The International Initiative for Impact Evaluation (3ie) is aiming to obtain an understanding of the relationship between malnutrition treatment and prevention and generate evidence of the value of the interrelationship. Related to this would be knowing how effectiveness varies in emergency and post emergency conditions and the extent to which impact of moderate acute malnutrition (MAM) treatment programmes varies when prevention interventions are also present.
3ie expects the evaluation to make use of experimental or quasi-experimental methods to examine the full causal chain to answer questions about what works, why, how and at what cost and to identify changes needed to enable fulfilment of potential impact of MAM interventions.
Proposed evaluation questions
We are proposing a core evaluation question of:
What is the impact on incidence and prevalence of MAM and SAM in children under 5 years and PLW of different packages of MAM treatment and prevention in acute/protracted emergencies in Sudan (i.e. TSFP, TSFP with eBSF1, TSFP with FBPM)?
Of this core evaluation question, we propose to address the following sub-questions:
- How are these impacts effected by different intervention modality in terms of product used, delivery of service, duration of intervention and coverage?
- What is the impact of FBPM and eBSFP on effectiveness of MAM treatment (performance and coverage)?
- How timely and effective is the rapid response (eBSF) intervention?
- How does the inclusion of SBCC impact on the effectiveness of MAM treatment and prevention and what factors influence this?
- How appropriate are geographical and individual targeting criteria for each intervention?
- Cost measures and comparison of different packages (cost-effectiveness)?
- What are the wider impacts, positive or negative, of the packages at household, community or institutional level (opportunity, social, economic, environmental)?
Assumptions on the planned MAM intervention packages
Given this background and the evaluation questions proposed, the study design for the proposed evaluation will be affected by the eventual or actual MAM intervention package/s to be provided in Sudan and the way / manner by which such packages are to be implemented. In lieu of this, we state the following assumptions in relation to these required details so as to elucidate a preliminary proposed evaluation study design that will provide answers to the questions stated above.
We assume that:
- Any implementation of proposed MAM prevention package/s will be done in a roll-out fashion; that is initiation of the provision of the package/s will be done in a staged or step-wise fashion with a select number of areas or clusters among a full set of intended areas or clusters receiving the MAM prevention package/s first and then over a set time interval, new areas or clusters are to be initiated into the MAM prevention package/s until after a number of stages or steps in which all intended or planned areas or clusters have been initiated.
- The rollout can be randomised.
- An area or cluster is specified as the villages or settlements within a pre-determined catchment of a centre or a unit from which the intervention is to be provided from.
- The current status quo in terms of nutrition intervention for acute malnutrition in areas or clusters in Sudan is either of 4 types: a) SAM treatment only; b) MAM treatment only; c) SAM and MAM treatment together; and d) no SAM and no MAM treatment. For the purposes of this study, we will choose areas or clusters with existing MAM treatment as the ‘baseline’ or ‘control’.
- The proposed MAM prevention packages are a combination of the following components a) FBPM; b) eBSFP ; c) SBCC; and d) home fortification. For this study, we state that an area or cluster is considered to become an ‘intervention’ when at least the FBPM has been initiated in the area.