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What would you recommend in terms of sustainability of the programme (probe for less or no
support from M‐USA)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What are your general comments on these Programs?
Nutrition
………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………
…………..
WASH
………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………
……..
ANNEX 1:d) 
TOOL2: FGD Guide for School Committee
What do you know about MERCY USA?  
………………………………………………………………………………………………………………………………………………………………
…………………
2. What activities does M‐USA implement in your schools to create Nutrition and WASH awareness
among the pupils? (Probe for more)  
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
…………………
How does M‐USA help children in school and out of school? {Probe for food and nutrition, WASH}  
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
2.0 Establishment of Rural Community Support Centers, providing information, education and
Referral  
17 
Are you aware of Community support centre established by MERCY USA to provide information and
referral (probe for location, mode of operation, services offered to various groups, etc.)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How has the setting up of these centres helped the children in Nutrition and WASH
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Of what benefit are the centres to Children in particular (probe for services or support that particular
groups gets from the centres
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What are your opinions on access, relevance, and sustainability of the centres?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What is the community's awareness now as compared to the past (probe for community’s
perception)
Nutrition 
WASH) 
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
3.0 Improvement of the Skills and capacity of the community in Nutrition
What types of support and services towards improving the livelihood of children, are offered by
MERCY USA?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How is the support provided (probe for channels of service delivery such as through schools, home
visits,)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
18 
How is the support/services channelled to reach children  
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What training, support, assistance is available to improve 
Nutrition…………………………………………………………………………………………………
……………………………………………………………………………………………………………
…… 
WASH 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………… 
How have your skills improved through this program? 
Nutrition 
WASH 
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………
What changes are there due to the above at home, and community at large?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What are the impacts of these activities on the community 
Nutrition programme 
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
B) WASH
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
4.0 Enhancement of the sustainability of community activities through training in income generation
for mothers
What are your sources of income?  
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Have you received any training or support from MERCY USA on income generation?
19 
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
If yes, how has it helped you improve the livelihood status of the community?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
5.0 Establishment of mother to mother services
What is your opinion on the mother to mother services introduced by MERCY USA programme on?
What benefits have you seen as a result of these services? Probe for: Creating awareness on Nutrition
and WASH
Nutrition…………………………………………………………………………………………………
……………………………………………………………………………………………………………
…… 
WASH 
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How has these helped change the lives of children and others in the community?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How sustainable are the programmes?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What would you like done differently to achieve higher results
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
7.0 General Improvements, Networking and Best Practice
Impacts
Their Health
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Children accessing schooling
20 
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Community acceptability of the program
………………………………………………………………………………………………………………………………………………………………
……………………………
Formation of groups to help in access to services  
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Other groups they know of working in the area
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What do they like about the groups
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Are they aware these groups work with MERCY USA, and on what issues
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
If no, do you feel there is need for these groups and why?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What would you recommend in terms of sustainability of the programmes (probe for less or no
support from M‐USA)
………………………………………………………………………………………………………………………………………………………
ANNEX 1:e) 
GUIDE FOR MOH STAFF 
What Special Health Package does this facility offer the OVCs? What children would be eligible for 
the Services mentioned and how do you identify them? 
What do you consider to be the Special Health needs of the OVCs in this community? 
Do you have a Special Referral System for OVCs? Can you describe the Process? If not mentioned 
then probe: 
Who refers 
21 
 Who receives the referral 
 Verbal paper or Physical 
Documentation, filing and feed back to the source of the referral 
 How is the payment of the referrals managed 
In your opinion is this structure /system for Home Based Care working well? Probe for 
Success 
Challenges 
How it can be improved 
Does your Health Facility support a HBC Program for PLWHA? Probe further 
HBC Services 
HBC Components 
What are the Structures for Community-Facility Engagement for HBC? Probe on 
HBC committee? 
HBC Coordinator? 
Referral system for patients referred to and from the community– describe the system (who refers, who 
receives the referral, verbal, paper or physical referral, documentation, filing and feedback to the 
source of the referral, how is the payment managed?) 
Role of the Mentors in HBC 
Training and Supervision of the Mentors 
Provision and Monitoring of HBC kits – how is it handled? 
How can we ensure the sustainability of this Program? 
What are your challenges in HBC? How can these be overcome? 
ANNEX 1:f) 
TOOL KII 2 = HEADTEACHERS 
Do you have M‐USA program supporting Nutrition and WASH in your school?
....................................................................................................................................................................
....................................................................................................................................................................
......................................................................................
What do you consider to be the special needs of the children in your school that affects their
education?
....................................................................................................................................................................
....................................................................................................................................................................
..........................................................................
Do you hold meetings concerning this project?
....................................................................................................................................................................
....................................................................................................................................................................
..............................................................................
22 
What are the other teachers’ involvement and attitudes towards these projects?
....................................................................................................................................................................
....................................................................................................................................................................
.........................................................................
Do you have committees and active clubs concerning this Program?
....................................................................................................................................................................
....................................................................................................................................................................
.........................................................................
How has this Program enhanced the children's knowledge, attitude and practices towards Nutrition
and WASH? (Probe)
....................................................................................................................................................................
..................................................................................................
In your opinion what are more important ways that the program can assist the pupils’ access and
excel in their education.  
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................
Are you a aware of examples where a school committee member have  come to school to follow up
the pupils’ educational progress on behalf of the family
....................................................................................................................................................................
....................................................................................................................................................................
.........................................................
Do you have challenges in implementing this program?
....................................................................................................................................................................
....................................................................................................................................................................
...................................................................
In your opinion, how can the children's educational support be improved?
....................................................................................................................................................................
...............................................................................................................................................  
23 
ANNEX 1:g) 
As a partner in this programme, how have you participated or been involved in the programme (probe for 
location and target groups – widows, PLWA, OVC etc.?) 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………… 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………… 
TOOL K1: GUIDE FOR KEY INFORMANT INTERVIEWS MOH Staff 
What special health package does this facility offer the OVC? What children would be eligible for the 
services mentioned and how do you identify them? 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
………………… 
Do you have a special referral process for OVC? Can you describe the process? (If not mentioned then 
probe: who refers, who receives the referral, verbal paper or physical, documentation, filing and feed back 
to the source of the referral, how is the payment of the referrals managed) 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………… 
In your opinion, how is the referral system for OVC healthcare working? How can it be improved? 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………… 
Does your health facility support a HBC program for PLWHA? Please describe the HBC 
services/components provided at this facility? 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………… 
What are the structures for community-facility engagement for HBC? 
Referral system for patients referred to and from the community– describe the system (who refers, who 
receives the referral, verbal, paper or physical referral, documentation, filing and feedback to the source of 
the referral, how is the payment managed?) 
Role of the HBC//MENTOR? 
Training and Supervision of the HBC/mentors? 
Provision and Monitoring of HBC kits – how is it handled? 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………… 
24 
What can you comment on with regard to the changes and trends in stigma and discrimination in this 
community? Probe on acceptance, knowledge on HIV and AIDS, response to VCT, disclosure, Living 
positively and community support 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………… 
In your opinion is this structure /system for Home based care working well? How can we ensure that 
these things continue to work well/are sustained? 
 (Probe for achievement and sustainability) 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………… 
What are your challenges in HBC? How can these be overcome? 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………… 
8. Comment on the trend incidence and prevalence of STI and HIV infection since 2004 (Check the 
records) 
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………… 
25 
ANNEX 1: (H) 
1.0 Introductory Questions  
In your opinion how would you rate the prevalence of malnutrition in this area
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What are the possible causes of the above?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Are there affordable, accessible, adequate health care facilities in the area?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
If there are shortages, how severe is it?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What are the health trends of PLWA and OVC in the area?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How would you rate the awareness level of Nutrition among the community here?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What is the community's knowledge, attitude and practices about Nutrition?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What are the challenges of adapting the recommended nutritional practices in this community?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What efforts are undertaken by M‐USA and other actors to mitigate the effects of malnutrition in the
community?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
2.0 Establishment of Rural Community Support Centers, providing information, education and
Referral  
26 
How does M‐USA generally provide support to mitigate the impacts of malnutrition among the people
in the community (probe for channels of service delivery)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How are community members involved in provision of this support for sustainability and ownership
purposes  (Probe for community contribution)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How do you facilitate service delivery to the community (probe for community support centres
,training, awareness)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What is your opinion on the effectiveness of Community Support Centers
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
3.0 Improvement of the Skills and capacity of the community in Nutrition
How does M‐USA deliver capacity building on nutrition and WASH?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………
What support do you give as   M‐USA to enable you deliver on the above and how effective is it?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What are some of the successes you see among the communities due to this component of the
project?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
If it were to be done all over again, what would you recommend (approach, activities, and
sustainability?)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
…………………………………………………………………………………………………………
27 
4.0 Enhancement of the sustainability of community activities through training  
How does M‐USA deliver training in Nutrition and WASH?  (Probe Content, method of training,
Adequacy, preparedness, Feedback and Impact)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How are you involved in the activities?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What support do you receive from M‐USA to enable you deliver on the above and how effective is it?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What are some of the successes you see among the communities due to this component of the
project?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
If it were to be done all over again, what would you recommend (approach, activities, and
sustainability?)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Establishment of mother to mother services
What is your opinion on the mother to mother services introduced by M‐USA?
How have M‐USA services brought about change in the lives of children and the community in
general?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
…………………………………………………
28 
How sustainable are the programmes?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What would you like done differently to achieve higher results
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
6.Facilitation of raising levels of awareness in the community
How do you rate the public awareness about nutrition now as compared to the past (probe for
community’s perception and participation)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How are you responding to these issues in as M‐USA?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How has life of children changed in terms:
Their Health
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Children accessing schooling
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
For the time M‐USA has been working what positive impacts have you seen in terms of the nutrition
and WASH (probe for indicators)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
…………………………………………………………………………………………………………
Networking and Collaboration
Which other groups, partners, people, organizations are collaborating in this programme and in which
way
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
29 
How are these partnerships between M‐USA and these groups structured?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
How successful has M‐USA steered this networks and partnerships
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Would you say the networks (if any) are guided by programmatic issues (the felt need) on mitigating
or prompted by organisational missions and objectives?  
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What working relationship exists between M‐USA and;
The areas health infrastructure (government, private and NGO led)
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Children’s department
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Ministry of education  
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Community leaders
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
In what areas do you think the programme has made progress in Nutrition and WASH?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What would you like to say on the programmatic approach M‐USA has deployed in implementing the
project?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
30 
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Achievements and Recommendations   
What can you say the programme has achieved so far especially on  
Training in Nutrition and WASH  
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Mother to mother awareness
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
Provision of Nutritional supplements  
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What challenges have been experienced in the programme both from internal and external to M‐USA
and partners?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………
Comment on M‐USA’S nutrition and WASH (Probe for its integration in the community, degree of
success in implementation)
………………………………………………………………………………………………………………………………………………………………
…………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
What are your recommendations for future programming?
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
………………………………………………………………………………………………………………………………………………………………
……………………………………………………
31 
Appendix 2: Map of Garissa County
32 
Appendix 3: List of Supervisors and enumerators for the Garissa County Evaluation 29th‐7th March
2012
Adan Hussein Ibrahim –DPHN Garissa Survey coordinator  
Garissa District (Team 1)
Mohamed Abdille Noor Supervisor
Abdifatah Hussein Team leader
Pamela Kaguri Enumerator
CarolynePuti Enumerator
Garissa District (Team 2)
Lisa Muthoni Team leader
CarolyneMaiyo Enumerator
Abshira Hussein Abdi Enumerator
Mbalambala (Team 3)
ShahmatYussufWarsame Supervisor
Mohamed HaretLohos Team leader
ZeinabJilleAbdulahi Enumerator
Hussein Hure Enumerator
IJARA (Team 4)
Adam Supervisor
LydiahBosiboriNyamoko Team leader
Felicity NdegeKinya Enumerator
Issa Ahmed Enumerator
IJARA (Team 5)
Dr Priscilla chepkemboi Team leader
Henry JumaNgweiyo, Enumerator
Amina Hassan Ibrahim Enumerator
Lagdera (Team 6)
Leyla Ahmed Supervisor
Osman Kotebe Team leader
Hamed Hassan Enumerator
Japheth Malombe Enumerator
FAFI (Team 7)
Mohamud Osman supervisor
Siat Hassan Team leader
Florence NjeriGitumbo Enumerator
Ahmed nor Abdullahi Enumerator
FAFI (Team 8)
David MbuguaNgige Team leader
FatumaDiis Mohamed Enumerator
JulitaKathabikaburu Enumerator
33 
Appendix 4: Summary of expected tasks, information required, sources of information and methods
and tools
Expected tasks Information required Sources of information Methods and
Tools
Establish the
relevance of project
objectives and
activities towards
meeting the needs
identified within the
community
What are they promising
practices for maternal and child
health.
projects in Kenya implemented
by Mercy USA
DHMT, HFMC, CHW,
NGOs, schools,
children homes, social
development worker,
care givers, guardians,
DNO, project staff,
beneficiaries, project
documents,
government policy
documents.
‐Desk review:
Checklist
‐KII:KII Guide
‐FGD: FGD Guide.
Efficiency (the cost,
speed and
management
efficiency with which
inputs and activities
were converted into
results and the
quality of the results
achieved)
The overall budget, the
outputs, the duration, the unit
costs, the quality versus the
cost
DHMT, HFMC, , CHW,
NGOs, schools ,
children homes, social
development worker,
care givers, guardians,
, project staff,
beneficiaries, project
documents,
government policy
documents.
‐Desk review of
policy guidelines :
FGD:FGD guides
‐KII:KII Guide
Impact of the project
on its wider
environment.  
;
Anthropometric measurements
Age, Height, Weight ,MUAC
What are the innovations of
promising practices that should
be scaled up to better the lives
of the under 5 year children
DHMT, HFMC, , CHW,  
schools , children
homes, social
development worker,
care givers, guardians,  
project staff,
beneficiaries, project
documents,
government policy
documents.
‐Desk review:
‐KII:KII Guide
‐FGD: FGD Guide.
Body
measurements
for the Under 5yr
children  and PLW
Effectiveness of the
contribution from the
project results and
how assumptions
have affected the
What lessons have been
learned through these
promising practices (salient
positive change in peoples
practice)
DHMT, CHW, schools,
children homes, social
development worker,
care givers, guardians,
project staff,
Desk review:
‐KII:KII Guide
34 
project   beneficiaries, project
documents,
government policy
documents.
Sustainability of the
project activities and
likelihood of
continuation of the
benefits produced by
the projects to the
beneficiaries
What lessons have been
learned through these
promising practices ( salient
positive change in peoples
practice)
DHMT, HFMC, CHW,
schools, children
homes, social
development worker,
care givers, guardians,
project staff,
beneficiaries, project
documents,
government policy
documents.
FGD:FGD guides
‐KII:KII Guide
Household
interviews
Relevance of the
program to the needs
and priorities of the
community.
The immediate needs of the
beneficiary compared to how
the prog meets these needs
PROG STAFF
Beneficiaries and other
focal people in the
community. Also the
health workers and
DHMTs
FGD:FGD guides
‐KII:KII Guide
Coherence of the
program in relation
to other
interventions in the
geographical area of
implementation.
Program staff
Stakeholders ()
‐KII:KII Guide
FGD:FGD guides
Coverage of the
program activities;
whether specific
needs to be
addressed were met.
The coverage assessment
methodology  
IYCF‐ High Impact Nutrition
Interventions (HINI)
Program staff
Community
Beneficiaries and
facility reports
‐KII:KII Guide
FGD:FGD guides