Joint Action to Overcome Malnutrition in North Lombok District 2019
Background The project started its three-year project period in 2018. The goal is to improve nutrition, food variety, hygiene and sanitation practices in Bayan, Lombok to combat malnutrition among children under the age of three. Significant approaches and methods are Positive Deviance; Nutrition Education Rehabilitation Sessions; farmer field school for home gardening; and community mobilization. The project is implemented in cooperation with the local village governments. In July/August 2018, a series of earthquakes destroyed the three target villages. The project intervention quickly turned to emergency aid followed by a recovery phase that lasted until summer 2019. Purpose/objective The main goal for the evaluation was to assess the project progress, effectiveness and efficiency, accountability, impact, sustainability, local ownership, gender equality, level of empowerment, strengths and weaknesses, and relevance, as well as provide lessons learned and recommendations for the post-emergency phase. Methodology The data were collected from in-depth interviews, focus group discussions, and observations. Key findings Program adjustments after the earthquakes were well implemented. The community kitchen program during the emergency response was quite successful in changing the behavior of the targeted mothers in providing nutrition to their children. Behavior changes can also be seen in the children, especially in their variety of food consumed, and a clean lifestyle. Changes in maternal and child behavior have a positive impact on the weight of some children participating in this program. Further quantitative studies are required to obtain the number of positively affected children. In terms of accountability, the JAAM Project has been implemented according to the plan, even when considering the project adjustments when the earthquake hit the area. The project faces severe challenges in terms of staff turnover that directly handles the field implementation. Program strengths are program compatibility with the real needs of the community, empowerment of the local community, the involvement of medical personnel, applicability and practicality, and the creation of media for mothers to socialize. There are also strengths related to the human resources. The YNLM staff, cadres and community kitchen responsible have succeeded in building a very good relationship with the local stakeholders. The program acceptability level is therefore relatively high. The project still has some weaknesses: number of human resources, the timing of activities, variety of activities, program sustainability for pregnant women, program facilities, and quality control/assistance. There are some supporting factors of success, especially related to program relevance, high stakeholder acceptability, and the tangible results achieved so far. On the other hand, YNLM needs to overcome the challenges of community conditions in the aftermath of the earthquake, which can hamper the smooth implementation of the project. Recommendations To ensure sustainability, the following is recommended: innovation of activities, which can be more varied and with more counselling about the impact of malnutrition and participation of external technical expertise. More attention to human resources, reward for members, member capacity building, control and field supervision, as well as YNLM management and staff coordination. Links with Puskesmas/Posyandu (public health center/integrated healthcare center) should be strengthened, achievements should be promoted to the community to increase participation, and the program should be replicated to other villages. Targets need to be broadened, not only mothers with children on yellow line and below red line, but also mothers who have problems with the child's diet. In addition, the role of the target mother needs to be increased in food preparation. Setting the schedule of activities by coordinating with related parties in the village is essential. Community participation is expected to increase since the probability of crashing schedule with other activities can be minimized. Routine counselling services should be improved. Nutritional counselling services, infant and child health, and pregnant women are regularly supervised with counselling provided directly by medical personnel, not just pre- and post-natal care and information staff. This service needs to be provided in remote villages. YNLM needs to encourage Puskesmas to do this. Facilities at the Hearth center should be added, such as educational games and reading materials that are simple and detailed so that mothers can easily understand them regarding nutrition and childcare. The number of staff managing and implementing the project need to be increased so that activities can take place optimally and provide maximum results. The staff capacity needs to be improved so that they can provide more in-depth and varied information to the target mothers. YNLM needs to consider giving rewards to the members/volunteers as an appreciation for their efforts and performance. Comments from the organisation From YNLM: Monitoring Evaluation and Learning officer has been hired to improve data collection, information and communication of project achievements, and discussions of lessons learned within the project team. The project is in process of hiring new staff and further strengthen the capacity of the staff, coordination and supervision. Mothers’ involvement in nutrition activities will be further addressed. The variation of activities has been limited during the emergency response. The project is now more varied in accordance with the original plan. The Hearth center will be provided with educational material. Due to the total damage of community health service in sub district of Senaru and its geographical coverage area, the project will promote using the social media and propose extension service to reach the most remote area. From NLM: The evaluation report generally corresponds with NLM’s perception of the project. The post-earthquake period has been challenging for the project in many ways, as described in the report. The activities were, however, well adapted to fit with the original objectives and cater for the immediate needs of the target group. The project is behind schedule to reach the objectives and will apply for an extension of the project period. An extension to other villages is not planned at this stage. Digni consider the evaluation as a valuable input in the design of the project further. It provides a good assessment of positive factors in the achievement of goals, while providing good and well-founded recommendations for further efforts.