Working document : evaluation of PL-480 Title II and PPNS program, Senegal (program de protection nutritionelle et sanitaire - groupes vulnerables)

480 Title II program in Senegal. Special evaluation covers the period to 5/84 and is based on document review; site visits; interviews with personnel of USAID/S, Catholic Relief Services (CRS), and the Ministry of Health's (MOH) Division d'Alimentation et Nutrition de Senegal (DANAS); analysis of data collected from all feeding centers and from nonparticipants; and analysis of growth data for 6,000 children at 20 sample centers. The P.L. 480 food distribution program is inseparable from DANAS's Program de Protection Nutritionelle et Sanitaire-Groupes Vulnerables (PPNS). Title II food is distributed with CRS assistance in 457 feeding centers, most in MOH dispensaries. Most centers (67%) are located in rural areas, where malnutrition is most acute, yet because of their dependence on MOH infrastructure, are not situated in the poorest communities. Program participants tend to be of lower socioeconomic status than are nonparticipants who know about the program, but of higher status than are nonparticipants who live in PPNS communities but are unaware of the program. Most children enter the program before age 2, which is best as it is easier to identify malnutrition among the very young. Length of participation in PPNS was associated with higher nutritional status, and for certain vulnerable age groups, with a faster growth rate; however, statistically it is impossible to attribute these effects solely to PPNS. Mortality rates in the most vulnerable age groups were consistently lower for participants than for nonparticipants of a similar socioeconomic level; this appears related to several factors including food supplementation, nutrition education, and the fact that food distribution clearly encourages center attendance and the use of primary health care. Participant mothers were more likely to have their children vaccinated against measles and to utilize malaria prophylaxis and postnatal health services. Suggestions are made concerning: integration of health and nutrition (especially to combat diarrhea, which this study has conclusively related to low nutritional status); targeting to avoid "aging" of the recipient population; and further strengthening of the program in the areas of maternal education, growth surveillance, reduction of personnel workload, personnel training, and supervision of child weighing and maternal education.