Madagascar - Food Security and Nutrition

 ICRR 10459 Report Number : ICRR10459 ICR Review Operations Evaluation Department 1. Project Data : OEDID : OEDID: C2474 Project ID : P001553 Project Name : Food Security and Nutrition Country : Madagascar Sector : Other Population Health & Nutrition L/C Number : C2474 Partners involved : Japan, UNICEF, World Food Program Prepared by : Timothy A. Johnston, OEDST Reviewed by : Helen Abadzi Group Manager : Gregory K. Ingram Date Posted : 08/20/1999 2. Project Objectives, Financing, Costs and Components : Objectives : Reduce food insecurity and malnutrition in Madagascar's two most food -insecure provinces through income generating projects and targeted nutrition programs . Components : a) income generating activities carried out through (i) an autonomous social fund ($10.8 million); and (ii) a food for work program targeted at the urban poor in Greater Antananarivo ($7.9 million); (b) nutrition interventions including (i) a community nutrition program in the target provinces, working through community nutrition agents supported by NGOs ($6.1 million); (ii) a national iodine deficiency disorder control program ($0.9 million); and (iii) institutional strengthening to support the development and execution of an information, education, and communication (IEC) program and to support the development of a national food security strategy . Financing : The total project cost was originally estimated at $ 32.4 million, but the final cost was $28.8 million, including cancellation of $3.1 million of IDA financing. Sources of financing included IDA ($17.2 million); the World Food Program ($9.2 Million); UNICEF ($0.4 million); Japan ($0.5 million); government ($1.1 million); and beneficiaries ($0.4 million). 3. Achievement of Relevant Objectives : The project was implemented outside of the regular government ministries, by two independent organizations created as a result of the project (the social fund entity (FID) and the SECALINE project unit). GOM was highly committed to the project, and most components were successfully implemented . The social fund component reached its primary objectives for funding projects and person days of employment; secondary objectives regarding income generating activities and permanent jobs created were below targets, however . The urban food for work component reached less than half the planned beneficiaries, partly because of shortfalls of food supply from WFP, but 70 percent of beneficiaries were poor women . The impact of the social fund and food for work components on nutrition is not documented, however . The community nutrition interventions exceeded their original targets both in terms of nutrition centers built (535) and beneficiaries reached, with substantial community involvement; the IEC program was effectively designed and implemented; the food security strategy was developed and adopted in 1997. The number of children referred for nutritional rehabilitation was substantially below the targets, due in part to inadequate coordination between the implementing agency and the ministry of health . Impact on severe malnutrition was therefore less than anticipated . Finally, while the project contributed to reduced malnutrition in target communities, it did not achieve its broadly stated objective of reducing overall malnutrition in the target provinces . 4. Significant Achievements : The project contributed to a 48-58 percent reduction in malnutrition in the areas near community nutrition centers; The social fund subcomponent executed 348 sub-projects, which contributed to improved social infrastructure in target communities; generated nearly two million person days of temporary employment; and catalyzed the creation of approximately 100 rural subcontractors, which will be available to implement for future rural activities;. The presence of goiter in pregnant women and schoolchildren decreased from 45 percent in 1992 to 15 percent in 1998, as a result of targeted iodine supplementation and introduction of iodized salt; The IEC component appears to be contributing to improved nutritional behaviors (although the impact is not  documented); the project was the first IDA project in Madagascar to catalyze substantial NGO and community involvement (in implementing the nutrition and social fund components ); the project achieved a high level of government ownership, and was implemented almost entirely by Malagasy, with only targeted expatriate technical assistance 5. Significant Shortcomings : As noted in the ICR, although the stated project goals were to improve nutrition in the two target provinces, project activities were more narrowly focused and were unable to affect overall nutrition rates . Nutrition indicators-- both nationally and in the target provinces -- stagnated or worsened, apparently from a combination of dramatically increased food prices, inadequate rainfall, and locust problems (factors outside of project control ). This suggests both that project goals should have been more explicit, and possibly that project design might have given greater attention to the cost-effectiveness of alternative approaches . Although the social funds and food for work components represented most of project expenditures, the extent to which they actually improved nutrition and food security is not clear. It is also unclear from the ICR if the infrastructure finance by the project is being effectively maintained or utilized -- a common problem with social fund projects . 6. Ratings : ICR OED Review Reason for Disagreement /Comments Outcome : Satisfactory Satisfactory Although the originally objective of improving nutrition in the target provinces was not met, the goals of subcomponents were largely achieved. Institutional Dev .: Partial Substantial Although the ID impact on line ministries was modest, the project made a substantial contribution to establishing the social fund organization and SECALINE, and catalyzing greater NGO involvement . Sustainability : Likely Uncertain Key activities in regard to nutrition and the social funds are likely to be sustained through follow-on projects, but the food for work component is not being continued . It was not possible to judge from available data whether recurrent funding will be adequate for infrastructure built by the social fund. Bank Performance : Satisfactory Satisfactory Borrower Perf .: Satisfactory Satisfactory Quality of ICR : Satisfactory 7. Lessons of Broad Applicability : Lessons from this project include : an effective nutrition and food security strategy requires a holistic, intersectoral approach, of which targeted nutrition interventions may be one component, but alone are unlikely to impact overall nutrition levels . The Bank in its nutrition work should strive to better understand the relative roles and cost -effectiveness of income generating programs; targeted nutrition interventions; and nutrition IEC; particularly in relation to macroeconomic and agricultural policies . implementing projects outside traditional government ministries and using a contracting approach can contribute to more efficient and effective implementation, but care must be taken to avoid undermining relations with key partner ministries; the project affirmed the importance of strong government ownership and community participation, and demonstrated the viability of engaging NGOs in implementation; sustainability issues need to receive attention both project design and implementation, including the staffing and maintenance of infrastructure, and designing an "exit strategy" when food supplementation is part of the project; 8. Audit Recommended? Yes No Why? Although the ICR recommends that an OED audit of this project is not necessary, an audit might contribute to further understanding of some of the issues raised above, and provide valuable background information for the Bank's planned nutrition strategy paper . 9. Comments on Quality of ICR : The ICR does a good job describing the implementation experience of the project, but focuses primarily on successes without sufficient consideration of why the ultimate objectives were not achieved . This represents a lost opportunity to seriously consider the overall strategy, cost -effectiveness, and priorities for future Bank work in the nutrition field. For example, the key policy issue of whether and when to finance food supplementation is not addressed. The SAR clearly places the project in the overall context of the Bank's economic and agricultural strategy, but the ICR does not . The ICR criticizes the Bank's decision to not include a food -for-work component in the subsequent project, but without a clear underlying analysis .