Comparison Villages Research Articles

Impact of microfinance on income generation: Evidence from a rural community‐driven development programme in Myanmar

AbstractThis paper evaluates the impact of a rural community‐driven development programme in Myanmar, which promoted village‐level microfinance for income generation. Utilizing a three‐round household survey consisting of 100 treatment and 50 comparison villages with approximately 8500 households per round, we employ difference‐in‐differences and two‐stage least squares estimations. Our analysis shows three key findings. First, the programme significantly increased access to microfinance, primarily for production. Second, formal and informal finance were substituted in part with village‐level microfinance. As a result, treated households were less likely to borrow money from formal banks or informal lenders such as their relatives, friends or neighbours. Third, the village‐level microfinance nudged rural households to harvest, yield and sell their products more, which led to increase in seasonal income. Our study suggests that microfinance targeted for productive investment can significantly improve income of rural households in developing economies.

Developing a social mobilisation intervention for salt reduction: participatory action research in Bombali district, Sierra Leone

BackgroundHigh salt intake is a major risk factor for hypertension, which in turn contributes to cardiovascular diseases, the major cause of death from non communicable diseases (NCDs). Research is limited on social mobilisation interventions to tackle NCDs, including in fragile health settings such as Sierra Leone.MethodsParticipatory action research methods were used to develop a social mobilisation intervention for salt reduction in Bombali District, Sierra Leone. A team of 20 local stakeholders were recruited to develop and deliver the intervention. Stakeholder workshop reports and interviews were used to record outcomes, enablers, and barriers to the intervention. Focus group discussions were used to observe knowledge, attitudes, and behaviours of community members pre- and post- the intervention.ResultsStakeholders showed enthusiasm and were well engaged in the social mobilisation process around salt reduction. They developed radio jingles, radio show talks, organised community awareness raising meetings, school sensitisation outreaches, and door to door engagements. Stakeholders reported benefiting personally through developing their own skills and confidence in communication and felt positive about their role in educating their community. The interventions led to reported increased awareness of risks of high salt intake and NCDs, resulting in a reduction of salt use in the community, leading to perceived health gains. However, salt reduction was also met with some resistance due to social factors. Local community structures were also reactivated to work on the interventions and connect the community to the local health facility, which saw an increase in patients having their blood pressure checked. The comparison villages also experienced an increase in awareness and perceived reductions in salt intake behaviours. This was as messages had cascaded via the radio and initial focus group discussions. The social mobilisation stakeholders also agreed on future activities that could continue at no or low cost.ConclusionSocial mobilisation interventions can provide low-cost strategies to tackle NCDs in fragile settings such as Sierra Leone through the utilisation of community structures. However, more research is required to ascertain the key enablers for replicability and if such successes can be sustained over a longer follow up period.

Netball Shoots for Physical and Mental Wellbeing in Samoa: A Natural Experiment.

Sport-for-development programs claim to address key determinants of recreational physical activity participation and subsequent development outcomes in low-income settings. We conducted a natural experiment with pre–post measures taken from women in the 12 villages in Samoa, some of which voluntarily participated in the sport-for-development intervention. The intervention comprised a six-week netball league delivered by local volunteers who attended coaching workshops, received ongoing support from the national governing body and were provided with infrastructure and equipment to conduct local training sessions. Changes in netball participation, recreational physical activity, body composition, mental wellbeing and socio-ecological determinants of physical activity were compared between intervention and comparison villages using a univariate ANOVA. The intervention reached women who participated in little recreational physical activity and had poor physical and mental wellbeing. Program uptake was higher in villages with the strongest social support for netball participation. Local social support and capacity to independently organize netball activities increased. There were concurrent improvements in netball participation, physical activity levels, mental wellbeing and body weight in the intervention villages. Our findings support scaling-up of the intervention in similar settings but preceding this with formative evaluation to identify low active communities that are “primed” to participate in the proposed activity.

The evaluation of effect Gammarana intervention to reducing stunting during the Covid-19 pandemic: Protocol evaluation of stunting intervention in Enrekang District.

Background: Evaluation of large-scale stunting interventions in Indonesia has never been carried out, because it found limited sensitive and specific interventions that were carried out massively at the village level. The provincial government of South Sulawesi Indonesia in 2020 has implemented a stunting intervention model called Gammarana. The purpose of this evaluation is to analyze the impact of Gammarana on changes in stunting at the project site. Location project as many as 30 villages with an estimated 60,000 units population.Design and methods: Evaluation in this study using a retrospective method and internal and external audit to document potential, then validated after the field visit Gammarana first phase in 2020. Basic Logic Model evaluation model with 22 indicators (input, process, secondary output and primary output). Proving the effect of Gammarana on changes in stunting by comparing the phenomena in the comparison village.Results: The comparison villages were set as equal and comparable in 13 indicators that could disturb the study conclusions. The result of the initial condition is that the conditions of the two villages of Gammarana and Villages Comparison are seen as the same in various characteristics, so that whatever the results of this evaluation study are believed to be the impact of Gammarana Project.Conclusions: this protocol eligible to evaluation of Gammarana Project Intervention in Enrekang District, South Sulawesi Indonesia. Significance for public healthThe South Sulawesi Government of Indonesia, is in need of this protocol to evaluate The Gammarana project during the Covid-19 pandemic. It is estimated that there will be an increase in stunting. Early detection can be done, if there is an appropriate protocol and time.

Financial inclusion in the digital banking age: Lessons from rural India

AbstractIn the digital age, financial inclusion continues to be connected to social inclusion. While most personal financial transactions are shifting from cash currency to digital transactions, we must ensure that marginalized members of society are not unbanked and excluded from financial opportunities. Many countries are declaring their intention to transform to cashless societies. India is one such country. As a case study, we investigated rural Indian villages that declared themselves as cashless to assess the financial reality of villagers. We conducted a survey of households (N=3,159) within villages across seven Indian states. In each state, we studied a village that was officially declared cashless and a nearby comparison village. Our findings suggest that the comparison villages did as well as the cashless villages, as financial inclusion via digital banking was minimal to nonexistent. Alongside significant state variations, we found that financial literacy and online access were the best predictors of performing any digital banking activity. This study concludes with a warning against rushing toward digital banking and the formation of cashless societies, as marginalized populations may be excluded.

Health of Farming Communities Prior to Modification of the Occupational Environment through a Watershed Development Project in Kolar, India.

Background:Watershed development (WSD) projects, aimed primarily at enhancing soil and water conservation and supporting livelihoods in semi-arid areas, have the potential to impact health by modifying the occupational and household environments in agrarian communities. To identify and address potential health concerns arising from a planned WSD project in Kolar district, India, a health impact assessment (HIA) was conducted. This necessitated understanding the health status and concerns in the project villages.Objective:To characterize the health of farmers and their household members in close proximity of the planned WSD project.Methods:We carried out a cross-sectional survey between April and July 2019. The study comprised: (i) a household survey covering the four project villages and two comparison villages (e.g. socio-demographic characteristics, occurrence of vector-borne diseases (VBDs), access to safe water, sanitation and hygiene, and utilization of healthcare); and (ii) an anthropometric survey for children under the age of 5 years in the four project villages and four comparison villages.Results:Respondents (n = 333) reported household-level occurrences of VBDs (chikungunya, 3.3%; and dengue, 1.5%), consuming unsafe water (54.5%) and frequent pesticide application in fields (26.7%). The prevalence of child underweight was 23.8%.Conclusions:VBDs, poor water quality and child undernutrition were found to be important local health concerns, amenable for preventive and promotive measures through the planned WSD project. Occupational environments in agricultural settings affect the workers and their households, and comprehensive projects such as WSD can seize the opportunity for improving health of farming and other rural households.

Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial

SummaryBackgroundEarly childhood development (ECD) programmes can help address early disadvantages for the 43% of children younger than 5 years in low-income and middle-income countries who have compromised development. We aimed to test the effectiveness of two group-based delivery models for an integrated ECD responsive stimulation and nutrition education intervention using Kenya’s network of community health volunteers.MethodsWe implemented a multi-arm, cluster-randomised community effectiveness trial in three rural subcounties across 60 villages (clusters) in western Kenya. Eligible participants were mothers or female primary caregivers aged 15 years or older with children aged 6–24 months at enrolment. If married or in established relationships, fathers or male caregivers aged 18 years or older were also eligible. Villages were randomly assigned (1:1:1) to one of three groups: group-only delivery with 16 fortnightly sessions; mixed delivery combining 12 group sessions with four home visits; and a comparison group. Villages in the intervention groups were randomly assigned (1:1) to invite or not invite fathers and male caregivers to participate. Households were surveyed at baseline and immediately post-intervention. Assessors were masked. Primary outcomes were child cognitive and language development (score on the Bayley Scales of Infant Development third edition), socioemotional development (score on the Wolke scale), and parental stimulation (Home Observation for Measurement of the Environment inventory). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03548558.FindingsBetween Oct 1 and Nov 12, 2018, 1152 mother–child dyads were enrolled and randomly assigned (n=376 group-only intervention, n=400 mixed-delivery intervention, n=376 comparison group). At the 11-month endline survey (Aug 5–Oct 31, 2019), 1070 households were assessed for the primary outcomes (n=346 group only, n=373 mixed delivery, n=351 comparison). Children in group-only villages had higher cognitive (effect size 0·52 SD [95% CI 0·21–0·83]), receptive language (0·42 SD [0·08–0·77]), and socioemotional scores (0·23 SD [0·03–0·44]) than children in comparison villages at endline. Children in mixed-delivery villages had higher cognitive (0·34 SD [0·05–0·62]) and socioemotional scores (0·22 SD [0·05–0·38]) than children in comparison villages; there was no difference in language scores. Parental stimulation also improved for group-only (0·80 SD [0·49–1·11]) and mixed-delivery villages (0·77 SD [0·49–1·05]) compared with the villages in the comparison group. Including fathers in the intervention had no measurable effect on any of the primary outcomes.InterpretationParenting interventions delivered by trained community health volunteers in mother–child groups can effectively promote child development in low-resource settings and have great potential for scalability.

Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China

BackgroundEmpirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.MethodsWe designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT).ResultsOverall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.ConclusionsThe CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities.

If Only I Knew: Nutrition Behavior Change Delivered by Women’s Groups Has Impacts on Diet Quality That Are Mediated by Knowledge in Rural Bihar, India

Abstract Objectives Poor diets are a major challenge in India. Barriers to improving diets include limited knowledge, access to resources and availability of affordable nutritious foods. Bihar, a poor state in India, has scaled up women's savings and credit self-help group (SHG) programs state-wide to improve livelihoods and access to resources. SHGs are now being leveraged to integrate health and nutrition discussions into their activities but rigorous evidence on the impact of integration is limited. Methods Cluster-randomized impact evaluation comparing 12 treatment and 12 comparison villages. Treatment area SHGs engaged in facilitated bi-monthly health/nutrition discussions, and increased coordination efforts between SHGs and their federations and health/nutrition service providers. Control SHGs conducted routine savings & credit activities. We surveyed 2000 households (1000 treatment; 1000 control) in April 2016 and again in Oct 2018. We assessed impact on diet diversity of women and their children and body mass index (BMI) of women using analysis of covariance, adjusting for sample clustering, baseline levels of outcomes & other characteristics. We did a mid-term mixed-methods process evaluation to assess implementation and uptake and a retrospective costing study to estimate implementation costs. Results Sample characteristics were generally balanced across arms at baseline. The intervention led to a 7–8% increase (P < 0.05) in the number of food groups consumed by women and children but had no impact on women's BMI. Consumption of pulses, fruits, vegetables and dairy increased significantly, but not eggs or flesh foods, suggesting resource constraints and social norms were barriers. A pathway analysis showed that the intervention worked primarily by improving awareness about diets. Process evaluation identified various implementation challenges that affected intervention exposure. The implementation cost $6/SHG member/year, comparable to other similar interventions. Conclusions SHG platforms have potential to influence awareness about nutrition and dietary practices but impact can be constrained by exposure to interventions and household-level economic and social constraints. Funding Sources World Bank Strategic Impact Evaluation Fund; Bill & Melinda Gates through WINGS, managed by IFPRI.

Use, Acceptability, Performance, and Health Impact of Hollow Fiber Ultrafilters for Water Treatment in Rural Kenyan Households, 2009-2011.

Diarrheal illness remains a leading cause of morbidity and mortality in children < 5 years in developing countries, and contaminated water contributes to diarrhea risk. To address this problem, a novel hollow fiber ultrafilter (HFU) was developed for household water treatment. To test its impact on water quality and infant health, we conducted a cluster-randomized longitudinal evaluation in 10 intervention and 10 comparison villages in Kenya, attempting to enroll all households with infants (< 12 months old). We conducted a baseline survey, distributed HFUs to intervention households, made biweekly home visits for 1 year to assess water treatment practices and diarrhea in infants, and tested water samples from both groups every 2 months for Escherichia coli. We enrolled 92 infants from intervention households and 74 from comparison households. During the 1-year study period, 45.7% of intervention households and 97.3% of comparison households had at least one stored water sample test positive for E. coli. Compared with comparison households, the odds of E. coli contamination in stored water was lower for intervention households (odds ratio [OR]: 0.42, 95% CI: 0.24, 0.74), but there was no difference in the odds of reported diarrhea in infants, adjusting for covariates (OR: 1.19, 95% CI: 0.74, 1.90). Although nearly all water samples obtained from unprotected sources and filtered by the HFU were free of E. coli contamination, HFUs alone were not effective at reducing diarrhea in infants.

Assessing the downstream socioeconomic impacts of agroforestry in Kenya

Abstract Agroforestry is widely purported to improve the livelihoods of smallholder farmers, rehabilitate degraded landscapes, and enhance the provisioning of ecosystem services. Yet, evidence supporting these longer-term impacts is limited. Using a quasi-experimental impact evaluation design informed by a theory-based and mixed methods framework, we investigated selected intermediate and final outcomes of a nine-year effort led by Vi Agroforestry, a Swedish non-governmental organization (NGO), to promote agroforestry in large sections of Bungoma and Kakamega counties in western Kenya. We compared households belonging to 432 pre-existing farmer groups operating in 60 program villages and 61 matched comparison villages. To address potential self-selection bias, we used program targeting as an instrument for program participation, combined with the difference-in-differences approach to control for time-invariant differences between our treatment and comparison groups. We complemented the above with semi-structured interviews with a sub-sample of 40 purposively selected program participants. Despite evidence of variable program exposure and agroforestry uptake, we found modest, yet statistically significant, effects of Vi Agroforestry’s program on intermediate outcomes, such as agroforestry product income, fuelwood access, and milk yields among dairy farmers. We also found that this program modestly increased asset holdings, particularly among households represented by female program participants.

Impact of the eKutir ICT-enabled social enterprise and its distributed micro-entrepreneur strategy on fruit and vegetable consumption: A quasi-experimental study in rural and urban communities in Odisha, India

This paper reports results of a quasi-experimental study designed to assess the impact of an information and communication technology (ICT) –enabled ecosystem, led by the social enterprise eKutir, on household fruit and vegetable consumption in Odisha, India. eKutir aims at providing self-sustaining solutions to poverty and undernutrition in developing countries by leveraging ICTs through ecosystem development anchored into a distributed micro-entrepreneurial strategy. eKutir’s farming micro-entrepreneurs (FME) provide agricultural knowledge, inputs, and market linkages at household and community level, followed by progressive integration of other micro-entrepreneurs at different points along the value chain on both supply and demand sides. The present case examined core FMEs along with retail micro-entrepreneurs (RMEs) deployed in low-resource rural and urban communities. Structural equation modeling was used to compare rural outcomes and the role of homegrown consumption as a mediator. Multivariable linear regression and ANOVA were used to test group differences in the urban sample. Positive β coefficients represent an increase in fruit and vegetable consumption in communities exposed to the eKutir ecosystem in contrast to the comparison group. Farmers in rural communities exposed to the eKutir ecosystem consumed more overall fruit and vegetables (β = 0.30, p < 0.001) and fruits alone (β = 0.53, p < 0.05) than those farmers in comparison villages unexposed to the eKutir ecosystem. This effect was concentrated in households exposed to both FMEs + RMEs (β = 0.60, p < 0.0001) and was mediated by homegrown consumption. A non-significant directional effect was observed in comparing fruit and vegetable consumption in rural households exposed to RMEs only over comparison communities. Urban consumers, exposed to the eKutir ecosystem through access to RMEs operating in their neighborhood community, did not increase their fruit or vegetable consumption compared to non-intervention communities. The results reveal the potential of reaching nutritional impacts through homegrown consumption and with farm-level support outside of governmental/philanthropic interventions through an ICT-enabled social enterprise. They also underscore, however, the challenges of both changing eating behaviour and intervening along the agri-food value chain. Implication for more effective digital ecosystem design and intersectoral policies are discussed.

The impact of adding community-based distribution of oral contraceptives and condoms to a cluster randomized primary health care intervention in rural Tanzania

BackgroundEfforts to expand access to family planning in rural Africa often focus on the deployment of community health agents (CHAs).MethodsThis paper reports on results of the impact of a randomized cluster trial of CHA deployment on contraceptive uptake among 3078 baseline and 2551 endline women of reproductive age residing in 50 intervention and 51 comparison villages in Tanzania. Qualitative data were collected to broaden understanding of method preference, reasons for choice, and factors that explain non-use.ResultsRegression difference-in-differences results show that doorstep provision of oral contraceptive pills and condoms was associated with a null effect on modern contraceptive uptake [p = 0.822; CI 0.857; 1.229]. Discussions suggest that expanding geographic access without efforts to improve spousal and social support, respect preference for injectable contraceptives, and address perceived risk of side-effects offset the benefits of adopting contraceptives provided by community-based services.ConclusionsThe results of this study demonstrate that increasing access to services does not necessarily catalyze contraceptive use as method choice and spousal dynamics are key components of demand for contraception. Findings attest to the importance of strategies that respond to the climate of demand.Trial registrationControlled-Trial.comISRCTN96819844. Retrospectively registered on 29.03.2012.

Effectiveness of a multilevel intervention to reduce violence and increase condom use in intimate partnerships among female sex workers: cluster randomised controlled trial in Karnataka, India

IntroductionSamvedana Plus is a multilevel intervention working with sex workers, their intimate partners (IPs) and communities to reduce intimate partner violence (IPV) and to increase condom use within intimate relationships...

How does a Social and Behavioral Change Communication Intervention Predict Menstrual Health and Hygiene Management: A Cross-Sectional Study

BackgroundInterventions in India to improve menstrual health and hygiene management (MHHM) have been implemented at the national, state, district and school level. However, evaluations of these interventions have been scarce. The objective of the study was to determine if a social and behavioral change communication (SBCC) intervention (GARIMA) had a relationship with knowledge, attitudes, interpersonal communication, restrictions and MHHM using a comparison group post-test only design among 2206 adolescent girls.MethodsIntervention villages and adolescent girls were selected through stratified random sampling based on where GARIMA was implemented. Villages and adolescent girls in comparison villages were matched socio-demographically to intervention villages and adolescent girls. Multi-level logistic regressions assessed the relationship between the encoded exposure, mediators and MHHM.ResultsThe results showed that the encoded exposure predicted all behaviors corresponding to MHHM. Additionally, adolescent girls in the high encoded exposure group had significantly higher knowledge about puberty and reproductive parts (AOR: 2.03 (95% CI: 1.31 – 3.15)), positive attitudes towards gender (AOR: 1.48 (95% CI: 1.02 – 2.16)) and higher levels of some discussion and dialogue (AOR: 1.41 (95% CI: 1.04 – 1.92)).ConclusionsFuture programs should use SBCC to improve MHHM behavior but involve families, peers and community members to a greater extent in order to improve attitudes towards menstruation, attitudes towards restrictions, attitudes towards absorbent use and reduce restrictions within the community.

The impact of paid community health worker deployment on child survival: the connect randomized cluster trial in rural Tanzania

BackgroundThis paper reports on a rigorously designed non-masked randomized cluster trial of the childhood survival impact of deploying paid community health workers to provide doorstep preventive, promotional, and curative antenatal, newborn, child, and reproductive health care in three rural Tanzanian districts.MethodsFrom August, 2011 to June 2015 ongoing demographic surveillance on 380,000 individuals permitted monitoring of neonatal, infant and under-5 mortality rates for 50 randomly selected intervention and 51 comparison villages. Over the initial 2 years of the project, logistics and supply support systems were managed by the Ifakara Health Institute. In 2013, the experiment transitioned its operational design to logistical support managed by the Ministry of Health and Social Welfare with the goal of enhancing government operational ownership and utilization of results for policy.ResultsThe baseline under 5 mortality rate was 81.3 deaths per 1000 live births with a 95% confidence interval (CI) of 77.2–85.6 in the intervention group and 82.7/1000 (95% CI 78.5–87.1) in the comparison group yielding an adjusted hazard ratio (HR) of 0.99 (95% CI 0.88–1.11, p = 0.867). After 4 years of implementation, the under 5 mortality rate was 73.2/1000 (95% CI 69.3–77.3) in the intervention group and 77.4/1000 (95% CI 73.8–81.1) in the comparison group (adjusted HR 0.95 [95% CI 0.86–1.07], p = 0.443). The intervention had no impact on neonatal mortality in either the first 2 years (HR 1.10 [95% CI 0.89–1.36], p = .392) or last 2 years of implementation (HR 0.98 [95% CI 0.74–1.30], p = .902). Although community health worker deployment significantly reduced mortality among children aged 1–59 months during the first 2 years of implementation (HR 0.85 [95% CI 0.76–0.96], p = 0.008), mortality among post neonates was the same in both groups in years three and four (HR 1.03 [95% CI 0.85–1.24], p = 0.772). Results adjusted for stock-out effects show that diminishing impact was associated with logistics system lapses that constrained worker access to essential drugs and increased post-neonatal mortality risk in the final two project years (HR 1.42 [95% CI 1·07–1·88], p = 0·015).ConclusionsCommunity health worker home-visit deployment had a null effect among neonates, and 2 years of initial impact among children over 1 month of age, but a null effect when tests were based on over 1 month of age data merged for all four project years. The atrophy of under age five effects arose because workers were not continuously equipped with essential medicines in years three and four. Analyses that controlled for stock-out effects suggest that adequately supplied workers had survival effects on children aged 1 to 59 months.Trial registrationRegistration for trial number ISRCTN96819844 was retrospectively completed on June 21, 2012.

The Care for Life Family Preservation Program: Outcome Evaluation of a Holistic Community Development Program in Mozambique

Objective: In 2016, Mozambique ranked 13th worldwide in infant mortality (67.9 deaths/1,000 live births) and 20th worldwide in maternal mortality (489 deaths/100,000 live births). This study’s objective was to determine whether a comprehensive program, incorporating the International Association for Community Development’s recommended holistic elements was effective in a country such as Mozambique. Method: Over a 5-year period (2012–2017), an independent, randomized between-group outcome study was conducted to determine whether the holistic Care for Life ( CFL) Family Preservation Program was effective in reducing infant mortality ratios (IMRs) and maternal mortality ratios (MMRs) in Mozambique. Results: At preintervention assessment, intervention and comparison villages were statistically equivalent in both IMR and MMR. After 5 years, intervention villages were significantly below the comparison villages in both IMR (odds ratio = 2.3) and MMR (odds ratio = 4.6). Conclusion: The use of comparison groups demonstrated the CFL program comprehensive, holistic, and sustainable approach is effective.

The Millennium Villages Project: a retrospective, observational, endline evaluation.

The Millennium Villages Project (MVP) was a 10 year, multisector, rural development project, initiated in 2005, operating across ten sites in ten sub-Saharan African countries to achieve the Millennium Development Goals (MDGs). In this study, we aimed to estimate the project's impact, target attainment, and on-site spending. In this endline evaluation of the MVP, we retrospectively selected comparison villages that best matched the project villages on possible confounding variables. Cross-sectional survey data on 40 outcomes of interest were collected from both the project and the comparison villages in 2015. Using these data, as well as on-site spending data collected during the project, we estimated project impacts as differences in outcomes between the project and comparison villages; target attainment as differences between project outcomes and prespecified targets; and on-site spending as expenditures reported by communities, donors, governments, and the project. Spending data were not collected in the comparison villages. Averaged across the ten project sites, we found that impact estimates for 30 of 40 outcomes were significant (95% uncertainty intervals [UIs] for these outcomes excluded zero) and favoured the project villages. In particular, substantial effects were seen in agriculture and health, in which some outcomes were roughly one SD better in the project villages than in the comparison villages. The project was estimated to have no significant impact on the consumption-based measures of poverty, but a significant favourable impact on an index of asset ownership. Impacts on nutrition and education outcomes were often inconclusive (95% UIs included zero). Averaging across outcomes within categories, the project had significant favourable impacts on agriculture, nutrition, education, child health, maternal health, HIV and malaria, and water and sanitation. A third of the targets were met in the project sites. Total on-site spending decreased from US$132 per person in the first half of the project (of which $66 was from the MVP) to $109 per person in the second half of the project (of which $25 was from the MVP). The MVP had favourable impacts on outcomes in all MDG areas, consistent with an integrated rural development approach. The greatest effects were in agriculture and health, suggesting support for the project's emphasis on agriculture and health systems strengthening. The project conclusively met one third of its targets. The Open Society Foundations, the Islamic Development Bank, and the governments of Japan, South Korea, Mali, Senegal, and Uganda.

Value chain development of bay leaf in Nepal: an impact assessment

ABSTRACTWe assessed an impact of bay leaf value chain intervention programme on household welfare in mountain agroforestry context. We used primary survey data from project and comparison villages and propensity score matching for creating a valid counterfactual. Results indicate that households in the project villages planted 75 per cent more bay leaf trees, produced 170 per cent more bay leaves and sold more quality products at higher prices than households in comparison villages; per-capita household income increased by NPR 5000–7300, share of bay leaf income in total household income increased by 8–10 per cent and level of poverty declined by 6–8 per cent. Households with female respondents benefited more in some aspects but not so in others, especially in enrolling children in school.

Sustainability of a Community-Based CHOICE Program to Improve the Health and Nutrition Status of Mothers and Infants in Indonesia.

Objectives Few studies have been undertaken to determine whether and how project results are sustained. University of Notre Dame (ND) and Project Concern International conducted a Post-Project Sustainability Study (PSS) of a USAID-funded program (CHOICE), implemented in Indonesia, Banten province, between 2003 and 2007, in order to determine lasting effects and improve PSS methodologies. Methods Sustainability was measured through a comparison of data collected on mother-infant pairs in 2014 with final evaluation data from 2007; and through a comparison of 2014 data collected from the CHOICE villages and comparison villages. Results The analysis showed positive differences in multiple indicators in CHOICE villages between 2007 and 2014, including births attended by skilled personnel (Mean Difference 48.56, 95% CI 38.68 to 58.43) and treatment of diarrhea (MD 16.42, 95% CI - 0.94 to 33.37). However, only one statistically significant difference between intervention and comparison groups in 2014 was observed, infants with diarrhea whose mothers sought advice or treatment (MD - 5.48, 95% CI - 9.55 to 1.39), showing more mothers in intervention group sought advice or treatment. Because contextual factors were not studied in detailand baseline data was not available for the comparison villages, it is difficult to determine the reasons for the results. Given that longitudinal data was not collected, it is also difficult to determine whether results fluctuated between 2007 and 2014. Conclusions for practice This PSS contributes to the limited body of knowledge in sustainability research. Lessons learned from this study will increase potential for sustainable impact of projects, as more rigorous measurement will lead to greater overall understanding of how sustainability actually "happens".