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The United Nations University agreed in early 1981 to take the lead, on behalf of the United Nations agencies represented on the Sub-committee on Nutrition of the UN Administrative Committee on Co-ordination, in convening a workshop to address the problem of how to evaluate the impact of supplementary feeding programmes targeted to vulnerable women, infants, and children. The original charge to those who prepared papers and participated in their review was to develop straightforward guidelines and procedures for evaluating programmes with nutritional goals. The objective of the workshop was to compile state-of-the-art knowledge, which could then be made available to planners and field workers involved in or contemplating the evaluation of the impact of food and nutrition programmes.
A number of conceptual issues provide a framework for the papers in this publication. In the first place, they are primarily focused on the issue of determining the impact of an intervention. We recognize that, more often than not, evaluations are process-oriented, examining service delivery, project plans, and so forth; and it is not our intention to suggest that process evaluation can be ignored in the search for programme impact. However, there is a need now to design methods and measures to determine whether. and to what extent, programmes have an impact.
A second issue is the challenge of how to do evaluations in the absence of adequate baseline data, or where there are financial constraints that militate against a rigorous evaluation effort. Outside evaluators are often called on to perform their task under less than optimal conditions, confronted by severe constraints on data availability and financing, and especially by a lack of baseline data. It is our strong belief that all projects should have evaluation procedures integrated into the planning and implementation cycle, but the reality is that such a concept will take time to gain acceptance. The workshop participants and authors of this book agreed that, in the interim, something has to be done to evaluate the impact of large-scale projects already under way.
A third important issue is the recognition that a food and nutrition programme can have a variety of beneficial effects on the programme participants that go beyond traditional health impacts or that are not measurable using indicators and techniques usually employed in the field. Therefore, specific attention is given to the numerous social, economic, and political consequences that may accompany a feeding programme (see chapters 10, 11, and 13 respectively).
Furthermore, this book differs from previous reviews of evaluation methodologies by proposing and examining new methodologies that have not generally been part of nutrition and health surveys or evaluations. These include the use of such indicators as immunological competence (chapter 7), work performance (chapter 81, and cognitive performance and behavioural assessment (chapter 9). In addition, up-to-date information is provided on the use of the array of anthropometric and laboratory methodologies (chapters 3 and 4) as well as on the role of clinical data, vital statistics, and dietary methods (chapters 5 and 6).
As a corollary to this perspective of considering the range of possible measures of outcomes, it is the aim of this book not only to examine impact on targeted individuals actually enrolled in a programme but to broaden the purview to include the variety of benefits that may accrue to other household members. Such an approach is suggested because it is possible that examining impact on children in terms of traditional parameters may yield little information, but very tangible negative or positive effects on other targeted individuals or family members may be found if innovative indicators that go beyond traditional limited nutritional status measurements are employed in the field.
A further underlying premise is that before any well-designed evaluation effort can be implemented, it is necessary to perform preliminary reconnaissance in order to gain detailed knowledge of the political lifestyles, cultural features, and household patterns as well as the demographic, geographic, and logistic characteristics of the population the programme is designed to affect. Similarly, other systematic steps, such as field trials and assessment of training, equipment, and administrative and personnel requirements, are also integral components of any well-performed evaluation. All these aspects of the evaluation protocol should be clearly and concisely delineated in the standard operating procedures, following the basic principles of programme evaluation and research to the extent feasible. These considerations, however - as well as such issues as the presentation, publication, and dissemination of results - are not addressed in detail here. The reader who is unacquainted with these fundamental aspects of the evaluation process should consult appropriate technical literature and seek expert advice.
The first two chapters do introduce the basic concepts for designing evaluations during programme implementation, and the stages of evaluation of ongoing programmes. Chapters 3-10 address the major themes of the book: what measurements and indicators should be employed to assess the impact of food and nutrition programmes, and how and under what conditions should they be selected and used. These chapters cover the numerous measurements of nutritional and other possible impacts of supplementary feeding programmes Chapter 12 considers issues related to data recording and processing. Chapter 13 provides a framework for assessing the impact and role of an intervention from a macro-policy perspective, as contrasted with the previous chapters that look at impact from the point of view of the individual or household. The last chapter details how and why to develop a built-in evaluation system; it was included in response to the consistent urgings of the workshop participants that an internal evaluation system should be incorporated into all projects, regardless of whether or not complementary external evaluation procedures are undertaken.