Nutrition Nut

About a month before I left NYC, I spent an evening with some friends at a Brooklyn bar and someone asked me exactly what I'd be doing for the next two years. This can be a tricky question, because if I get overly excited I end up blathering on and on about the organization, the issues, the amazing programs, the challenges.... Or I can just say, "I'll be working on a nutrition program." However, this is pretty vague, and the beauty of a blog is that I can blather on and on. Buckle your blathering seat belts, folks!

A lot of you who know me know that this job means a lot to me. Not because it's my first position after graduate school or because it allows me to pay off my loans, but because this is my dream job. I've pretty much solely worked in maternal and child health programs over that last 5 years, but way back during my first stint in India I began to become really interested in food systems, access to food and malnutrition. What people were able to purchase/grow to eat, what people chose to eat and how social norms affected what got into peoples' bellies was intimately tied to pregnancy, child health and reflected the the gender dynamics within communities and society at large. But I had always envisioned myself as a "gender-person," and thought that my career path would be one straight shot towards work in reproductive rights and women's health. I began reading more about nutrition and health, volunteering with some exciting NYC-based food security NGOs, and gave myself two years during grad school to marinate. By the end of my first year, I still felt the pull towards the nutrition sector.

Fast forward to April, when everything falls into place and I accept a two-year contract with an organization (from here on called The Org) doing some of the most (in my opinion) innovative and interesting work in the field of nutrition. I'll be working on two programs over two years, in 3 countries: Cambodia for 6 months, Mozambique for 6 months and Senegal for 1 year. I've just wrapped up my second week of work here in Phnom Penh and am really thankful for the opportunity to be here.

Cambodia faces some extreme challenges with undernutrition. Around 37% of kids under 5 years of age are stunted (meaning their height is too short for their age), 36% are underweight (meaning their weight is too low for their age), and 7% are acutely malnourished (meaning their weight is too low for their height). 62% of these children under 5 years of age are also anemic, as well as 47% of women of reproductive age and 57% of pregnant women. All these scary numbers translate into kids that are at greater risk for disease and death, women who are at greater risk for death during delivery, and kids who may not develop to their full physical and mental potential. So what do you do about it? The Org I'm working with has some pretty great ideas.

While in Cambodia, I'll be working on a program that supports small-scale agriculture and animal husbandry among households in rural areas. Typically, one of these gardens would be run by a woman, provide a diverse, vitamin-rich diet for her and her family, and any surplus fruits, vegetables or eggs could be sold to generate additional income for her household. Sounds pretty awesome, right? Here's what makes it even more awesome: The Org believes in community-supported, sustainable programs, and that any program must be proven to work. So all operations of the program are delivered by local Cambodian NGO's (non-governmental organizations) and in partnership with the Cambodian government. And The Org evaluates this program to verify that a) it's running as it is supposed to b) the gardens actually are increasing production of food for the household and c) that this increase in production is also leading to an increase in consumption of nutritious foods.

Where do I come in? My role for the next 6 months will be based more in the latter portion of this, in program evaluation. I'll be working on setting up several research projects to answer the following questions:

1) How does this program lead to increased women's empowerment and what effect does this have on maternal and child health and nutrition? This program has been around for 20-something years and has always focused on women's production of food, but has only recently began thinking about how this role and income-generation may affect female decision-making power, and how this in turn may affect what foods are consumed, who consumes these foods, what additional income is spent on, and how healthcare is accessed and utilized. My job is to help clarify this aspect of the program. Additionally, a lot of The Org's research has shown increases in consumption but the link to the ultimate goal, improved health and nutrition, has been more difficult to pin down. Part of this is time (changes in health and nutrition take many, many years to occur) and money (assessing nutritional changes means measuring kids and collecting blood serum to check micro-nutrient levels); so I'll be brainstorming additional ways to measure this impact.

2) What is the cost effectiveness of this program? Program costs as compared to program benefits is a pretty hot topic these days in the world of development. The Org is interested in finding out what impact every dollar of donor money has; I'll be charting out the input costs for the program, and more interestingly, charting out the benefits for beneficiaries. Beyond the income generation that a family may have from these household farms there are other societal benefits that may be experienced, and it will be my job to identify and quantify those. For instance, if a family is consuming a nutritious, diverse diet and children are healthier, they may experience a lower incidence of disease, which may translate into reduced healthcare expenditure. After mapping out all these costs/benefits, we see what the program produces for every dollar spent, both in terms of financial and societal gains for families.

3) Evaluation design for the program as a whole. This is less of a research question and more of a task that will assist The Org in answering future questions related to program operations and impact. As of right now, a lot of the monitoring and evaluation of the program is based on what a donor wants to know. Because different donors fund the program in different provinces, what is being monitored and evaluated differs between provinces. In the last few years, The Org has created a model for the program that details all the inputs, activities, outputs, outcomes and impacts that should theoretically occur. Having an evaluation plan that is designed on this model, rather than a few aspects here and there according to donor interest, will allow The Org to streamline their monitoring and evaluation (M&E), collect the same data for every province, and ultimately allow them to answer all questions and compare across program sites. This may all sound pretty technical, but I'm a bit of an M&E nerd and this is part of my work plan that I'm most excited about.

Ok, blathering done... for now.