inspiration today leads to an inspirational future_khan_5.1.12

The SHOUHARDO Program Impact (Transforming Lives)CARE Bangladesh

Funded by USAID and the Government of Bangladesh

Total Funding: USD 126 Million

Duration: October 2004 – May 2010

Presented By: Faheem Khan (Chief of Party)

NUTRITION – IS IT REALLY THAT IMPORTANT………

The consequences of malnutrition include childhood morbidity and mortality, poor physical

and mental development and school performance, and reduced adult size and

capacity for physical work

This in turn has an impact on economic productivity at the national level (WHO, 1995a)

Goal and Working Area of SHOUHARDO

Goal: Sustainably reduce chronic andTransitory food insecurity of theMost disadvantaged and hardest

To reach 400,000 households (2 million beneficiaries)

in 18 districtsOf bangladesh

North Char

Mid Char

Haor

Coastal

So why are we so confident………..

HigherIncome

BetterServices

BehaviourChangeLess

UnderweightLess

Diarrhea

DietDiversification

HandWashing

BreastFeeding

LessMigration

LessAdvance Labour

LessNon-Formal

Loans MoreAssets

AntenatalCare

Iron/FolicAcid

VitaminA

Immunization

Reduce“Stunting”

BetterFood &

Health Env.

Safe Water

SanitaryLatrines

BetterServices

AntenatalCare

Iron/FolicAcid

VitaminA

Immunization

At least 3 antenatal visits- Baseline: 16%- Endline: 58%- Difference: + 266%

- National: 32%

- Baseline: 27%- Endline: 81%- Difference: + 197%

Child (in last 6 mnth)- Baseline: 62%- Endline: 86%- Difference: + 38%

- Baseline: 68%- Endline: 84%- Difference: + 22%

- National: 76%

Mother (1.5 M of delivery)- Baseline: 9%- Endline: 79%- Difference: + 739%

BehaviourChange

DietDiversification

HandWashing

BreastFeeding

- Baseline: 89%- Endline: 93%- Difference: + 4%

- Baseline: 60%- Endline: 94%- Difference: + 56%

HH Diet Diverse. Score - Baseline: 5%- Endline: 6%- Difference: + 26%

HigherIncome

LessMigration

LessAdvance Labour

LessNon-Formal

Loans MoreAssets

- Baseline: 43%- Endline: 20%- Difference: - 54%

- Baseline: 15%- Endline: 4%- Difference: - 75%

- Baseline: 49%- Endline: 21%- Difference: - 56%

- Baseline: 697- Endline: 3,356- Difference: + 382%

Income in BDT- Baseline: 1,487- Endline: 3,390- Difference: + 128%

Income Sources- Baseline: 1.32- Endline: 1.64- Difference: + 24%

BetterFood &

Health Env.

LessUnderweight

LessDiarrhea

Oral Rehydration - Baseline: 57%- Endline: 92%- Difference: + 63%

- Baseline: 56%- Endline: 44%- Difference: - 21%

HHs with 3 square meals/day- Baseline: 34%- Endline: 74%- Difference: + 121%

# of Mnth Food Secure- Baseline: 5.5%- Endline: 8.9%- Difference: + 62%

Safe WaterSanitaryLatrines

- Baseline: 57%- Endline: 72%- Difference: + 25%

- Baseline: 14%- Endline: 55%- Difference: + 296%

- Baseline: 23%- Endline: 9%- Difference: - 60%

So what was the final impact………..

25

30

35

40

45

50

55

60

2004 2005 2006 2007 2008 2009 2010

P r o j e c t I m p a c tN a t i o n a l A v e r a g e

45.3Jan-May04

45.6Feb06

56.1Feb06

37.2Mar-Aug07

40.4Nov08-Jan09

45.8Jan-Apr10

Source: BDHS 2004; NNSP-HKI 2006; BDHS 2007; HH Food Security Assessment by WFP, UNICEF, IPHN 2008/09; NNSP-HKI 2010

Pre

vale

nce o

f S

tun

tin

g

Could external factors be responsible……….

2530

35

40

45

50

55

60

20042005 200620072008 20092010

All 4 regions experienced significantreduction in “stunting”

Analysis from HKI data shows that stunting, in the same districts,decreased from 45% in 2006 to 40% in 2010 (only 1.4 PPs per annum)

Average reduction nationwide is 1.3 PP / annum and ONLY 0.3 PP for the poorest quintile

SHOUHARDO achieved 4.5 PP / annum

Only 10% HHs at endline confirmed assistance from other agencies

WHAT MAKES SHOUHARDO UNIQUE……………

This project stands apart from its predecessors in thatit is the first large-scale development program that, inaddition to direct nutrition interventions, including

food aid, addressed a broad range of structural causesspecific to the population in its area of operation using

a rights-based, livelihood approach

(Tim Frankenberger)

Programs need to fit into higher goals………..

SHOUHARDO II SOs

SO1: Entitlement & Economic Growth

SO2: Health, Hygiene, Nutrition

SO3: Women Empowerment

SO5: Disaster Management andClimate Change

Economic Growth & Agriculture Development

Democracy

Education & Training

Population & Health

USAID

MDG 1: Eradicate Poverty & Hunger

MDG 2: Universal Primary Education

MDG 3: Women Empowerment

MDG 7: Environmental Sustainability

MDGs

Environment

Disaster Management

SO4: InstitutionalStrengthening

Explaining the shouhardo approach….

Accurate “targeting” is key……….

Poverty Maps Dialogue with UZ

Dialogue with UP

Dialogue with Communities

Provisional Village Ranking

Final Village Ranking

Well-BeingAnalysis

MasterBeneficiary

List

Baseline&

Census

SO 1: “Availability ofnutritious food enhanced and protected

SO 1: “Availability of” nutritious food enhanced and protected

SO 1: “Availability of”nutritious food enhanced and protected

SO 1: “Availability of”nutritious food enhanced and protected

SO 1: “Availability of”nutritious food enhanced and protected

SO 1: “Availability of”nutritious food enhanced and protected

SO 1: “Availability of”nutritious food enhanced and protected

SO 1: “access” to nutritious food enhanced and protected

SO 1: “access” to nutritious food enhanced and protected

SO 1: “access” to nutritious food enhanced and protected

SO 1: “access” to nutritious food enhanced and protected

SO 1: “access” to nutritious food enhanced and protected

SO 1: “access” to nutritious food enhanced and protected

SO 1: “access” to nutritious food enhanced and protected

SO 2: Improved health, hygiene, and nutrition status

SO 2: Improved health, hygiene, and nutrition status

SO 2: Improved health, hygiene, and nutrition status

SO 2: Improved health, hygiene, and nutrition status

SO 2: Improved health, hygiene, and nutrition status

SO 2: Improved health, hygiene, and nutrition status

SO 2: Improved health, hygiene, and nutrition status

SO 2: Improved health, hygiene, and nutrition status

SO 3: PEP women and adolescent girls empowered

SO 3: PEP women and adolescent girls empowered

SO 3: PEP women and adolescent girls empowered

SO 4: Local elected bodies & government service providers work proactively with communities

SO 4: Local elected bodies & government service providers work proactively with communities

SO 4: Local elected bodies & government service providers work proactively with communities

SO 4: Local elected bodies & government service providers work proactively with communities

SO 4: Local elected bodies & government service providers work proactively with communities

SO 5: Community members & government institutions are better prepared for, mitigate,

& respond to disasters and adapt to climate change

SO 5: Community members & government institutions are better prepared for, mitigate,

& respond to disasters and adapt to climate change

SO 5: Community members & government institutions are better prepared for, mitigate,

& respond to disasters and adapt to climate change

SO 5: Community members & government institutions are better prepared for, mitigate,

& respond to disasters and adapt to climate change

SO 5: Community members & government institutions are better prepared for, mitigate,

& respond to disasters and adapt to climate change

SO 5: Community members & government institutions are better prepared for, mitigate,

& respond to disasters and adapt to climate change

SO 5: Community members & government institutions are better prepared for, mitigate,

& respond to disasters and adapt to climate change

SO 5: Community members & government institutions are better prepared for, mitigate,

& respond to disasters and adapt to climate change

SO 5: Community members & government institutions are better prepared for, mitigate,

& respond to disasters and adapt to climate change

FoodSecurity

AvailabilityA

cces

s

Utilizatio

n

Stability

IncreasedProduction M

CHN /

PM2A

Incr

ease

dIn

com

eM

arke

ts

DRR

WA

TS

AN

Strategic Objective 1Strategic Objective 5

Str

ateg

ic O

bje

ctiv

e 1

Strateg

ic Ob

jective 2

VE

HIC

LES

FORDEVELOPMENT

“Occupational

Gro

up

s”“S

aving’s

Groups”“EKATA

“ECCD”

Groups”

CHANGE

CATALYSTS

“Volu

nteers”

“CARE”

“PNGOs”

“PDs”“V

DC

s”

“In

stit

uti

on

s”

N u

t r

i t

i o

n

S

e c

u r

i t

y

IMPROVEDHEALTHSO 4

SO 3

So whAT CONTRIBUTED THE MOST TO SUCH “EXTRAORDINARY” IMPACT………..

Multiple treatment propensity scoring

MCHN+

Sanitation

MCHN+

Agri/Fisheries

MCHN+

Empowerment

Perc

en

tag

e P

oin

ts (

Stu

nti

ng

)

- 1

- 2

- 3

- 4

- 5

- 6

- 7

- 8

- 9

MC

HN

San

itatio

n

MC

HN

+ S

anita

tion M

CH

N Ag

/F

ish

MC

HN

+ A

gri /

Fis

herie

s

MC

HN

Wom

en E

mpo

wer

men

t

MC

HN

+ W

omen

Em

pow

erm

ent

Do we need to target everyone…………

Availa

bility

AccessUtilization

Stability

PEPNon-PEP

So in conclusion……………

Stunting prevalence fell by an extraordinary 4.5 PP per year

Empowering Women is KEY

Common issues serve as a CATALYST to galvanize communities

Communities and Key Stakeholders must be involved from the outset

SHOUHARDO IMPACT DEMONSTRATES THAT TO BRING ABOUTCONCRETE IMPACT LEADING TO SUSTAINABLE “SELF

RESILIENCY”REQUIRES A COMBINATION OF APPROACHES TOUCHING ON

THE SPECTRUM OF “LIVELIHOOD” REQUIREMENTS OF A HH /

COMMUNITY

Quote of the Week: - “In order to support a population this large, we'll need to double global food production. All while a changing climate leads to warmer temperatures, more erratic rains and longer, more vicious droughts. The only way we're going to get ahead of this curve is to fight poverty and spur economic growth is to take advantage of three critical opportunities today.

1. We have to help communities build real resilience to disasters-so that droughts don't shatter development gains or give rise to instability.

2. We need to strengthen food security and drive economic growth.

3. And we need to help countries reap a demographic dividend-focusing on efforts that ensure all children can enjoy healthy, productive lives.”

– USAID Administrator Rajiv Shah, Global Philanthropy Forum, April 16, 2012

AND FINALLY……………