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Tamil Nadu Integrate Nutrition Program
Transcript of Tamil Nadu Integrate Nutrition Program
Project II (TINP II) PUBHLTH 622: Program Evaluation
Ami Kumiga, Manuel Mantilla II and Ashley Metellus Program Description Background The Tamil Nadu region of India had some of the highest rates of malnutrition prior to the 1980's
Funded by the World Bank in collaboration with the Indian government
The program was designed to address the issues of severe malnourishment in Southern India Included moderately malnourished children in the supplementary feeding program
Improved the coverage and quality of services formed to improve maternal nutrition and reduced low birth weight incidence
Much stronger referral service than TINP I
Community education to improve child feeding and care practices with better and more effective communication
TINP II was based upon social theories of behavioral change theories and models, including the social cognitive theory and self-efficacy Program
Evaluation Focus Group Questions What do you consider to be a healthy meal?
In what ways do you feel that your eating habits have changed since beginning the TINP-II program?
What other changes could be made in the community to improve health and nutrition?
What are the barriers that keep you from providing better nutrition to your family?
How do you feel that your knowledge of nutrition has changed since TINP-II?
What do you think the government’s role should be in relation to poverty and malnutrition?
Compared to others around you, how do you feel about your own food security?
How do you feel that breastfeeding relates to child nutrition?
What program activities have been the most successful, and why do you feel that they have been successful?
What are the biggest challenges that the TINP-II program faces in achieving its’ goals of the reduction of malnutrition, nutrition education and community development?
How has the program changed over time?
What unmet needs remain? Logic
Model Justification of Evaluation Goals and Objectives Assess and determine the success of the TINP-II program
Provide focus groups 9 groups of 12 mothers (or 108 mothers total) who participated in TINP II are selected by computerized random sample from 9 of the 32 districts with the highest rates of malnutrition in Tamil Nadu.
Ensure that community nutrition workers, educators and other TINP-II workers are carrying out their roles effectively.
Utilize quantitative and qualitative data collected from focus groups, surveys and evaluation meetings to accurately measure strengths and weaknesses, and to improve the program in progress Will provide both quantitative and qualitative data
These methods will involve the TINP-II team, who would be trained throughout the process of the evaluation.
Focus groups will provide qualitative data, while surveys will provide comprehensive quantitative data.
Mothers who were participants, as well as those whose children were participants, will be included in the evaluation of TINP-II.
The TINP-II program provides a true benefit to participants that lasts beyond the life of the program, and the programs’ objectives and goals are met. Guided by the principles of empowerment evaluation, including: community ownership
capacity-building Conclusion The Tamil Nadu Integrated Nutrition Project (TINP I), a World Bank assisted intervention program in rural south India, offered nutrition and health services to children under five and pregnant and lactating women.
TINP I was successful in decreasing severe malnutrition, however, a problem of high rates of moderate malnutrition still persisted.
The objectives of TINP II were to expand upon the TINP I program and increase the scope of the region affected by TINP I. To reduce severe malnutrition among children 6-72 months,
Increase the proportion of children 6-36 months of normal or mild malnutrition status in project areas,
contribute to a reduction in the infant mortality rate from 84 to 55 per 1,000 live births,
improve the nutritional status of pregnant and lactating women, to reduce the incidence of low birth weight in the project area Goals of TINP II Program Features: Due to the increased pressures of funding and the severity of malnutrition, the evaluation seeks to ensure the the program is reaching its goals and objectives. We hope to gain empowerment among participants to
have a lasting sustainable evaluation method. Qualitative and quantitative data are used as methods to increased the strength of the evaluation Focus Groups Focus groups provided qualitative data, while surveys provided comprehensive quantitative data.
A focus group was determined in order to evaluate the attitudes, behaviors and motivations of the mothers.
Allow the evaluators to gain valuable qualitative data regarding the program.
Focus groups consisted of in-depth discussions of participants in groups of 12 that generated qualitative responses and opinions.
The focus group sessions were videotaped, so that future reviews and analysis were completed on not only the group discussions, but the body language and facial expressions of the participants. Evaluation Questions The goal of the evaluation plan was to conduct focus groups every year, beginning with a baseline at the start of the program, to determine the programs’ needs, improve the program while in progress, for organizational development, policy making and testing, to pilot test new ideas or changes, and to improve program design. Survey Design Surveys were administered once per year at opposite intervals from the focus group, starting from baseline at the beginning of the program.
The survey results were used throughout the TINP-II program to monitor the program, to make adjustments as needed and to determine how well the objectives were being met.
Additional surveys were used to determine if the mothers attitudes and behaviors have changed, to be combined and analyzed with the focus group results.
Numerical values will be assigned to the survey results and statistical analysis will be performed using SPSS software to obtain a numerical evaluation of the results. Sample Size Variance from the mean was calculated, and standard deviation was derived by using specific formulas icluding the z-score and confidence interval. The appropriate sample size was determined to be 52,800 children.
The questions answered by the evaluation were:
did program have an impact on the the attitudes and behaviors of mothers in the rural regions of Tamil Nadu?
Was there a meaningful change in the growth rates of children?
Was there a meaningful change in malnutrition levels of children ages 0-6 in rural Tamil Nadu?
In order to answer these questions, an experimental design was used, specifically including a randomized controlled trial of children ages 0-6. In order to assess the validity of the data, and to control for confounding factors, results from the baseline were compared to results from surveys performed during each year of the program, including monitoring data surveys and a mid-term survey.
Dissemination Mothers who were involved in the program received a bi-annual newsletter documenting the results of the evaluation, as well as other useful information, such as health tips and reminders.
The newsletters was delivered by the community health workers who regularly visited the homes of program participants.
This allowed the mothers to ask any relevant questions to the community health care worker.
As a means to disseminate information to the communities as a whole, signs, mailings, and radio announcements were delivered at opposite intervals annually.
Stakeholders such a governmental leaders, physicians, and investors also received mailings, as well as attended annual stakeholder meetings, at which pertinent information about the program was shared.