Use of concurrent evaluation to improve implementation of a home fortification programme in Bangladesh: a methodological innovation

Abstract

Objective: This paper focuses on the use of 'concurrent evaluation' to evaluate a nationally scaled-up programme in Bangladesh that was implemented by BRAC (an international development organisation) using Shasthya Shebika (SS) - volunteer community health workers - to promote home fortification with micronutrient powders (MNP) for children under-five.

Design: We developed a programme impact pathway to conceptualise the implementation and evaluation strategy and developed a strategic partnership among the key programme stakeholders for better use of evaluation evidence. We developed a multi-method concurrent evaluation strategy to provide insights into the BRAC programme and created provision for course correction to the implementation plan while it was in operation.

Setting: One hundred sixty-four sub-districts and six urban slums in Bangladesh.

Participants: Caregivers of children 6-59 months, SS and BRAC's staff members.

Results: The evaluation identified low awareness about home fortification among caregivers, inadequate supply and frequent MNP stockouts, and inadequate skills of BRAC's SS to promote MNP at the community level as hindrances to the achievement of programme goals. The partners regularly discussed evaluation results during and after implementation activities to assess progress in programme coverage and any needs for modification. BRAC initiated a series of corrections to the original implementation plan to address these challenges, which improved the design of the MNP programme; this resulted in enhanced programme outcomes.

Conclusions: Concurrent evaluation is an innovative approach to evaluate complex real-world programmes. Here it was utilised in implementing a large-scale nutrition programme to measure implementation process and effectiveness.

Keywords: Bangladesh; Concurrent evaluation; Home fortification; Implementation science; Mixed method.

Fig. 1

Programme impact pathway of BRAC’s home fortification programme in Bangladesh

Fig. 2

Implementation and timeline of concurrent evaluation activities. QA, quality assessment; CS, coverage survey

Fig. 3

Synergies and partnership around concurrent evaluation

Fig. 4

Increased sale of MNP sachets after addressing implementation bottlenecks and gaps based on evaluation findings. We analysed data on BRAC’s sale of MNP to measure a periodic sale trend and triangulated this trend with different evaluation events. The line indicates the sale of MNP sachets at different time-points of implementation. The blue box indicates recommendations made, based on evaluation findings at different time-points of implementation. The green box indicates course correction initiatives by BRAC at different time-points of implementation. MNP, micronutrient powders