Evaluating the Impact of Nutrition and Health Programs

467 Pages·1979·49.22 MB·English

by  James A. Brown Jr. (auth.), Carlos H. Daza (eds.)

Evaluating the
Impact of Nutrition and
Health Programs
Evaluating the
Impact of Nutrition and
Health Programs
Edited by
Robert E. Klein
Pan American Health Organization/Institute of
Nutrition of Central America and Panama
Guatemala, Guatemala
Merrill S. Read
Pan American Health Organization
Washington, D.C.
Henry W Riecken
University of Pennsylvania
Philadelphia, Pennsylvania
James A. Brown, Ir.
u.s. Agency for International Development
Washington, D.C.
Alberto Pradilla
Foundation for Higher Education
Cali, Colombia
and
Carlos H Daza
Pan American Health Organization
Washington, D.C.
PLENUM PRESS . NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Pan American Health Organization International Conference on the Assessment
of the Impact of Nutrition and Related Health Programs, Panama, 1977.
Evaluating the impact of nutrition and health programs.
Includes index.
1. Public health-Evaluation-Congresses. 2. Nutrition-Evaluation-Con-
gresses. 3. Evaluation research (Social action programs)-Congresses. 4. Malnutri-
tion-Latin America-Prevention-Congresses. I. Klein, Robert E. II. Pan Amer-
ican Health Organization. III. Title. IV. Title: Impact evaluation. [DNLM: 1.
Nutrition-Standards-Congresses. 2. Nutrition disorders-Congresses. 3. Evalua-
tion studies-Congresses. 4. Public health America-Congresses.
QU145 C747p 1977]
RA427.P2161977 614 79-11321
ISBN 978-1-4684-3491-0 ISBN 978-1-4684-3489-7 (eBook)
001 10.1007/978-1-4684-3489-7
Based on the proceedings of the P AHO International Conference on the
Assessment of the Impact of Nutrition and Related Health Programs,
held in Isla Contadora, Panama, August 1-4, 1977
© 1979 Plenum Press, New York
Softcover reprint of the hardcover 15t edition 1979
A Division of Plenum Publishing Corporation
227 West 17th Street, New York, N.Y. 10011
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Preparation of this volume has been a joint effort of Plenum Press
and the Pan American Health Organization, Regional Office of the
World Health Organization. This volume also is to be published in
Spanish for distribution through the Pan American Health Organiza-
tion, Washington, D.C. 20037
Foreword
As is noted in the opening chapter of this volume, nutrition
and public health programs have been important throughout Latin
America and the Caribbean for many years. This is due to the spe-
cial concerns of those responsible for setting national policies,
the program experience and leadership in public health developed
by the national governments, and the stimulus and cooperation of
the Pan American Health Organization (PARO), including its twelve
associated centers which focus on research, training and program
development.
The need for a coordinated hemisphere-wide attack on malnu-
trition and other health problems was expressed clearly in the
"Ten Year Health Plan for the Americas" (1). This plan established
specific targets for reducing the prevalence of the major nutri-
tional diseases and other health problems for the decade 1971-1980.
It was noted at that time that very few countries had formulated
adequate comprehensive national food and nutrition policies and
plans, nor had they developed strategies for combating the nutri-
tional deficiencies known to affect large numbers of people through-
out the Region. Following a review of the available data on a
country by country basis in 1975, the PARO Directing Council en-
dorsed recommendations for formulating the necessary national poli-
cies and strategies for the intersectorial execution of food, nutri-
tion and health programs (2). This report also summarized the
available national data related to nutritional status, existing
programs such as food fortification, and the human resources avail-
able for services as well as for research and education.
The nutritional problems in the Americas are varied. The
most frequently encountered deficiency is protein-energy malnutri-
tion (PEM). It affects the growth and health of large numbers of
young children and also contributes importantly to low birth
weight of infants born to inadequately nourished mothers. PEM is
seen most often among the rural populations and the marginal urban
vii
viii FOREWORD
poor in rapidly expanding cities. It is seen much less frequently
in those areas and countries where health and community services
have been extended to provide adequate coverage or in those areas
where extremes of wealth or poverty are not great. In nearly all
its forms under-nutrition is associated with higher incidence of
gastroenteritis and other childhood diseases, either as a result
of decreased food intake during illness or because malnutrition
adversely affects the development of immunologic defense mecha-
nisms. Therefore the development of appropriate national programs,
and their evaluation, must be approached on a multisectorial and
multi-disciplinary basis.
Several of the countries in the Western Hemisphere have
developed extensive national food and nutrition plans. In these
countries a variety of program activities have been projected or
implemented. These include food stamps or food supplements for tar-
get populations, nutritional fortification of commonly eaten foods,
extension of primary health care coupled with nutrition and health
education, agricultural reform, and income maintenance.
Information systems, (i.e., health and nutritional surveil-
lance) are being implemented in several countries to determine
where problems lie, what services are being delivered, and what
may be the impact of national programs as they are implemented
(3,4). Frequently these efforts are centered in the health minis-
tries (5). However, a multisectorial approach to impact evalua-
tion will obviously be required if serious attention is to be
given to the well-being of the needy populations. Papers in this
volume make this pOint abundantly clear.
It is clear that evaluation of the impact of nutrition and
health programs will become increasingly more important as co~atries
throughout the world seek to provide services to meet the needs of
their populations. We believe that this volume will stimulate new
and innovative approaches to this end.
The Pan American Health Organization wishes to express its ap-
preciation to the United States Agency for International Development
for financial support of the conference and preparation of this vol-
ume.
Hector R. Acuna
Director, Pan American
Health Organization
FOREWORD ix
REFERENCES
1. Pan American Health Organization. Ten Year HeaZth PZan for
the Ameriaas. PAHO Official Document No. 118, Washington
1973
2. Organiazcion Panamericana de la Salud. PoZ!tiaas NaaionaZes
de AZimentaai6n y Nutriai6n. Publ. Cientif. No. 328.
Washington 1976.
3. Joint FAO/UNICEF/WHO Expert Committee. MethodoZogy of Nutri-
tionaZ SurveiZZanae, Technical Report Series #593.
Geneva: World Health Organization 1976.
4. Coloquio sobre Sistemas de Vigilancia Epidemiologica Nutri-
cional, IV Congreso Latino Americano de Nutricion,
Caracas, Venezuela, November 1976. Published in Arah.
Latinoamer. Nutr. 27 (2)., Supplement, June 1977.
(English translation: Pan American Health Organiza-
tion 1978. In preparation).
5. Daza, C. H. and M. S. Read. Health-related Components of a
Nutritional Surveillance System. Paper presented at
Plenary Session of IX International Con(J!'est! on Nutrition,
Rio de Janeiro, August 1978.
Contents
I. INTRODUCTION
Rationale for the Conference and Organization
of the Volume • • • • • • • • 1
Determinants of Health and Nutritional
Status •••••••••• 7
John A. Daly, Joe H. Davis, and
Robert L. Robertson
Comments by H~ctor Correa • 34
General Discussion • • • • 35
II. APPROACHES TO IMPACT EVALUATION
Recent United States Experiences in Evaluation
Research with Implications for
Latin America • • • • • • 39
Thomas D. Cook and Emile G. McAnany
Comments by Robinson G. Hollister • 76
Special Issues for the Measurement of Program
Impact in Developing Countries 99
John W. Townsend, W. Timothy Farrell,
and Robert E. Klein
Comments by Guillermo Herrera • 123
General Discussion for Section II • • • • 127
xi
III. ASSESSING SPECIFIC OUTCOMES OF INTERVENTIONS
Measurement of Health and Nutrition Effects
of Large-Scale Intervention Projects 133
Jean-Pierre Habicht and William P. Butz
Comments by Alberto Pradilla, L.F. Fajardo,
and G. Acciarri • • • • • • • • 170
General Discussion 179
Family Composition and Structure in Relation to
Nutrition and Health Programs • • • • 183
Susan C. M. Scrimshaw and Gretel H. Pelto
Comments by Nelson Amaro 218
General Discussion 224
The Economic Theory of the Household and Impact
Measurement of Nutrition and Related
Health Programs 227
Dov Chernichovsky
Comments by Sebastian Pinera 258
General Discussion • • • • 261
Educational Outcomes and Nutrition 269
Selma J. Mushkin
Comments by Ernesto Pollitt • 302
General Discussion • • • • 306
IV. IMPLEMENTING AND USING EVALUATIONS
Political and Organizational Issues in Assessing
Health and Nutrition Interventions 309
Antonio Ugalde and Robert Emrey
Comments by Adolfo Chavez • 331
Some Suggestions for Improving the Applicability
and Utilization of Evaluation Assessments 339
Jerome S. Stromberg
Comments by Ricardo Galan Morera 356
CONTENTS xiii
V. PRACTICE AND PROBLEMS OF IMPACT EVALUATION
Practice and Problems of Evaluation:
A Conference Synthesis 363
Henry W. Riecken
Clarification of Concepts and Terms Commonly
Used in Evaluative Research • 387
Karen M. Hennigan, Brian R. Flay,
and Richard A. Haag
Participants 433
Index • • • • • . .'. 441