Women's and infants' nutrition (WIN) project : mid-term evaluation

The project includes four components: lactation management education, implemented by Wellstart International; operations research, implemented by the International Center for Research on Women (ICRW); an information clearinghouse, implemented by the American Public Health Association (APHA); and field support and TA, implemented by the Educational Development Center (EDC). The evaluation covers the period 1989-12/93. The project is well-managed, and the solid working relationships among the various implementing agencies and USAID have led to the delivery of high-quality, well-documented, and well-monitored products and services. All components are on track except field support, which is somewhat behind schedule and may have to be scaled back if activities now underway are to be completed by project end. Project implementors have built on the successes of the predecessor Maternal/Infant Nutrition project (9311010), but have added several new dimensions to reach broader audiences and contain costs. Wellstart has developed core teams of health professionals to promote breastfeeding, facilitated the development of national breastfeeding programs, and expanded lactation management education into two new languages. ICRW has implemented peer review research on the nutritional status of adolescent girls around the world. APHA has produced a newsletter, "Mothers and Children," managed data bases for health and nutrition practitioners, and responded to information requests from around the world. Finally, EDC has provided TA and integrated, community-based programming for nutrition promotion through local organizations. The project has had an impact on several levels. At the individual level, each component -- through training, mentoring, and TA -- has prepared professionals, para-professionals, and nonprofessionals to improve the nutrition of women, infants, and children. At the organizational level, Wellstart has influenced hospital policies and practices regarding breastfeeding, ICRW has strengthened research networks, APHA is strengthening regional capacities for information dissemination, and EDC has effected health policy changes within institutions. At the sectoral level, Wellstart, through education, information, and advocacy, has influenced breastfeeding policies and programs of government agencies, health professionals, and community organizations. Impact at the beneficiary level has been difficult to document, although the Wellstart program has clearly been effective. It is recommended that the Office of Nutrition emphasize the importance of maternal/child nutrition as part of USAID's overall development strategy; and that the project's design be modified to clarify the project purpose, better integrate its components, and reflect a more realistic mix of core funds, buy-ins, and non-USAID resources. As for the individual components, recommendations are to: (1) make lactation management education less reliant on USAID funding and accessible to a wider audience; (2) expand operations research to include intervention research and dissemination, with focus on action-oriented issues; (3) expand the activities of the Clearinghouse -- which is highly dependent on USAID funding and recovers little of its costs -- and either scale down its structure in the interests of efficiency or incorporate it into a larger information service; and (4) re-evaluate the field support component on the basis of cost, Mission interest, and effectiveness of delivery.