Implementation and impact evaluation of PL-480 Title II program : report of Winrock International Institute for Agricultural Development study team

480 Title II program in Honduras. Impact evaluation covers the period through 3/87 and is based on document review, site visits, and a random sample survey of rural and urban beneficiaries of the school feeding (SF) and maternal/child health (MCH) programs run by CARE. CARE administers about 90% of all Title II commodities and distributes most of them in its SF and MCH programs, which reach about 446,000 persons in 16 of the Honduras's 18 departments. (CARE's other programs - food-for-work and refugee feeding - affect only about 10,000.) In the SF program, drinking of a supplemental beverage made from nonfat dry milk and corn-soy-milk (CSM) was found to be positively related to mathematics and science grades, but not to several other academic measures, to height or weight, or to absenteeism. At the same time, most participating mothers and children felt that the beverage did improve children's health and school performance; a longitudinal study of the impact of the beverage in these areas should be conducted. Also, the Ministry of Education should consider increasing the caloric content of the beverage, which currently provides only 8-10% of the children's caloric requirements. Program benefits were greatest among the poorest children. In the MCH program, consumption of the foods (nonfat dry milk, rice, wheat flour, soy oil, and CSM) was found to improve both women's success in childbearing (thus exacerbating the population problem, however) and children's height-for-age. Food is delivered in this program either at a feeding site under the supervision of the Ministry of Public Health (MOPH) or via a take home program run by the National Welfare Board (NWB) and community agencies. While the program as a whole was targeted at individuals with nutrition problems, few of the take home programs have surveillance mechanisms to ensure that intended beneficiaries actually receive the food; these programs require better supervision and should be evaluated by outside personnel to determine their actual impact. In general, CARE is doing a good job of controlling food delivery until it reaches the feeding or take-home program site, but sufficient problems exist at the sites to suggest the need to improve communication between the sites and government agencies, voluntary agencies, and CARE. In addition, the MOPH should consider using a chart to record weight gain during pregnancy and then target women with insufficient weight gain for additional food, and both it and NWB should establish quantifiable targets for the program. Finally, nutrition education should be part of the MCH program, as it is of the SF program.