A Process Evaluation of a Nutrition-Sensitive Agriculture Project in Timor-Leste Open Access

Georgial, Gabriela (Spring 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/tq57ns24c?locale=en


Background: Timor-Leste has one of the highest rates of undernutrition in the world. These high rates of undernutrition and anemia in mother and children may be attributed to a diet high in carbohydrates and low in protein and micronutrients, as wells as insufficient consumption and availability of nutrient dense foods.

Methods: A process evaluation of a project in Timor-Leste was conducted to describe whether the project is being implemented as designed and if it has reached its intended participants. The domains of a process evaluation - fidelity, dose, reach, and participant satisfaction - were used as an overarching framework to guide the process. Data were collected using qualitative methods that included comprehensive document abstraction and key informant interviews with project staff in Timor-Leste. Barriers and facilitators to implementation were also documented as well as the extent to which the project followed best practices to social behavior change.

Results: The project has implemented four key activities in the intervention zone that draw on existing agriculture to nutrition pathways to achieve its goal. The different activities have had different levels of success so far. The agriculture and economic activities have been implemented as planned and generally been well received by the communities. The nutrition and health component have been implemented alongside the government health structure and enlisted community health workers as the primary conduit of the intervention. These components have faced more barriers to implementation, likely due to context specific factors and project design elements.

Conclusions:   The process evaluation of this project revealed that it is imperative for projects to incorporate best practices into project design and implementation and to document the process. Documenting best practices and barriers to facilitation will ensure that future projects can take the lessons learned from nutrition-sensitive agriculture projects that can be scaled to achieve desired outcomes. 

Table of Contents

Table of Contents. i

Table of Figures. iii

Table of Tables. iv

Introduction. 1

Problem Statement 3

Purpose Statement 5

Objectives. 5

Significance. 5

Literature Review.. 6

Global Burden & Causes of Malnutrition. 6

Food Insecurity. 6

Child Care. 7

Access to Healthcare. 8

Strategies to Address Undernutrition. 9

. 10

Nutrition-Specific Interventions. 10

Nutrition-Sensitive Interventions. 11

Nutrition-Sensitive Agriculture. 11

Timor-Leste. 13

Nutrition in Timor-Leste. 15

The Project 16

Methods. 19

Introduction. 19

Population and Sample. 19

Research Design and Procedures. 20

Data Collection Procedures and Instruments. 22

Data Analysis Plan. 25

Limitations. 26

Results. 28

Introduction. 28

Findings. 28

Project Description. 28

Organizational Context 34

Gender 37

Dose Delivered. 38

Dose Received-Reach. 40

Satisfaction. 41

Fidelity. 42

Discussion. 49

Recommendations. 52

References. 54

Appendix A.. 58

Appendix B.. 73



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