United in Building and Advancing Life Expectations
The Friedman School of Nutrition at Tufts University recently worked with Catholic Relief Services (CRS) and other partners in Malawi on the UBALE project, a five-year development food assistance program funded by USAID’s Office of Food for Peace with additional research funding under Feed the Future.
The United in Building and Advancing Life Expectations program – or UBALE, which means partnership in Chichewa – was implemented with local NGOs through existing government structures in three food-insecure, chronically malnourished and disaster-prone districts of Southern Malawi: Chikwawa, Nsanje, and rural Blantyre. UBALE covered all 284 communities in these districts, totaling about 248,000 households with children under 2, and delivered an integrated set of agriculture and nutrition interventions.
The Friedman School’s work with UBALE began in 2015-16, and ran through 2019. We contributed to UBALE’s aims through research to help guide improvements in two domains: delivery of program interventions and control of aflatoxin contamination.
Improving program delivery
Many programs like UBALE are typically delivered through a cascade model, in which the central management and leadership of Catholic Relief Services or other large agency serves to coordinate the fieldwork of several specialized NGOs, which in turn work through numerous local government offices and village-level volunteers to reach remote households and individuals throughout a targeted region. This model of program delivery allows a single large project to involve many more diverse organizations and dispersed individuals than would be possible if all activities were delivered by a single organization. The corresponding challenge is to understand how the cascade works in practice, and what conditions lead to greater success maintaining curriculum fidelity and achieving outcomes.
In the first year (2015-16) of Tufts research on UBALE program delivery we conducted formative, qualitative research on the constraints facing front-line staff and village volunteers to completing the recruitment and training required to start up the project. Staff and volunteers bring different types of experience to their work on the project, leading to different kinds of knowledge and capabilities. The second and third years (2016-18) of Tufts-UBALE research on program delivery built on our first-year results, to quantify the nature of differences in nutrition knowledge, aflatoxin control measures and other changes needed for villagers to improve agriculture, nutrition and health. Work to date assesses the extent of program-related and objective (factual) nutrition, health and aflatoxin knowledge and practices held by mothers in households of children under two as well as other actors in the cascade providing nutrition information at each level of program implementation.
Improving aflatoxin control, sorting and storage
Nutrition and health outcomes in Malawi are heavily affected by mold on cereal grains (especially maize) and leguminous grains (especially groundnuts). These fungi release mycotoxins (especially aflatoxins), which are known carcinogens and widely believed to cause stunting and malnutrition. Mold on foods is not always visible, and the resulting toxins cannot be seen or tasted. The toxins are typically not destroyed by processing or cooking. UBALE and many other development actors are actively engaged in delivering new approaches to aflatoxin control, through both in-field agricultural measures and post-harvest food system improvements.
In the first year (2015-16) of Tufts research with UBALE, our aflatoxin control research focused on post-harvest sorting decisions to determine how households choose what maize and groundnuts to sell, buy, or devote to each distinct type of food use. This work built on UBALE’s partnership with ICRISAT to address the in-field mechanisms and harvest practices that can limit mold growth in the first place. The second and third years (2016-18) of research extended our initial findings to investigate storage choices, particularly among households for which hermetic PICS bags capable of limiting mold growth from month to month have become available. This analysis was centered on demand for bags over time as farmers gained experience with improved storage, using random-price auctions to measure willingness-to-pay of program participants. Findings suggest that product promotion through free distribution and demonstration events could lead to market sales and welfare gains in the future. Ongoing work in the final year of Tufts-UBALE research (2018-2019) builds on results from previous years, using the random-price design to distinguish between community-level and individual experience with the hermetic PICS bags, and identify effects of improved storage on household food insecurity and nutrition.
Gloria Guevara Alvarez, Program Coordinator, provided direct oversight for Tufts research through the UBALE project. She is a doctoral candidate at the Friedman School, focusing on sustainable agriculture, small holders, farm-to-fork continuum, food systems and regional distribution systems, especially in Africa and Latin America, as described on her personal blog. Her own research for UBALE focuses on farmers’ demand for improved storage and has been been presented at the American Society for Nutrition [poster] and also the 30th International Conference of Agricultural Economists.
Kate Schneider conducted fieldwork in 2016-18 on program delivery, and is planning doctoral dissertation at the Friedman School focusing on food policy, household economics and nutrition in developing countries. Results from her 2017 fieldwork are published in Maternal and Child Nutrition [article; preprint; replication files], and were presented at the American Society for Nutrition [poster] and the World Bank ICABR [slides].
Rebecca Frank conducted the formative work in 2015-16 on program delivery, while a graduate student in the Public Health Program at Tufts Medical School, as well as the Food Policy and Applied Nutrition Program at the Friedman School. Her concentration at Friedman was in humanitarian assistance, and her public health interests include psychosocial issues, the double burden of malnutrition and obesity, and infectious diseases.
Caroline Nathan conducted the formative work in 2015-16 on aflatoxin control and how potentially contaminated grains are used. She was a masters student at the Friedman School, focusing on the linkages between agriculture and nutrition in low- and middle-income countries.