title: Planning an integrated agriculture and health program and designing its evaluation: Experience from Western Kenya.
abstract: Multi-sectoral programs that involve stakeholders in agriculture, nutrition and health care are essential for responding to nutrition problems such as vitamin A deficiency among pregnant and lactating women and their infants in many poor areas of lower income countries. Yet planning such multi-sectoral programs and designing appropriate evaluations, to respond to different disciplinary cultures of evidence, remain a challenge. We describe the context, program development process, and evaluation design of the Mama SASHA project (Sweetpotato Action for Security and Health in Africa) which promoted production and consumption of a bio-fortified, orange-fleshed sweetpotato (OFSP). In planning the program we drew upon information from needs assessments, stakeholder consultations, and a first round of the implementation evaluation of a pilot project. The multi-disciplinary team worked with partner organizations to develop a program theory of change and an impact pathway which identified aspects of the program that would be monitored and established evaluation methods. Responding to the growing demand for greater rigour in impact evaluations, we carried out quasi-experimental allocation by health facility catchment area, repeat village surveys for assessment of change in intervention and control areas, and longitudinal tracking of individual mother-child pairs. Mid-course corrections in program implementation were informed by program monitoring, regular feedback from implementers and partners' meetings. To assess economic efficiency and provide evidence for scaling we collected data on resources used and project expenses. Managing the multi-sectoral program and the mixed methods evaluation involved bargaining and trade-offs that were deemed essential to respond to the array of stakeholders, program funders and disciplines involved.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; International Potato Center (CIP), Peru. Electronic address: donald.cole@utoronto.ca.
authors.forename: Donald C
authors.initials: DC
authors.lastname: Cole
authors.affiliation: University of Washington, Seattle, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Levin
authors.affiliation: International Atomic Energy Agency, Vienna, Austria.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Loechl
authors.affiliation: CGIAR Research Program on Roots, Tubers and Bananas, Lima, Peru.
authors.forename: Graham
authors.initials: G
authors.lastname: Thiele
authors.affiliation: CIP, Dar es Salaam, Tanzania.
authors.forename: Frederick
authors.initials: F
authors.lastname: Grant
authors.affiliation: Rollins School of Public Health, Emory University, GA, USA.
authors.forename: Aimee Webb
authors.initials: AW
authors.lastname: Girard
authors.affiliation: CIP, Nairobi, Kenya.
authors.forename: Kirimi
authors.initials: K
authors.lastname: Sindi
authors.affiliation: CIP, Nairobi, Kenya.
authors.forename: Jan
authors.initials: J
authors.lastname: Low
mesh_terms: D000383:Agriculture / Q000379:methods / Q000458:organization & administration*; D005523:Food Supply / Q000379:methods; D006285:Health Planning / Q000379:methods* / Q000458:organization & administration; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D000070516:Intersectoral Collaboration; D027723:Ipomoea batatas; D007630:Kenya; D009752:Nutritional Status; D016730:Program Development / Q000379:methods; D015397:Program Evaluation
keywords: Agriculture; Bio-fortification; Development evaluation; Maternal and child health; Micronutrient; Multi-sectoral program; Nutrition; Vitamin A