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End-Term Review of the Support to Improved Nutrition Status of Vulnerable Groups in Malawi 2015

1. IntroductionThis report contains the outcome and conclusions of the end-term review (ETR) of the Support to Improved Nutrition Status of Vulnerable Groups in Malawi (SINSM) carried out from the 26th of October till the 20th of November 2015. The SINSM programme was a pilot programme implemented by the Department of Nutrition and HIV and AIDS (DNHV) in conjunction with the line Ministries of Health (MOH), Agriculture and Food Security (MOAFS), Gender (MOG) and Education (MOE) and two NGO’s, namely “Welthungerhilfe” (WHH) and the Foundation for Irrigation and Sustainable Development (FISD).

The SINSM programme consisted of two Programme Estimates (PE), PE1 from 1st of February 2011 till 30th of September 2012 and PE2 from the 1st of November 2012 till 31st of October 2014, each covering the following Result Areas (RA):

1. Support to nutritional products distribution to vulnerable groups (PE1) and to the school meals programme (PE2);

2. Strengthen the capacity in nutrition for the communities and other stakeholders; 3. Nutrition Surveillance System strengthened to enable tracking of malnutrition for

timely and rational response; 4. Capacity of health facilities to manage nutritional rehabilitation improved, and 5. Project coordination and management activities improved.

Under PE21 (?) two Grants of each € 750,000 (+ € 172,000) were allocated to WHH1 and FISD to implement the school feeding programme. The programme’s total allocated budget through two (2) MOU was € 7,650,000. Under PE1 48% of the total budget was absorbed and under PE2 77% of the total budget was used. The DNHA used € 4,840,000, the Grants for school feeding of € 1,500,000 and the extra grant of € 172,000 allocated to CBS. (Abbreviation=?/Correct interpretation?) Therefore, the expenditure for the whole SINM 2011-2014 was totally € 6,510,000 (i.e. € 4,840,000 + € 1,500,000 + € 172,000). This is 85% of the total allocated amount.

The SINSM programme aims to contribute towards the improvement of the nutritional status of all Malawians with special emphasis on vulnerable groups such as pregnant and lactating women, children below the age of 5 years, both school aged and school going children, orphans and people living with HIV and AIDS through improved service delivery systems in 10 selected Districts in Malawi. In each district the SINSM had a food and nutrition focal point: one in the District’s Health Office and one in the District’s Agriculture Development Office. The school feeding programme was implemented by the District’s Education Management (DEM) Office through the DEM education health and nutrition officer.

The two main purposes of this ETR according to the Terms of Reference (see annex 1) are:

1. To make an overall independent assessment of the performance of the SINSM programme with special attention to the analysis of relevance, efficiency, effectiveness, impact, sustainability, coherence and the EU added value of the programme.

2. To analyse the feasibility of the programme design and the implementation for reaching the stated objectives.

1 The expenditure for the two Grants €1,500,000 were under Special Commitment and not included in the PE2 expenditure summary. The School Meals Programme also benefited from a Supply Contract for Corn Soya Blend (CBS) – value €172,000 (source: NAO).

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Inception phaseThe first week of the ETR from 26th till 30th October 2015 was the inception period for the review. An inception meeting took place on the 2nd of November with the EUD, NAO, DNHA, MOH, MOAFS etc. An official inception report with a more detailed work plan and methodology was presented and sent to the EUD.

FieldworkDuring the second and third week of the ETR, i.e. from Monday 2nd of November till Friday 13th of November, nine (9) out of the ten (10) SINSM Districts2 were visited. All the implementing partners3 were extensively interviewed. Based on the results of the implementation phase, visits to health facilities, schools and involved communities were scheduled as far as feasible given time constraints, distance and availability of beneficiaries.

All questions related to SINSM service implementation, its Surveillance system and backstopping from the DNHA were intensively assessed. Based on the assessment complementary field visits were planned to health facilities and schools supported by the programme. In each of the Districts, a visit was paid first to the District’s Council office to officially inform the District Commissioner and the District Planning Director on the objective of the visit. The ETR-team made a final District’s Assessment Fiche for each District in which main findings and results were capitulated. The ETR-team used the District Assessment Fiches as a basis to write up the general impressions in a concessive way. The overall findings of the field work can be found in Annex 7.5.

Final Validation WorkshopThe fourth week (16-20th of November) was used for writing of the aide memoire, debriefing and a final validation workshop in which all partners on Central and District level participated. The workshop aimed at cross-checking the factual basis of the evaluation and to present and discuss the findings, conclusions and recommendations of the ETR-team. (Is gathering and incorporating the feedback in the final report not an objectives of the workshop?)

ConstraintsThe Terms of Reference for the review (see part 2.3) provided the ETR-team with a list of bulleted “guidelines” to concentrate on for the five Result Areas. The team faced some constraints in conducting the ETR:

• According to the TOR ten Districts were to be visited while only nine effective days were made available for field visits. As a result, working days of more than 8 hours were mainly used for long distance travels and interviews. However, most District’s services, schools and health facilities have official working hours from 7.30 AM – 4.00 PM.

• In a number of Districts staff members of Government services were new and had never been involved in the implementation of the SINSM programme, which ended in October 2014. The programme had no central coordination entity at District level, so there was no district’s institutional memory in place.

• The TOR also states that the ETR is to provide the reader with sufficient explanation on the methodology used during the review to enable him/her to gauge the credibility of the conclusions and to acknowledge limitations or weaknesses, where relevant. This can only be done once we have analysed the optimal implementation of the programme and on condition that the DNHA supplied optimal support to the Districts. It also means that if the Districts were in a position to support the sentinel sides or APE in an optimal way and a good working surveillance system, the nutritional status of the vulnerable groups in these sites would have been improved

2 Nkhatabay, Rhumpi, Dowa, Salima, Mangochi, Phalombe, Chikhwawa, Chiradzulo, Neno, Dedza3 District Agriculture Development Office, District Nutrition SINSM focal point, District Education SINSM focal point and

District M & E Officer

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substantially. The ETR-team can only assess this during the visits to the Districts. Only if the Districts and also the DNHA were in a position to provide clear data on the nutritional and the food security status in the concerned Districts, the assessment could point out whether the programme was able to meet its objectives. If this was not or only partially implemented by the Districts and DNHA, the ETR has to find out why it was not implemented as planned. The programme was, however, to piloting or testing how the proposed activities were able to improve the food and nutrition security status of the proposed vulnerable groups. If these data are not readily available, it will be difficult for the ETR-team to assess the relevance, the efficiency, the effectiveness, the impact and certainly the sustainability and the coherence in an objective way.

• The ERT-team would like to point out the results and recommendations made during the 2008 final evaluation of ACF-UK as listed in annex 7.6. It is important to know how the first emergency food and nutrition security surveillance system performed and what the recommendations were on how to implement the surveillance system by the GoM.

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2 Supporting improved nutrition and health and building institutional capacity for sustainable home grown school meal programmes in Malawi' (01/01-31/12/14).


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Important background documentation for this review included the PE1 and PE2 official documents and the two (2) final progress reports. The PE1 provided the ETR-team with information on the Human Resources that were made available for this programme and the “ORGANOGRAM” or organisational chart, the role of the steering committee as well as its implementation structure at the District level (see annex 7.7).

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