Outcome Evaluation Pilot Project (OEPP) Measuring Outcomes of THP’s Epicenter Strategy

June 2013

Emmanuel Avevor, M&E Officer THP-Ghana Henry Chungu, M&E Officer THP-Malawi Francis Osei-Mensah, M&E Officer THP-Ghana Carolyn Ramsdell, Impact & Influence Officer THP-Global Qualitative Analysis: Alister Munthali, Centre for Social Research, Zomba, Malawi Godwin Amenorpe, PhD, Senior Research Scientist, Agriculture Research Centre, Ghana Final edits, key findings: John Coonrod, PhD, Exec. Vice President, THP-Global

Contents Acknowledgements ...... 4 EXECUTIVE SUMMARY ...... 4 Key Household Survey Findings ...... 4 Results at a Glance by Module ...... 5 Key Qualitative Findings ...... 7 INTRODUCTION ...... 9 BACKGROUND AND CONTEXT ...... 9 Stakeholder Involvement ...... 13 Target Population and Sampling Methodology ...... 14 Simple Random Sampling ...... 15 Design and Methodology ...... 16 Innovative New Technology ...... 16 FINDINGS AND CONCLUSIONS ...... 17 Utility and relevance of results ...... 17 Progress out of Poverty (PPI) Results ...... 18 SNAPSHOT OF THP-MALAWI DATA (by Module) ...... 21 Household Demographics & Dwelling Characteristics ...... 21 Community Mobilization & Leadership ...... 29 Food Security & Agriculture ...... 38 Health & Nutrition ...... 38 Water, Environment & Sanitation ...... 53 Livelihoods & Microfinance ...... 58 Literacy & Education ...... 62 SNAPSHOT OF THP-GHANA DATA (by Module) ...... 67 Household Demographics & Dwelling Characteristics ...... 67 Community Mobilization & Leadership ...... 72 Gender Equality ...... 76 Food Security & Agriculture ...... 80 Health & Nutrition ...... 91 Water, Environment and Sanitation ...... 103 Livelihoods & Microfinance ...... 106 Literacy & Education ...... 109 MALAWI QUALITATIVE ANALYSIS OF KII/FGD ...... 112

The Hunger Project OEPP 2 June 2013 Community mobilization ...... 112 Agriculture and food security ...... 114 Gender and development ...... 119 Literacy and education ...... 122 Health problems being experienced in the selected area ...... 127 Livelihood and microfinance ...... 130 The role of THP on community environmental issues ...... 133 GHANA QUALITATIVE ANALYSIS OF KII/FGD ...... 138 Module 1: Community Mobilization and Gender Equality ...... 138 Module 2: Agriculture and Food Security ...... 139 Module 3: Literacy and Education ...... 140 Module 4: Health and Nutrition ...... 142 Module 5: Livelihood and Microfinance ...... 144 Conclusions based on the Key Informant Interview ...... 145 THE RESULTS OF THE FOCUS GROUP DISCUSSION ...... 146 Module1: Community Mobilization ...... 146 Module 2: Gender Equality ...... 148 Module 3. Agriculture and Food Security ...... 149 Module 4. Literacy and Education ...... 151 Module 5. Health and Nutrition ...... 154 Module 6. Livelihoods and Microfinance ...... 156 Module 7. Water, Sanitation and Environment ...... 157 The Overall Outcome and Impact of THP based on Focus Group Discussion ...... 157 Contributions and Suggestions ...... 160 LESSONS LEARNED ...... 160 RECOMMENDATIONS ...... 160 Annex 1: Theory of Change ...... 162 Annex 2: Core Outcomes and Indicators ...... 163 Annex 3: Household Surveys ...... 167 Annex 4: FGD ...... 167 Annex 5: KII ...... 167 References ...... 167

The Hunger Project OEPP 3 June 2013 Acknowledgements The Hunger Project expresses its deep appreciation to the people and local government representatives participating in our epicenters in Ghana and Malawi who so enthusiastically embraced this initiative, and who were so generous with their time in contributing their perceptions and insights. We hope that the findings of this study are an empowerment to your local planning and efforts.

We greatly appreciate the efforts of two teams of graduate students from George Washington University who helped design and test the instruments and train the staff and enumerators as their Capstone Project. Ghana: Anna Bezrukov, Thomas Blackburn, Brian Dockstader and Clare Kelley. Malawi: Naomi Basik, Katie Campbell, Richard Waite and Sheldon Yoder.

We thank the leadership and staff of THP-Africa, led by Dr. Idrissa Dicko; THP-Ghana, led by Dr. Naana Agyemang-Mensah and now Samuel Afrain; and THP-Malawi, led by Rowlands Kaotcha, for their guidance and support.

EXECUTIVE SUMMARY

The primary goal of this report is to provide background information about the Outcome Evaluation Pilot Project (OEPP), present an overview of the findings for The Hunger Project (THP) staff and stakeholders, and highlight recommendations for scaling up the evaluation across other THP Africa Program Countries.

Over the course of six weeks in July and August of 2012, THP staff trained enumerators in Ghana and Malawi visited more than 50 villages to conduct 1,000 household surveys, 50 in-depth interviews, and 20 focus group discussions. The information gathered from community partners will be used to guide further revision of THP’s outcome evaluation strategies (including indicators and corresponding data collection tools) as well as provide a rich picture of a segment of the population living in THP’s partner communities.

The OEPP aimed to refine a set of data collection tools and indicators that can be adapted to local contexts implemented across all THP Africa Program Countries to systematically measure the results of THP’s activities and the outcomes of the integrated programs implemented through the Epicenter Strategy.

Key Household Survey Findings Below you will find a summary of key results from the randomized household survey “at a glance.” This guide will be very useful us in automating the analysis process. As soon as possible, we will create a database application that should be able to print out such a report, or any analysis we feel would be useful.

Some of the immediate findings you will see in this data include a number of areas where we may want to take action.

• Poverty: The households in our Malawi epicenters are clearly more impoverished than those in our Ghana epicenters. Their housing and plot sizes are poorer, there is much less use of

The Hunger Project OEPP 4 June 2013 electricity, and educational access and attainment much lower. Our Progress Out of Poverty index reading show poverty rates in our communities significantly lower than the last national surveys for both countries, which could be due to significant overall rural economic progress.

• Outmigration of Youth: In both countries there is evidence that the rural population is getting older, with a small population in productive age supporting a larger aging population and lots of small children. This causes a high “dependency ratio” and would encourage us to get a clearer sense of whether households are gaining income from urban remittances.

• THP Participation is surprisingly strong, with 1/3-1/2 of respondents having participated on THP epicenter committees or subcommittees.

• Microfinance participation is about as expected – between 20-30% - and indicates pent up demand. Saving rates are too low to internally fund much expansion.

• Lack of comparative data: We hope to use this data within each epicenter to measure changes from year to year, however people will want to know how they measure up to the nation and to international norms. Since we do not collect “control group” data, we need to find ways to find current comparison data. We were fortunate to have one “new” epicenter in our pilot study – Majete in Malawi – and in a number of measurements we were able to see dramatic differences between Majete and the other Malawi epicenters, highlighted in the third column below.

• Agriculture remains the main occupation and crop values far exceed the value the landowner could make by leasing out the land.

• Diet: A large percentage of people are not eating fruit, despite its wide availability, and this could be the subject of a campaign. Only about 10% of people are not meat, poultry or fish in a given week, which could be an indicator of the rate of the most extreme poverty.

• Malaria continues to be a huge health challenge despite wide-scale usage of bednets.

• Condom use is surprisingly low, despite major communication campaigns.

• Attitudes towards the environment, safe motherhood, women’s rights, 1000 Day nutrition and gender-based violence are far more progressive than one might have predicted – consistent both with THP messaging and national gender progress.

Results at a Glance by Module Malawi Ghana Majete Household (HH) Demographics & Dwelling Characteristics HH Size Avg 4.8 5.3 % Women 50% 55% Dependency Ratio 50% Completed primary school 8% 24% Roofing 80% thatch 97% metal

The Hunger Project OEPP 5 June 2013 Lighting 92% 26% candles candles Cook with collected wood 95% 85% Community Mobilization and Leadership W/M confident they can change community 70% / 80% 60% / 67% W/M comfortable speaking about infrastructure 60% / 84% 74% / 88% W/M Voted in Last Election 78% / 84% 92% / 92% W/M think local leaders not effective at all 33% / 33% 8% / 8% W/M ever on epicenter committees/subs 28% / 31% 50% / 50% Gender Equality Believe males are a lot more responsible for community 28% 33% development Believe males are a lot more responsible for family decisions 48% 35% Girls do more of the chores than boys 30% 39% Strongly agree that women should get more involved with 64% 63% politics Strongly agree that women should get more involved with 73% 82% civil society Strongly disagree that wife beating is acceptable 89% 93% Aware of Gender-based violence programs 77% 87% Food Security and Agriculture Plot size (Hc) 1.35 4.2 Value of plots if leased $17 Profit from plot if crops sold, USD $46 Health and Nutrition No fruit within last week 36% 51% 54% No meat/poultry/fish within last week 14% 10% 31% Within 30min walk of health facility (HF) 45% 57% W/M visited HF in last 6 months 58%/41% Confident in the HF 63% 75% Reason for HF visit is illness 80% 57% HH hit by malaria in last 6 months 50% 41% HH not using bednets 16% 8% Believe exclusive breast-feeding should last for at least 6 94% 75% months Accessed HIV testing & counseling 70% 54% Never uses condom when having sex 65% 68% Water, Environment and Sanitation Open defecation 9% 3% Drinking water from rivers or ponds 10% 4% 53% Does not treat drinking water 60% 85% Concerned or very concerned about climate change 84% 71% “ about deforestation 87% 80% Livelihoods & Microfinance PPI: below National/Int’l Poverty Line 35/58% 24/20% 70% Have accessed THP microfinance 22% 24% 4% Using THP savings 14% 20% Involved in non-ag econ. activity 55% 46% Literacy & Education Participated in THP adult literacy 15% 16%

The Hunger Project OEPP 6 June 2013 Never participated in nursury school 57% 15% Primary school within 30 min 69% 93% Junior High beyond 60 minutes 49% 5% Students have all necessary supplies 12% 40%

Key Qualitative Findings Key informant interviews (KII) and Focus Group Discussions (FGD) were held during the same time period as the household surveys. The results were analyzed by independent, local, professional researchers and their reports below make for fascinating reading. You can see the faces, hear the voices and feel the triumphs and frustrations in people’s responses from these discussions.

Community Mobilization: In Malawi, THP has successfully built on and expanded traditional levels of cooperation among villages. When implementation of community projects gets delayed, it can lead to mistrust, which is hard to overcome. In Ghana, overcoming mistrust among villages was even more valued.

Agriculture: In Malawi, fertilizer loans and improved “Sasakawa” farm techniques were greatly appreciated. Similarly, in Ghana, the most significant change was seen as a result of workshops organized by THP to improve farming practices such as line planting, fertilizer application, proper fertilizer use and improved storage.

Gender: In both countries, dramatic changes were both reported in gender equality and are greatly appreciated. It was previously unheard of for women to have any voice in decision-making, and now people believe women are fully engaged as equal leaders and decision-makers. In Malawi, both women and men saw real advantages to having girls and boys share equally in chores.

Education: People in Malawi are very frustrated with the poor quality of the educational system. They greatly appreciated the introduction of nursery schools and see the difference it is making in primary school. They would love to find a way to send more kids to secondary school, where school fees are required.

Both men and women are “not shy” to go for literacy training, and appreciate it, although instances of teacher absenteeism are frustrating.

In Ghana, people highlighted THP’s promotion of education, and the role of better educated adults in supporting children to do better in school.

The biggest challenge in both countries is dropouts due to teenage pregnancy. Other challenges include the cost of materials and the lure of the city.

Health: People generally appreciate the health centers as before they had to walk long distances, Health staff members are frustrated when they don’t have electricity. People living with AIDS in Malawi greatly appreciated the ability to access ART in the community. Water-borne disease is a problem that people are grappling to solve in several of the epicenters.

Courtesy is important. People in some of Ghana’s epicenters feel truly respected: “the nurses treat us like Kings and Queens.” In others, people expressed frustrations when facilites are understaffed, or when staff members are unresponsive or rude.

The Hunger Project OEPP 7 June 2013 People in Ghana also felt that improvements in maternal and child health was very significant due to good quality pre-natal, delivery and post-natal care. Malaria and Cholera are being reduced not only through treatment, but also through better access to bed-nets and community clean-up campaigns.

Livelihoods: People are establishing diverse businesses and purchasing livestock with THP microfinance, and these businesses are perceived to be thriving, and people can pay school fees and keep their children in secondary school. Some complain that the loans are too small due to rising prices. In Ghana, people remark on how improved incomes have contributed to better nutrition, better education and better health.

Environment: People are particularly frustrated by the wanton cutting of trees, and readily embrace campaigns to plant trees.

Water: THP-Malawi has only invested in boreholes where they were completely missing – for such areas people were very happy, in areas with some existing supplies, people were more frustrated.

General Impact: People feel progress is being made. Animators have a desire for more training. Other NGOs have worked in these same areas, but people felt that THP was unique in living up to its promises. Not all epicenters are making progress in all areas.

Recommendations: When asked for recommendations, people requested help meeting specific needs to their area – better water supplies, electricity, and grain mills. People also desired more training in agriculture and food preparation. In terms of the actual FGDs, the researcher recommends specific youth groups, as it is difficult for youth to speak out in groups with adults. In most areas, people want a greater flow of loans from the banks.

The Hunger Project OEPP 8 June 2013 INTRODUCTION The overall objective of the pilot project was to field-test revised data collection tools and outcome indicators in two THP Africa Program Countries (Ghana and Malawi). Based on the results of the pilot project, necessary adjustments will be made to the data collection tools before they are implemented on a larger scale (across all THP Africa Program Countries).

As a global strategic organization, the pilot project helped THP strengthen our internal capacity to more effectively analyze programmatic outcomes and critically evaluate progress of targeted clusters of communities (epicenters) over time. In order to cohesively report on meta-level outcomes and impact, it’s crucial that THP further develop a standardized information collected system (on a limited number of indicators). The OEPP provided a framework for THP to begin rigorously and systematically collecting and comparing data not only across districts and countries where THP works, but also to compare results at a global level over time.

Over the past year and a half THP has been engaged in a participatory process to refine our theories of change – asking “What actions lead to the change we hope to see in the communities where we work as a result of our programs?” The OEPP was designed to test that hypothesis by using three mixed-methods of data collection tools (household surveys, focus group discussion, and key informant interviews). The data collection tools were created to ask questions that would yield both quantitative and qualitative data to measure towards expected outcomes.

The integrated nature of the Epicenter Strategy programs calls for an equally integrated approach to outcome evaluation. Although it is often more time-consuming and resource intensive to study multiple outcomes in an evaluation (versus a single project or single sector evaluation), THP has decided that in order to paint a comprehensive picture of the impact programs are having on the lives of our community partners, it was necessary to design the OEPP to be a multi-sectoral tool that looked at holistically at all key program areas (community mobilization, women’s empowerment, health & nutrition, literacy & education, agriculture & food security, basic sanitation, water and environment). THP believes strongly in an integrated approach to development and the Africa Program Theory of Change (annex 1: Theory of Change) clearly outlines the integrated causal pathways that lead to sustainable social change.

In addition to this report, THP staff members in Ghana and Malawi have outlined a dissemination strategy to share results with our community partners as well as key stakeholders and external audiences. Sharing key findings of the OEPP and analysis of the epicenter level data is a high priority as we expect epicenter leadership and animators are eager to engage with the results and incorporate the information into their regular planning meetings.

BACKGROUND AND CONTEXT The Hunger Project (THP) is a global, non-profit, strategic organization committed to the sustainable end of world hunger. In Africa, South Asia and Latin America, THP seeks to end hunger and poverty by empowering people to lead lives of self-reliance, meet their own basic needs and build better futures for their children.

THP carries out its mission through three core approaches: ● Mobilizing village clusters at the grassroots level to build self-reliance

The Hunger Project OEPP 9 June 2013 ● Empowering women as key change agents ● Forging effective partnerships with local government

In Africa, THP works in eight countries: Benin, Burkina Faso, Ethiopia, Ghana, Malawi, Mozambique, Senegal, and Uganda. Across Africa, THP's methodology is implemented through the Epicenter Strategy, clusters of rural villages (known as epicenters) where women and men are mobilized to create and run their own programs to meet basic needs. After several phases of the strategy are completed (over a 5-8 year period) the goal is that an epicenter will become sustainably self-reliant, meaning it is able to manage and fund its own activities and no longer requires further investment from THP. In each country, the Epicenter Strategy is locally adapted to cultural contexts and the communities themselves set development priorities.

Program Monitoring and Evaluation Since 2008, THP program countries have been systematically monitoring programmatic inputs (budgetary expenses, materials, etc.), activities (workshops, trainings, etc.), and outputs (# people trained, #trees planted). Over the past few years THP has worked to further refine our Theories of Change (ToC). Through the ToC process, THP program staff has defined the causal pathways that lead to the changes (outcomes), which we expect to see at the household and community level as a result of our programs. The OEPP was designed to further refine core global programmatic outcomes and indicators in order to better measure program efficiency, effectiveness and short and medium term effects of program activities.

THP’s goal throughout this process and in all M&E activities is to use a participatory approach to program monitoring and evaluation designed to:

• Support community partners (community members who participate in THP programming) as they identify their needs, set priorities and track progress towards their own development;

• Promote organizational learning and enable THP staff and partner organizations to continuously monitor and improve programs, and share best practices with the wider international development community;

• Promote accountability and transparency within the organization and among donors and partners; and

• Provide evidence needed to influence policymakers and other thought leaders to adopt THP’s approaches to bottom-up development.

The Hunger Project OEPP 10 June 2013

In order to critically analyze the outcomes and impact of THP’s programs, it will be extremely important to collect reliable primary data for outputs as well as outcomes (both qualitative and quantitative) as well as existing data from secondary sources. This will allow THP to compare “how we are doing” and where our partner communities rank when it comes to issues, such as malnutrition or access to healthcare, compared to regional and national averages.

Because THP Africa Programs operate in rural and sometimes isolated communities, the epicenter- level information gathered through the Outcome Evaluation Pilot Project is unique information about the target population that is often not readily available from other sources. Once the epicenter outcome evaluation tools have been revised, longer-term plans will be designed to systematically collect outcome-level data on a regular basis in order to begin measuring each Africa Program County’s progress over time.

Theory of Change A Theory of Change (ToC) provides a clear and testable hypothesis about how change will occur and what it will look like. The theory describes the types of interventions (either a single program or a comprehensive community initiative) needed to bring about the expected outcomes. This theory is then depicted in the format of a map. A good way to think of THP’s Theory of Change is as a roadmap – outlining the different pathways of change that lead to the expected outcomes of The Hunger Project’s Epicenter Strategy which helps viewers visualize the pathways that lead to the desired social change. Each outcome in the causal pathway is tied to an intervention and set of indicators, revealing the often a complex web of activity is needed to bring about change. As a roadmap, Theory of Change helps us to identify measurable indicators of success and keeps the process of implementation and evaluation transparent while promoting organizational learning. ToC includes linkages between the inputs, activities and outputs of THP’s program areas and their outcomes, but it also maps out the preconditions necessary to reach the specified goals. ToC also guides the selection of indicators used in the M&E process.

The Epicenter Strategy defines an epicenter as “a dynamic center where communities are mobilized for action to meet basic needs.” THP sees its comparative advantage as its experience and success as a capacity-building organization; accordingly, it seeks to measure its ability to train, mobilize and develop the capacity of epicenter populations to become successful agents of their own

The Hunger Project OEPP 11 June 2013 development. THP believes that its strategy, when implemented fully over the appropriate amount of time with sufficient funding and staff oversight, leads to epicenter self-reliance. THP conceives self-reliance to be a threshold at which communities are sufficiently mobilized to become successful agents of their own development.

THP’s Epicenter Strategy is currently divided into four distinct phases of varying durations. Phases I, II and III are generally implemented over a total of six years. Phase IV is defined as a two-year Transition to Self-Reliance, during which THP significantly reduces its financial contributions to and oversight of the epicenter, allowing it to begin autonomously managing its fiscal, material and human resources.

According to its Theory of Change, THP expects implementation of Phase I, II and III of the Epicenter Strategy to result in specific “Shifts in Community Capacity and Conditions” (please refer to Annex 2: Africa Regional Theory of Change). At the epicenter level, these shifts reflect THP’s implementation of activities that focus on awareness raising, leadership development, capacity building, and skill transfer.

As noted on the Theory of Change Map, Phase II and III show the community- level outcomes of the Epicenter Strategy, including increased gender equality, improved nutrition, and increased access to financial services. Program evaluation in Phase II and III will depend upon a variety of tools, including the systematic collection of outcome indicator data (being tested through the OEPP). Phase IV will bring about community-level impact which will most often be measured through external impact assessments.

Outcome Indicator Matrix THP program staff has worked collaboratively over the past two years to develop Core Outcome Indicators that THP intends be measured across all program countries (for a more detailed list of the program area outcomes and indicators (see annex 2: Core Outcomes and Indicators). In addition to the core indicators, each program country will continue to further develop program-specific outcome indicators and corresponding ToC maps based on local contexts.

In order to test the Core Outcome Indicators, a set of standardized data collection tools were drafted to collect data in a way that is systematic and statistically rigorous. In order to ensure the quality of the survey design, THP pre-tested the tools at two epicenters in March 2012 and again through the implementation of the OEPP at 10 epicenters across Ghana and Malawi in August 2012. Additionally, THP will seek support from an expert statistician and/or research organization to review the surveys and analysis in order to provide additional feedback before they are implemented on a larger scale.

Overview of OEPP The primary goal of the Outcome Evaluation Pilot Project was to further develop the tools needed to accurately and systematically measure outcomes at the household and community level that are a direct and/or indirect result of THP’s Epicenter Strategy.

During the OEPP, staff in two Africa Program Countries field-tested the outcome indicators as well as a newly developed and standardized set of data collection tools. THP-Ghana and THP-Malawi were the countries selected to pilot the outcome evaluation tools:

The Hunger Project OEPP 12 June 2013 THP-Ghana: THP-Ghana was chosen as a pilot country because of the sheer scale and reach of the program. With the scale-up project, initiated in 2006 with the financial support of the Robertson Foundation, THP Ghana now works in 49 epicenters. The M&E team in Ghana has previous experience with various data collection tools and has in the past implemented a set of MDG focused tools (MDG focused household surveys, focus group discussion guides, key informant questionnaires). In early 2011, THP-Ghana began facilitating refresher workshops for M&E Animators. This ensured THP-Ghana would have a strong team of community volunteers trained and fully engaged in the M&E process and able to assist with the OEPP.

Additionally, THP Ghana has been instrumental in the development of the core outcome indicators. During a field visit in April 2011, the THP-Ghana M&E team assisted the global office in outlining a set of progress indicators that are aligned with the ToC and current programming structures (budget templates, M&E online system, current logframe with activities and outputs).

THP-Malawi: THP-Malawi works in eight (8) epicenters. Malawi was chosen to participate in the pilot because the M&E Officer and program staff have experience designing and implementing large-scale baseline studies and household surveys. For a recent baseline study conducted for the Majete Epicenter, an extensive household survey was used which included ten relevant questions from the Progress Out of Poverty Index (PPI). This is a similar approach that will be taken in the pilot project; therefore, the THP Malawi team had valuable field experience and lessons learned which they could contribute to the pilot project. They have also hired and trained enumerators for the purpose of data collection in the past and have a strong support system in place to complete the additional data analysis work that will be required.

Stakeholder Involvement In order to facilitate participation from all stakeholders in the OEPP it was important to engage the following groups of people at different levels:

Direct participants in THP’s programs: Community partners participated in focus group discussions (FGDs) and key informant interviews (KIIs) - where they were given the opportunity to describe changes they have seen in their communities as well as the impact of THP’s programs on their lives. In the coming months, it will be critically important for THP to close the feedback loop and encourage community partners to participate in meetings that will allow them to discuss results of the evaluation, give feedback, and set priorities accordingly.

THP Animators: M&E Animators worked closely with the evaluation teams to help identify participants, serve as guides for the enumerators while working in the communities, and will also be instrumental in working with the epicenter committees to report and analyze the results of the OEPP.

Women, men and children living in the communities where THP works: Through random sampling, all households in the selected communities (even those not involved with THP programs directly) were eligible to participate in the household survey.

The Hunger Project OEPP 13 June 2013 Community leaders: Epicenter community leaders helped staff inform the communities about the purpose of the evaluation, in some cases served as participants in FGDs, and will also play a key role in the feedback sessions.

THP field staff (at least one program officer and the M&E officers): Staff members have coordinated epicenter orientation visits, enumerator training, and data collection trips for the OEPP, and are currently working on data analysis. Staff will also work closely with M&E Animators and epicenter leadership to facilitate feedback sessions with the communities.

Representatives from local government agencies working with THP: in some cases, epicenter leadership and THP staff selected local government workers as key informants. Additionally, local government officials will be invited to attend feedback sessions to learn about the results of the OEPP.

Investors and donors: THP investors such as epicenter underwriters and other donors such as the Robertson Foundation will have access to reports and be able to provide feedback and recommendations to improve the evaluation tools before they are implemented on a larger-scale.

Researchers: THP is open to sharing our primary data with local research teams including Innovations for Poverty Action (IPA) which is conducting a longitudinal impact evaluation of the Scale-Up program in Ghana.

Target Population and Sampling Methodology In coordination with the M&E officers, ten (10) epicenter communities were selected for the field test of the outcome data collection tools. Five Epicenters in each country were purposively selected to participate in the pilot project. Epicenters were chosen based on a number of criteria considered by staff (location, phase, status of leadership, animator engagement, etc.). In order to compare data between the two countries M&E Officer’s selected five epicenters in each country that are in the same phase (one Phase II, three Phase III and one Phase IV epicenters in each country).

Initially, THP-Malawi’s only Phase IV epicenter, Nsondole Epicenter, was chosen to participate in the pilot project. Unfortunately at the last minute a change had to be made due to local disputes in the area that could have delayed the data collection process. As a replacement, Mpingo Epicenter was chosen to participate in the OEPP, although it is a Phase III epicenter, it is more advanced in the mobilization process and was therefore the most comparable replacement.

Another consideration in selecting epicenters to participate in the pilot project was a concerted effort not to compromise the integrity of an on-going impact evaluation being conducted by Yale University and Innovations for Poverty Action (IPA) in the Easter Region of Ghana1. In order to avoid survey fatigue, all epicenters that are included in the Yale impact assessment were not eligible to participate in the OEPP.

1Researchers from Yale University and IPA partnered with THP to evaluate the long term-impact of this strategy on health, nutrition, income, gender roles, social cohesion and education. A pre-intervention baseline survey of approximately 4,000 households with over 20,000 individuals was completed in 2008 (in both THP communities and control villages). A follow-up survey of the same households will be launched in early 2013. The longitudinal nature of the survey allows us to examine if the effects of the centers are sustained over time and whether or not the strategy is financially sustainable. For more information visit http://www.poverty-action.org/project/0063

The Hunger Project OEPP 14 June 2013

OEPP Target Population

Country Epicenter Phase Start Date Total No. of Villages Total Population

Ghana Banka 1 2004 7 6,725

Kyempo 2 2003 9 6,105

Nkawanda* 3 2006 9 8,135

Nsuta-Aweregya* 4 2001 8 6,478

Odumase-Wawase* 3 2006 8 5,150

SUB-TOTAL 41 32,593

Malawi Champiti 3 2007 33 7,396

Kachindamoto 3 2009 29 10,950

Ligowe 3 2005 24 22,024

Majete 2 2011 21 4,189

Mpingo 3 2003 21 7,962

SUB-TOTAL 128 52,521 * Robertson Foundation Scale-Up Epicenters

Simple Random Sampling Because the primary objective of the pilot project is to field test the data collection tools in order to make revisions, the sample size was intentionally kept to a manageable size so that adequate staff time and resources could be most efficiently utilized. To keep travel costs and staff time at a minimum it was preferable to randomly select five (5) villages in each epicenter and survey and interview a total of 20 households per village. In total, 50 out of 169 of the target villages were included in the sample. In Ghana, 60% of villages in the selected catchment area (25 out of the 41 total villages) participated in the pilot project and in Malawi 19.5% of villages (25 out of the 128 total villages) participated in the study.

Simple random sampling for villages was used because the sampling units (epicenter catchment area populations) vary considerably in size; this technique assured that larger villages had the same probability of getting into the sample as smaller villages, and vice versa. This method also facilitated planning for field work because a pre-determined number of respondents were interviewed in each village selected, and limited staff time and resources were able to be allocated accordingly.

Simple random sampling was also used to determine which households participated in the OEPP household survey (ensuring that each household in the community has the same chance of being selected to participate in the survey). The results can then be reliably projected from the sample to the larger population with known levels of certainty/precision. In Ghana, with the assistance of

The Hunger Project OEPP 15 June 2013 Epicenter Project Officers (EPOs), Epicenter Leadership and M&E Animators, community maps were created of each selected village. Community partners used these maps to create a list of every household in the community. The 20 households to be surveyed were then randomly selected.

Design and Methodology The M&E team used a mixed-method approach to data collection (collecting both quantitative and qualitative data) and by using a variety of multi-level survey tools for primary data collection. The following data collection tools were used for the OEPP:

• Household Survey: Household surveys provide important sources of socio-economic data that are often difficult and costly to gather on a large-scale. Questions were outlined based on outcome indicators, which THP plans to monitor at the household level. These household surveys will provide program staff with rich information that can inform ongoing projects as well as demonstrate impact of THP’s programs at the household level (See Annex 4: Household Survey).

• Focus Group Discussion (FGD): Focus Groups were used to gather information from a targeted group of people at each epicenter. Participants included animators, community leaders, community partners as well as people who may not be currently involved in THP programs. At each epicenter two focus groups were conducted based on gender (ranging from 6-12 participants in each group). Groups of men and women were asked the same set of questions to gain insight about their unique perceptions, opinions, beliefs and attitudes around THP program areas and the outcomes of these programs at a community level. Questions were asked in an interactive group setting, which encouraged participants to speak freely with other group members and the group moderator (see Annex 5: Focus Group Discussion Guide).

• Key Informant Interviews (KII): Key informant interviews involved interviewing a select group of individuals who were deemed most knowledgeable about THP’s key program areas (community mobilization, agriculture, education, health and nutrition). Key informants provide needed and often expert information, ideas, and insights on particular subjects. Epicenter leadership was consulted to select key informants and they were selected on criteria that they were considered by their peers to be ‘the most reliable source of information’ for very specific topics. For example, it is most important to ask the nurse at the health clinic about specific diseases and other health issues affecting the community; and it’s equally as important to ask the farmers about agricultural production and yields per acre; or to ask teachers about student attendance. In each epicenter, 5-10 Key Informants were identified and interviewed (see Annex 6: Key Informant Interview Guide).

Once the data collection tools were finalized they were pre-tested at an epicenter community (not part of the study sample). Feedback from enumerators on the survey design, questionnaires and delivery methods was then used to make modifications before the primary data collection began.

Innovative New Technology In order to reduce inefficiencies in the data entry process, for the purposes of this pilot project THP employed, for the first time, electronic survey methods to collect household survey data. After

The Hunger Project OEPP 16 June 2013 consideration of multiple platforms, THP selected iPod Touch and iFormbuilder as the hardware and software to be used for the OEPP household surveys.

iFormBuilder is a multiple-interface software that allows users to create, complete, and compile surveys in a variety of settings. It can be used on any computer or device with Internet access and ability to browse the Web (eg:/ iPod, smartphone). iFormBuilder secures both the survey itself and respondents’ answers by storing it on the device, then syncing the information to the user’s account on the website. Through a field test of the technology in March of 2012 (conducted by a team of graduate students from George Washington University) THP found that using iPods and iFormBuilder cut down on the amount of materials needed to conduct fieldwork (paper, printing) and also decreased the amount of staff time required for traditional paper surveys (recording and transcribing data).

FINDINGS AND CONCLUSIONS

Utility and relevance of results Through the process of implemented the data collection tools are review the data THP has learned that the data collection tools were successful in setting a benchmark for success of THP’s Epicenter Strategy (particularly in communities where extensive baseline data is unavailable). The results of the surveys, interviews, and focus group discussions provide a rich picture through both quantitative and qualitative data of how partner communities are moving towards self-reliance. The evaluation provides staff and epicenter leadership a valuable tool to gauge household and community well- being and an effective way to measure progress overtime through THP’s theory of change. The outcomes and indicators selected outline a framework for measuring social change that can be modified to capture specific country specific contexts. It is recommended that further analysis be

The Hunger Project OEPP 17 June 2013 conducted to compare results against THP outputs as well as self-reliance indicators and epicenter snapshot data.

This report presents detailed results of the household survey, however, local university professors at the Agriculture Research Centre, Legon-Ghana and the Centre for Social Research, Zomba-Malawi conducted qualitative analysis of results of the Focus Group Discussions (FGD) and Key Informant Interviews (KII) independently. We recommend that further analysis be done to triangulate responses and compare quantitative and qualitative results.

Focus Group Discussions were conducted with groups of men and women separately – asking each group the same series of questions in order to gauge difference in perspectives based on gender. A tag cloud or wordle (a visual representation for text data) from the FGD conducted in Nkwanda Epicenter in Ghana show some of the key words participants used in their discussions. It is interesting to see the differences and similarities of these groups (see figure below). The full qualitative reports on the FGDs and KIIs are available from the program country offices and should be made available as an addendum to this report.

Figure 1: Nkwanda Epicenter FGD (women left, men right)

Progress out of Poverty (PPI) Results

Progress Out of Poverty Index (PPI) As part of the pilot project, questions from the Progress out of Poverty Index (PPI) were integrated into the household survey in order to collect data that will help measure the impact of THP’s Livelihoods and Microfinance Program, as well as the overall progress our communities and partners are making towards self-reliance.

The PPI is a simple, accurate and user-friendly data collection tool that measures poverty levels of groups and individuals. The PPI was developed in 2005 by Grameen Foundation and is now used in 40 different countries. The PPI is being used primarily by microfinance institutions to better determine clients’ needs and the effectiveness of programs. When used over time the PPI helps

The Hunger Project OEPP 18 June 2013 measure how quickly clients move out of poverty, and what helps them to increase their living standards most.

CGAP and the Ford Foundation have endorsed the use of the PPI as a rigorous poverty assessment tool that estimates where clients rank compared to the national poverty line2. While the PPI follows a single methodology (10 simple survey questions), each PPI is country specific and based on that country's best nationally representative income and expenditure household survey. THP M&E Officers and program staff (and/or enumerators) collect information on the ten indicators as part of the household survey. Each indicator then receives a score based on responses and all ten indicators receive a total score. Data then can be easily disaggregated and analyzed based on whether or not households are participating in THP’s Microfinance Program.

Specific indicators for each country are drawn from sources such as a country’s national household survey (such as Ghana Living Standard Survey), or the country-specific World Bank Living Standards Measurement Survey. The index can then serve as a baseline from which THP’s epicenters and community partners’ progress can measured and even compared to other NGOs working in the same regions.

● Ghana PPI (http://progressoutofpoverty.org/ghana) ● Malawi PPI (http://progressoutofpoverty.org/malawi)

THP PPI Results The household surveys included the 10 PPI questions that were disaggregated and analyzed across each epicenter using the corresponding PPI score cards for each country. The PPI results show that overall epicenter communities and THP partners are better off than most other communities in their district3. When collected on a regular basis, this valuable baseline data can be used to compare changes over time of the general economic health and well being of THP’s epicenter communities.

Overall 24.2% of households surveyed in Ghana and 22.2% of households surveyed in Malawi are currently participating in THP’s Microfinance Program. Further analysis is needed to determine if MFP participants are generally better off than non-participants.

2The poverty line that defines the poorest half below the national poverty line or the $1/Day/PPP and $2/Day/PPP international poverty lines. The household-level poverty rate is the share of households in a given group whose per-capita expenditure is below a given poverty line (PPI 2010). 3 * Microfinance Risk Management, L.L.C. based on the 2005/06 GLSS **Microfinance Risk Management, L.L.C. based on the 2004/2005 IHS2

The Hunger Project OEPP 19 June 2013 *Poverty Poverty likelihood likelihood *District (estimated (estimated Poverty Total Avg. below, %) below, %) Levels % HH survyed Start Epicenter # HH PPI National $1.25/Day 2005 (2005 participating Country Epicenter Phase Date Population Surveyed Score Poverty Line PPP Poverty Line GLSS) in THP's MFP Banka 1 2004 6,725 102 41 22.6% 18.9% 35.7% 0.0% Kyempo 2 2003 6,105 100 40 25.7% 21.8% 35.7% 22.0% Ghana Nkawanda 3 2006 8,135 101 38 28.2% 24.3% 48.4% 34.7% Nsuta-Aweregya 4 2001 6,478 98 42 22.1% 18.3% 48.4% 27.6% Odumase-Wawase 3 2006 5,150 100 42 21.9% 18.2% 48.4% 37.0% TOTAL: 32,593 501 24.1% 20.3% 24.2%

**Poverty Poverty likelihood likelihood (estimated (estimated **District Total Avg. below, %) below, %) Poverty % HH survyed Start Epicenter # HH PPI National $1.25/Day 2005 Level (2004 participating Country Epicenter Phase Date Population Surveyed Score Poverty Line PPP Poverty Line IHS2) in THP's MFP Champiti 3 2007 7,396 99 37 31.7% 54.4% 51.6% 28.3% Kachindamoto 3 2009 10,950 101 31 39.4% 63.2% 54.6% 12.9% Malawi Ligowe 3 2005 22,024 100 37 31.1% 53.1% 64.4% 28.0% Majete 2 2011 4,189 101 27 47.5% 70.5% 65.8% 8.9% Mpingo 3 2003 7,962 100 38 27.1% 48.8% 46.5% 32.0%

TOTAL: 52,521 501 35.4% 58.0% 22.0%

Figure 2: Progress Out of Poverty Scores (PPI)

Ghana In Ghana, there is a 24.1% likelihood that THP partner community households are living below the national poverty line. This is significantly lower than district poverty levels from the 2005 Ghana Living Standard Survey (GLSS), which indicates that epicenter communities are better off than the average household in their district.

Based on the results of the household survey PPI analysis, average likelihood of households living below the international $1.25/day poverty line is 20.3%. Therefore, THP-Ghana can conclude that 20.3% of its community partners are living below the $1.25/day poverty line.

Malawi In Malawi, there is a 35.4% likelihood that THP partner community households are living below the national poverty line. This is also much lower than district poverty levels from the 2005 Integrated Household Survey (IHS2). These results indicate that epicenter communities are better off than the average household in their district.

Based on the results of the household survey PPI analysis, average likelihood of households living below the international $1.25/day poverty line is 58.0%. Therefore, THP-Malawi can conclude that 58.0% of its community partners are living below the $1.25/day poverty line.

The Hunger Project OEPP 20 June 2013 SNAPSHOT OF THP-MALAWI DATA (by Module)

Household Demographics & Dwelling Characteristics This section analyses household information; it gives demographic details of the HHs sampled for the HH survey. The survey collected information on household size (number of HH members); composition, age and gender and education levels attained.

Household Size Size of a household is important as it has a bearing on food security, and overall quality of life at household level. Fig 3 below illustrates the HH size on average. There were 2336 HH members in the 500 HH sampled giving a 4.7 members per HH on average. The average household size for Malawi is 4.6 persons per household4. Kachindamoto epicenter showed a relatively higher HH size.

Fig. 4: Proportion of HH members per Family Against Frequency of HH

Champiti K'moto Ligowe Majete Mpingo Aggregate

1 Member 3 0 3 3 1 2 2 Members 9 6 9 10 6 8 3 Members 16 16 20 14 19 17 4 Members 21 21 15 15 24 19 5 Members 19 16 20 19 16 18 6 Members 15 21 16 10 18 16 7 Members 8 13 8 10 11 10 8 members + 9 7 9 20 5 10

On aggregate, the table above shows that HHs with four members (per HH) were the most common; 19 percent of the HHs had four members followed by those with five members (18 percent); three members (17 percent); six members (16 percent); seven and eight plus members (10 percent each), two members accounted for eight percent and one member two percent.

Households Distribution by Age and Sex Fig 5 below illustrates the households’ population structure (proportion by age group and by sex).

Households Distribution by Age and Sex

Champiti Kachindamoto Ligowe Majete Mpingo Aggregate Female Male Female Male Female Male Female Male Female Male Female Male under 5 7 7 9 11 7 6 8 9 5 7 7 8 5 to 12 12 13 14 15 15 12 13 13 11 16 13 14 13 to 17 7 5 5 5 7 7 4 8 6 6 6 6 Above 18 27 23 23 17 24 22 23 23 26 25 25 22 Total 52 48 51 49 53 47 48 52 47 54 50 50

4 Malawi Integrated Household Survey (IHS3) Report 2010 to 2011

The Hunger Project OEPP 21 June 2013

On aggregate, fig 5 above displays an equal distribution of female and male population in the HHs (50 percent for each sex). However, at epicenter level there are some significant variances; three epicenters: Champiti, Kachindamoto and Ligowe were female predominant (52 percent, 51 percent and 53 percent respectively) while Majete and Mpingo had higher male population (52 percent and 53 percent respectively). The 2008 national census results had rural areas predominantly female population which the three epicenters demonstrate. This trend has been attributed to rural-urban migration which is mostly selective; educated male adults migrate more depriving the rural area of development. THP Malawi could turn around this trend through its Microfinance and Food Security programmes; these two can create self-employment to the educated population right there in the rural areas.

Furthermore fig 5 illustrates the epicenters’ households have a relatively youthful population. Almost 54 percent of the HHs on aggregate is below age of eighteen years. This affirms the importance of rolling out the Youth Development program in the epicenters.

Dependency Ratio The dependency ratio in this context refers to the ratio between the total number of persons in the household outside the economically active age (children under the age of 15 and adults 65 years or older) and the total number of family members. This is an indicator of the potential effects of changes age structures of the population for social and economic development5. Overall, the dependence ratio was at 50 percent. This is higher than the national level, which IHS3 reported to be at 47 percent as of 2011. However, some epicenters had lower than the national level, for instance Champiti and Mpingo it was at 45 and 46 percent respectively. Kachindamoto had the highest at 57 percent and Majete 51 percent. The high dependence ratio has a negative influence on progress out of poverty of a HH.

Household Educational Status The subsection looks into the level of education attained by the HH members. The table on page below illustrates the proportions of each age group that has attained or not attained respective educational level.

Fig 6 below illustrates Higher male literacy is consistent throughout all age groups. At Champiti 18 percent of the HH members had not attended any sort of formal education or had not yet enrolled for formal education (case of under 5). At Kachindamoto, this equals 33 percent; 17 percent for Ligowe, 44 percent Majete, and 19 percent for Mpingo.

Across all the epicenters, the table shows a greatest proportion of the HH members had attained some primary education with an average of 55 percent of the total population. It further shows the 13 to 17 age group dominated in the some primary education level.

It also comes out clear from the table that there was low enrolment to adult classes (one percent at Champiti, and Ligowe while the rest were at Zero percent) despite high illiterate proportion in the

5Malawi Integrated Household Survey Report 2010 t0 2011 (National Statistics of Office)

The Hunger Project OEPP 22 June 2013 above 18 years age group. Majete registers the highest proportion of the uneducated adults (39 percent) followed by Kachindamoto at 26 percent (seven percent lower than during the baseline survey). Both these epicenters had no THP’s ALP programme running during time of the survey; perhaps this could explain.

Fig 6 further shows a very high proportion of under-five children who were out of school in Majete Epicenter. Lack of nursery school in the area (Majete) could contribute to this; up to 98 percent of the under-five children had not enrolled for any formal education. THP Mw nursery school programme could easily make a difference in the area.

The Hunger Project OEPP 23 June 2013 Fig 6: Level of Education Attained at each Age Group in Percentages (of each age group)

Age No formal Adult Presch Some Comple Some Comple Some Comple Technic Comple education/ litera ool or primar ted junio ted second ted al or ted Groups/ Not yet in cy kinder y primary r junior ary second vocatio /univer School only educati school high high educati ary nal sity Education on scho school on educati (tertiar ol on y) al level

Champiti Under 5 72 0 25 3 5 to 12 12 0 4 83 0 1 13 to 17 2 0 0 84 13 2 0 0 0 0 0 Above 18 11 1 0 50 13 9 4 2 11 0 0 Average 18 0 4 56 8 5 2 1 5 0 0 Kachindamoto

Under 5 81 0 14 5 5 to 12 15 0 8 77 13 to 17 13 0 0 85 2 0 0 0 0 0 0 Above 18 26 0 0 60 7 3 0 1 2 0 0 Average 33 0 5 56 3 1 0 0 1 0 0 Ligowe

Under 5 61 - 39 5 to 12 3 - 16 81 0 13 to 17 0 - 0 76 13 3 3 3 2 0 0 Above 18 17 1 0 54 11 5 6 4 3 0 0 Average 17 0 9 57 7 3 3 2 1 0 0 MAJETE under 5 98 - 0 2 5 to 12 36 - 0 64 0 0 0 0 0 0 0 13 to 17 7 - 0 85 3 5 0 0 0 0 0 Above 18 39 0 0 52 5 2 1 0 1 0 0 Average 44 0 0 51 3 1 1 0 1 0 0 MPINGO under 5 82 0 18% 0 5 to 12 13 0 11 76 0 0 0 1 0 0 0 13 to 17 2 0 0 78 5 5 4 4 2 0 0 Above 18 12 0 0 57 8 6 3 6 6 1 1 Average 19 0 5 57 5 3 2 4 3 1 0

The Hunger Project OEPP 24 June 2013

Fig 7: Level of Education Attained across Gender

No Adult Presc Some Compl Some Compl Some Compl Techni Compl formal literacy only hool prima eted junior eted secon eted cal or eted educa or ry primar high junior dary second vocati univer tion kinder educat y schoo high educat ary onal sity ion school l school ion educat (tertia ion ry) Champiti Female 12 0 2 30 3 3 1 1 1 0 0 Male 6 0 2 26 5 2 1 1 4 0 0 Total 18 0 4 56 8 5 2 2 5 0 0 Kachindamoto Female 15 0 3 30 1 1 0 0 0 0 0 Male 17 0 2 26 2 0 0 0 1 0 0 Total 33 0 5 56 3 1 0 1 1 0 0 Ligowe Female 8 0 6 34 3 1 1 1 0 0 0 Male 8 0 4 24 4 1 2 2 1 0 0 Total 16 0 10 57 7 3 3 2 1 0 0 Majete Female 22 0 0 24 1 1 0 0 0 0 0 Male 21 0 0 27 2 1 1 0 1 0 0 Total 44 0 0 51 3 1 1 0 1 0 0 Mpingo Female 10 0 2 28 2 0 0 2 1 0 0 Male 10 0 3 31 3 3 2 2 2 0 0 Total 19 0 5 58 5 3 2 3 3 1 0

Educational Levels across Gender The table above analyses the data on the HH members’ education levels by sex. Overall, there were more men who had attended any level of formal education. Majete registered highest proportion of females who had not attended any sort of formal education (at 22 percent). This is however lower than the national female status for the same indicator; the 2010 Third Integrated Household Survey results showed a 28 percent of females under this indicator. Interestingly, at Kachindamoto there are fewer females who had not attained education than males (15 percent and 17 percent respectively).

One other notable thing from the table is the decrease of females with increase in level of education; at the lower level (primary school) there are more females but at secondary level it is the opposite. This indicates high dropout rate of girls in the schools.

Dwelling Characteristics The OEPP Household Survey collected information on housing characteristics such as the type of dwelling occupied by the households, tenure status and the main building materials of the roof, the wall and the floor. The survey also gathered information on sources of lighting, and cooking fuel.

The Hunger Project OEPP 25 June 2013 A dwelling in this context refers to a unit as the living space occupied by a household regardless of the physical arrangement of facilities available. It may be one room or more occupied by household members or it may be one, two or more dwelling units occupied by an extended family.

Ownership of Home (Tenure Status) The graph in Fig 8 below depicts the Fig. 8: Ownership of Homes proportions of the HHs for each type of home ownership. A home would be 100% 90% Borrowed borrowed, owned, or ranted. 80% (no 70% payment) 60% Owned Overall, the graph on the right shows that 50% most of the HHs’ homes are owned (95 40% 30% percent) with Majete having the highest 20% Rented 10% (100 percent). This is higher than the 0% national status; IHS3 report indicates that Other 88 percent of homes in the rural were own occupied compared to 40 percent in the urban. Thus, this underscores that THP Mw are epicenters are in typical rural.

Number of Rooms Used by HH The results (in proportion of the HHs) for this Fig 9: No. of Rooms at Household indicator are displayed in the graph below. 50% On aggregate the graph reveals that most of 40% One Room the HHs used two rooms (accounting to 36 30% percent of the HHs). The graph shows some 20% Two rooms significant variances across the epicenters. 10% Three Kachindamoto had the highest proportion of 0% Rooms HHs with two rooms (46 percent) while Four Rooms Majete had most of the HHs with one room Above Four (35 percent). The Majete scenario could Rooms perhaps indicate poor quality of living conditions; there could be overcrowding in the homes. Unlike the relatively older epicenters, the most HHs could not afford to build better homes. Mpingo Epicenter on the contrary has most of the homes with two and three rooms 33 and 32 percent in that order.

Main Source of Lighting in the Homes The graph in fig 10 below analyses the results on the question by showing proportion of the HHs using a particular source of light.

The Hunger Project OEPP 26 June 2013 Fig 10: Main Source of Lighng

Other Aggrgate Public or Shared Mpingo generator Majete Solar panel Ligowe Kachindamoto Lanterns/candles/ paraffin Champi Fire lit scks, grass 0% 50% 100% or pit

The graph reveals that the majority of the HHs used lanterns/candles/ paraffin as main source of lighting (92 percent on aggregate). This was extremely higher than the national rural usage as reported by IHS3 which reported 54 percent of paraffin usage in the rural. This could be due to lack of other sources of lighting in the epicenter villages like electricity or most of the partners cannot afford solar panels. The Government of Malawi has installed electricity grid lines to some rural areas through Rural Electrification programme. None the epicenters in the OEPP are in these areas.

Source of Fuels used for Cooking

Firewood has been traditionally the main source of cooking fuel in most Malawian HHs. OEPP sought to find the source of cooking fuel. The graph in fig 11 below presents the results.

The results were not different from the Fig 11: Main Source of Cooking Fuel tradition of using firewood. The graph reveals 95 percent of the HHs across all 98% 100% 100% 95% Charcoal 92% 87% epicenters used this as their fuel. That was relatively lower than national Collected status. The IHS3 indicated that in 2011 Firewood 99 percent of the rural HHs used 9% firewood. Thus, Kachindamoto and 2% 0% 0 0% 5% 3% 0 0 4% 2% 2% Purchased Fired Majete (at 100 percent) were way Wood higher than the national statistics, while Mpingo was far much lower at 87 percent.

Main Sites for HH Wasted Disposes

The Hunger Project OEPP 27 June 2013 Table below analyses the results in proportion of where each of the HH disposes wastes. This is an aspect of sanitation of the HH. From the table, majority of the HHs own garbage pit/heap where the waste is disposed of, this accounts for 46 percent overall. However, Majete had 51 percent of its HHs dumping waste in vacant land; a very big compromise to hygiene of the area. This calls for the health and sanitation committee to work hard to overturn the situation in Majete.

Fig. 12: Waste Disposal Sites

Champiti Kachindamoto Ligowe Majete Mpingo Aggregate

Dumped in vacant land 28 26 31 51 28 27 Own burned or buried 6 10 9 8 10 7 Own garbage pit or heap 60 63 56 40 58 46 Public garbage 4 0 3 0 2 2 Collected by pvt firms 0 0 1 0 0 0 Other 2 1 0 0 2 1

Type of HH Home Structure Material Used to Roof the House Based on the materials used for 100% Corrugate construction of wall and roof, dwellings are d metal classified into three major groups: 80% permanent, semi-permanent and 60% Thatched traditional. 40% 20% Graph below shows that overall 79 percent Tile 0% 47 percent of the houses in Malawi are traditional houses, 29 percent are Other permanent and 25 percent semi-permanent houses.

Type of Floor of the HHs Homes Type of Floor of the House Overall, the graph shows 89 percent of the 94% HHs had earth/mud floors. This was highest 90% 89% 92% 89% 80% at Kachindamoto where 94 percent of the Concrete/flag HH had mud floor, and was lowest at stone/cement Mpingo, 80 percent. The results in the two Earth/mud 19% graphs illustrate most of the HHs had 10% 10% 8% 11% 0% 0 6% 0% 0 0% 1% 0% 0% 1% 0 0% 0% traditional homes made of locally available Tile/birck materials. The trend might change if THP’s intervention positively impacts the Other communities.

In conclusion of the section, majority of the HHs in the epicenters had four members and the majority of the members were in the youthful age group. Overall, the dependence ration is high posing a threat to THP’ efforts to improve livelihoods.

The Hunger Project OEPP 28 June 2013 On education, the results show a very big dropout rate especially among female population, very few had attained secondary school education. Proportions of adult members that attended ALP were lower which indicates very little utilization of the same. On dwelling characteristics majority of the HHs the results show most of the HHs relied owned their homes opposed to renting. The HHs used firewood for cooking and lantern/paraffin for lighting their homes. This is true of the national statistics.

Community Mobilization & Leadership Community mobilization plays an integral role in the epicenter strategy approach. The communities learn more about THP’s strategy through village-based workshops including Vision Commitment and Action (VCA). Through VCAs the THP Mw trains its partners the five principles of ending hunger and poverty (Change of Mindset, Good Leadership, Vision, Commitment and Action). These five principles are the pillars of transformation from poverty to prosperity and hunger free households. The OEPP assessed the impact such meetings have on the community.

For this module, two respondents (man and woman from same household) were asked same questions separately to compare their views on the issues of community mobilization. The questionnaire focused much on the communities’ perceptions on gender and development.

Level of Confidence in Men/Women to Influence Change to Their Community The first question asked male/female respondents if they (man/woman) feel they can change things in the community if they want to. The graph below shows the results for each of the five responses the questioned had and for each sex for all epicenters and aggregate.

Fig 13: Whether women/men feel they can change the community

Men

ate Yes, very easily

Aggrer Women Men o

Mping Women Yes, fairly easily Men e

Majet Women Yes, but with a lile difficulty Men e

Ligow Women Yes, but with a great deal of Men difficulty o damot Kachin Women No, not at all Men pi

Cham Women 0% 10% 20% 30% 40% 50% 60%

Figure 3: Perceptions of ability to create social change

Overall, more men than women indicated “yes, but with a great difficulty”: three percent of women against five percent men. The graph shows that in all epicenters but Ligowe and Mpingo, more women than men feel they cannot change the community if they want to.

The Hunger Project OEPP 29 June 2013 Furthermore, more men and women expressed confidence to influence change than those who indicated they could not and the trend shows increase in proportion from “Yes, but with difficulty” to “Yes, fairly easy”.

Comfortable to Speak on Decision on Infrastructure The table below analyses the data on this indicator.

Fig 14: Proportion of women/men who feel comfortable to speak on Decision on Infrastructure Development Champiti K’moto Ligowe Majete Mpingo Aggregate Wom Me Wom Me Wom Me Wom Me Wom Me Wom Me en n en n en n en n en n en n No, not at all comfortable 22 5 24 5 18 3 34 7 13 3 22 4 Yes, but with a great deal of 8 5 2 10 2 6 14 2 6 3 6 5 difficulty Yes, but with a little 18 9 13 5 11 3 8 4 7 10 11 6 difficulty Yes, fairly comfortable 28 34 41 55 30 33 18 20 38 15 31 31 Yes, very comfortable 24 48 20 25 39 55 27 67 36 69 29 53

Across all epicenters, there is a big gap on the proportion of women who expressed “not comfortable at all”. Mpingo Epicenter shows the lowest proportion of women in this group while Majete has the highest. Geographical location and culture could explain this. Mpingo is located closer to the urban setting of Blantyre City unlike the other four epicenters while Majete is the most remote. Proximity to the urban setting could have a bearing to easier access to information on gender issues and exposure to educated women who are influential.

The cultural aspect has a bearing as well; Champiti, Ligowe and Kachindamoto epicenters are predominantly Ngoni tribe. Women in this tribe have to respect their men so much. The social norms render women more passive and men more active in social gatherings. This could be supported by the results as well; the table further shows that on aggregate, biggest proportion of men are very comfortable to speak on decisions (53 percent) against 29 percent for women.

Proportion of men/women that voted in last national/local elections The survey sought to find how many men and women exercised this right in the last local elections. In the graph below, are the results for this indicator.

The Hunger Project OEPP 30 June 2013

Figure 15: Political Participation

Overall, the graph shows more men exercise this right to vote than women (84 percent of men and 78 percent women voted). However, at Kachindamoto more women than men voted: 78 percent women and 75 percent men.

The results above indicate the extent to which women are still behind in terms of exercising their rights and freedom; they lack that knowledge. As THP advocates empowering women to attain decision-making positions, this cannot be achieved if they (women) cannot exercise voting rights; it is rare for men to vote for a woman. This calls for more civic education in our epicenters to empower the women in this aspect.

Leadership Effectiveness The table below shows the distribution of men and women’s perceptions from ”not at all” to “very effective” scale across all the epicenters on good leadership.

Fig 16: How Women/Men Perceive their Community Leaders (whether they are effective) Champiti K’moto Ligowe Majete 1 Mpingo Aggregate Wome Men Wome Men Wome Men Wome Men Wome Men Wome Men n n n n n n No, not at all 30 23 29 30 30 33 35 35 35 45 32 33

Yes, but with a great deal 3 7 9 5 15 6 14 4 6 5 9 6 of difficulty Yes, but with a little 6 9 16 10 0 15 18 15 19 13 12 13 difficulty Yes, fairly effective 38 26 25 30 32 21 14 20 31 18 28 23

Yes, very effective 22 35 20 25 23 24 20 26 9 18 19 26

Overall, almost one third of the population perceived their leaders as not effective at all (32 and 33 percent of women and men respectively). The remaining two thirds perceived the leaders as effective though at different degrees. Good leadership has a bearing on development. Through VCA workshops, the communities are drilled on good leadership; this ought to be portrayed by the leaders.

The Hunger Project OEPP 31 June 2013 Proportion of the Community in Community Committee/Cooperatives The survey sought to find the proportion of the community in various committees/cooperatives at local level. The question asked was whether they (man/woman) are members of any community committee or cooperative. The graph below illustrates the proportions of the community in and not in groups.32 Women/Men in Community Groups/Cooperaves

90% 80% 70% 60% 50% YES 40% 30% NO 20% 10% 0% Men Men Men Men Men Men Women Women Women Women Women Women

Champi Kachindamoto Ligowe Majete 1 Mpingo Aggregate

On average, 36 and 47 percent of women and men respectively belonged to one of the community’s groupings. At epicenter level, Champiti had equal proportion of men and women in community groupings (45 percent for each sex); Kachindamoto had more men in local committees than women (45 percent against 29 percent); Ligowe shows an equal distribution between those who were in any grouping and those not and across both sex (50 percent each); Majete showed a great variation between men and women; 17 percent women and 33 percent men were members of a particular local committee. For Mpingo, 38 percent women and 59 percent men belonged to some local committee.

Two major observations can be made from this data analysis: overall low community participation in committees and gender imbalances within those committees. The latter could be a key issue for THP to address; low women participation in these could hinder efforts to achieve gender equality in epicenters. Two epicenters (Kachindamoto and Majete) show great disparities in gender and in general participation as well. Age of the epicenters could explain this, the trend shows smoothing of the gap with age of the epicenter, with Ligowe being the oldest followed by Mpingo, Champiti, Kachindamoto and Majete as newest of all.

Participation of Men/Women in THP Epicenter Committee/Subcommittee THP’s Gender program advocates for equal representation of men and women in epicenter leadership. The indicator here tried to measure the extent to which equal representation is achieved in the epicenters. The graph below shows the results in proportions. 3232

The Hunger Project OEPP 32 June 2013 Proportion of Women & Men in Committees 50 Women 44 Men 31 31 31 27 27 28 28 24 20 11

Overall, the graph shows more men are members of THP epicenter committee/ subcommittees; 31 percent men against 28 percent women indicated they belonged to THP epicenter committees. Compared to national statistics on decision-making positions of women, indicates 27 percent of members of parliament were women. Thus in a number of epicenters THP’s women participation is above that of national level.

Participation in THP Community Meetings The extent to which community mobilization is effective can also be measured by the number of meetings partners participated in, in a specified period. The survey also measured this element. The respondents were asked to state how often they participated in community meetings hosted by THP animators in the last twelve months. The table below illustrates the results on a scale of “never” to “sometimes” in proportion for each of the five epicenters and for each sex.

How often women/men have participated in THP meetings

Champiti Kachindamoto Ligowe Majete 1 Mpingo Aggregate Women Me Women Men Women Me Women Me Women Me Women Me n n n n n Never 54 40 59 60 59 48 64 49 52 44 57 48 Often 11 14 4 0 10 15 9 16 13 18 10 13 Rarely 11 16 15 25 10 12 9 9 14 21 12 17 Sometimes 24 30 22 15 20 24 18 27 21 18 21 23

On average, the table shows more women than men “never” participated in THP animator hosted meetings (57 percent women versus 48 percent); and fewer women than men “often” participated (10 percent versus 13 percent men); fewer women “rarely” participated (12 percent against 17 percent) and fewer women “sometimes” participated (21 percent against 23 percent). The results are however contrary to the monthly output data across all epicenters (apart from Majete) which always show much more women than men participating in THP animator-hosted meetings. This could mean the very same group of people patronizes the village-based workshops.

The Hunger Project OEPP 33 June 2013 Gender Equality

One main area addressed by Women Empowerment Program (WEP) and the HIV/AIDS & Gender is to close the gap between men and women. THP Malawi advocates for women empowerment in all its programs whereby women are encouraged to take active roles in decision making position including at epicenter leadership. The survey sought to find out the extent to which women influence the leadership at different levels.

The survey first sought to know whether men and women have equal responsibilities on community developments. The table below shows the results from this survey question.

Whether Men and Women Have Equal Responsibilities on Community Developments

Champiti Kachindamoto Ligowe Majete Mpingo Aggregate Shared Equally 54 29 41 58 51 47 Males have a lot more 29 44 36 12 21 28 Females have a lot more 7 13 12 9 14 11 Males have a little more 6 4 3 12 5 6 Females have a little more 3 9 6 4 7 6 Don't know 1 1 2 4 2 2

On average, the survey shows that the majority (47 percent) of the respondents felt men and women share equal responsibilities as regard community developments. This is same across all epicenters but Kachindamoto where 29 percent expressed this against 44 percent that said men had a lot more responsibilities. One interesting finding is that Majete shows highest percent of men and women sharing equally (58 percent) though it is THP Malawi newest of the five epicenters.

Responsibility on Family Decision The survey sought to find whether men and women share same responsibility on making family matters including financial and health decisions. The table below illustrates the results from the survey.34Whether Men and Women Have Equal Responsibilities about Family (Financial, Health)

Champiti Kachindamoto Ligowe Majete Mpingo Aggregate Shared Equally 35 23 34 29 38 32 Males have a lot more 56 57 46 47 38 48 Females have a lot more 3 5 2 3 6 4 Males have a little more 2 7 10 15 8 9 Females have a little more 2 4 5 4 6 4 Don't know 1 3 3 3 4 3

Table above shows that males in these epicenters hold a lot more responsibility than females in their families, an overall of 48 percent expressed that while 32 percent was of the view that there are equal responsibilities in the family. It also shows that males in Kachindamoto have a lot of responsibilities about family than women followed by Champiti and Majete.

The Hunger Project OEPP 34 June 2013 Whether Boys and Girls in the Household Share Chores Equally

Champiti Kachindamoto Ligowe Majete Mpingo Aggregate Shared Equally 34 29 28 19 31 28 Males have a lot more 7 5 3 8 2 5 Females have a lot more 11 16 18 19 17 16 Males have a little more 1 0 2 1 3 1 Females have a little more 10 17 16 14 15 14 Don't know 37 33 33 39 31 35

The above fig shows that across all epicenters majority (28 percent) of the HHs felt boys and girls share house chores equally. However, there were more HHs that felt girls have a little more responsibilities than boys, 16 percent on aggregate against five percent that said boys have a little more. Accumulatively, the proportions in fig above, (minus those under ‘shared equally’ & ‘Don’t know), whatever the case show girls have more working hours on domestic chores than boys which truly reflect national status. One report indicates girls dedicate over six times as much time to domestic activities than boys – 16.9 hours/week compared to 2.7 hours/week. While the same pattern of time allocation to respective activities applies also for boys, the number of hours is substantially lower6. Thus, there more that ought to be done to break the gender disparities.

Household Decision Making

The table shows that decision-making was mostly done by the husband in all the epicenters (45 percent) with Majete showing a highest rating (63 percent) followed by Kachindamoto, 48 percent. The aggregate also shows husbands were the core decision makers in the family on children health care.

35 Champiti Kachindamoto Ligowe Majete Mpingo Aggregate Husband 39 48 36 63 41 45 Wife 37 34 35 20 34 32 Hasband/Wife 21 15 22 10 17 17 No Children in the House 2 3 5 7 6 5 Someone Else 2 0 2 0 2 1

Figure 4: Decision making about child health

Women that Accessed Credit Loans. The graph shows ratings related to proportion of HH with women that accessed credit from all the epicenters. The highest aggregate shows that none of the women from these HHs accessed credit. Majete had the highest rating of women who did not access a credit followed by Kachindamoto. Ligowe had a highest rating of a single woman from HH accessing loans. Mpingo shows highest rating of two women from HH accessing loans.

6 Gender Inequalities in Rural Employment in Malawi: An overview 2011

The Hunger Project OEPP 35 June 2013 Proporon of HH with women that Accessed Credit

100 80 60 None 40 20 One 0 Two

Whether Women should participate more in Politics

80% 70% 60% Completely Disagree 50% Somewhat Disagree Somewhat Agree 40% Strongly Agree 30% Don't Know 20% 10% 0%

The table above reveals that the majority strongly agrees that women should be more involved in politics through voting among others, 64 percent of the respondents on aggregate were of this view. At epicenter level, the same trend is portrayed across all five. However, Ligowe had the highest proportion of those who strongly agreed (73 percent) while Majete had the lowest of the same (53 percent).

A similar question to the one above (whether women should be more involved in civil society was also posed. The table below analyses the survey results.

Whether Women Should be more Involved in Civil Society (Churches, NGOs) Champiti Kachindamoto Ligowe Majete Mpingo Aggregate Completely Disagree 3 10 4 12 5 7 Somewhat Disagree 4 2 2 4 2 3 Somewhat Agree 18 23 9 15 19 17 Strongly Agree 75 64 83 67 74 73 Don't Know 0 1 2 2 1 1

The table above reveals the majority felt women should be involved more in civil society; 73 percent strongly agreed to this and another 17 percent somewhat agreed on aggregate. Comparatively, the

The Hunger Project OEPP 36 June 2013 epicenters show some variances with Kachindamoto registering the lowest proportion of those who strongly agree (64 percent) then Majete (67 percent).

Attitudes about Domestic Violence Gender violence against women especially takes different forms and men beating their wives, is one such form. The survey sought to assess the respondents’ perceptions on men beating their spouse. The graph below illustrates the results of this survey question.

whether husbands beang wives is acceptable

100 90 80 70 60 Completely Disagree 50 40 Somewhat Disagree 30 Somewhat Agree 20 10 Strongly Agree 0

Figure 5: Attitudes about gender-based violence

Overall, it is clear that the communities disapprove of the act (men beating their wives), 89 percent completely disagreed to this. The trend is the same across all the five epicenters. A lot of campaigns are conducted to curb any form of GBV against women. The above results certainly reflect the outcome of these meetings.

To ascertain the above outcome, the survey sought from the respondents whether they had ever heard of such form of campaigns in their communities. THP Malawi through its HIV/AIDS and Gender Program carries out such campaigns. The graph below illustrates the results of the survey question.

Awareness of GVB Programs 89 82 81 77 Don't Know 70 61 Yes

38 No 29 23 17 19 9 1 1 2 1 0 1

The Hunger Project OEPP 37 June 2013 Figure 6: Awareness of GBV programs

From the graph above, it is evident that the majority of the respondents (77 percent) have ever heard of such campaigns. Comparing the epicenters, quite a big variance with Majete registering the least proportion of respondents who have ever heard about the campaigns at 66 percent and Ligowe registered the highest, 89 percent. Since Majete epicenter is the newest, this low figures could explain that.

Food Security & Agriculture A more detailed description of the data collected in this module is included in the discussion of the Ghana data. Based on those indicators that were deemed most sensitive, the Malawi data presents the following findings:

Katchidomodo Ligowe Mpingo Champiti Majete Average

No fruit in last 7 32% 30% 26% 38% 54% 36% days

No meet, poultry 11% 10% 10% 7% 31% 14% or fish in last 7 days

Plot size 0.91 1.66 1.2 1.2 1.8 1.35

Lease value of 3082 6084 5250 5003 9538 5791 plots

Profit value of 8936 23,159 18936 18880 22196 15023 crops land # 183 148 187 201 150 174

Health & Nutrition The overall policy goal of the Ministry of Health (MoH) of the Malawi Government (MoG) is to reduce the incidence of illness and occurrence of death in the population through the development of an effective health delivery system. The Hunger Project-Malawi works hand in hand with the Ministry of Health at district level to achieve this goal through the following:

• The Epicenter building houses a clinic and/or a maternity facility. Government of Malawi provides personnel and medicine for the facilities.

• In some cases, nurses quarters are also built, separate to the Epicenter building, allowing 24- hour emergency medical care if required.

• An out-patient dispensary stocked with necessary medications and vaccinations enables on- site or visiting clinicians to dispense required drugs, and immunize the community

• Insecticide Treated Mosquito Nets (ITNs) dispensed free to the community by the clinics

The Hunger Project OEPP 38 June 2013 The aim of this chapter is to assess outcome indicators marking improvements in the areas THP Mw intervenes in. These include accessibility to the health services, occurrence of illnesses and other public health indicators.

Walking time to Health Services (Access to health services) Access to health services in this context is defined as the percentage of households that are within 30 minutes of travel (walking on foot) to the nearest health facility (Malawi Core Welfare Indicators Questionnaire Report). The graph below illustrate time taken and distance covered to the nearest H/F by HHs interviewed respectively.

Time it takes to walk to nearest health facility 96

1 - 30 Minutes 71

43 43 38 39 36 38 31 - 60 31 32 31 27 26 26 Miniutes 17 3 2 1 > 60 Minutes

Figure 7: Distance to nearest health facility

Overall, the graph shows that 36 percent of the epicenter HHs took between a minute to 30 minutes to walk to their nearest H/F. The proportion is highly influenced by Majete that had 96 percent that walked an hour or more to the nearest H/F. Kachindamoto has the highest proportion that live within 30 minutes-walk to H/F.

At national level, a study done by National Statistics Office (NSO) in 2003 showed that only 16 percent of the rural households were within 30 minutes-walk to their nearest H/F. This shows that out of the five epicenters, one (Majete) has accessibility that is far below the national statistics of 16 percent. Excluding Majete Epicenter, overall accessibility improves further to 45 percent HHs within 30 minutes-walk to nearest HF. Thus, inclusion of HF at the epicenters has improved the rural health service accessibility by 29 percent on average.

Distance to nearest Health Facility (H/F)

To further measure accessibility, the survey also sought to find the distance the HHs cover to their nearest H/F. The graph on the right illustrates the proportion of the HHs that cover a specified distance range to the nearest H/F.

The Hunger Project OEPP 39 June 2013 Distance to Nearest Health Facility

94 Less than 77 3-Km 58 3 - 5 Km 51 45 31 33 35 6 - 15 24 25 17 21 20 Km 8 10 1 2 0 1 0 6 0 0 3 > 15 Km

Figure 8: Distance to nearest health facility

Overall, the graph reveals that 45 percent of the HHs lives within 3-Km to the closest H/F. At epicenter level, the graph shows 51 percent of Champiti HHs walk less than 3-Km revealing a big change compared to the baseline report; 100 percent of the HHs walked more than 5-Km to nearest H/F. For Majete, there was no health center within 13-km. This emphasizes the need for a health center inclusion in the construction of the epicenter underway. In a summary, the results reveal that where THP Mw epicenter has H/F, there is better access to health services than the one without H/F. This is both in terms of distance and time covered.

Type of Nearest Health facility The type of the health facility could also limit accessibility; public H/F could be more accessible than private H/F; the latter requires one to pay for the services. The survey sought to find from the HHs the type of H/F they accessed. In all its epicenters, THP partners with government’s district health office to operationalize the epicenter H/F to improve accessibility. The graph below shows the results on type of nearest H/F. stipend

The Hunger Project OEPP 40 June 2013 Type of Health Facility Accessed by HHs Members 100 100 100 90 89

Public H/F 64

36 Private H/F

10 10 0 1 0 0 0 0 0 0 0 Don't know

The graph reveals on average that 90 percent of the HHs had public H/F as the nearest and the remaining 10 percent had private H/F as their nearest. At epicenter level, Champiti had 89 percent of the HHs nearer to public H/F; 10 percent was closer to private H/F. Kachindamoto had 64 percent of HHs nearer to public HF and 36 percent to private. The other three epicenters Ligowe, Majete and Mpingo HHs had 100 percent accessing public H/F.

The results show a big change for Kachindamoto as compared to before THP Mw came to the area; the baseline report of 2007 showed 89 percent of the HHs were nearer to private HF. Relying on private HFs could limit accessibility and equity to the services due to financial aspect. Financial barriers are evident especially at CHAM and for profit private facilities where user fees are charged at the point of service delivery. This poses a serious threat to equity especially amongst the poor. This shows that the operationalization of Kachindamoto Epicenter H/F has improved both accessibility and equity with about 60 percent.

Satisfaction with Health Service Delivery

The indicator in question measured the community’s’ perception of the health services being delivered. This is a proxy indicator to accessibility; the communities could be discouraged to visit a particular H/F because they are not satisfied with services. In the survey the respondents were asked how confident they felt on the service delivery. The graph below illustrates the communities’ feelings over the service delivery.

The Hunger Project OEPP 41 June 2013 Health Service Delivery Sasfactory

77 Don't Know 63 64 64 54 56

38 Not Confident 32 29 27 30 19 17 7 7 Somewhat 3 6 1 1 1 2 2 0 0 confident

Very Confident

Figure 9: Satisfaction with health service delivery

On aggregate the graph reveals that 63 percent of the respondents were very confident, 29 percent somewhat confident, seven percent not confident, and one percent were indifferent (did not know). Out of the five epicenters, the community of Majete had the highest proportion of respondents who were not confident with the service delivery; 17 percent.

Members who Accessed Health Services in the past six Months The indicator could reflect magnitude of health problems in the epicenters or the problem; the number of the visits could signal some health problem or absence of the same. Conversely, the frequency could also reflect poor accessibility to H/F. The table below analyses the results by showing how many HHs had how many members who had a health service need in the last six months.

No. of Visits to HF in last Six Months Champiti K'moto Ligowe Majete Mpingo Aggregate # of HH # of HH # of HH # of HH # of HH # of HH Zero Members 32 16 16 43 26 133 1 Member 29 31 32 34 47 173 2 Members 18 29 28 17 20 112 3 Members 15 15 15 3 4 52 4 Members 3 5 3 2 2 15 5 Members and above 1 5 5 1 1 13

The table above reveals that overall 214 HHs did not have any member who accessed H/F; 184 HHs had one member; 65 HHs had two members; 27 HHs had 3 members; and 6 HHs had four members in need of health services.

The graph also shows Majete had the highest number of HH members that did not access HF (43 HHs). Perhaps this could be due to distance factor as discussed above; Majete communities had the furthest distance to nearest HF.

The Hunger Project OEPP 42 June 2013 Need for Health Services Need in this context refers to the reason for visiting a H/F; the survey sought to find whether one visited H/F for either illness, injury, follow ups, checkups, prenatal care, postnatal care, vaccination, or any other services. If no house hold member sought any service they indicated did not visit Health Facility. The table below illustrates the need for accessing health services.

Reason for Visiting H/F Champiti K'moto Ligowe Majete Mpingo Aggregate Illness 70 82 77 65 68 362 Injury 1 1 2 3 1 8 Follow ups 0 0 0 0 1 1 Check up 1 0 0 0 1 2 Prenatal Care 2 1 2 4 4 13 Postnatal Care 3 3 1 2 4 13 Vaccination 0 0 0 0 2 2 Other 5 3 1 3 2 14 Did not visit HF 16 11 15 23 16 81

The graph above reveals that majority of the HHs sought health services because of illness; on aggregate, 362 HHs of the respondents indicated this as the reason for visiting H/F. The other health services needs including injury; follow ups, checkups, prenatal care, postnatal care vaccination, did not have relevant demand.

Common Illness that Occurred in the HHs The graph below illustrates the results. On aggregate, the graph reveals that malaria had the most occurrences of all the diseases, (38 percent) followed by cold/cough (21 percent), then other illnesses, fever (14 percent), and diarrhea at (10 percent). At national level, the IHS3 (2010) report indicates malaria was the highest reported illness at about 43 percent followed by sore throat and flu at 12 percent and diarrhea at 10.9 percent. From the graph Ligowe and Majete toped as first and second on malaria cases 46 and 44 percent respectively were above the national statistics. In case of diarrhea, the epicenter status (save for Majete) was better off than the national level. The analysis in Water, Environment and Sanitation section in which Majete records poorly on sources of water explains the results.

The Hunger Project OEPP 43 June 2013 Illnesses that occurred at HH

Malaria 46 44 36 38 34 Cold/Cough 27 26 24 23 25 20 21 21 Fever 18 17 14 16 14 15 16 15 14 11 10 8 10 10 10 10 6 Diarrhea

Other

Malaria Cases

Malaria is endemic throughout Malawi and continues to be a major public health problem, with an estimated six million cases occurring annually. It is the leading cause of morbidity and mortality in children under age 5 and pregnant women (Malawi Demographic and Health Survey 2010). Already, the graph above shows Malaria as most common illness in the epicenter HHs. The survey sough to find number of Malaria cases a household had in the past six months. The table below illustrates the results in number of HH members affected against number of HHs.

Malaria Cases Champiti K'moto Ligowe Majete1 Mpingo Aggregate # of HH # of HH # of HH # of HH # of HH # of HH Zero cases 54 30 29 43 55 211 1 case 25 39 43 37 33 177 2 cases 14 22 12 8 11 67 3 cases 5 4 8 7 1 25 4 cases 0 2 3 2 0 7 5 and above cases 0 4 4 3 0 11

Out of the five epicenters, Ligowe, Kachindamoto and Majete in that descending order, recorded highest cases of Malaria of over 50% of the HHs while Mpingo and Champiti had lower than 50% HHs affected. The geographical locations of Kachindamoto and Majete explain the magnitude of the malaria cases. Transmission of malaria is higher in areas with high temperatures and during the rainy season (October through April), particularly along the lakeshore and lowland areas of the lower Shire Valley of which Kachindamoto and Majete fall in respectively.

Bed Net Usage

The Hunger Project OEPP 44 June 2013 The ownership and use of both treated and untreated mosquito nets is the primary prevention strategy for reducing malaria transmission in Malawi. Although THP Mw does not distribute bed nets, it advocates for bed nets usage in its epicenters as one way of reducing malaria transmission. The survey sought from the HHs to find out number of members in the household that sleep under bed net. Table below analyses the results.

Members who Slept under bed net Champiti K'moto Ligowe Majete Mpingo Aggregate # of HH # of HH # of HH # of HH # of HH # of HH No Bed net Used 3 18 35 15 8 79 1 Member 6 5 3 2 7 23 2 Members 11 12 11 18 9 61 3 Members 17 15 19 19 24 94 4 Members 17 17 11 17 26 88 5 Members & Above 44 35 20 31 26 156

The above table reveals that on aggregate, 16 percent did not sleep under bed net (those HHs did not own mosquito nets), which means that the remainder, 84 percent of the HHs own and at least a member slept in bed net. This is higher than the national level status of bed nets ownership as per 2010 Malawi Demographic and Health Survey report, which revealed that 67 percent of HHs owned a bed net.

Reading the table epicenter by epicenter, Champiti had highest bed net usage; with only three percent that did not use nets, 97 percent owned bed net and one or more members slept under bed net in proportions depicted by the table. There has been a very good partnership between THP Malawi and Ntcheu District Health Office (DHO) where Champiti is. The DHO has shown keen interest to take part in the running of the epicenter health facility compared to other DHOs. This could explain the higher net usage in Champiti.

From the above analysis, it shows that Ligowe had the lowest bed net ownership; 35 percent of the HHs did not sleep under bed nets. Second from Ligowe is Kachindamoto, 18 percent of the HHs, followed by Majete at 15 percent of the HHs without bed nets. One observation on geographical location of the epicenters, these two (Majete and Kachindamoto) are distanced from the DHO. This could have a bearing on the lower net usage.

The results in table above and in graph above show a correlation; the epicenters with highest number of HHS without bed nets had highest number of malaria cases. These epicenters are Ligowe (71 percent of Malaria cases), Kachindamoto (70 percent) and Majete (57 percent of Malaria cases).

Much as THP Mw could advocates for bed net usage through its village-based workshops, it could further reduce the infection rate in these epicenters by helping the communities source bed nets perhaps by utilizing government’s policy on ITNs. The ITN policy includes free distribution of ITNs for pregnant women at their first visit to an antenatal care (ANC) clinic, for children born in health

The Hunger Project OEPP 45 June 2013 facilities, and for children attending their first visit under the Expanded Program on Immunization (EPI), if an ITN was not received at birth.

Maternal Health Care Promotion of safe motherhood is yet another important component in the quest to achieve a poverty and hunger free community. The health care services that a mother receives during pregnancy, childbirth, and the immediate postnatal period are important for the survival and wellbeing of both mother and infant. Through its First 1000 Days Initiative Program, THP Mw aims at reducing maternal deaths and securing life of unborn child until the age of two years. This is done through advocating for prenatal and postnatal care, and delivery at health facility, exclusive breast- feeding, and PMTCT. The section evaluates all outcome indicators related to this.

Importance of Prenatal Care to Pregnant Mothers This refers to health care service that a mother receives during pregnancy. Through the Health and Nutrition Campaigns THP animators sensitizes pregnant women to access prenatal health care at H/F. The survey asked the respondents on importance for a pregnant woman to receive antenatal care from a health facility. Graph below illustrates the results.

Importance of Prenatal Care at HF to Pregnant Mother Extremely 31 Important Mpingo 24 42 1 2 44 Very Majete 24 28 Important 2 33 Important Ligowe 21 44 0 1 24 27 Kachindamoto 4 43 Somewhat 2 Important 41 Champi 26 30 0 3 Not 35 Important Aggregate 26 36 1 2

Figure 10: Perceptions about the importance of prenatal care

The graph above reveals overall that 35 percent of the respondents felt prenatal health care from H/F is extremely important for a mother; 26 percent felt it was very important, 36 percent said it was important, two percent said it was somewhat important, and one percent felt it was not important.

In Malawi, a skilled attendant is a health professional who is trained to manage normal labor and to identify and refer obstetric complications during labor, delivery, and the postnatal period. The skilled attendant is also trained to identify and refer complications in the newborn. Skilled attendant include doctors, clinical and medical officers, nurses, and midwives. A skilled attendant in Malawi is neither a patient attendant nor a trained or untrained traditional birth attendant (Malawi Demographic and Health Report, 2010). The survey sought to find form the respondents how they

The Hunger Project OEPP 46 June 2013 feel on the importance of delivering under assistance of a skilled birth attendant. The graph below reveals the community’s views on this question.

Importance of Delivering under Assistance of Skilled Birth Aendant

Not Important Somewhat Important Important

Very Important Extremely Important

47 43 45 38 36 35 37 36 32 32 30 28 29 25 27 27 25 18

1 1 0 0 1 2 1 1 1 1 1 0

On aggregate, the graph shows that majority of the communities recognized importance of the skilled birth attendants; from important to extremely important accumulatively accounts for 98 percent. Champiti had the highest proportion of those who believed the skilled attendants are extremely important.

Under-five Clinic The survey tried to assess the communities’ view on the importance of children under-five clinic attending a clinic when ill. The graph below gives the results on a scale of not important to extremely important. Overall, the graph below reveals that 32 percent and 26 percent respectively, felt that under-five clinics are extremely and very important, 39 percent.

The Hunger Project OEPP 47 June 2013 Importance of Under-five Clinic

Mpingo Extremely Important Majete Very Important Ligowe Important Kachindamoto Somewhat Champi Important

Aggregate

0 10 20 30 40 50

Exclusive Breast Feeding UNICEF and WHO recommend that children be exclusively breastfed during the first six months of life and that children be given solid or semisolid complementary foods in addition to breast milk from age 6 months to 24 months (or more) when the child is fully weaned. Exclusive breastfeeding is recommended because breast milk is uncontaminated and contains all the nutrients necessary for children in the first six months of life. The survey sough to find form the respondents what they feel is the optimal period for breast feeding. The graph below illustrates the responses in percentages.

Period for Breast Feeding Not Important 62 64 64 62 59 1 - 4 Weeks 47 43 4 - 8 Weeks 35 33 32 35 28 At least 4 Months

At least 6 Months 6 4 4 1 1 2 1 0 2 2 1 0 0 2 2 0 0 1 3 0 2 0 1 0

Figure 11: How long a baby should be exclusively breastfed

On average, 59 percent and 35 percent felt that at least six months and more than six months are optimal period for breast feeding in that order; while one percent was for at least four months; two percent was for four to eight weeks another one was for one to four weeks period, and one percent felt breast feeding was not important.

The analysis above reveals that majority of the HHs recognizes the optimal period of breast feeding, which according to WHO and UNICEF is first six months; 59 percent indicated this period. It therefore

The Hunger Project OEPP 48 June 2013 leaves some work for THP Mw to teach the HHs of the optimal period for breast-feeding through the First 1,000 Days Initiative Program.

HIV &AIDS

THP Malawi’s HIV &AIDS Program aims at achieving increased HIV/AIDS awareness on prevention, HTC, and provision of support services for people infected and affected by HIV and AIDS, and to reduce the vulnerability of adolescent girls and women to the same. Through its trained HIV &AIDS specialized animators, THP Malawi strives to achieve the above. The animators conduct village- based workshops on the aforementioned issues to raise awareness on HIV and AIDS-related knowledge among the communities; risk behavior modification; promotion of condom use (especially female condoms); provision and uptake of HIV counseling and testing; and access to care and antiretroviral therapy (ART), including prevention and treatment of opportunistic infections. The principle objective of this chapter is to show the level of outcomes resulting from THP’s efforts on HIV &AIDS.

Awareness on HIV&AIDS On this indicator, the aim was to establish the community’s level of knowledge on HIV &AIDS. Knowledge about AIDS is vital not only in the fight against spread of HIV&AIDS but also providing support to infected individuals. The graph below illustrates the results in proportions of each sex on the knowledge.

Awareness of HIV/AIDS

100% 100% 100% 97% 97% 99% 98% 96% 95% 93% 94%

85% Men Men Men Men Men Men Women Women Women Women Women Women Champiti K'moto Ligowe Majete Mpingo Aggregate

The graph reveals a lower knowledge about what HIV &AIDS is in women than men. Overall, 94 percent of women and 98 percent of men expressed that they knew what HIV/AIDS is. The situation is least in Kachindamoto where only 85 percent of the women had the knowledge. At national level, it is reported that 99 percent of women and men in Malawi have heard of AIDS (Malawi Demographic and Health Survey [MDHS] 2010). This shows overall THP Mw epicenter communities have almost a similar level of awareness on HIV to the national level.

The Hunger Project OEPP 49 June 2013 Knowledge of HIV Prevention The indicator measures what behaviors the community thinks are ways of preventing contacting HIV. The HIV & AIDS specialized animators through village-based HIV & AIDS workshops disseminating facts and addressing cultural-based myths about the disease and use of condom, among others.

Knowledge on Prevention

90% Abstain from sex 80% 70% Use condom 60% consitent 50% Limit sex to one 40% partner 30% Avoid injections 20% 10% 0% Other

Nothing

The graph shows that the communities felt abstinence from sex is the most ideal way of HIV prevention. Overall, 76 percent expressed this. Consistent use of condom came second with 40 percent.

Eighty-six percent at national level men consider that limiting sexual intercourse to one, uninfected HIV negative partner could reduce the chances of contracting HIV. Seventy-two percent almost believed that consistent use of condoms prevents the spread of HIV. From the graph, all the epicenters are below the national statistics (MDHS 2010).

On others, some felt use of condoms with high-risk partners only, avoid kissing and avoid blood transfusion as other ways of HIV & AIDS prevention.

In summary of this, THP Malawi ought to put more effort on awareness campaigns.

SOURCE OF INFORMATION ON HIV Access to information is one important aspect in both prevention and providing support and care to the HIV &AIDS infected individuals. The HH survey asked the respondents where they go to for HIV &AIDS information. The table below shows the results.

Important Source of Information on HIV &AIDS Champiti K'moto Ligowe Majete Mpingo Aggregate Govt. Health Care Workers 46 55 56 34 54 49 HIV&AIDS Animators 26 10 22 10 22 18 Community Health Workers 0 14 19 11 18 12 Private Health Care 7 4 3 0 2 3 Friend/Neighbor 5 2 4 0 3 3 Others 11 8 14 6 7 9 Nowhere 16 19 16 28 16 19

The Hunger Project OEPP 50 June 2013 The results in table above reveal government health care workers are the most reliable source of HIV &AIDS information; 49 percent of the respondents indicated so. The specialized HIV &AIDS animators come second (18 percent). The animators were most important source in Champiti where 26 percent indicated so and they were relatively least relevant across all epicenters in Majete (10 percent). For Majete, which is relatively new, the proportion is satisfactory, however in the other epicenters the animators ought to be more visible than the other sources.

Condom use as means of preventing HIV/AIDS Condom use is one of the preventive measures being advocated for. THP HIV &AIDS animators through village based workshops advocate for the use of condoms, with much emphasis on female condoms. The indicator here aimed at measuring the extent to which the female condom and condom use in general has penetrated.

Always Most of the times Never Not Applicable Rarely Sometimes Women Men Women Men Women Men Women Men Women Men Women Men Champiti 1 4 4 0 63 65 15 4 1 15 15 12 Kachindamoto 1 0 2 0 53 79 18 0 7 7 18 21 Ligowe 1 8 0 0 59 67 23 4 3 8 15 13 Majete 0 2 5 7 63 77 14 5 5 5 12 5 Mpingo 0 3 0 4 50 67 22 11 3 0 19 15 Aggregate 1 3 2 2 57 71 19 5 4 7 16 13

The results show low condom usage among both sex across all epicenters. Champiti, Kachindamoto, and Ligowe show each has only one percent of women consistently using condoms and 0 for Majete and Mpingo.

Although all epicenters experience inconsistent supply of condoms from the District Health Office (DHO), the results above do not reflect the monthly condom distribution outputs which go as high as 3,500 condom uptake a month; the outputs are higher than reflecting in the survey. The interpretation to the low condom use could be two fold. Firstly, the survey being household, interviewed married respondents mostly, a group that might rarely on not need condoms if they have faith in each other. Secondly, the animators’ condom clientele is small; there is need to widen it.

The results for the question on more preferred type of condom is in graph below. The graph shows male condom has higher demand than female and by both women and men across all the epicenters but Majete; more men, 13 percent against eight percent of women prefer female condom.

Promotion of female condom use and general increase of condom use is thus an area that needs improvement for THP Mw’s HIV &AIDS and Gender program.

The Hunger Project OEPP 51 June 2013 Condonm Type Preference Male Condom Female Condom

100% Men 0% 80% Mpingo Women 20% 87% Men 13% 92% Majete Women 8% 100% Men 0%

Ligowe 100% Women 0% 100% Men 0%

moto Women 96% Kachinda 4% 100% Men 0%

Women 94% Champi 6%

Figure 12: Preference of condom type

Condom Sources Where the communities access condoms was of some importance in the study. The HIV & AIDS specialized animators are also agents of condom distribution. Through this survey’s question, it is revealed how important the animators are in condom distribution. The graph below shows the outcome. Overall, health facility was the main source of the condoms. However, at Mpingo the HIV &AIDS animators emerged as most important; 52 percent of the condom users accessed the condoms from them (animators).

Condom Sources 62% 63% 64% Health Facility 52% 48% 38% 35% 30% HIV/AIDS Animators

18% 15% 16% 10% 12% 7% 8% Supermarket 3% 6% 6% 6% 0%

Other

Figure 13: Where community members are accessing condoms

Access to HTC

The Hunger Project OEPP 52 June 2013 The village-to-village base workshops also campaigns for partners to access HTC. The intended outcome is to see an increase in the number accessing the service. The outcome indicator in question was to measure this extent. The graph below shows women and men that accessed HTC before.

Propoon of Partners that had ever Accessed HTC Women Men 96% 89% 87% 89% 82% 86% 71% 71% 67% 66%

Figure 14: HTC Access

The graph shows that Mpingo and Ligowe epicenters had more men that accessed HTC (87 percent - women against 96 percent - men in Ligowe and 86% - women against 89 percent -men for Mpingo).

Water, Environment & Sanitation The section analyses the survey’s findings on water, sanitation and environment. THP Mw through its Water, Environment and Sanitation (WES) Program, sinks boreholes, and supports tree planting. The survey assessed indicators on availability of portable water, use of sanitary latrines and perceptions about the environment.

Types of Toilets Used The survey sought to find what sort of toilets the communities used. The findings reflect indicators of good sanitation in the communities. The responses expected to the question were: pit latrine, community toilet, ventilated improved latrine (VIP), and no toilet at all. The graph below illustrates aggregated proportions of HHs that use a particular type of toilet for all five epicenters.

The graph shows that 82 percent of the HHs used pit latrine, seven percent used community toilet; two percent used VIP toilets, and nine percent had no toilet. At epicenter level however, there is some variations in the types used.

The Hunger Project OEPP 53 June 2013 Types of Toilets Used

Pit Latrine 90 80 70 60 Community 50 40 Toilet 30 20 VIP 10 0 No Toilet

Access to Drinking Water Sources A household is considered to have access to safe drinking water if the source of water is piped into dwelling, piped into yard or plot, communal standpipe, protected well in yard or plot, protected public well, borehole only in rural areas, tanker truck or bowser and bottled water7. The survey sought to find where the communities drew their drinking water in the past one month prior to the survey. The pie chart below shows overall proportions of the sources of water in a month prior to the survey.

HH's Source of Drinking Water Shared or communual tap 5% 1% Tap piped into dwelling/Yard 10% 6%

10% Well or borehole

Rivers/ponds

Protected Well 68%

unprotected well

The pie chart reveals that 68 percent of the HHs fetched their drinking water from well or borehole; 10 percent used rivers or ponds; another 10 percent used unprotected wells; six percent fetched its water from protected well; five percent got its water from tap piped yard; and one percent from shared or community taps. Accumulatively, using the definition above, about 78 percent of the HHs had access to improved water sources. This is just one percent lower to the national status; about 79 percent of HH in Malawi have access to improved water source.

7 Integrated Household Survey 2010 Report

The Hunger Project OEPP 54 June 2013 However, at epicenter level, the results shows variance; some have proportions in one source predominating than other sources. The graph below reveals the results.

Source of Drinking Water Shared or communual 100 tap 90 80 Tap piped into 70 dwelling/Yard 60 50 Well or borehole 40 30 20 Rivers/ponds 10 0 Protected Well

unprotected well

From the graph above, Champiti had almost 100 percent of HH with access to improved water sources (55 percent from taps, and 44 percent on borehole/well). Compared to the baseline results, the present results show a drop in proportion of HHs that used taps from 69 to 55 percent; borehole increasing from 14 percent at baseline to 44 percent. It however shows improvement from 83% having access to safe drinking water to now 100 percent.

Majete had the lowest accessibility to improved water sources; only seven percent had access to boreholes. The majority of the HHs (53 percent) relied on rivers/ponds as main source of water; 39 percent relied on unprotected wells; seven percent on borehole or well; and two percent on protected well. At the time of the survey, the epicenter had one functional borehole provided by the government; this was same situation at baseline; about two percent had access to safe water at baseline.

Treatment of Drinking Water The graph below reveals on aggregate that majority (60 percent) of the HHs do not treat their drinking water before consuming it. It is also revealed 19 percent of the HHs used iodine or other minerals to treat their drinking water; 13 percent filtered and boiled the water; eight percent just boiled the water and almost zero percent treated it using solar.

At epicenter level, proportion of HHs not treating the water dominated, however some epicenters had less proportion than others.

The results show how at-risk most of the HHs could be to waterborne diseases by consuming water not treated. Those most at-risk HHs are those that relied on unimproved water sources. Thus, Majete communities were at highest risk owing to the fact that the Majority fetched its water from rivers/ponds. THP Mw’s Water and Sanitation Program could reduce this if more boreholes were drilled in those epicenters with less access to safe drinking water

The Hunger Project OEPP 55 June 2013 Treatment of Drinking Water

90 80 70 No Treatment 60 50 40 Idone/other 30 minerals 20 Boiled 10 0 Filtered & Boiled

ENVIRONMENT THP Mw implements a Program in the epicenters that helps sustaining the environment through promoting afforestation and reforestation and promoting modern farming technologies that increase production per unit area. The survey assessed how much the communities are concerned with degradation of the environment.

Concern on Climate Change Climate change is one of the contemporary issues affecting development. It is a crosscutting issue; it affects food production, gender and health and nutrition among others. Knowledge about it and taking action are vital in curbing it. The survey sought the community’s perception on climate change; the question asked was how much they are concerned with global warming/climate change. The responses were either very concerned, concerned, somewhat concerned, not sure and not concerned. The graph below shows the proportions of the communities across the five epicenters on each of the responses.

The graph reveals that 40 percent of the community was very concerned; 44 percent was concerned; five percent was somewhat concerned; another five was not sure and six percent was not concerned at all with the issue of climate change.

The Hunger Project OEPP 56 June 2013 Proportions of HH Concerned with Climate Change

47 46 47 Very Concerned 43 44 43 43 45 38 40 40 31 Concerned

Somewhat Concerned 11 10 6 8 7 7 6 6 3 4 5 3 5 5 5 Not Sure 0 2 1

Not Concerned At All

Figure 15: Households concerns about climate change

The results above show the majority is concerned with the climate change issue. However, there is need to sensitize the community on evils of climate change, how it is contributing negatively to their health, food production and socioeconomic growth as whole. The fact that there is some proportion in the communities that is not sure or not concerned about climate change calls for some action to be done to raise awareness in this group of individuals. THP’s could embark on sensitization of the same in its village-based VCA workshops.

Deforestation The survey sought to find how much the communities in the epicenters are concerned with deforestation. The responses aggregated for all epicenters have been analyzed in graph below. The graph reveals that 42 percent of the community was very concerned with deforestation; 45 percent was concerned; six percent somewhat concerned; two percent was not sure; five percent was not concerned at all.

Proportions of HHs Concerned with Deforestation

60% Very Concerned 50% 40% Concerned 30% Somewhat 20% Concerned

10% Not Sure 0% Not Concerned At All

The Hunger Project OEPP 57 June 2013 The results above just like for climate change, are calling for more action in the conservation of the environment. Although the majority is concerned, there is still need to sensitize the community on the importance of the forests. There is need to create industrious communities in businesses that sustain the environment; that do not endanger the environment. THP Mw should make deliberate efforts to change people’s mind on charcoal burning for instance.

Livelihoods & Microfinance The survey aimed at assessing the extent to which THP Malawi’s Microfinance Program has managed to transform the community in terms of access to credit loans, influencing non-agriculture businesses, and saving culture. The section presents details on accessibility to credit loans, proportion of households in off-farm economic activities and savings made.

Access to Credit Loans As pointed above, one of the objectives to the MFP is to provide access to credit loans. The graph below analyses the results on the survey that sought to find the proportion of HHs that had accessed THP’s credit loans.

The graph below reveals that on aggregate 21 percent of the HHs in the five epicenters had accessed THP credit loans. The results are far much better compared to national level. The results from IHS3 indicate that in Malawi about 14 percent of the households had some interaction with the credit market, eight percent of whom successfully obtained at least a loan, five percent of the households tried to get a loan in the last 12 months but were turned down and two percent are still waiting for a response on their loan applications.

At epicenter level, there is a big variance; Majete and Kachindamoto compared to the rest of the three epicenters had lower proportion of HH that had not accessed a credit loan (this could be because these are the two newest epicenters); five percent and 13 percent respectively. The age of these two epicenters could be an explanation to the trend; the two are relatively new. Compared to baseline survey at Majete, only three percent had accessed before THP Malawi came into the area.

Proportion of HH that Accessed THP Loans

35% 30% 25% 20% 15% 10% 5% 0%

The Hunger Project OEPP 58 June 2013 Savings The survey ought to find out the proportion of the HHs that made some savings with THP rural banks. The graph below illustrates proportions of the HHs that had made savings.

Proporon of Members Per HH that saved with THP Rural Bank

92% 95% 89% 86% 85% 86% Zero Members

One Member

10% 12% 13% 11% 8% 5% 1% 2% 0% 2% 0% 3% Two Members

From the graph it is evident enough that a small proportion of the HH in all epicenters had saved with THP rural banks; on aggregate, a total of 10 percent and one percent had one and two members respectively that saved with the rural banks. At epicenter level, Ligowe led with 15 percent (13 plus two percent) of HHs that had saved seconded by Champiti at 14 percent (12 plus two percent); then Mpingo at 13 percent (11 plus three percent); Kachindamoto on fourth with eight percent and Majete last with five percent. There is need to do more mobilization on savings (especially Kachindamoto and Majete to graduate the epicenters to government recognized.

Proportion of HH Engaged in Non Agricultural Economic Activities The indicator reflects how much the MFP has influenced businesses that are not agricultural based. The graph below illustrates proportion of HHs in all the five epicenters engaged and not engaged in non-agricultural economic activities.

The Hunger Project OEPP 59 June 2013 Proporon of HHs Engaged in Non Agricultural Economic Acvity

78% Yes 60% 55% 57% 57% 45% No 43% 40% 43%

22%

The graph reveals Champiti had 55 percent of the HHs that were in non-agricultural economic activities. Kachindamoto had 43 percent; Ligowe had 40 percent; Majete had 22 percent; and Mpingo 43 percent. Thus, the HHs did not rely on only farming; they have diversified their source of income. The more the HHs are involved in off-farm activities, could imply more impact of the MFP has had on the communities.

Main Source of Income at HH The table below illustrates the proportion of HHs against their source of income. Each source of income has frequency of HH and what proportion the frequency is of the total number of HHs at the epicenter.

HH Main Source of Income in Proportions of the Households Aggregate Champiti Kachindamoto Ligowe Majete Mpingo Crops & Vegetable Sales 40 42 32 40 51 33 Livestock Sale 5 7 2 6 8 2 Labour 24 15 30 26 25 25 Natural Resources Extraction/Sale 3 6 2 0 1 5 Trading Handcrafts/Carpentry 2 4 2 1 0 2 Artisanal Services (Sewing) 0 0 0 1 1 0 Remittances 3 1 3 3 2 5 Other Sources (Business) 20 20 27 22 8 22 Other Sources (Non-Business) 3 4 3 1 4 5

The table reveals that crops and vegetable sales was the main source of income across all epicenters with aggregate of 40 percent while offering labor services came second; 24 percent. A proportion 20 percent relied on other sort of businesses, while the rest relied on livestock sales (five percent); natural resource extraction/sale and remittances from relations had three percent each, while trading handcrafts/carpentry, accounted for two percent.

Asset Acquisition

The Hunger Project OEPP 60 June 2013 Asset acquisition could indicate progress out of poverty. The survey sought from the HHs if they possess any of the listed assets in the table below. The table shows proportion of the HHs that had that particular asset.

Lantern Bicycle/ Chair/sofa Hifi/CD Pressing Iron motorbike player Champiti 67 48 48 34 29 Kachindamoto 65 57 14 15 6 Ligowe 67 26 45 26 16 Majete 47 59 37 23 6 Mpingo 69 26 58 25 23 Aggregate 63 43 40 25 16 National Level (Rural) N/A 40.6 33 3.9 8.7

The table above reveals a lantern was the most common asset, on aggregate 63 percent had at least one. The second common asset was a bicycle; 43 percent then a chair as third: 40 percent; followed by Hifi/CD player with 25 percent and lastly, pressing Iron, 16 percent. Compared with the national statistics (shaded in green), the epicenters showed a higher asset acquisition proportion in all the four assets applicable.

Expenditure of HH Incomes The survey sought from the households to see what they spend their income on. The table shows a particular product and how many HHs had access to such a product.

What HHs Spent their Moneys on in the Past Year Aggregate Champiti Kachindamoto Ligowe Majete Mpingo Clothes/Shoes 58 57 52 58 56 66 Consumable Durables 25 15 24 32 25 29 School fees/supplies 22 14 14 27 25 33 Buying Assets for 14 16 14 17 13 11 Farming Buying Assets for 5 4 3 5 3 8 Business Social Events 8 14 7 9 4 8 Drinking Alcohol 6 4 9 7 3 7 Housing Costs 10 7 6 15 8 12 Medical 5 5 8 7 1 4 Travel 2 3 2 4 0 1 Charitable Donations 0 0 1 1 0 0 Other 16 15 14 19 18 14 Don't Know 3 1 3 2 4 6 No Extra Money 19 18 26 15 22 12

The table above reveals the products that most HHs spent their money on in the past year. The table shows that clothes was the most product that HHs spent their money on with an average of 58 percent, then followed by consumable durables with an average of 25 percent and school fees/supplies at 22 percent.

The Hunger Project OEPP 61 June 2013 School fees/supplies as one of the top three expenditures reflects how youthful the population is as analyzed in Household Characteristics Section above. The dependence age groups is predominantly in 0 to 14 age cohort which is a school going age.

Literacy & Education THP Malawi runs two educational Programs namely: adult literacy (ALP) and nursery. Adult literacy is seen as a necessity for people to conduct a basic business, and is therefore a pre-requisite for participation in THP Mw’s Micro Finance Program, while nursery school relieves the parents of the duty looking after their kids; they instead concentrate on socioeconomic activities in a way improving their livelihoods. The OEPP assessed THP Mw’s education Program in terms of enrolment and accessibility.

Adult Literacy The Survey defined adult literacy as the ability of a person aged 15 years or more to read and write a simple statement in any language. This is in accordance with the UNICEF definition of adult literacy. THP Mw runs a Program on Adult Literacy (ALP) in all eight epicenters to improve literacy in the rural communities. The classes are in the selected villages. The survey ought to find out whether or not the respondents know of any ALP class in their village or nearby. Graph below shows the results on this survey.

Availability of ALP Class Don't Know 81 75 61 60 59 55 No 38 41 32 35 22 19 In nearby Community 5 2 1 2 4 1 0 0 2 1 4 0

Yes

The graph reveals that on average, 61 percent of the HHs were aware of an ALP class in their village; five percent was aware of ALP classes in the nearby community, 32 percent lived neither in villages with ALP nor nearby a village with ALP, and two percent did not know of any ALP.

At epicenter level, the graph reveals Kachindamoto had the lowest awareness of ALP (35 percent). This could be because the ALP had just rolled out in the epicenter during the time of the OEPP.

Adults Attending ALP Classes Of more importance than just having or knowing about APL classes is the actual participation in these classes as learners to those who are illiterate. The graph below shows the results in proportions.

The Hunger Project OEPP 62 June 2013 The graph reveals 84 percent of the HHs had no members attending ALP classes; 15 percent had one member and one percent had two members attending ALP classes. But going epicenter by epicenter there is a variation with some epicenters having higher proportions of attendance in ALP.

Propoon of Adults Aending ALP Classes

96 99 None 84 80 83 64 One

Two 32 15 18 17 1 4 4 0 2 1 0 0

The graph reveals Majete and Kachindamoto had lowest proportions of HHs accessing ALP, (one and four percent respectively). This was slightly higher for Kachindamoto from zero during baseline and no improvement for Majete. Champiti on the other hand, had 32 percent of members attending ALP classes, highest of all the epicenters. The two epicenters Majete and Kachindamoto had the not rolled out ALP at the time of the survey. This could explain the results. The lower proportion of HHs with members in ALP classes in Mpingo and Ligowe could perhaps mean with more years of implementation of the Program, more adults have attained literacy, hence need has relatively decreased.

Nursery School The table below shows proportion of the five epicenters of HH that had children that attended nursery school.

Proportion of HH that at ever sent a child for Nursery Education

Aggregate Champiti Kachindamoto Ligowe Majete Mpingo None 57 51 58 39 100 40 one child 29 39 38 29 0 37 two children 11 9 3 25 0 18 three children 2 2 0 3 0 5 Four children & above 1 0 0 4 0 0

On aggregate, there were more HHs had children that had not enrolled for nursery school; 57 percent of HHs indicated so. At epicenter level however, Majete recorded zero percent of those that had not attended nursery school; thus 100 percent of the HHs had no child that ever been to a nursery school. Ligowe on the other hand had the highest proportion of HHs that had nursery

The Hunger Project OEPP 63 June 2013 school-going children 61 percent on aggregate of the HHs had one, two, three or four children that ever went to nursery.

The results show correlation between age of the epicenter and proportion of HHs with children in or out of the nursery school. The enrolment is higher in older epicenters and vice versa. The enrolment is highest in Mpingo, followed by Ligowe, Champiti, Kachindamoto and Majete, which has zero enrolment. This reveals how important the epicenter nursery schools are in providing access also the impact of the VACs that campaign for the same.

Time it takes to walk to Nearest Primary School 1 - 30 min 84 83 69 63 59 54 31 - 60 35 Min 23 26 23 23 16 16 11 8 6 1 0 More than 60 Min

Accessibility

Children have access to school if they live within 30 minutes of travel the nearest school using whatever means of transportation. Access is defined as the percentage of children in households that live within 30 minutes of travel to their school (Malawi Core Welfare Indicators Questionnaire 2002). The graphs below illustrate the results in percentage of time taken to nearest primary and junior high school respectively.

For primary school, the graph reveals that on aggregate, 69 percent of the HHs live within 30 minutes-walk to the nearest primary school; 23 percent lives 31 to 60 minutes away from the nearest primary and eight percent lives more than one hour away. Thus, overall, 69 percent of the epicenters’ HHs have access to primary education with Kachindamoto and Mpingo topping the list (84 and 83 percent respectively); followed by Champiti (63 percent) and Ligowe (59 percent). The graph reveals Majete has the lowest accessibility of the five epicenters with 54 percent.

The graph below on accessibility to junior secondary school reveals that on aggregate 28 percent of the HHs are within 30 minutes-walk to their nearest junior secondary school, 22 percent are 31 to 60 minutes away, and 49 percent are beyond one hour-walk.

At epicenter level, Majete has the worst accessibility to secondary education with 98 percent HHs living more than one hour away from the nearest secondary school. Mpingo on the other hand has the highest proportion of HHs within 30 minutes to nearest secondary school, 51 percent, followed by Ligowe with 46 percent, Kachindamoto at 29 percent and Champiti (14 percent).

The Hunger Project OEPP 64 June 2013 Time it Takes to Walk to Nearest High Junior School 98 1 - 30 min

58 31 - 60 51 49 48 46 Min 37 28 28 29 22 23 23 26 17 14 More 0 2 than 60 Min

Availability of Necessary School Resources to Children at HH level Assessing availability of resources such as textbooks is equally important to accessibility of education. These resources will determine quality of education the children undergo. The survey sought from the HH respondent whether their kids in school had all necessary materials for school or not. The chart below illustrates proportion of HHs with or without enough of these school resources for the kids.

Proporon of HHs with Necessay School Resources ( E.g Text Books) Have Some but not all No, Have None Yes, Have all Material

12%

31% 57%

Figure 16: provision of school materials

The aggregated data shows in the above chart reveals that 12 percent of the HHs had all necessary material necessary for the school-going kids; 57 percent had some but not all and 31 percent had not one necessary material. The results show that more HHs had some school materials but not all across all the epicenters; thus there is need to supplement for the deficit.

At epicenter level, the results have not varied from one epicenter to the other; the graph below shows the proportions for each epicenter.

The Hunger Project OEPP 65 June 2013 Proporon of HH with Necessary School Material

Yes, Have all 7 9 7 21 15 Material 11 35 38 32 37 No, Have None

68 52 58 54 55 Have Some but not all

From the graph Champiti Epicenter had 21 percent of the HHs with all material; 68 percent HHs had some but not all, and 11 percent had no school material for the kids. Kachindamoto had 15 percent HHs with all material; 52 percent HHs with some but not all material, and 32 percent that had no material.

Ligowe had seven percent of the HHs with all school material, 58 percent with some but not all material, and 35 percent without any material. Majete had nine percent HHs with all necessary material, 54 percent with some but not all and 37 percent had none. Mpingo shows it had seven percent of the HHs with all material; 55 percent with some but not all material, and 38 percent with none.

The above results affirm the importance of having an education resource center (library) as one of the features on the epicenter building. The libraries that are well stoked could supplement the deficit in school material to school-going-children. This calls for THP Mw to equip the libraries with prescribed textbooks.

Household Expenses on School The survey sought to find how much a household spent on its kids to cover school expenses in the last school year. The HH respondent was asked to give on average how much money the HH spent during the last school year. The expenses were to include uniform, supplies, books, and fees. Table below illustrates the results in proportions of HHs that spent a specified amount.

Expenses on School Aggregate Champiti Kachindamoto Ligowe Majete Mpingo Less than K500 9 6 12 12 15 3 Between K500 - K1000 14 8 22 13 18 15 Between K1000 - K2000 18 12 31 16 11 22 Between K2000 - K5000 21 15 20 28 18 25 More than K5000 22 15 14 29 27 32 Don't Know 3 1 2 3 7 2 N/A 13 42 0 0 4 2

The Hunger Project OEPP 66 June 2013

On average, the table reveals that nine percent of the HHs spent less than MK500; 14 percent spent between MK500 and MK1000; 18 percent spent MK1000 to MK2000; 21 percent spent MK2000 to MK5000; and 22 percent spent MK5000. The trend as illustrated by the table above is that the proportion of HHs is increasing with the increase in the cost incurred.

In conclusion of this section, THP Malawi through ALP and nursery school programme has had a positive impact on the accessibility to literacy and early childhood education respectively. However, this is true in some epicenters and not others. There is still need to campaign for adult literacy education as a better proportion still remained illiterate. The bigger proportion of 0 to 10 years age group of the dependence ratio led to HHs spending more on education.

SNAPSHOT OF THP-GHANA DATA (by Module)

Household Demographics & Dwelling Characteristics

Household Size The number of people in a household has direct bearing on the level and incidence of poverty and hunger especially among the vulnerable such as children in rural settings. Research indicates that small household sizes are better able to meet and provides for their basic needs such as food, clothing and shelter than large size household. The chart below (Figure 2) reveals that majority (55%: 274) of the households surveyed had between three to six persons per household, 15% had one or two children while 25% had larger household size of between seven and ten persons. Only 1% of the surveyed households had between 11 and 14 household members. The findings are not unexpected as in Ghana most rural communities tend to have large family sizes.

3 13 6 5 11 5 17 9 26 40 7 43 70

Household size 5 78 71 3 55 47 1 35 0 10 20 30 40 50 60 70 80 90 No. of Household Surveyed

Education level of Head of Household A look at the educational background of the heads of household surveyed showed that 24% (121 HH) had the equivalent of a Junior High School education (JHS) while 25% (124 HH) had no formal

The Hunger Project OEPP 67 June 2013 education at all (Figure 45). Nearly 19% had only some primary education (incomplete) while 9% completed primary education; 13% also entered JHS but could not complete while only 1% completed secondary education. Also only 1% of the respondents had vocational and tertiary education. The study also shows that nearly 9% of households surveyed had no female head. This was not surprising as is expected in Ghanaian cultural and socially norms that males head most households.

Head of Household's Educaon Level

0% 1% Univ/Terary 1% 9% Junior High Sch

24% Primary Sch Secondary Sch

19% No Formal Sch

Pre-school/Kinder 6% Some JHS

Some Prim Sch 1% 13% Some Sec Sch

25% Technical/Voc

1% No Female Head

Number of children in Household aged 0-12 years The study indicated that 26% (103) households had one child, while 25% (100) had two children. Also 26% (105) of households had between 3 and 4 children in their homes, while a less significant number of households, 7% had a relatively high number of children ranging from 7 to 12 children. The chart (Figure 4) also showed that 18% (75) households did not have children at the time of the survey.

120 103 100 100 75 78 80 60 40 27

No. of Households 20 6 3 3 2 0 0 1 2 3 4 5 6 9 12 Age of Children

Gender of Primary Respondents

The Hunger Project OEPP 68 June 2013 As depicted in the chart below, the study results showed that more females made up of 270 (55%) than males 218 (46%) constituted the proportion of primary and secondary respondents in the households surveyed by gender. This results is consistent with that overall sex ratio of Ghana which indicates there are slightly more females than males.

Gender Composition of Households

The study reveals that there were more females made up of 55% (270) than males 45% (218) in all the households surveyed. In terms of relationship of other household HH Gender Composition members to the primary/secondary respondents, majority (442) were primary respondents, followed by sons/daughters of primary Male respondents (139); 53 were spouses 45% of the primary respondents while 30 Female were grandsons/granddaughters to 55% the respondents. The latter brought to light the practice of fostering of children by extended-family members, which is quite common in Ghana although reliable regional data on is this not readily available. It is estimated that 19% of Ghana households include fostered children less than 18 years of age made up of mostly girls who are used for child labor and performing of domestic work at the expense of their education and development (MoWAC & UNICEF, 2011). Other members of the household with insignificant presence were siblings (9), parents (9), and nephews/nieces among others. Relaonship to Primary/Secondary Respondents 600 442 400 139 200 30 53

No. of People 9 3 1 9 1 5 4 5 0

Age of Household Membership Surveyed At the aggregate level, 701 respondents’ data were captured across the 501 households surveyed. Most of the household members surveyed were between the ages of 30 and 60 years 49% (339). Children aged below 20 years constituted about 20% while the aged 60 years and above made up of 21% (137) of household composition. Given that in total the proportion of children (below 20 years) and the aged (60 years and above) would make up of 41% of household composition in the surveyed epicenters poses serious challenges for the provision of the basic needs of these category of people

The Hunger Project OEPP 69 June 2013 with its consequences on productivity and high dependency ratio for the energetic and working class, most of whose livelihood depended heavily on agriculture.

Age of Household members

Age Group Frequency Per cent

0-9 78 11.1 10--19 65 9.3 20-29 82 11.7 30-39 100 14.3 40-49 109 15.5 50-59 130 18.5 60-69 68 9.7 70-79 53 7.6 80-89 11 1.6 90+ 5 0.7 TOTAL 701 100.0

Ownership of Home Respondents answered two questions that sought to find out about ownership of the house in which they live. The study reveals majority of the respondents live in their own home constituting 81% (404 HH); 11% live in a borrowed (no payment) accommodation, while 10% (32) live in rented accommodation. About 6% of households did not fall under any of the listed categories.

RENTED 32

OWNED 404

OTHER 10

BORROWED( NO PAYMENT ) 54

Type of House Ownership 0 50 100 150 200 250 300 350 400 450 No. of Households

Main lighting source for Household The main source of lighting for the survey households comes from the national electricity grid (ECG) for 190 households (38%); this is followed by other lighting sources such as touch light/LED lights for 150 households (30%). The study also shows that 26% of the households use candles/lanterns while a small proportion uses solar and private generator sets.

The Hunger Project OEPP 70 June 2013 ECG 5 (1%) 21 ( 4%) Fire lit scks 190 (38%) 150 (30%) Lanterns/ candles Other

129 ( 26%) Private generator

5 (1%) Solar power

Figure: Main source of lighting

Main source of cooking fuel The research shows majority of households (85%) use collected firewood as their main fuel for cooking. The next option is charcoal (11%) followed by purchased firewood (3%) biogas (1%). An insignificant proportion of the households less than 1% of the sampled survey use electricity for cooking.

This finding shows that more people, especially in the rural communities of Ghana, continue to rely on charcoal and firewood for cooking fuel. This has negative consequences for the environment as more trees are cut and burned in an unsustainable manner leading to deforestation.

Charcoal Collected Firewood Electricity Biogas 0% 1% 3% Purchased Firewood 11%

85%

Figure: Main source of cooking fuel

Type of Rooftop material for houses

The Hunger Project OEPP 71 June 2013 Using observation, enumerators recorded that the majority of the households live in homes whose rooftop is mainly corrugated metal (97%), followed by thatched/vegetable materials (2%) and other materials such as wood and sheeting materials.

Disposal of household waste Improper disposal of waste can have implications for health including outbreak of cholera and other infectious diseases, especially for the vulnerable such as the elderly and 294 children. The aim of soliciting 300 household waste disposal 250 information is to find out risk to 200 health and environment. From the 150 92 chart, about 59% of households (294 100 55 54 HH) use public garbage sites for the 50 2 1 1 No. of Households disposal of solid waste, while 18% 0 also indicated dumping their garbage material at nearby vacant land/property while an equal proportion of 11% either burned/buried or have their own garbage pit for disposal of waste. Other insignificant modes of disposal used are collection by local authority Desnaon of Garbage Disposal and private firm among others.

Community Mobilization & Leadership Comfortable speaking out about infrastructure development? Banka Kyempo Nkawanda Nsuta - Odumase - (148) (146) (131) Awaregya(127) Wawase (128) F M F M F M F M F M No, not at all 19 3 7 7 9 1 6 1 8 1 comfortable Yes, but with a great 5 1 4 4 2 2 5 1 3 2 deal of difficulty Yes, but with a little 10 4 4 4 10 1 8 2 5 0 difficulty Yes, fairly comfortable 16 15 21 21 22 5 18 5 19 10 Yes, very comfortable 30 45 37 37 44 35 38 43 48 32

Community Mobilization and Leadership are the bedrock of THP’s epicenter strategy approach. Community partners learn about THP’s strategy through village-based training sessions and workshops including Vision Commitment and Action (VCA) aimed at changing the mindset, developing good and effective leaders. For this module of the study, two respondents (a man and woman from same household) were asked same questions separately to compare their views on the issues of community mobilization. The questionnaire focused on their perceptions on gender and community development. Respondents were asked if they think that women/men can generally change things in the community if they want to.

The Hunger Project OEPP 72 June 2013 Response to this question is aimed at assessing the impact of one of THP flagship programs such as Community Mobilization the Women Empowerment Project (WEP) with the objective of empowering women as equal partners in development and taking decisions to effect community development. In response to the question “Do they feel that men can generally change things in the community if they want to?” Banka, Kyempo, Nkawanda, Nsuta-Awaregya and Odumase-Wawase Epicenters had 100, 147, 103, 109 and 96 valid respondents for the above question.

In general, it can be observed that in response the question about whether women feel they could change their community, “yes, very easily” had the highest score across Epicenters, except in Banka and Odumase-Wawase. Moreover, the percentage score for this response was significantly different across Epicenters, the highest being 22% (Nsuta-Awaregya) and lowest being 10% (Banka). These results demonstrate that there is need to carry out further research to find out what hindrances are impeding women’s perceptions about their ability to influence changes in Banka and Odumase- Wawase epicenters. For men, the response “yes, very easily” was highest across all Epicenters with 20% being highest (Kyempo and Nkawanda) however, this did not differ significantly among Epicenters. Moreover, men felt more confident about changing things in their community than women and this situation implied development in some epicenters/communities could be gender sensitive and also influenced by the culture of the people.

Respondents were asked about their confidence in participating in community development when asked the question, “Do you feel comfortable speaking up to help decide on infrastructure (like small wells, roads, water supplies) to be built in your community?” The proportion of women and men who feel comfortable to speak on decision on infrastructure development is presented in Figure 8. Generally, more women felt comfortable to speak up about decisions on infrastructure than men. In most epicenters, except in Kyempo, both sexes felt equally comfortable. Confidence to participate in decision making about infrastructure was gender dependent because women are generally inclined to stay at home, nursing/caring for children, rather than men who are mostly at work and/or outside

The Hunger Project OEPP 73 June 2013 the home. The total number of responses could be ranked from highest to lowest as 389 respondents (57%) said “Yes, very comfortable” was the highest followed by 152 respondents (22%) who claimed yes, fairly comfortable; 62 respondents (9%) who said “no, not at all comfortable”; 48 (7%) who claimed “Yes, but with a little difficulty” and 29 (4%) respondents who said “Yes, but with a great deal of difficulty”. That means the total number of responses ranged ranked from 57% of respondents who said “yes, very comfortable” to 4% respondents who said “Yes, but with a great deal of difficulty”. There was significant difference between these responses.

Proportion of women men that voted in last election

Respondents that attempted answering the question “did you vote in the last election” saw each epicenter respectively having the same number of valid respondents as the total population of Epicenter. This implies there was no missing data.

The representation of women/men that took part in the last voting exercise carried out at each epicenter is presented in Figure 2. General observation across five epicenters showed that “yes” responses of both women and men to voting in the past election were higher than “no” responses. Moreover, the score for these responses were significantly different across Epicenters. Similar trend were observed across other epicenters. In Banka Epicenter, Women and Men had 51 and 42% for yes and 3 and 4% for no respectively. Kyempo Epicenter Women and Men had 45 and 45% for yes and 5 and 5% for no respectively. In Nkawanda Women and Men had 63 and 32% for yes and 4 and 1% for no respectively. In Nsuta-Awaregya Epicenter, Women and Men had 53 and 37% for yes and 6 and 4% for no respectively. Odumase-Wawase Women and Men had 53 and 30% for yes and 12 and 5% for no respectively. It could also be deduced that both women and men were enthusiastic

The Hunger Project OEPP 74 June 2013 about using voting as a mechanism of selecting good leaders to champion their developmental activities in a peaceful manner than any other means.

(NOTE: the percentages reflect percentage of total respondents – total voting rates are above 90%).

Leadership Effectiveness The study measures the level of effectiveness of leadership at the communities. Without visionary and good leadership, development efforts tend to stall. The household survey sought to find how the community members perceive their local leaders when it comes to problem solving and initiating development projects. Figure 9 below shows the distribution of men and women’s perceptions from “not at all” to “very effective” scale across all the epicenters.

Banka Kyempo Nkwanda Nsuta-Awaregya Odumase-W Average WomenMen WomenMen WomenMen WomenMen WomenMen Response No, not at all 9 5 2 2 4 3 2 1 6 5 4 Yes, but with a great deal of difficulty 6 8 3 4 5 1 3 0 4 5 4 Yes, but with a little difficulty 8 8 2 0 12 6 9 7 5 5 6 Yes, fairly effective 20 18 16 22 30 10 19 11 24 7 18 Yes, very effective 37 29 49 40 36 24 42 33 43 22 36 Total 80 68 72 68 87 44 75 52 82 44

Figure 17: How Women/Men perceive their Community Leaders (Are they effective?)

Respondents were asked, “Do you feel that leaders in your community are effective at solving problems?” Women and men on average perceived their community leaders as “very effective” or

The Hunger Project OEPP 75 June 2013 “fairly effective”. There were significant differences between genders and survey results show that across epicenters more women than men perceived their leaders as effective.

Proportions of Women/Men in THP Epicenter Committee/Subcommittee

Respondents were asked about their involvement with epicenter committees and subcommittees, the chart above represents the proportion of women and men serving on THP epicenter committee and subcommittees. Approximately 50% of both women and men respondents have served on epicenter committee or subcommittees, although this varied considerably by epicenter.

Gender Equality One of the pillars of THPs strategy is the Women’s Empowerment Program (WEP) which seeks to train women in legal, civic and reproductive health rights as well as deal with issues of discrimination and promote gender equality. This module seeks to elicit from respondents, the extent to which key principles of gender equality are being practiced in epicenter communities.

To what extent do men and women share responsibility for making decisions about the community? The table below represents the various levels in which men and women have equal responsibilities for decision making in the community. In response to the question if men and women share equal responsibility most of the respondents 44% said responsibilities are ‘shared equally’. However about a third of the respondents (33%) indicated men have a lot more responsibility than their counterpart women. Respondent who expressed the view ‘don’t know’ represents the least with 0.6 % of data collected. Obviously from table below, decision making about the community with respect to men and women is shared nearly equally.

Variable Frequency Percentage (%) Don’t Know 4 0.6 Females have a little more responsibility 27 4.2 Females have a lot more responsibility 52 8.1 Males have a little more responsibility 66 10.2 Males have a lot more responsibility 210 32.6 Shared equally 286 44.3 Total 645 100

To what extent do men and women have equal responsibility for making decisions about the family (financial, health, education, etc.)?

The table below represents the various levels in which men and women have equal responsibilities for decision making in the family. The response ‘Don’t know’ had the lowest occurrence with 0.6 % while the variable ‘shared equally’ records the highest frequency of 286 representing 44.3 %. It can therefore, be concluded from respondents interviewed that the decision making about the family wellbeing is more often shared equally, but with men still having more say that women.

Sharing of Family Decision Making among Men and Women

The Hunger Project OEPP 76 June 2013 300 247 250 227

200

150

100 67 59 38 No. of Respondents 50 6 0 Don’t Know Females have Females have Males have a Males have a Shared a little more a lot more little more lot more equally responsibility responsibility responsibility responsibility Responses

Sharing of household chores among Boys and Girls In response to the question the extent to which boys and girls (children) share household chores and responsibilities (cleaning the house, preparing food, caring for animals, etc.), respondents gave varied responses. In table below, the extent to which boys and girls share household chores is analyzed critically. The response ‘females have a lot more responsibility emerged with the highest frequency of 247 representing 38.5 %. This is followed by ‘shared equally’ 30% (192). Other respondents (15%) indicated that girls have a lot more responsibility than the boys. Also the variable ‘Don’t know’ emerged with the lowest frequency of 8, which represents 1.2 %. It can therefore be concluded that girl children have a lot more responsibility in terms of household chores than boys. These results demonstrate that that much more education and sensitization needs to be carried out to ensure that girls are not overburden doing most of the household chores.

Table 1: Sharing of household responsibility among girls and boys

247 250 192 200

150 97 100 75

No. of Respondents 50 23 8

0 Don’t know Females have Females have Males have a Males have a Shared equally a little more a lot more little more lot more responsibility responsibility responsibility responsibility Response

The Hunger Project OEPP 77 June 2013 Decision taking in the family usually regarding the health and care of the children at home From the chart below, we take a look at who in the family has the final say concerning the health and care of children including giving medication or treatment to sick child etc. From the respondents’ answers, the variable ‘husband’ came out with the highest frequency of 295 (out of 642 respondents) representing 46.0 %. 30% of respondents indicated that decisions are taken jointly (husband and wife). One can easily conclude therefore that, in most cases it is the husband who has the final word regarding the health and care taking of the children at home.

Decision-making regarding the health and care of children

Someone else 3% Wife 19% Husband children in the 46% home 2% Husband/ Wife jointly 30%

How many women in your household have access to credit (savings, loans, and cooperatives)? In table below, we are looking at within the range on 0 – 3 how many women in a household have access to credit. From the survey, the variable 0 has the highest frequency of 450, which represents 70.2% while the variable 3 has the least occurrence of 4 representing 0.6 %. Only 26% of women received loans. It can therefore be concluded that most women in a household do not have access to credit.

Women’s access to credit

Women in HH Frequency Percentage (%) 0 450 70.2 1 166 25.9 2 21 3.3 3 4 0.6 Total 641 100

Women’s involvement in politics

In the table below, the idea that women be more involved in politics (voting, participating in political office etc.) is examined. The variable ‘Don’t know’ has the least occurrence with 9 (out of total of 643 responses) which represents 1.4 % whiles the variable ‘strongly agree’ has the highest frequency of 405 representing 62.9 %. One can therefore conclude that majority of respondents strongly agree with the idea that women be involved more in politics.

The Hunger Project OEPP 78 June 2013 Table 2: Women's involvement in politics

Strongly agree 405

Somewhat disagree 28

Somewhat agree 136 Response Don’t know 9

Completely Disagree 65

0 50 100 150 200 250 300 350 400 450 No. of Respondents

Women’s involvement in Civil Society Groups In table below, the women’s involvement in civil society (organized groups, churches, campaigns, NGOs etc.) was analyzed. 530 respondents representing 82.3 % as the highest occurrence chose the position ‘strongly agree’. 5 respondents representing 0.8 % had the least occurrence for the position ‘don’t know’. Therefore in conclusion, most respondents strongly agreed that women should be more involved in civil society activities.

Women’s Involvement in Civil Society Groups

600 530 500 400 300 200 69 26 No. of Repondents 100 5 14 0 Completely Don’t Somewhat Somewhat Strongly Disagree know agree disagree agree Responses

Domestic Violence and Wife beating In the table below, the questionnaire sought to find out from respondents whether or not it is socially acceptable for a husband to hit his wife. Upon interviewing the variable ‘completely disagree’ emerged with the highest occurrence of 597 representing 92.8 % whiles the variable ‘don’t

The Hunger Project OEPP 79 June 2013 know’ had the least occurrence of 1 representing 0.2%. However, a less significant proportion of respondents constituting 4% (27 no.) ‘Strongly agree’ it is ok for husband to hit his wife. Therefore one can conclude that majority completely disagrees with the idea that it is acceptable for a husband to hit his wife. However, more sensitization and awareness need to be created to totally eliminate wife battering from communities.

Social acceptance of domestic violence

1000 597

500 1 11 7 27 0 No. of Respondents

Responses

Knowledge about campaigns or activities preventing violence against women In the table below, we assessed whether or not people had heard of campaigns or activities in their communities that talk about violence against women. The analysis showed that 556 respondents representing 86.6 % responded ‘Yes’ whiles 86 respondents representing 13.4 % answered ‘No’. In conclusion majority of the people had heard of the campaigns and activities in their communities.

Yes No

13%

87%

Knowledge of GBV Programs

Food Security & Agriculture THP’s Agriculture and Food Security program focuses on increased food production and farm incomes to improve standards of living. The project offers technical and material support in improved agronomic practices as well as access to improved planting materials and other basic farm

The Hunger Project OEPP 80 June 2013 inputs. In order to eliminate hunger and starvation, food shortage or scarcity should be avoided in rural communities.

The Demographic Values of Epicentres

The figure below shows the demographic table of Epicentres. It shows average number of Households, Agricultural Plots, Livestock owned, People who ever benefited from THP’s (The Hunger Project) Microfinance and People from Household who participated in THP’s Programme. In addition to these it also shows the income generated from the sale of crop and vegetable as compared to other household income sources. Banka Epicentre covers the activities of Amantia, Kokobeng, Muronaim, Tokwai and Tokwai Asuboi communities. Kyempo Epicentre covers Komeaboi, Kyempo, Menamenaso, Subinso and Takyikrom communities. Nkawanda Epicentre covers Abetensu, Asuoso, Nkawanda 1, Nkawanda 2, Ohene Akura and Omari communities whilst Nsuta-Aweregya epicentre has Atwedie, Aweregya, Kwahu, Nsuta and Omari as its communities and Odumase-Wawase covers activities of Besease, Odumase, Sitey, Wawase and Wisiwisi communities.

Av. No. of Av. No. of Crop and People benefited people from vegetable sales (%) Av. No. of Av. No. of Av. No. of Av. No. of from THP’s Household partici- over other househ- Epicentres Age Households Agric. Plots Livestock owned Businesses owned Microfinance prog.pated in THP’s old income sources Banka Amantia 54.9 5.4 2.4 7.1 0.6 0.0 0.1 72.7 Kokobeng 27.7 6.2 2.9 9.0 0.8 0.0 0.0 95.0 Muronaim 44.1 4.1 2.3 6.7 0.7 0.0 0.0 80.0 Tokwai 48.3 5.5 1.6 11.4 0.7 0.0 0.1 45.0 Tokwai Asuboi 51.6 6.8 3.3 16.2 1.0 0.0 0.1 100.0 Banka Average 45.3 5.6 2.5 10.1 0.8 0.0 0.0 78.6 Kyempo Komeaboi 49.5 5.8 3.2 9.9 0.6 0.1 0.1 95.0 Kyempo 52.0 4.5 1.4 8.3 0.4 0.4 0.4 60.0 Menamenaso 47.6 5.2 2.7 13.9 0.7 0.1 0.2 90.0 Subinso 47.2 6.1 2.4 11.3 0.7 0.5 0.0 90.0 Takyikrom 47.6 4.5 1.8 10.4 0.6 0.3 0.2 65.0 Average 48.8 5.2 2.3 10.7 0.6 0.3 0.2 80.0 Nkawanda Abetensu 49.7 4.0 2.3 15.2 1.2 0.3 0.1 47.4 Asuoso 56.8 5.1 1.6 12.6 1.0 0.3 0.0 60.0 Nkawanda 1 57.9 4.7 0.7 6.6 1.0 0.4 0.5 55.0 Nkawanda 2 46.7 6.4 1.6 9.7 1.4 0.8 0.6 60.0 Ohene Akura 56.9 5.9 2.6 24.8 0.9 0.6 0.4 70.0 Omari 37.0 5.5 0.6 10.0 0.0 0.0 0.0 100.0 Average 50.8 5.3 1.5 13.1 0.9 0.4 0.2 65.4 Nsuta-Aweregya Atwedie 52.2 4.9 2.4 16.8 1.1 0.3 0.3 72.2 Aweregya 52.3 5.6 2.4 8.9 1.0 0.3 0.5 85.0 Kwahu 56.5 4.2 2.6 8.3 1.4 0.2 0.1 65.0 Nsuta 55.4 5.5 0.9 9.9 1.0 0.7 0.7 40.0 Omari 43.1 5.4 2.1 14.5 1.1 0.2 0.1 65.0 Average 51.9 5.1 2.1 11.7 1.1 0.3 0.3 65.4 Odumase-Wawase Besease 51.8 4.2 2.4 10.8 0.5 0.6 0.2 83.3 Odumase 51.3 5.4 3.3 8.3 0.4 0.2 0.2 63.6 Sitey 44.8 7.1 3.1 23.2 0.4 0.3 0.0 90.0 Wawase 46.5 3.7 1.0 6.7 0.5 0.8 0.5 100.0 Wisiwisi 48.5 6.4 2.1 14.9 1.0 0.6 0.2 50.0 Average 48.6 5.4 2.4 12.8 0.5 0.5 0.2 77.4 Grand Average 49.1 5.3 2.1 11.7 0.8 0.3 0.2 366.7

Age Distribution across the Epicenters

The Hunger Project OEPP 81 June 2013 The distribution of age of people across the five epicentres has the tendency of affecting agricultural production in the future as shown in Figure 1. The distribution of age of people across five epicenters was key among other factors controlling the demographic values of epicenters. The grand mean age of all the epicentres was 49.1. In increasing order of age values, the mean ages of people in Banka, Kyempo, Odumase-Wawase Nkawanda and Nsuta-Aweregya Epicentres were 45.3, 48.8, 48.6, 50.8 and 51.9 respectively. This shows that more youths were available to take over agricultural business in Banka and Kyempo than Odumase-Wawase Nkawanda and Nsuta-Aweregya Epicentres. If more youth are unsure about the future of Agriculture, they turn to shy away from Agriculture activities and the sustainability of agriculture in these communities would be brought to ruin if not salvaged by THP. Migration of youth to big cities for greener pastures could account for higher mean age observed in Nkawanda and Nsuta-Aweregya Epicentres and therefore the exuberant energy of the youth needed for working more efficiently in agricultural fields was eroded by migration, and thus affect the demographic values of Nkawanda and Nsuta-Aweregya than the rest.

Age was observed to range from 27.7-54.9 (Kokobeng-Amantia in Banka Epicentre); 47.2-52.0 (Subinso-Kyempo in Kyempo Epicentre); 37.0-56.9 (Omari-Ohene Akura in Nkawanda Epicentre); 43.1-56.5 (Omari-Kwahu in Nsuta-Aweregya Epicentre) and 44.8-51.8 (Sitey-Besease in Odumase- wawase Epicentre) respectively. Age difference among people of Banka Epicentre was 27.2 followed by Nkawanda (19.9), Nsuta-Aweregya (13.4), Odumase-wawase (7) and Kyempo (4.8) Epicentres. The wider the age between people living in agricultural communities the more inclusive of both youth and old people in agriculture to enhance agricultural productivity.

Average Number of Household Members

Another factor that affects the demographic values of Epicentres is the average number of household members across Epicentres. The grand mean number of Household members of all the Epicentres was 5.3. The mean number of Household Members is presented in increasing order of values across Epicentres as 5.1, 5.2, 5.3, 5.4 and 5.6 for Nsuta-Aweregya, Kyempo, Nkawanda, Odumase-Wawase and Banka respectively. Since there is no half human being, the mean values could be taken as 5, 5, 5, 5 and 6 for respective centres and there is no significant difference between average numbers of Household Members across Epicentres. Agriculture commodity chains could be largely influenced by the number of Household Members because larger households collectively turn to have larger farmlands in farming communities. Moreover rain-fed agriculture demands larger number of household at the beginning of raining season than farming under planned irrigation. Fewer numbers of household members could hire farm hands as casual labourers from other households or import labour from other communities for the expansion of their farms. Failure to do so in time might result in late planting and poorer yield. The mean number of Household Members ranged from 4.1-6.8 (Muronaim- Tokwai Asuboi in Banka Epicentre); 4.5-6.1 (Kyempo and Takyikrom - Subinso in Kyempo Epicentre); 4.0-6.4 (Abetensu - Nkawanda 2 in Nkawanda Epicentre); 4.2-5.6 (Kwahu - Aweregya in Nsuta-Aweregya Epicentre) and 4.3-7.1 (Besease-Sitey in Odumase- wawase Epicentre) with the respective difference of 2.7, 1.6, 2.4, 1.4 and 2.8 for Banka, Kyempo, Nkawanda, Nsuta-Aweregya and Odumase-wawase Epicentres respectively. The range difference was also not significantly different from each other.

Average Number of Agricultural Plots per household

The Hunger Project OEPP 82 June 2013 The average number of Agricultural Plots owned by households also affected the demographic values of Epicentres. The grand mean of the number of Agricultural Plots owned by each household across Epicentres was 2.1 acres. The mean numbers of Agricultural Plots owned across five epicentres were 1.5, 2.3, 2.4, 2.5 and 2.5 acres for Nkawanda followed by Kyempo, Odumase- Wawase, Banka and Nsuta-Aweregya in increasing order of values. There are significant differences between average numbers of Agricultural Plots across Epicentres. Agriculture productivity could be largely influenced by the Number of Agricultural Plots and their sizes at various locations. Even if those who want to farm are not having plots and those who own plots are not ready to farm, there is a probability that those who really wants to farm can come to tenancy agreement with those who owns. In Ghana there are two types of that agreements. The “Abunu” system where the farm proceeds are shared equally between the land owner and the tenant who contributes financially to the development of their farm. The “Abusa” system where the tenant takes two-third and the Landlord takes only one-third of the farm proceeds because apart from his land, he/she does not contribute to the development of the farm. Through these systems, even strangers who want to invest in agricultural commodity development chain are catered for by these few numbers of Agricultural Plots owned across five epicentres. Beyond this level of development, family heads and the chiefs who are the custodian of stool lands could be contacted for outright purchase or lease holds for a number of years. The mean number of Household Members ranged from 1.6 – 3.3 (Tokwai- Tokwai Asuboi in Banka Epicentre); 1.4- 3.2 (Kyempo - Komeaboi in Kyempo Epicentre); 0.6- 2.6 (Omari - Ohene Akura in Nkawanda Epicentre); 0.9-2.6 (Nsuta-Kwahu in Nsuta-Aweregya Epicentre) and 1.0 - 3.3 (Wawase-Odumase in Odumase-wawase Epicentre) with the respective difference of 1.7, 1.8, 2.0, 1.7 and 2.3 for Banka, Kyempo, Nkawanda, Nsuta-Aweregya and Odumase-wawase Epicentres respectively. The range differences were not significantly different from each other.

Average Number of Livestock owned per household

Livestock here is limited to cattle sheep and goats. The average number of livestock owned was considered as one of the contributing factors to the demographic values of Epicentres. The grand average of the number of livestock owned by each household was 12 ruminants across five Epicentres. The average numbers of Livestock owned across five epicentres were 10.1, 10.7, 11.7, 11.7 and 13.1 livestock for Banka Average followed by Kyempo, Nsuta-Aweregya, Odumase-wawase and Nkawanda respectively in increasing order of values. This showed that farmers under Banka raised at least 10 livestock whilst 13 livestock were raised per household under Nkawanda Epicentre. This could bring about a significant economic difference between Banka and Nkawanda Epicentres when the average numbers of Livestock raised per household across Epicentres is extrapolated based on their population with growth measured over the years. The Average Number of Livestock owned per household Members ranged from 7.1-16.2 (Amantia -Tokwai Asuboi in Banka Epicentre); 8.3- 13.9 (Kyempo - Menamenaso in Kyempo Epicentre); 6.6- 24.8 (Nkawanda 1 - Ohene Akura in Nkawanda Epicentre); 8.3-16.8 (Kwahu - Atwedie in Nsuta-Aweregya Epicentre) and 6.7 - 23.2 (Wawase-Odumase in Odumase-wawase Epicentre) with the respective difference of 9.1, 5.6, 18.2, 8.5 and 16.5 for Banka, Kyempo, Nkawanda, Nsuta-Aweregya and Odumase-wawase Epicentres respectively. The differences in the range of “number of livestock owned per household members” were significantly different from each other.

The average number of businesses owned by household

The Hunger Project OEPP 83 June 2013 The average number of businesses owned by household was considered as other contributing factors to the demographic values of Epicentres. The grand average number of businesses owned by household or operated by household was 0.8. This shows that agriculture is only one predominant business common to all Epicentres. If there is drought and agriculture fails, hunger would pursue the villages across Epicentres. The mean numbers of businesses owned by households across five epicentres were 0.5, 0.6, 0.8, 0.9 and 1.1 for Odumase-Wawase, Kyempo, Nkawanda and Nsuta- Aweregya respectively in increasing order of values. Since the means could be approximated to only one business owned, there are no significant differences between average numbers of businesses owned by households across epicentres. The mean number of businesses owned by households ranged from 0.6 – 1.0 (Amantia- Tokwai Asuboi in Banka Epicentre); 0.4- 0.7 (Kyempo - Menamenaso and Subinso in Kyempo Epicentre); 0.0-1.4 (Omari - Nkawanda 2 in Nkawanda Epicentre); 1.0-.4 (Aweregya and Nsuta - Kwahu in Nsuta-Aweregya Epicentre) and 0.4-1.0 (Odumase and Sitey - Wisiwisi in Odumase-wawase Epicentre) with the respective difference of 0.4, 0.3, 1.4, 0.6 and 0.6 for Banka, Kyempo, Nkawanda, Nsuta-Aweregya and Odumase-Wawase Epicentres respectively. The range differences were also not significantly different from each other.

Average number of households benefited from THP’s Microfinance programme

The factors contributing to the demographic values of Epicentres also include the number of people in the household who benefited from THP’s Microfinance programme. The grand average of the THP’s Microfinance programme beneficiaries was 0.3. This shows that on the whole 30% of household have taken a loan from THP’s Microfinance Program across all epicentres except Banka. There is therefore a need to expand the loans programme to allow more people to be covered by this safety net. At least it should be enough to cover two-third of the people in each household. The mean numbers of people in the household who benefited from THP’s Microfinance programme across five epicentres were 0.0, 0.3, 0.3, 0.4 and 0.5 for Banka, Nsuta-Aweregya, Kyempo, Nkawanda and Odumase-Wawase respectively in increasing order of values. It was observed that households under Banka Epicentre were not yet covered by THP’s Microfinance programme as compared to the other epicenters. More resources and education is therefore needed on THP’s Microfinance programme in Banka Epicentre because, without these loans, no household can break the chains of poverty circle and free themselves from the shackles of hunger. The number of people in the household who benefited from THP’s Microfinance programme ranged from 0.1- 0.5 (Komeaboi and Menamenaso - Subinso in Kyempo Epicentre); 0.0-0.8 (Omari - Nkawanda 2 in Nkawanda Epicentre); 0.2-0.7 (Omari - Nsuta in Nsuta-Aweregya Epicentre) and 0.2-0.6 (Odumase-Besease and Wawase in Odumase-wawase Epicentre). The respective range difference of 0.4, 0.8, 0.5 and 0.4 for Kyempo, Nkawanda, Nsuta-Aweregya and Odumase-wawase Epicentres were observed to be significantly different from each other.

The Average Number of people from each household who participated in THP’s voluntary savings Programme

THP’s Micro-Credit programme encourages community members to save money at the epicenter bank without necessarily benefiting from loan. The average number of people from Household who participated in THP’s savings programme could contribute effectively in the reduction of hunger in communities and the demographic values of Epicentres. The grand average of the number of people from Household who participated in THP’s voluntary savings programme was 0.2. This shows that

The Hunger Project OEPP 84 June 2013 20% of people from each household have participated in THP’s savings Programme across the Epicentres except Banka. This is not enough representation of a household. More resources are needed for education more households in the communities about the importance of participated in THP’s savings in order to build up capital as fall back in the event of unforeseen circumstance and avoid hunger. The mean numbers of people in the household who participated in the THP’s savings 0.0, 0.2, 0.2, 0.2 and 0.3 for Banka, Kyempo, Nkawanda, Odumase-Wawase and Nsuta-Aweregya, respectively in increasing order of values. There are no significant differences between these means across the four participating epicentres. The range of the number of people in the household who participated in the THP’s programmes were 0.0- 0.4 (Subinso- Kyempo in Kyempo Epicentre); 0.0-0.6 (Omari - Nkawanda 2 in Nkawanda Epicentre); 0.1-0.7 (Kwahu and Omari–Nsuta in Nsuta-Aweregya Epicentre) and 0.0-0.5 (Sitey-Wawase in Odumase-wawase Epicentre). Incidentally, a few respondents in Banka epicenter indicated participating in THP’s savings programme. This could be due to error or mis-understanding of the question in the data collection process. In actual fact, THP has not extended Micro-Finance programme to the Banka epicenter.

The Average Crop and Vegetable sales (%) over other household primary sources of income

The factors contributing to the demographic values of Epicentres also include the Crop and vegetable sales (%) over other household primary sources of income. People in five epicentres of Ghana engages in Crop and vegetable sales and other sources of income such as: Artisanal services (sewing, hairdressing, etc.), Casual farm hand labour, Natural mineral resource extraction/sales, Remittances and Trading (handicrafts, carpentry, etc.) for generation of household primary income. It was observed that the grand average for the crop and vegetable sales (%) over other household primary sources of income was 73.3% across the five Epicentres in Ghana. This shows most households have taken crop and vegetable sales as their main business as compared to other sources. This ratio is very significance but liable to change in times of crops failure due to flooding, high incidence of pest and disease, drought, earth quake, fire, or glut at the market. The THP should train them to improve upon other sources of income to avoid over dependence on crop and vegetable sources alone. The mean Crop and vegetable sales (%) over other household primary sources of income for the five Epicentres were 65.4, 65.4, 77.4, 78.6, and 80.0 for Nkawanda, Nsuta- Aweregya, Odumase-Wawase, Banka and Kyempo respectively in increasing order of values. These were significant differences among these values. It was observed that more households in Banka and Kyempo depended on Crop and vegetable sales than other household primary sources of income as compared with households under Nkawanda, Nsuta-Aweregya Epicentres. The primary income from the sale of crop and vegetables ranged from ranged from 45.0 – 100 (Tokwai -Tokwai Asuboi in Banka Epicentre); 65.0 – 95.0 (Takyikrom – Komeaboi in Kyempo Epicentre); 47.4 – 100 (Abetensu – Omari in Nkawanda Epicentre); 40.0 – 85.0 (Nsuta – Aweregya in Nsuta-Aweregya Epicentre) and 50.0 –100 (Wisiwisi – Wawase in Odumase-Wawase Epicentre).

Figure: Agriculture land lease and Profit from Earnings

The Hunger Project OEPP 85 June 2013 Epicentres Average Area of Plot Average Annual Lease Value (GHI) Average Profit (personal earnings after expenses) GHI Banka Amantia 1.5 454.4 584.6 Kokobeng 4.3 746.5 407.5 Muronaim 3.7 790.0 790.0 Tokwai 5.2 1393.8 732.2 Tokwai Asuboi 6.8 1282.3 1114.3 Average 4.3 933.4 725.7 Kyempo Komeaboi 4.4 354.8 582.3 Kyempo 2.9 1789.1 639.3 Menamenaso 4.3 991.5 867.7 Subinso 5.0 1967.0 961.5 Takyikrom 5.5 521.3 1177.3 Average 4.4 1124.7 845.6 Nkawanda Abetensu 3.0 278.8 324.6 Asuoso 5.7 750.0 616.1 Nkawanda 1 9.6 836.2 193.8 Nkawanda 2 3.5 427.5 231.3 Ohene Akura 3.3 250.4 272.2 Omari 2.0 50.0 0.0 Average 4.5 432.1 273.0 Nsuta-Aweregya Atwedie 5.0 1883.9 539.0 Aweregya 3.3 430.8 452.7 Kwahu 2.8 218.1 627.6 Nsuta 4.6 533.3 176.1 Omari 4.6 383.2 516.5 Average 4.1 689.9 462.4 Odumase-Wawase Besease 3.6 597.8 542.3 Odumase 3.7 2373.1 498.0 Sitey 4.1 1039.4 1244.4 Wawase 2.4 1085.0 237.5 Wisiwisi 3.8 456.6 318.2 Average 3.5 1110.4 568.1 Grand Average 4.2 858.1 575.0

The table above shows the average area of agriculture plot cultivation, annual lease value and the average profit after expenses. At the aggregate level, the average agriculture plot size recorded is 4.2 hectares. This did not vary much from each of the epicenters such as Banka, Kyempo, Nkawanda, Nsuta Aweregya and Odumase-Wawase recording 4.4; 4.5; 4.1 and 4.3 hectares respectively. The annual lease value for plot of farm land at the aggregate level is about GHC 200 per hectare. There are slight variations across epicenters with Kyempo and Odumase Wawase recording the most expensive price of GHC225 and GHC317 per hectare respectively and Nkawanda recording the least price of GHC 96 per hectare. The high cost of lease at Odumase-Wawase could be attributed that the fact it is located close to District capital (Nkawkaw) and therefore there is high demand as a result of population pressure.

Respondents answered question about how much profit on the average they made if harvest/produce from their land was sold during the last farming season. At the aggregate level, an amount of GHC575 was mentioned as profit. Across the epicenters the highest profit recorded was from Kyempo (GHC845) followed by Banka (GHC725). The least profit recorded came from Nkawanda (GHC 273).

Agriculture as primary occupation

In terms of occupation, agricultural activities came up as the main source of livelihood for the respondents constituting 68% whilst 32% indicated that agriculture was not their primary source of occupation. This finding is not surprising but a little higher that the overal situation in Ghana which point to the fact that majority of the population of Ghana is engaged in agriculture, 56% (GLSS,

The Hunger Project OEPP 86 June 2013 2008). Across each of the five epicenters the situation is not different although, Kyempo happend to record the highest proportion of 79% of population engaed in agriculture as compared 77%, 67%, 64% and 52% for Banka, Odumase-Wawase, Nsuta Aweregya and Nkawanda respectively.

Agriculture as primary source of occupation NSUTA ODUMASE BANKA KYEMPO NKAWANDA AWEREGYA WAWASE Average Y% N% Y% N% Y% N% Y% N% Y% N% Y% N% 77.5 22.5 79 21 52.5 47.5 66.3 33.7 67 33 68.5 31.5

Households primary source income

From table in the whole the main source of household income for majority of respondents is from the sale of crops and vegetable constituting 71%. This is followed by other businesses made up of 8.7% and trading in handicrafts, carpentry (7%). Across the epicenters Banka and Kyempo seems to depend more on sale of crops and vegetables (78% and 80% respectively) as primary source of income compared to the rest, Nkawanda, Nsuta-Aweregya and Odumase-Wawase accounting for 62%, 69% and 67% respectively. Surprisingly, none of the households in two epicenters Nsuta-Aweregya and Odumase-Wawase indicated artisanal services such as Sewing and Hairdressing as primary source of income. In conclusion, agricultural production as expected continuous to be the main source of income and livelihood for people in the catchment areas that THP operates. In this case, THP’s agriculture and food security program should be intensified for more partners to benefit from. Issues of diversification including rearing of livestock should be encouraged as secondary income to supplement income from crop cultivation.

The Hunger Project OEPP 87 June 2013 NSUTA ODUMASE BANKA KYEMPO NKAWANDA AWEREGYA WAWASE AGGREGATE Freq % Freq % Freq % Freq % Freq % Freq % Artisanal Services (sewing, hairdressing) 1 0.98 1 1 4 3.96 0 0 0 0 6 1.2 Crop and vegetable sales 80 78.43 80 80 62 61.39 68 69.39 67 67 357 71.26 Labor 6 5.88 3 3 2 1.98 3 3.06 7 7 21 4.19 Livestock Sales 0 0 0 0 0 0 0 0 2 2 2 0.4 Natural resource extraction/ sales 0 0 1 1 0 0 1 1.02 0 0 2 0.4 Other source (business) 6 5.88 4 4 11 10.89 9 9.18 13 13 43 8.66 Other source (non- business) 2 1.96 3 3 4 3.96 4 4.08 2 2 15 2.99 Remittances 1 0.98 2 2 4 3.96 6 6.12 6 6 19 2.99 Trading (handicrafts, carpentry, etc) 6 5.88 6 6 14 13.86 7 7.14 3 3 36 7.19 Total 102 100 100 100 101 100 98 100 100 100 501 100

Households Benefitting from THPs Micro-credit program

About 14% of households indicated that at least one member of their households participated in THP’s savings programme as against only 3% of households indicating that two (2) members of their household participated in the savings programme. On the other hand majority of households constituting 83% stated that none of their household members participated in THP’s savings programme. Across the epicenters with the exception of Banka epicenter that does not operate THP loan programme, the other four epicenters record 14%, 20%, 22% and 25% for Kyempo, Odumase- Wawase, Nkawanda and Nsuta-Aweregya respectively indicated between one and two persons in their households are participating in THP’s savings programme. This revelation points to the fact that a substantial number of THP’s partners are still outside the savings and loans programme. It could also be deduced that, the culture of savings being promoted by THP as fall back in the event of emergency need to be intensified and the loan portfolio expanded to cover more beneficiaries.

Purpose of Taking THP Loan

As follow up question to respondents who indicated they had taking loan were asked the purpose of taking the loan. A majority of households indicated they needed the money to expand their agricultural work (12%). This is followed by ‘starting a new business’ (7.7%), and improvement or expansion of existing business (6.5%). Other reasons given were education and others each had (0.5%), and household improvement (0.7%). Across the epicenters, there is not much difference in reasons given for taking the loan. Since majority of the beneficiaries of the THP loan programme take the loan for agricultural purposes, it will be prudent and in the interest of THP loan managers to disburse the loan money timely so that it can be put to good use during the farming season and thereby making the loan re-payment easy for the farmers.

Balanced diet and Nutritious foods

Good nutrition is very essential for a healthy living, and to achieve that, we have to eat balanced diet all the time. A balanced diet is defined as any combination of food that contains the right proportions of all the essential food nutrients. Increased food production and access are crucial to achieving major nutritional improvement. More foods should be produced that are rich in all the essential micronutrients, available in sufficient quantities and accessible to people all year round It is a truism that most people in our world today, especially in Africa, overlook the idea of eating a balanced diet hence high rate of malnutrition.

It is also believed that the people living in the rural areas are usually malnourished because of poor nutrition resulting from poor eating habits. It is therefore appropriate to preach the gospel of imbibing good eating habits, eating balanced diet, and encouraging breastfeeding in nursing mothers through the creation of awareness campaigns.

The goal of The Hunger Project in this direction is to ensure the effective reduction of malnutrition in the first 1000 days of children throughout all the epicenters and activities carried out towards the achievement of this goal includes nutrition education, food demonstration exercises and promotion of school feeding program in kindergartens.

The purpose of the food demonstration exercises are to sensitize and educate the nursing mothers especially, about supplementary feeding as a way of improving their children’s growth and development in their first 1,000 days. Locally available ingredients such as moringa leaves and flowers, soya beans and other food stuffs are introduced to partners and used in the preparation of various local dishes high in food nutrients. The project encourages communities to plant beans and other nourishing food crops to improve the diet of the children in the nursery schools supported by THP, as well as other children in the communities at large.

A survey was conducted to find the eating patterns of respondents in terms of nutrition and balanced diet for the last seven days. From the survey, which has been depicted in the table below, it could be deduced that respondents are more likely to eat potatoes, cassava and other roots, cereals vegetables, fish and oil/fat throughout the seven days in a week. The above deduction could be based on the fact that those food items are used in every day’s preparation of food. Just a little more than half of the population interviewed had taken wheat, fruits, legumes and egg within the last seven days. People in rural communities might not consider food items like wheat, legumes and eggs as priority due to its accessibility. Only 51.3% had taken either fruits or fruit juices in the last seven days though fruits like oranges, mangoes and pawpaw are available in most rural communities. Most farmers cultivate fruits for commercial purposes and not for consumption. Partners are still being educated on the importance of taking fruits or fruit juices.

The Hunger Project OEPP 89 6/20/13 It was realized that only a few of the respondents had consumed food items like dairy products, meat and poultry which might basically be due to accessibility and cost involved in getting those food items. It was also realized that only 120 respondents out of a total of 490 people interviewed had taken either alcohol or tobacco within the last seven days as at the time of survey.

From the survey, it is interesting to note that respondents have taken variety of foods within the last seven days during the time of interview. This could be ascribed to the nutrition education carried out by the health personnel together with trained animators in the various partner communities. Partners are balancing their diets now and have improved on the consumption of nutritious foods.

Table Balanced diet and nutritious foods

Food Time Percent 1 day 2 3 4 5 6 7 Not Total age that days days days days days days eaten had eaten food item Wheat 74 80 68 36 17 13 55 148 491 69.9 flour (bread, noodles) Rice 74 91 91 54 21 19 75 65 490 86.7 Potatoes, 35 64 77 45 36 29 184 16 486 96.7 Cassava, other roots Cereals 28 56 87 62 45 34 150 27 489 94.5 (Maize, Sorghum, millet, barley) Vegetables 10 21 29 41 36 29 278 35 479 92.7 Fruits/Fruit 37 66 49 32 19 14 29 234 480 51.3 juices (fresh & dry) Legumes 62 79 79 46 19 11 26 167 489 65.8 (beans, peas, nuts) Egg 67 74 58 29 20 5 14 215 482 55.4 Dairy 46 32 23 14 9 8 21 333 486 31.5 products (milk, cheese) Meat 45 45 25 15 9 1 16 331 487 32.0 (Goat,

The Hunger Project OEPP 90 6/20/13 beef) Poultry 79 63 37 21 8 3 10 265 486 45.5 (chicken, duck) Fish (fresh 13 16 24 32 28 13 341 14 481 97.1 & dry) Oil/fat 26 51 57 64 53 32 166 41 490 91.6 (geese, butter, veg oil) Sugar, 47 57 69 51 39 18 103 106 490 78.4 honey Alcohol & 29 18 18 13 9 3 30 370 490 24.5 Tobacco Total 672 813 791 555 368 232 1498 2367 7296 Percentage 9.2 11.1 10.8 7.6 5.0 3.2 20.5 32.4 100. (%) 0

Health & Nutrition The Hunger Project seeks to empower partners towards healthy living. The Epicenter clinics over the years have contributed to the prevention and management of malaria cases in partner communities. These clinics have been built as components of the epicenter buildings by THP in partnership with local communities and staffed with Ghana Health Services personnel (local government workers). THP’s intervention’s goal is to help transform the health status of partners so they can lead a healthier life with access to reliable services. In order to find out about the outcome of THP’s health intervention program the research questions were targeted at those with the most knowledge on family health issues. In most case it was the female head of household who responded to questions in the health and nutrition module. A total of 496 respondents were interviewed concerning health and nutrition issues. A total of 54.4% females were interviewed representing majority of respondents.

Gender segregaon

Male Female

45%

55%

The Hunger Project OEPP 91 6/20/13

How far is the nearest facility? Accessibility of services plays a huge role in improving health conditions of community partners. A question was asked to find out about the distance in kilometers from respondents location to the nearest health facility. From the Table below, it was realized that majority of the respondents (56.5%) covered a distance of less than 3km to access the nearest health facility which brings to bear the importance of proximity in improving access of partners to health facilities. This was followed by a total of 161 respondents representing 32.6% also covering a distance within 3 to 5km to access the nearest health facility.

Table 3: Figure 11: How far is the nearest health facility?

NEARNESS OF HEALTH FACILITY FREQUENCIES % < 3km 280 56.5% 3-5 km 161 32.6% 5-15 km 50 10.1% 15 -30 km 1 0.2% Don’t know 4 0.8% TOTAL 496 100%

Number of household members visiting the health facility within the past six months It is not enough to have a health facility available but to ask “are partners making use of the facility?” This inquiry was to find out about the health seeking behavior of partners and if partners are benefitting from the health facility. From the survey as depicted in the table below, the popular notion that females are likely to visit the health facility more than males was affirmed. A total of 58.1% representing 400 females visited the health facility more than the 41% males. It could be inferred from the survey that at least on the average more than one individual from each household interviewed visited the health facility within the past six months.

The Hunger Project OEPP 92 6/20/13 No. of household members that have visited health facility in the past six months

400 309 300 172 200 No. of households 100 11 2 1 0 1-5 o 6-10 11-15 16-20 Household members Range of household members

Type of health facility whether public or private Many of the respondents reported that they had attended a public health facility within the past six months period, 56.3% of them reported that the nearest clinic was a ‘publicly owned health facility’. The survey also disclosed that 207 (41.7%) respondents attended private non-religious owned health facilities during the period.

Types of health facilies accessed by respondents

DON’T KNOW

PUBLIC

PRIVATE(RELIGIOUS)

Type of health facility PRIVATE (NON RELIGIOUS)

0 50 100 150 200 250 300 Number of health facilies aended

Respondent’s confidence level in the nearest health facility The idea of ensuring partners have access to a health facility is also to meet their health needs. This will fail if partners have no confidence in the facilities and still have to cover a greater distance to nearby towns and cities to access reliable health care.

The Hunger Project OEPP 93 6/20/13

Confidence level in the nearest health facility

NO RESPONSE 0.4%

DON’T KNOW 2.4% Confidence level VERY CONFIDENT 75.2%

SOME WHAT CONFIDENT 17.7%

NOT CONFIDENT 4.2%

0 50 100 150 200 250 300 350 400

Respondents were asked, “How confident do you feel that the nearest health clinic can treat your household’s injuries or illnesses?” This question aims to determine partners’ perception of the quality of care available at the nearby health facilities. Results demonstrate that the majority of respondents (75%) expressed they were very confident the nearby health clinic can treat their household’s injuries or illnesses. Eighty-eight respondents representing 17.7% unsure of their confidence level and 21 respondents mentioned they are not confidence that he nearest health clinic can appropriately treat injuries or illnesses.

Number of household members that have suffered illness in the past four weeks It came to light that a number of household members have suffered various illnesses within the past four weeks. Females were the majority of respondents who had suffered some a form of illnesses in the course of the period.

Household members that have suffered illness in the past few weeks

7 5 3 1 0 50 100 150 200 250

1 2 3 4 5 6 7 No. of households 238 155 66 19 10 4 1 No. of household members 0 1 2 3 4 5 6

The Hunger Project OEPP 94 6/20/13 In a follow-up question to identify the type of illnesses respondents household members have suffered in the past four weeks, fever (35%) and malaria (30.7%) where the two major illnesses affecting the respondents and members of their household.

Table 4: Type of illness suffered by household members

TYPE OF ILLNESS NO. WHO HAVE SUFFERED FROM ILLNESS %AGE COLD/COUGH 47 15.7% MALARIA 92 30.7% DIARRHEA 19 6.3% GUINEA WORM 1 0.3% EYE PROBLEM 3 1% FEVER 105 35% OTHERS 33 11% TOTAL 300 100%

Number of households that have been sick with malaria in the past six months Malaria is seen as the most common illness, affecting the majority of partners in rural communities. In a survey to find out about the extent to which people are diagnosed with malaria, it was realized that majority of the households (290 representing 58.7%) did not have household members getting sick with malaria. A total of 123 households had one person who had been sick with malaria in the past six months and 46 households reported of two persons with malaria in the past six months.

Number of household members with malaria in the past six months 9 8 7 6 5 4 3 2 1 0 50 100 150 200 250 300

1 2 3 4 5 6 7 8 9 No. households 290 123 46 16 12 3 2 1 1 No. household members aacked by malaria 0 1 2 3 4 5 6 7 8

The Hunger Project OEPP 95 6/20/13 Number of household members that sleep under a bed net Insecticide treated mosquito bed nets is one of the most effective ways to reduce the rate of malaria incidence. The government of Ghana in collaboration with other health-focused agencies has embarked on a nationwide free distribution of insecticide treated mosquito bed nets to help reduce the incidence of malaria.

Range of household members that sleep under bed net

350 301 300 250 200 136 Range of household members 150 that sleep under bed net 100 43 No. of households 50 14 0 0 1-5 6-10 11-15

Most households (representing 60.9%) had a range of between one and five household members sleeping under mosquito bed net. In 43 households the survey was conducted, nobody in the household was sleeping under mosquito bed net. 136 households had about six to ten household members sleeping under mosquito bed net comprising 27.5% of total households interviewed.

Main reason for the recent visit to a health facility People have various categories of health issues and different reason for visiting the health clinic. The household survey aimed find out the main reason why a respondent might have visited a health facility in recent times. Results demonstrated that most respondents (57.4%) visited the clinic because of illness, followed by 3.2% who visited the health facility because of injury.

The Hunger Project OEPP 96 6/20/13 REASONS FOR RECENT HEALTH FACILITY VISIT

300 250 200 150 100 50 0 Check-up Did not Illness Injury Prenatal Postnatal Vaccina Others visit care care on health facility Frequency 13 161 283 16 10 4 1 5

Others gave reasons like check-up, prenatal care, post natal care and vaccination as reasons for visiting the health facility. On the other hand, 161 of the respondents making up of 32.6% indicated they have not visited a health facility for a very long period.

How important is it for pregnant women to receive pre-natal care from a health facility? Prenatal care is very important for the health of both the mother and the unborn child. A lot of sensitizations have been implemented by THP in this area to ensure healthy lifestyle and safe deliveries. Through this study, THP would like to understand if this has helped influence the perception of community partners on pre-natal care? One can deduce from the Figure 11 below that 65.7% of the respondents believed receiving pre-natal care from a health facility is “extremely important” and 25.3% (constituting 125 respondents) mentioned it is “very important”. A handful of respondents (only of 0.4%) did not think it was important to receive pre-natal care from a health facility.

IMPORTANCE OF PRE-NATAL CARE

VERY IMPORTANT 25.3%

SOME WHAT IMPORTANT 0.6%

NOT IMPORTANT 0.4% Pre-natal care importance

IMPORTANT 7.8%

EXTREMELY IMPORTANT 65.7%

0 50 100 150 200 250 300 350

The Hunger Project OEPP 97 6/20/13 Figure 18: Prenatal Care

Importance for woman to give birth with the assistance of a trained birth attendant or nurse To ensure safe delivery it is recommended that a trained birth attendant or nurse assist the birth. Do community partners have the same perception or think otherwise? In this survey, more than half of the respondents considered it “extremely important” for a trained birth attendant or nurse to assist in delivery, while 109 respondents also agreed it was “very important” for a trained individual to attend to deliveries. It is however important to note that 14 respondents representing 2.8% regarded it as not important for a trained personnel to attend to birth deliveries.

HOW MPORTANT IS TRAINED NURSE IN AIDING DELIVERY

311 350 300 250 200 109 Perception of respondents 150 100 44 14 50 11 0 EXTREMELY VERY IMPORTANT NOT SOME WHAT IMPORTANT IMPORTANT IMPORTANT IMPORTANT

Figure 19: perceptions about skilled attended birth attendants

How important is it for all children under the age of five to receive vaccinations/immunizations? Mothers after delivery are sensitized and encouraged to attend post-natal care to ensure healthy growth of newborn babies. Health experts consider immunization and vaccination of children at early years as very important in safeguarding the child against all childhood killer diseases. More than half of the respondents (68.9%) agreed to the fact that it is extremely important for children under the age of five to receive vaccinations and immunizations.

The Hunger Project OEPP 98 6/20/13 Should children under the age of 5yrs receive vaccinaons/ immunizaons

400 340

300

200 124 Degree of importance 100 26 3 0 EXTREMELY IMPORTANT SOME WHAT VERY IMPORTANT IMPORTANT IMPORTANT

Figure 20: importance of child vaccinations

For how long should a baby be exclusively breast-fed by his/her mother? As part of THP’s strategic focus on 1,000 Days Nutrition, mothers are encouraged to practice exclusive breast-feeding for the first six months of a child’s life to help make the newborn baby grow strong and healthy. The question was to test the notion of partners about this assertion and also to find out about their perception in terms of the duration this should be practiced. Majority of the respondents made up of 70.9% identified that exclusive breast feeding should be practiced in at least 6 months period.

Table 5: How long should a baby be exclusively breast-fed?

RESPONSES NO. OF RESPONSES %AGE 1-4 WEEKS 17 3.4% 4-8 WEEKS 25 5.0% AT LEAST 4 MONTHS 54 10.9% AT LEAST 6 MONTHS 351 70.9% MORE THAN 6 MONTHS 20 4.0% NOT IMPORTANT 28 5.6% TOTAL 495 100%

HIV/AIDS Rural communities are often among the highest-risk groups in developing economies for HIV transition. Vulnerability to HIV/AIDS stems from complex factors that include cultural, traditional and socio- economic causes as well as poverty, adolescent sexual habits, the sub-cultures of risk taking and hyper- masculinity among rural dwellers. HIV/AIDS in rural communities is currently being dealt with as a public health issue and most of the rural projects have been conducted by both international and local NGOs that have focused on education and health care provisions. It is for this reason that The Hunger Project is committed to integrate strategies to stop the spread of AIDS into its work for the end of hunger and specifically strategies based on the recognition that gender inequality is a driving force in the epidemic

The Hunger Project OEPP 99 6/20/13 The survey targeted respondents over the age of 15. A total of 495 respondents made up of 53.7% females were interviewed during the survey exercise on the subject of HIV and AIDS.

Have you heard of an illness called HIV/AIDS?

The first step to curbing the HIV/AIDS menace is to educate partners on the causes, effects and prevention of the disease. It came to light from the survey that 99.2% of the respondents have heard of the illness, as expected. Only 4 of the respondents representing 0.8% had not heard of the disease yet.

Percentage of respondents that have gone for HTC

46% 54% Yes

No

Have you ever gone for HTC?

Partners are usually sensitized to go in for HIV testing and counseling (HTC) to enable so that they are aware of their status. Getting to know one’s status is considered very important since it builds the confidence of those who have not been affected to practice good prevention and also enable those affected to seek early treatment.

Survey results show that of 489 respondents, 224 of them (representing 45.8%) had gone for HTC, but a greater majority (53.8%) of the respondents were still unaware of their HIV/AIDS status. These surprising results demonstrate an opportunity for THP’s health program to further engage with communities to encourage HTC.

The Hunger Project OEPP 100 6/20/13 Percentage of partners that know their HIV status

8%

Yes 42% No 50% Don’t know

Knowledge of HIV Status

It is expected that people who have gone for HTC will know their HIV/AIDS status. The previous question revealed that 45.8% of the respondents had gone for HTC before. Partners who mentioned of knowing their HIV/AIDS status was 42.1% showing that 3.7% more partners had gone in for HTC but did not know their HIV/AIDS status. The survey also disclosed that 49.5% were confident of not knowing their status and 8.4% of partners interviewed stated they “don’t know”.

When last did you go for HTC?

According to experts, it is advisable for people who are at risk to be tested six every six months. Majority of respondents (28.1% representing 63) have tested for HTC more than a year ago. It is interesting to deduce from the survey that a considerable number of respondents (20.1%) who had tested for HTC did that within the last 3 months.

Table 6: The last time respondents went for HTC

Time Frequency %age (%)

More than 1 year ago 63 28.1% More than 2 years ago 42 18.8% More than 6 months ago 42 18.7% Within last 3 months 45 20.1% Within the last 6 months 32 14.3% Total 224 100%

How often do you talk about HIV/AIDS with your spouse or regular sex partner?

The Hunger Project OEPP 101 6/20/13 How oen do respondents talk about HIV/AIDS with sex partners

113 131 120

58 61 6

In Ghana, people used to have a lot of misconceptions about HIV/AIDS and would not like to talk about it. Some associated it to the doings of the gods and other traditional and cultural interpretations. THP hopes that with continuous sensitization of community partners about HIV/AIDS, this has helped to change these perceptions. The study aimed to learn if partners now feel comfortable to freely discuss the disease? From the survey, it was realized that the question did not apply to the majority of the respondents. However, 24.5% of the respondents mentioned they sometimes discuss HIV/AIDS with their spouse or regular sex partner. Only 6% always talk about HIV/AIDS with their partners and 23.1% mentioned they “never” talk about HIV/AIDS with their spouse or regular sex partner.

Do you ever use a condom when having sex? Condom Use Condom use is seen as one of the most effective ways to practice safe sex. Many 334 350 people who are not able to stick to one 300 250 sex partner are advised to use condom 200 150 73 during sexual intercourse but is it 100 2 12 35 36 50 something that people have embraced? 0 Through the survey, it came to light that majority of partners (67.9%) have never No. of Respondents used condom when having sex and only 0.4% of the respondents have always used condom when having sex. Figure 62: Rates of condom use by respondents Considering further analysis, 7.3% sometimes made used of condom whereas 7.1% of respondents rarely use condom when having sex. A greater majority of respondents (95.3%) who mentioned they use a condom when having sex preferred male condoms to female condoms.

The Hunger Project OEPP 102 6/20/13 encourage others to use condoms in the past month

36% Yes 64% No

Figure 63: Percentage of respondents who encourage others to use condoms to prevent HIV/AIDS

Encourage others to use condoms to avoid HIV/AIDS and other sexually transmitted diseases

One effective way to promote condom use is for people to encourage others to adopt the practice, especially if they have used condom before and can testify about it. It can be deduced from the survey that most of the respondents representing 63.9% did not encourage anyone in the past month to use condom to avoid HIV/AIDS and other sexually transmitted diseases.

Should HIV/AIDS patient keep it private or tell other people in the community?

Many people are afraid to go for HIV Testing and Counseling because of the potential discrimination they might face in the society. Should HIV/AIDS patients keep their status private or tell others in the encouraging to find out that a greater majority of respondents (426 representing 86.1%) believed HIV patients should tell others about their status and 11.9% of respondents thought otherwise that HIV patients should keep their status privately.

Table 7: Should an HIV patient keep his status private or tell others?

Response Frequency %age (%)

Don’t know or not sure 10 2.0% No, should keep it private 59 11.9% Yes, should tell others 426 86.1% Total 495 100%

Water, Environment and Sanitation Rural communities have very limited access to sanitation, intermittent supply and higher water losses. The lack of clean water and sanitation systems is a sever public health concern in Ghana, contributing to a number of diseases in the country. Consequently, households without access to clean water are forced to use less reliable and hygienic sources.

Access to safe, clean water and hygienic sanitation are important in ensuring healthiness of people and especially for the survival of children under the age of five. Use of safe water and sanitation reduces the risk of water borne-diseases especially among children. Lack of access to safe water and sanitation

The Hunger Project OEPP 103 6/20/13 (including toilet facilities) has increased consequences on women and children, especially girls who may drop out of school to collect water and have to travel long distances (MoWAC & UNICEF, 2011). The Hunger Project intends to provide support to communities for the construction of simple water catchment facilities as well as improved public toilets.

Main source of toilet facility households Freq., Community toilet, 188 Freq., Pit latrine, 158 Freq., Vent. Imp. Pit latrine, 132

Freq., No toilet No. of Households Freq., Flush, (use bush), 17 shared, 3 Type of Toilet Freq., Other, 2

As part of THP’s interventional programs, epicenter communities are encouraged and sometimes supported to construct improved community toilets in order to address the challenge of poor sanitation but progress is quite low and more sensitization need to be put into creating awareness in this regard.

From the chart, 188 households constituting about 38% used community toilet, 158 households (32%) use pit latrine while 132 (26%) use the ventilated improved pit latrine. Only a few households about 1% use flushed shared toilet while about 3% (17) households did not have any toilet facility and therefore use the bush. By WHO/UNICEF standard, the proportion of the population with access to improved toilet facilities is the percentage of people using improved and sustainable toilet facilities, which hygienically separates human feces from human contact. The MDG 7 targets 54% of population to have access to improved sanitation by 2015 but overall only 13% of Ghana’s population use improved, not shared, toilet facilities according to the GDHS (UNICEF Ghana, Annual Report 2009). Other studies have shown that while 16% of urban households and 7% of rural households use improved toilet facilities that are not shared with other households. The vast majority of Ghanaians use shared facilities (60%) and the rate of open defecation (use of nearby bush) is still considered very high; 6% in urban areas and 30% in rural communities as at 2010 (UNICEF et al, 2009).

Main source of drinking water Water from well/boreholes (280 households) and shared/community standpipes (132 households) constituting 56% and 26% respectively were the main source of drinking water from the surveyed epicenter communities (see figure below).

Figure: Main sources of drinking water

The Hunger Project OEPP 104 6/20/13 Well or Borehole 280 Water vender 1 Unprotected well 1 Tap (piped into dwelling/plot) 27 Shared or communal standpipe or tap 132 River/Ponds 19 Rain water collecon 2 Protected well/Spring 38

Main sources of Drinking Water Other 1

0 50 100 150 200 250 300 No. of Households

Other sources of drinking water mentioned were protected well/spring 8% (38 households); tap/ piped into dwelling/plot or yard 5% (27 households). Among sources mentioned although insignificant were water from river/ponds (4%), water vendors, unprotected well and rain water collection. At the national level 84% of Ghanaians have access improved water sources and 78% in rural settings. By this record Ghana has already achieved the 2015 target of 78% using improved drinking water under MDG 7. But data from local water service providers including the Ghana Water Company and Community Water Sanitation Agency reports indicated coverage for urban dwellers to be about 59% while that for rural areas is about 57% (MAPLE Consult report/MoWAC& UNICEF, 2011). The study is therefore consistent with other studies although about 4% of respondents still use water from rivers/ponds, which may expose them to diseases and even death among children.

Figure: Ways of Processing of drinking water 426 The study revealed that an 450 400 absolute majority of 350 households 426 (85%) 300 250 indicated they do not treat 200 150 their water before drinking it. 100 19 4 14 33 50 1 1 1 1 1 Only 4% made up of 19 0 households boiled their water before drinking while another 3% (14 households) uses iodine or other minerals to treat water before drinking. Also less than 1% of households filtered and boiled their water. There is need for for education on the need for community partners to treat their water before drinking. Also efforts should be intensified to empower communities to construct boreholes for usage instead of drinking from streams and rivers.

The Hunger Project OEPP 105 6/20/13 Concern about climate change and deforestation

Figure 67: Climate Change and deforestation The study sought to learn about respondents’ perceptions of 300 247 issues relating to climate 179 173 200 148 change/deforestation and its 89 effects such as erratic and 100 51 52 47 Climate 8 3 unpredictable weather Change 0 Deforestaon conditions that then effect agriculture production. The chart shows respondents’ interest in climate change issues ranging from “very concerned” made of 35% (173) to “concerned” 36% (179).

About 18% of the respondents indicated they were “somewhat concerned” about climate change while 10% indicated they were “not concerned at all” about the issue.

Concern about deforestation Respondents’ view on deforestation was also sought to find out how much they are concerned about it. The study revealed about 50% of respondents indicated they were “very concerned” while 30% and 10% said they were “concerned” and “not concerned at all.” While 9% indicated they were “somewhat concerned” about deforestation, nearly 1% indicated they were “not sure” of issues regarding deforestation. The positive responses for both climate change and deforestation are quite impressive and could serve as springboard for intensification of awareness about these issues in order to address them. Some epicenters have communities where serious environmental degradation resulting from illegal surface mining activities popularly called “galamsey” is of concern to both local and national authorities.

Livelihoods & Microfinance Through the Microfinance program, THP provides credit to farming groups, especially women food farmer and other income generating groups. The credit program aims to create savings and investments for improved living standards. A key objective of the credit is to establish credit groups that grow into Government certified Credit Unions that are initiated and managed by women. As part of the OEPP project, partners were interviewed to find out the extent to which THP’s microfinance program is impacting and improving their lives.

Non-farm economic activities or businesses

The Hunger Project OEPP 106 6/20/13 A large number of respondents (about 46.2% of the total respondents) were involved in businesses other than agriculture production. Those in the Public Administration or Compulsory Social Security category were just few (about 0.4% of the total respondents).

Type of business No. of %age respondents involved Agriculture, hunting, forestry, fishing, mining, 24 10.2% quarrying, manufacturing electricity, gas, or water Education 3 1.3% Health and/or social work 4 1.7% Hotels and/or restaurants 7 3.0% Other 109 46.2% Other community and social services 25 10.6% Public administration or compulsory social 1 0.4% security Real estate, renting and /or business activities 53 22.5% Repair (vehicle or household goods) 2 0.8% Transport and/ or storage 8 3.4% Total 236 100%

Who in the household would you consider the owner/manager of the business? From the diagram below, most primary respondents owned their own business (69.2% of the total respondents). However, the least number of businesses were owned by respondent’s son-in-law/ daughter-in-law.

REVENUE GENERATED in USD$ REVENUE NO. OF % (@1.978 GH) GENERATED GH₵ RESPONDENTS Respondents 0- 505 0-999 179 75.5% 506 - 1010 1000-1999 43 18.1% 1011 - 1514 2000-2999 4 1.7% 1515 - 2021 3000-3999 6 2.5% 2022 - 2526 4000-4999 3 1.3% 2527 - 3032 5000-5999 4 1.7% 3033 - 3539 6000-6999 2 0.8% 3540 -4043 7000-7999 2 0.8% 4044 - 4549 8000-8999 1 0.4% 4550 -5000 9000-9999 0 0% 5001 - 5570 10000-10999 2 0.8% 5571 - 6076 11000-11999 0 0% 6077 - 6593 12000-12999 2 0.8% TOTAL 237 100%

The Hunger Project OEPP 107 6/20/13 WHICH HOUSEHOLD MEMBER OWNS A BUSINESS

SPOUSE 52 SON-IN-LAW/ DAUGHTER-IN-LAW 1 SON/ DAUGHTER 12 PRIMARY RESPONDENT 164 OTHER RELATIONSHIP(SPECIFY) 1 MOTHER/ FATHER 4 BROTHER/ SISTER 3

Table 81: Revenue generated from business in the past 12 months

From the table, it is clear that in the last 12 months, a large number of respondents (75.5% of the total respondent) generated GH Ȼ0 to GH Ȼ999 as revenue from their businesses while just a single respondent (0.4%) generated GH Ȼ 8000 to GH Ȼ 8999. Just 0.8% of the total respondents generated quite a huge revenue of GH Ȼ12,000 to GH Ȼ12,999 from their businesses.

Businesses supported with a loan from The Hunger Project’s Microfinance Program A great number of the respondent’s (78%) did not rely on a loan from The Hunger Project’s Microfinance program. Just about 21.5% of the total respondents were supported with a loan from THP’s Microfinance Program.

Number of businesses supported by THP's microfinance program

185 200 150 51 100 1 50 0 YES NO DON’T KNOW

Figure 68: Businesses supported by THP’s Micro Finance

Has the business owner, manager participated in THP Activities in the last 12 months? It is interesting to know that owners or managers of these businesses who have never participated in THP activities in the last 12 months were more than those who have. About 30.4% of the total respondents responded to the fact that business owners/ managers have participated in THP

The Hunger Project OEPP 108 6/20/13 activities in the last 12 months whiles 69.2% responded to the fact business owners/ managers have not participated in THP activities in the last 12 months.

Number of business owners that have parcipated in THP's acvies within the past 12 months

164 200 72 YES 1 100 NO

0 DON’T KNOW YES NO DON’T KNOW

Literacy & Education Education undoubtedly has become one of the most powerful tools for reducing poverty and inequality. Education also plays an essential role in child survival and development especially for the girls’; this is correlated with reduced child mortality and improved health and nutrition (MoWAC & UNICEF, 2011). The questions under this section sought to find out about the educational attainment of children and adult members of the households surveyed. Adult literacy is also an MDG indicator relating to both men and women. Literacy is defined by the ability of men and women to read a short simple statement. In the first place, the study sought to find out about the number of children aged 0-16 years in each household. As depicted in the chart below, majority 55% (274) of household indicated having children aged 0 to 2 years; followed by 37% (184 HH) had children aged 3 to 5 years while 7% (36 HH) had children 6 to 8 years; and about 1% (5 HH) having children aged 9 to 16 years.

Table 12: No of children in HH aged 5-12 yrs. attending school Age Frequency % 0 75 18 1 103 26 2 100 25 3 78 19 4 27 7 5 6 2 6 3 1 9 3 1 12 2 1 Total 397 100

The Hunger Project OEPP 109 6/20/13 Respondents were asked how many Number of Children in Households children aged 5-12 years are attending school. The results 274 300 revealed that 14% indicated children 184 in that age bracket are attending 200 school. If one juxtaposes this 36 100 5 response against the total number of 0 children in HH in this aged group No. of Households 0 – 2 3 – 5 6 – 8 9 – 16 which is 79 (16%), it can be deduced Age Group about 2% of the children in that age

Number of children in household who had attended or currently attending a nursery school or KG program

children aending or have aended nursery school or KG 400 338 300

200

55

Number of HH 100 4 1 0 0 – 3 4 – 7 8 – 10 11- more Children per HH A majority of HH (85%) indicated their children aged below 3 years had or are currently benefiting from nursery or Kindergarten program. Other children aged 4 and above have also attended or attending pre-school programs.

158, 40% Have some but not all No, have none 217, 55% Yes, have all materials 21, 5%

Availability of textbooks and other suppliers for school children It is not enough for children to be going to school; effective learning materials such as books should be available for children for effective learning to take place. Households were asked if their children have the needed textbooks and other essential materials. The graph below indicated 55% of household stating they have some of the textbooks but not all; 40% said they have some materials while 5%

The Hunger Project OEPP 110 6/20/13 indicated they do not have any textbook and supplies for their children. The government of Ghana has for some years now, as part of its educational policy to enhance the quality of learning and teaching, has been supplying Free Textbooks and School Uniform to children of public schools especially in rural and deprived communities but the reality on the ground shows some of the target school children are yet to receive government free textbooks and uniform. Lack of basic teaching and learning materials has been identified as one of the major challenges affective quality education in Ghana. At the basic primary school level, each student is expected to have at least three core textbooks (English, Math and Science), which implies a ratio of core textbooks per pupil of 3:1, however, there exist significant disparities in terms of availability of textbooks (MoWAC & UNICEF, 2011) and it is worse in rural and poor communities where parents cannot afford to buy these textbooks or do no appreciate the need to buy then even if they have the money because they think it is the responsibility of the schools or government to provide them.

Distance between house and nearest primary/basic school

285 300

250

200 138 150

Populaon 100 39 30 50 6 0 0 – 5 6 – 10 11 – 17 20 – 45 60 – 120 Walking to nearest Primary School (minutes)

Distance between house and the nearest primary could serve as a contributing factor in either encouraging parent/children going to school or otherwise. In this respect, respondents were asked to estimate in hours/minutes how long it takes to walk to the nearest primary school. On average, the chart shows that majority of households (285hh) 57% lives about 5 minute walk to the nearest primary school; 238 (28%) of households uses less than 10 minutes to get to school; 8% takes between 11 and 20 minutes while 6% uses between 20 to 45 minutes. The farthest households (6 HH) spend between 60 minutes to 120 minutes before accessing primary school.

Access to Junior High School (JHS) Households were asked to estimate the distance of walking to the nearest JHS. The results compared to the primary school distance revealed that JHS are farther away from most households. For instance while 191 HH (58%) live about 10 minute walk to the JHS, 21% (104HH) walk for about 35 minutes to get to school while 15% (64HH) spend about an hour. At the extreme cases, few households (5%) live one- and-half hours to three hours walk from nearest JHS.

The Hunger Project OEPP 111 6/20/13 Availability of Adult Literacy Classes The question was asked to find out about community 200 156 partners access to adult literary to enhance basic 135 150 numeracy and literacy for the adult population. It turned out that an absolute majority of surveyed 100 64 64 64 40 communities constituting 83% (413HH) do not have 50 literacy classes as against only 16% (81 HH) No. of Households 0 responding positively 0 – 5 6 – 10 11 – 17 – 40 – 80 – 15 35 75 240 to having adult literacy classes in their communities. Minutes to nearest JHS About 1% of the respondents could not tell if literacy classes are being organized in their communities.

Proportion of Household adults that benefitted from literacy classes As follow up to measure the coverage of THP organized literacy classes in surveyed communities, respondents were asked how many adult household members are attending or have attended literacy class organized by THP-Ghana. The results showed that majority of households constituting 79% (393) never had any household member benefiting from literacy class. 20% (101) of households had at least one member attending literacy classes while about 1% or less had 3 members attending literacy classes.

4 (1%)

81 (16%) Don’t know Yes No 413 ( 83%) Aending Adult Literacy Classes

Figure: Proportion of household adults Attending Adult Literacy Classes

MALAWI QUALITATIVE ANALYSIS OF KII/FGD

Community mobilization During the FGDs and key informant interviews it was learnt that all communities around epicenters were working together in order to identify problems. Community meetings were being conducted for example organized by village headmen and other key stakeholders. During these meetings community members discussed a wide range of issues including their greatest needs or problems that they were experiencing and how these could be addressed. If they needed external support their representatives would then go The Hunger Project OEPP 112 6/20/13 to GoM and NGOs and request support for implementing the interventions they identified. In addition to conducting meetings within one village, there were also inter-village meetings which also discussed issues such as, as mentioned during an FGD with men in Champiti, HIV and AIDS, agriculture, animators and GBV and how to deal with emerging problems in the villages.

Various villages work together and committees have been formed with membership drawn from different villages for a specific purpose. In an FGD with students, farmers and casual labourers in Kachindamoto participants said that committees have been formed with members drawn from various villages on the problem of food in their area. Another committee, which has also been formed, is the one on family planning, which encourages people to use family planning methods such as condoms. The formation of these committees has been facilitated by THP and on their own members of the villages could not do anything. As has been mentioned above, various villages come together and implement activities for the benefit of their communities. For example (i) in Majete during an FGD with men participants said that community members from a number of villages moulded bricks for Majete Epicenter which will be constructed in the area; (ii) In Kachindamoto a number of villages collaborated to mould bricks for school blocks and since water is a problem in this epicentre as identified by communities villages also collaborated to build a well. In this epicenter there is also collaboration among villages as they have all been affected by the shortage of teachers in their community. As shall be demonstrated later, the wanton cutting down of trees has been mentioned in all the epicenters as a major problem; hence villages have also worked together in the planting of trees. They also work together in the maintenance of roads including construction of bridges in epicenters such as Kachindamoto.

In all the epicenters many people are also attending meetings called by the village headmen. One of the major factors that have led to increased collaboration, according to participants in all FGDs is the training that THP offered to community members which emphasized on collaboration among villages to address a common cause. With the coming of THP people have realized the importance of working together while previously it was a big hassle to organize people to work together. During the FGDs with community members in Champiti, Mpingo, Kachindamoto and Majete participants said that since THP started working in their respective areas generally collaboration between villages and village leaders has increased and this is demonstrated for example in the fact that the villages collaborated the initiative of coming up with the idea of moulding of bricks for various projects benefiting their villages as has been mentioned above. The working together of villagers and their traditional leaders is in line with THP’s approach of encouraging villages to work together and involves many chiefs and community members. It was mentioned in an FGD with community members that there used to be villages which never worked together: for example initially some village headmen such as Matsimbe and Malinda in Champiti never used to work together but now, through initiatives by THP, these villages have realized the importance of working together and have since started working together.

What is evident is that communities experience a lot of problems and while they appreciated the work being done by THP they also said that on their own they inform village headmen to take their concerns and needs to the Traditional Authority (TA) who can then take these issues to the DHO or other responsible Government authority at district level. This, as mentioned by participants in an FGD with farmers and businessmen in Mpingo, is according to decentralization:

The Hunger Project OEPP 113 6/20/13 “THP told us that they believe in decentralization as the starting point so they gave us ways and direction to follow so as villages we agreed to build bricks”.

While in most cases participants in this evaluation said that there was good collaboration between villagers and their leaders, it was also learnt that in some cases this was not the case. For example, in an FGD with women in Mpingo especially in Namende Village participants said that initially there was good collaboration and understanding between the villagers and their leaders and they moulded bricks, which were used for the construction of a maternity wing. While community members said that the construction of the maternity wing was a good thing, they, however, felt that this was incomplete because when a pregnant woman is admitted for labour there was no place where a guardian could stay. However in this village, which falls under Mpingo Epicentre, they started doubting their leaders mainly because five years had passed since community members were informed that a health centre would be constructed and community members moulded bricks and the construction had just began at the time of data collection. The long delays in the implementation of the construction of the health centre have created mistrust and the collaboration between leaders and their subjects has been affected somehow.

The case of Namende Village in Mpingo Epicentre was unique as in all epicenters people reported that there is collaboration between villages, between village leaders and between village leaders and their subjects. People are dedicated to development activities and both men and women are present in committees and they attend community meetings. This is attributed to the THP’s slogan of change of mindset, which has transformed the mindsets of many rural women, girls and men and they are now all taking part in development activities. For example women now realize they are capable of changing things at community level. The change in the mindsets of people was also mentioned by key informants such as Community Development Assistants who claimed that their job of mobilizing communities for development activities has been made easy as communities have realized that they can do some things on their own.

Agriculture and food security This constituted one of the major interventions being implemented in the epicentres with support from THP. THP is providing farmers with farm inputs and key informants such as the Agriculture Extension Development Officer (AEDO) in Champiti reported that there has been a decline in hunger in the area as those who used to have no food now they have. This is mainly because of the fertilizer loans being given by THP. The initiative by THP complements the nationwide farm input subsidy program run by Government of Malawi, which helps households to have enough food. THP has established farmers groups in its epicenters with which the AEDO works. The AEDOs, among other responsibilities, teach community members profitable farming such as appropriate spacing of ridges and the Sasakawa approach to farming. Sasakawa involves one maize seed per hole and such an approach yields high maize yields with small amounts of fertiliser. Previously, farmers in all the Epicentres experienced a lot of problems such as lack of farm inputs but this has since been addressed by THP even though cases have been reported where households share the fertilizer that they get on loan from THP. In order to address the shortage of fertilizer farmers are further advised to supplement the fertilizer they get on loan with manure as is done in the THP demonstration gardens where they apply manure and fertilizer.

The Hunger Project OEPP 114 6/20/13 Defining hunger In this evaluation participants in FGDs were asked what hunger meant to them and they defined hunger in a number of ways for example as “unavailability of any food in the home” and “one not harvesting enough maize in the year”. There was generally a consensus that if there is no hunger it implies that one has enough food to eat. If the food gets finished before the other season like the way it was at the time of data collection, then one can say that there is hunger. Some harvest enough while others do not. In general hunger is therefore perceived as lack of food in the home. In an FGD with men around Champiti participants emphasized that hunger is the lack of Malawian staple food, namely nsima as also mentioned by participants in an FGD with women in Ligowe:

“It is true, hunger is the lack of food, nsima. If there is no maize at the house, we say there is hunger”.

In an FGD with women in Majete participants introduced an element of money being available to purchase maize:

“Hunger is when there is no food at the house, there is nothing no maize, at least when you have money, you can buy food, but when there is no money that is when you say there is hunger”

Hunger is therefore lack of food in the home especially nsima. Even if households have other foods so long as there is no nsima then households say that they are facing hunger, a mindset that needs to be changed.

Causes of hunger Participants in this study were also asked about the causes of hunger at household level. What we see in this section is that there are other factors which can easily be addressed and THP has already started helping community members for example by providing fertilizer and other farm inputs on loan. Beneficiaries have appreciated that these loans are important. THP and other stakeholders including community members can easily address other factors such as laziness, the selling of maize to find money for beer and changing people’s minds about what should constitute food. There are however other factors that are beyond the control of human beings for example inadequate rains.

Lack of farm inputs including human resource Most of the participants said that the lack of fertilizer in the household is one of the major causes of hunger: if one does not apply fertilizer to his or her crops he or she cannot harvest enough maize and other crops hence they will not be able to have food for the whole year. Other causes of hunger frequently mentioned included the lack of manpower and financial support. For example, those who have children are easily helped in their gardens by their children but if one does not have children then he or she may have problems in terms of ensuring that work in the garden is completed in time.

Laziness In most FGDs conducted in various catchment areas of THP Epicenters participants also said that other community members experience hunger because of laziness. Participants for example around Champiti Epicentre reported that there are some people who can wake up in the morning and spend time

The Hunger Project OEPP 115 6/20/13 drinking beer while their friends are working in the gardens and it is obvious that such people will experience hunger. The brewing of beer also tends to reduce maize stocks as they use it as raw material in this process. It was also mentioned for example during an FGD with students, farmers and casual labourers in Kachindamoto that there are some people who go to town when first rains come. Such people run away from cultivating their fields and when they come back they have nothing to eat and they give tough time to their friends and relatives to feed them.

Sickness in the household Hunger can also come about because of sickness of household members including the head. When one gets sick during farming season and the children are young, the husband for example is busy taking care of his wife and he cannot really work as a result his household will experience hunger. This is especially the case when one is admitted and once discharged from hospital he finds that his friends are half way through the field or they have finished.

Occurrence of disasters Households may also not have enough food because of natural factors such as climate. This was mentioned in all the FGDs conducted in various epicentres. Changes in climate can lead to hunger even if people can work hard in their gardens for example rains can come very early and stop early as was the case during the 2011/2012 growing season in some epicentres; hence people did not harvest enough maize. This is why at the time of the evaluation people reported that most community members did not have enough food. The maize dried in the field because it was sunny and the rains stopped early as narrated during one FGD with members of a support group in Champiti:

“Most of the maize got burnt in the field with the sun. Those who planted their maize early, were able to harvest while those that planted late did not harvest”. [Participants in an FGD with a support group, Champiti]

“There is little maize this year as my friends have said, we would plant the maize and then it would get dry, you plant again and the same thing happened. Some have even planted four times to at least get something. Most families do not enough food”. [Participants in an FGD with a support group, Champiti]

In Ligowe participants said that with fertilizer loans being given by THP normally people have adequate harvests to last them till the next harvest. During the last harvest, however, even though they worked hard and applied the fertilizer they got on loan people did not harvest enough maize because of inadequate rains. They were looking forward to buying the maize that they have at the epicenter, as it will be explained later. For those who replanted some did not even have fertilizer as they used whatever they had during the first planting hence they also ended up with poor harvests.

Selling of maize after harvest Even if some households may harvest enough maize they may sell most of it and they end up experiencing hunger. For example in an FGD with men in Majete participants reported that in some cases people exchange maize for beer. It is not that people should not sell maize but, as mentioned by participants in an FGD with students, farmers and casual workers in Kachindamoto, one should first

The Hunger Project OEPP 116 6/20/13 check how much maize he or she has and if he or she has enough maize then a decision can be made to sell the extra. People should not start selling the maize before finishing the harvesting as this can bring about hunger. In Ligowe in an FGD with women participants said that THP advised them that they should not sell maize unless they have extra.

The definition of food and the growing of cash crops As has been said people define hunger as lack of nsima even if they have other foods. In an FGD with men around Champiti it was also mentioned that there is inadequate sensitisation of the people in the area in the area: a lot of people consider maize and hence nsima as food and that “other foods are not food”. In an FGD with men in Majete participants also said that another practice that brings about hunger is that people grow a lot of crops which performed well the previous year at the expense of maize. This also brings about hunger and to deal with this problem they thought that it was proper to practice crop diversification. The thinking is that when they grow cash crops they will sell them and purchase maize. This is quite difficult as at the time of harvesting people still have some maize hence purchasing maize is not a priority at the time.

Soil degradation and other factors There were also other factors which were mentioned as being responsible for causing hunger: in Kachindamoto during an FGD with students, farmers and casual labourers participants mentioned that soil degradation also led to low harvests and hence hunger. In the same epicenter during an FGD with women participants said that in some cases the farms are not enough to sustain big families for example half an acre may not be able to sustain a family the whole year because it is small. Another thing also mentioned in this FGD was that overpopulation was also responsible for hunger in homes as it becomes quite hard to feed all the people in the household.

The provision of agricultural loans to community members As has been mentioned above THP provides loans to members of the community in areas where it is working. Vulnerable groups such as people living with AIDS (PLHIV) and persons with disabilities are also included. While these loans are provided to groups such as support groups in Champiti, other people also get these loans as individuals. Once a person or group gets fertilizer on loan he is supposed to pay back at the end of the growing season. Participants explained that when they get 2 bags of fertilizer, they return 6 bags of maize after harvest depending on the cost of the fertilizer; if one gets 1 bag of 25 kg of urea then he or she gives back 3 bags of maize. Participants acknowledged that in some cases rains are conducive for the growth of maize but sometimes rains are in short supply. Some harvest enough maize while others do not. They explained that whatever the case they try to pay back the fertilizer they get on loan at the end of the growing season.

While most people appreciated the loans that THP provides to members of the community in its catchment areas, others also said that such loans tend to push community members into poverty because they get two bags of fertilizer such as a bag of CAN and UREA and they repay back with 6 bags of maize which was perceived to be too much. In some cases when one fails to pay back the loan he or she is forced to buy maize from others and pay back. The procedure is that one cannot pay back the loan with cash: it has to be bags of maize.

The Hunger Project OEPP 117 6/20/13 As far as farming is concerned participants in this study said that their communities were doing well mainly because of the fertilizer loans that THP provides. Because of these loans from THP community members are able to harvest enough maize depending on adequacy of rains and they sell some of this in order to get money and among other things pay school fees for their children and meet other household needs. They also harvest enough maize because of the new ridging system called Sasakawa. In the past the ridges used to be very far apart, taking space where there were supposed to be other ridges. With THP teaching community members about Sasakawa, they are able to harvest a lot compared to the past because ridges were few since they were far apart. Over the past year in an FGD with men in Champiti and other epicenters participants said that maize yields have declined due to inadequate rains and, as mentioned earlier, some had planted maize with first rains and even applied fertilizer but then this was followed by a dry spell. This was also mentioned by key informants such as the AEDO. One other impact of the provision of fertliser to members of the community, as mentioned by an HAS in Champiti is that there has been a decline in malnutrition in children.

Establishment of food banks Participants in an FGD with members of a support group in Champiti Epicentre said that after harvest beneficiaries pay back bags of maize as has already been highlighted. In the community food banks have been established and when maize is collected from beneficiaries of fertilizer loans it is stored in the food banks. There is a committee in each cluster that collects the maize from beneficiaries and they take this maize to food banks. Pesticides are applied to the stored maize so that it does not get damaged. During the time when community members don’t have maize in their homes the maize from the food banks is then sold to them. Money from selling the maize is kept by the rural bank, which is used next time to buy fertilizer when community members want it. Members of the community appreciated the assistance they get from THP as these initiatives are aimed at ending hunger. Even though there were poor rains in the 2011 and 2012 rainy season a significant proportion of community members harvested enough maize and the food banks were filled: in Champiti some maize was even kept in a hall which was not the case in the previous years. In Majete it was further mentioned that in the past people in the area used to sleep at ADMARC just to purchase maize. This was, however, no longer the case as people had maize in the food banks right in the village. The establishment of food banks at community level was therefore quite helpful to the people in the communities, as they did not have to travel long distances to purchase maize.

It should be added that previously people experienced hunger but this problem has been addressed by THP. Even in an FGD with women in Majete participants did mention that they have a problem of lack of food and that for them to survive their men have to go to Mozambique to look for piece work so that they can find food. As at the time of the data collection, participants in an FGD with women in Majete did mention that THP has given them loans but the major challenge was weather and the seeds given to them were inadequate. While people appreciated the loans that have been given to them to start businesses one major challenge as mentioned by women in an FGD in Majete was the lack of markets. Traders were coming to their communities to purchase Nandolo but for maize they do not have markets where they can sell the crop hence they just use it for food. As at the time of data collection it is evident that some households had enough to eat and last them the whole year while others did not and this was mainly because of erratic rains. Some do not even have maize to roast. Even though most people did not

The Hunger Project OEPP 118 6/20/13 harvest enough maize some harvested because of using modern methods of farming. One woman in an FGD with women in Majete did mention that she received the maize seed from THP and when she planted the sun came but it did not die because she did the ridging very late and the maize was able to do well since she followed the one seed per hole method. She harvested enough from this farm. She however stressed that if the rains came well hunger would have been history. The provision of fertilizer loans and establishment of food banks at village level have helped quite a lot in addressing hunger at community level in areas where THP is working. There might however be a need to intensify winter cropping in order to address the problem of inadequate rains.

Gender and development

Gender roles at household and community levels Before THP started implementing interventions on gender, participants in this evaluation reported that in their area there was a clear differentiation between men and women and boys and girls. Initially there was a clear differentiation between men’s and women’s roles in the household and at community level and people used to say that this is a man’s role and that one is a woman’s role. For example in an FGD with women in Majete participants said that initially there were misunderstandings in that men would not do certain pieces of work because it was regarded as for women only and they gave examples of collecting firewood, sweeping around the home and that even women could not cut grass because it was regarded as a man’s job. Participants said that it is good when there is equality between men and women.

With the coming of THP things have changed: there is clear understanding between the wife and the husband so much so that they are sharing their roles. They gave an example of cooking that in the past there was no way a man would say he will cook or even wash cooking utensils. These days there are men in the community who are cooking for their families, washing dishes, sweeping the house and even carrying the children. Couples go together to fetch firewood because after being made aware such activities are responsibilities of both men and women. It was also mentioned that even though some men may not be able to carry water, they do however escort their wives to draw water. In another FGD with men in Majete participants said that previously it was only men who moulded bricks and that this is not the case anymore as women are now also moulding bricks. In most epicenters including Kachindamoto participants reported that these days sending a child to school is not a man’s business alone but also that of women e.g. they may engage in business and the money they realize is used to pay school fees for the children.

While this is the case men also said that there are some tasks which up to now women cannot do and this was the digging of graves. Other things that were still being done by men only included building houses and that even in bed women are not supposed to initiate conjugal activities such as sex as demonstrated in the following quotation from an FGD with men in Majete:

Participant: Even in bed, a woman is not supposed to initiate conjugal activities like sexual intercourse.

Facilitator: Oky? (laughter, while some hum in agreement).

The Hunger Project OEPP 119 6/20/13 Participant: Always it’s the man who should initiate intercourse in bed that’s how God created it.

Participant: Eeeeh, like God created it that a woman should always lie and a man on top.

This study also found that equality between men and women is not only limited to the home but it extends to the community level. For example in an FGD with men in Majete participants said that nowadays women are preaching in churches just like men which was not the case in the past. Before THP came to the area it was also stressed that women did not have any rights; they were being looked down in marriage and if they tried to say anything concerning the home men perceived such women as desiring to become heads of households. Nowadays women have a voice and they are also able to find jobs while in the past the perception was that a woman should not work. In an FGD with men around Champiti participants said that even when it comes to committees previously women’s roles were restricted to being the secretariat but now they can even be chairpersons of committees. In the past people thought that women who were committee members were just after men: nowadays it was reported that women can walk with someone’s husband going to work without any problems and they feel liberated. It was further mentioned that in Ntcheu previously it was only men who used to be chiefs but that things have since changed and that they now have a lot of women who are chiefs.

With regard to education there are also a number of changes. For example in the past when a girl reached puberty, she was married off but now she is the one proceeding with education whereas boys are indulging themselves in beer drinking and chamba smoking. People have also seen that it is girls who help their parents after they get educated and start working; hence both boys and girls are going to school. In an FGD with women who were members of a support group around Champiti Epicentre participants also added that in the past men never got involved in small businesses but now both men and women are selling things together. Even access to loans is now spread equally to all men and women which demonstrates that there is gender equality.

The changes in gender perception have come about because of among other factors the prevailing democracy and women’s and men’s understanding that women as well have rights and there are many organizations such as THP which are operating at community level and creating awareness about gender issues and in turn those who have been trained are also teaching other members of the community these issues. Even key informants such as CDAs acknowledged that there have been significant changes in the area of gender equality demonstrated by women’s participation in development works. These results generally demonstrate that while a lot of changes have been brought to these communities through THP support there are still some challenges that need to be addressed in terms of ensuring that some of the things that men do such as graves are also being done by women.

Decision making at household level In the past participants in this study emphasized that men were the ones making decisions at household level. Women had no say as has been mentioned above. Things have now changed because husbands and wives sit together and they make decisions together. For example in an FGD with members of a support group around Champiti Epicentre participants said that if there is a need to build a toilet both the husband and wife will discuss on how they should go about building one. Husbands and wives jointly

The Hunger Project OEPP 120 6/20/13 look at other things that are needed at the house: for example if there is a need for a plate hanger, the wife may even tell her husband to rest as she goes and sources the materials for the plate hanger and build it; a thing which could not happen in the past. It was generally acknowledged that husbands and wives together with their children are working together, be it in the gardens or construction works. The changes in gender perception have come about because of THP and decision-making involves both husbands and their wives.

Household chores for boys and girls Previously there were defined roles and responsibilities for boys, which were different from those of girls. However participants in this study mentioned that things have since changed: both girls and boys are doing the same chores and there is no difference: a boy can cook and wash plates whereas a girl can do a boys’ job. Members of the community said that they generally do not differentiate between the works that they give to boys and girls in this area: if a girl washes plates today, a boy cooks and the following day the boys will sweep while girls will do the mopping. Boys and girls are therefore working together and sharing jobs within the household. In some cases participants in this study said that one may have only male children and the mother might become sick. If one does not teach his or her male children how to cook, they will stay hungry if the mother is sick. One’s children may therefore suffer because they were not taught how to cook and do other household chores, which previously were designated as either for boys or girls. Previously this was not the case and participants did acknowledge that this has come about because of the coming of THP. Previously when a boy was told to do something which was designated for girls, he would not do it. In the past when a boy wanted to draw water, men would say that’s not a boy’s job but a girl’s. But since the coming of THP, boys and girls are all working together and sharing responsibilities. THP has also demonstrated to community members that gender equality is possible. In an FGD with men in Champiti participants further said that the THP workers are also acting as role models. For instance the female driver from THP inspires many girls. The nurse and Epicenter bank clerks are males and women respectively, a thing which provokes gender dynamics in people.

In an FGD with women in Mpingo participants said that a boy can even prepare water for his father to bathe, a thing which never used to be the case.

“Nowadays people are more aware than in the past, for instance, when all your children are boys, what can you do, you still have to teach them how to cook, the same if you have girls only, and there is a need to cut a tree, you still have to teach them. This means that if you either have male of female children you have to teach them all the household chores” FGD with women, Mpingo]

One woman in an FGD in Mpingo even said that his children including boys all pound maize, go to the maize mill, are involved in winnowing and drawing of water for the household. Some girls even go to the maize mill on a bike. These changes have come about because of the coming in of different organizations such as THP and that according to participants in an FGD with women in Mpingo it was mentioned that with the increase in deaths these days parents are now teaching their children different chores so that when they die the children will not suffer as they will be raised by other people.

The Hunger Project OEPP 121 6/20/13 Literacy and education THP has been quite instrumental in the establishment of nursery schools and adult literacy classes in the different epicenters in the country and people generally appreciated such interventions. This section describes the role that THP has played in the establishment of nursery schools and adult literacy classes, explores the people’s perceptions about the quality of education as well as the challenges that make children to drop out of school.

Nursery schools Participants in the FGDs and key informants did mention that THP has played an important role in the establishment of nursery schools and the community generally appreciated this intervention. Children now start learning at nursery schools and when they have matured enough to proceed, a letter is written for them to refer them to start primary school. Participants in this study acknowledged that the introduction of nursery schools in their communities has helped their children to perform well in school and as a result they do not really repeat in classes. Previously children repeated classes quite often and hence they could not proceed to the next class. Participants in an FGD with members of a support group in Champiti said:

“The coming of THP has helped in that the nursery schools are helping our children to do well in their primary education because they have been taught the basics in nursery school. In addition, in the past boys were the ones who were hard working in schools but now there is competition between them and the girls in secondary school. This is because of the encouragement by THP. Illiteracy has also been reduced because of the adult literacy classes”.

Previously nursery school going children were being taken to the farm by their parents as they could not leave them alone at home. These children now go to school where they learn and also are given nutritious food such as porridge. Nowadays nursery school children can even speak English which was not the case previously as narrated by a participant in an FGD with members of a support group in Champiti:

“Education is really advancing, if you meet a child who learns here and you ask him ‘how are you’, he answers that ‘am fine’, we clap hands for them knowing that they are really learning, so when they go to primary school, there are no problems”.

While in general people appreciated the establishment of nursery schools in some cases there were problems that were being experienced. For example in an FGD with women in Mpingo participants said that teachers who teach at these schools are from the village and some of them have not been trained on how to teach nursery school pupils. They therefore requested THP to train some of the teachers in nursery schools.

Adult literacy classes Illiteracy level among adults is also decreasing: men and women are now attending adult literacy classes and they are not shy to do so. In some villages however the adult classes were not functional as teachers were not available. The adult literacy classes are useful as some people who never used to read and write are not able to do that. Some are even able to count money, a thing they never used to know. One The Hunger Project OEPP 122 6/20/13 PEA said that adult literacy has changed things in the area: in the past, during elections many people used to say that they don’t know how to write, but now some of the very same people are secretaries, treasurers in committees. Some men and women however get discouraged from attending adult literacy classes as teachers are from the same village and sometimes these teachers absent themselves from classes because of other chores. This tends to demoralize adults who are eager to learn. In an FGD with women in Kachindamoto participants acknowledged the existence of literacy classes but added that some people are reluctant to go; they however did not explain why some people are reluctant. In some places they are learning and not in others.

As at the time of data collection there were some adult literacy classes, which were introduced by the GoM and others by THP. For example in Champiti, 21 adult literacy classes already existed and that out of those introduced by THP (11), only 6 were active. These were functional because of the close supervision by THP and women are enthusiastic about adult literacy because it has enabled them to read and write. People are now able to read the bible. GoM has an adult literacy program and THP is complementing this and such a move will translate into a significant change. One of the factors that has contributed to high enrollment in adult literacy classes supported by THP is the requirement that when community members want to get a loan, anyone who cannot sign is not be allowed to get such a loan. This is why many adults were attending adult literacy classes so that they can at least learn how to sign and then be able to access to the loans. Therefore THP has helped to improve literacy levels in the areas where it works.

Quality of education In general participants in FGDs said that the quality of education in their communities was unsatisfactory. Even though this was also mentioned in FGDs conducted in Champiti it was not explained why they felt that the quality of education was unsatisfactory. In Majete in an FGD with men participants said that teachers are just like parents: female teachers encourage and support girls while male teachers support boys. However in their area there were no female teachers and this posed a problem as male teachers could not adequately advise and support girls. As was mentioned earlier in places such as Champiti nursery schools have been established to prepare children for enrolment in primary school. In Majete, however, this was not the case: there were no such schools as a result children never developed interest in school while young.

In an FGD with men in Majete participants also reported that there were inadequate teachers as one would find only two male teachers manning the whole primary school from standard 1 up to 8 hence some children spend the whole day without learning and sometimes they only learn one or two subjects per day; hence they get discouraged. In places such as Majete girls also lack female role models such as female teachers. They get excited when they see the female THP driver as she inspires them quite a lot. Since there are no female teachers in Majete participants said that when girls reach adolescence they lack support on how to handle their lives. In Mpingo the lack of teachers, as a problem that affects education quality, was also mentioned and that children spend a lot of time without learning as well. In an FGD with men around Mpingo participants also observed that secondary schools are far and the long distance tends to discourage children from going to school. They also lamented that they were promised that their children would start eating porridge at school but this is yet to be implemented.

The Hunger Project OEPP 123 6/20/13 In some places such as Kachindamoto some participants said that the quality of education was satisfactory. In an FGD with students, farmers and casual labourers in Kachindamoto participants said that the quality of education was very good and that in the past students could not pass national examinations in secondary schools but now they pass. They also said that in Kachindamoto they have enough teachers unlike in the past where one could find only 5 teachers per school and one teacher could take care of more than 100 pupils. In such a school environment where teacher: pupil ratio is very high there was a problem in that the teacher never comes to know the pupils closely and students may not concentrate due to large numbers. They also said that in the area of Kachindamoto previously there was a shortage of learning materials such as books but now this is not the case anymore. They also said that in their area there were a lot of pupils who were not going to school. In order to address this problem in Kachindamoto they found volunteers who are teaching the children. There are therefore a number of challenges within the education sector in the epicenters which need to be addressed in order to improve the quality of education.

Challenges that hinder continuing and completion of education One challenge that was mentioned almost in all FGDs conducted in the catchment areas of the different epicenters as being responsible for hindering continuing and completion of education among girls is early pregnancies: for the girls, one may find that a girl has written her standard eight or form two examinations but she cannot continue because she is pregnant. While girls may get pregnant and get married on their own, participants for example in an FGD with men in Champiti said that in some cases their parents are the ones who want them to get married while the girls themselves want to continue with school. During an FGD with women in Majete an example was given in which participants reported that most of the girls were in their homes at the time of data collection because parents wait for the girl to start menstruating and then they force them into marriage. Disagreements among parents can also force a girl to drop out of school and get married. If one parent wants the girl to continue with school and the other does not want then there is a problem.

In addition to parents forcing their children to get married it was also learnt that peer pressure can play an important role as mentioned during an FGD with members of a support group in Champiti:

“Some are failing because of peer pressure from friends when they go to school; when they see what other girls are doing, they end up joining them. In addition, sickness also hinders a child from continuing especially when he/she gets sick during exams, so without wanting to repeat, he just gives up and leave the school”.

Peer pressure may force girls to engage in sexual relationships and as a result they can get pregnant and drop out of school. As mentioned by members of a support group in Champiti if a child falls ill and fails to write examinations she may as well drop out of school because of not wanting to repeat. The introduction of community day secondary schools has also brought self boarding facilities where girls go and live on their own. When they see what other girls are doing or eating, they may be influenced to do the same thing such as having sexual relationships. High divorce rates, as mentioned during an FGD with men in Champiti, is also leaving children with single mothers who cannot afford to pay school fees for all the children. Eventually it is the girl child who is forced to drop out of school deliberately or through early pregnancies because of premarital sex.

The Hunger Project OEPP 124 6/20/13 The dropping out of girls from school because of pregnancies was mentioned in almost all FGDs. Currently there is a policy within the education sector that if a girl gets pregnant she can go back to school after delivery; however this is not acceptable to all the girls who experience early pregnancies. For example in an FGD with women in Ligowe participants said that once the girls drop out of school even if one tries to convince them to go back to school they will not be interested. However while others were aware that a girl can go back to school after she delivers some participants were not aware of this government policy. The attitude of parents towards girl children also makes such girls to drop out of school and get married. It was reported that when a girl is grown-up every time she asks for something from parents she is told “you have grown and you can provide for yourself “. Such responses from parents tend to push the girl child into marriage. When these girls are staying with their grandparents and there are problems in the home in terms of care they also opt to get married to run away from problems.

In Mpingo it was also mentioned that early marriages contribute to dropping out of children from school and that if parents encourage their children to go to school and point out some role models they ask their parents if at all they themselves went to school. One of the major problems is that young people do not pay attention to school:

“The problems are there, for example, education wise, if you tell them to go to school, they ask you if you have been to school yourself, if you try to advise her not to be found with boys, she answers back to you saying, but you are married, did your parent ban you from getting married? That’s the problem. Parent are busy fighting with their children to go to school” [FGD with women, Mpingo].

Such an attitude on the part of children is not good as it demonstrates that they do not listen to advice being given to them by parents and other adult members of the community. The other challenge for example as mentioned by students, farmers and casual workers in Kachindamoto, is that parents who did not attend school in their lives tend to discourage their children by giving them examples of people who are educated but are not employed. These participants further mentioned that some women say that they can’t send the girl child to school because they fear that when the child goes to secondary school, she is likely to engage in sexual relationships.

In primary school education is provided free of charge to all Malawians. However, students have to pay school fees in secondary school. Not everyone can be able to pay school fees and this is why participants in this study for example said that some children are failing to complete their education because of lack of financial support from the parents. In an FGD with members of a support group in Champiti participants did mention that when a parent is financially constrained they will choose a boy to proceed with education at the expense of the girl child and that this was a big problem in their area. Bursaries do exist and these are provided through the District Social Welfare Office but participants did acknowledge that these bursaries are inadequate to cater for a growing number of vulnerable children in their areas. The problem of school fees is not as common as it used to be. For example in an FGD with women in Ligowe participants said that before THP came into the area and started giving them loans a child would pass examinations and be selected to go to secondary school but fail to go because of lack of money but

The Hunger Project OEPP 125 6/20/13 that this is not a problem anymore as they get loans from THP and also harvest adequately to pay school fees for their children.

The other problem, as mentioned by men in an FGD in Mpingu, was that the children were learning at Madziabango Community Day Secondary School which was situated very far; hence they needed to pay school fees and at the same time pay costs for self boarding which is very difficult for most parents; hence children are forced to drop out of school. This was also mentioned during an FGD with women in Ligowe where again the secondary school is very far and students require accommodation near the school. In general there are also inadequate teachers and learning resources such as books and classes at both primary and secondary schools for example around Champiti Epicentre in Ntcheu. In Majete it was also mentioned that schools were very far and they mentioned the places where these schools are located and all of them were quite far for example they talked of schools being in Changambika and Changoima Villages. In an FGD with women in Majete participants mentioned that it was difficult for them to find money to rent houses for their school going children because of poverty; hence they sometimes drop out of school. If the schools were closer they would have taken the food to them. Other challenges as mentioned by participants in an FGD with men in Champiti included teachers who get drunk during work; the Ngoni culture which encourages boys to drink and initiation ceremonies which affect the education of both boys and girls by encouraging promiscuity which results into early pregnancies on the part of girls.

There was a feeling among participants in FGDs and key informants that the reasons spelt out as to why girls drop out of school are the same for boys. In an FGD with women in Mpingo participants said that the maternal health problems affect girls because when a girl is impregnated she drops out of school while the boy continues with his education. The girl may therefore just stay at her home taking care of the pregnancy and it is even worse when the home is poor and it becomes hard for her to go back to school. In some cases boys experience their own challenges in terms of continuing and completing their education. It was mentioned by participants that boys in some cases get the money for school fees from their parents and they spend it on girls instead of paying school fees and working hard at school. Sometimes they spend the money on chamba and drinking beer hence they drop out of school. In an FGD with women in Ligowe participants said that some boys lack vision and they like enjoyment:

“The parents may give him everything, money for rent, school fees and pocket money but when he goes to school he starts spending it on beer and girls because of peer pressure hence he does not proceed with school”.

In an FGD with women in Kachindamoto participants said that sometimes some parents start a business and use the child to go and sell the things at a younger age, when he gets used to that, he loses interest in school, so even if you tell him to go to school, he will see no good thing in going there but he will perceive going to the market or shop as a better thing to do. Parents start letting the child to handle money at an early age, so he starts loving money. Sometimes it happens that in primary school a child does not have a school uniform as a result; she is chased out of school. When exams come she will not pass because she was staying at home. When she keeps failing, she may give up and drops out.

A number of problems have been highlighted and participants were further asked how such problems can best be addressed. In order to address the problem of school fees participants in an FGD with The Hunger Project OEPP 126 6/20/13 women in Mpingo said that organizations should help in addressing this problem. These women gave an example of an orphaned girl in Tambala village in Mpingo who is being supported by THP and she is still in school. THP has also introduced a program in which they encourage girls who had been pregnant to go back to school. While some go back to school others fear that they will be laughed at. There was a suggestion also that parents should encourage their children about the goodness of going to school despite the prevailing poverty. In some cases however even if parents encourage the child to go to school he or she may not want to go to school. Children therefore also have a problem in that they may not want to go to school; hence the need for continued creation of the importance of getting an education to children. The PEA in Champiti added that children also drop out of school because of lack of proper sanitary facilities such as toilets which has had a great impact for girls at standard 6 and above. Girls eventually drop out because of this lack of toilets. While this problem was mentioned it seemed that people did not provide a solution for this. The PEA in Champiti cited initiatives by CRECCOM where teachers used to have retreats with girls but that the only advice they were giving was on AIDS.

There are also other initiatives that are helping to keep children in school. In a number of places it was mentioned that nowadays both boys and girls attend school and the dropout rate is quite low. Participants in an FGD with members of a support group in Champiti attributed this to the introduction of the school feeding program. The school feeding program encourages children to go to school and this year because of hunger no child will be at home because they will be forced to go to school since there will be porridge. Now children are continuing with school up to secondary school regardless of their age. The other problem that was mentioned by a PEA in Kachindamoto was that this is a lakeshore area and people are into fishing and many boys drop out of school to go into finishing business. In order to address this problem, chiefs agreed to ban boys from fishing. This is yet to be implemented but if boys are found fishing they will pay something to the chief.

Health problems being experienced in the selected area Participants in this study mentioned a number of health problems that they were experiencing in their communities and that some of these have already been addressed by THP. For example participants in an FGD with members of a support group around Champiti said that initially there was no health facility around the area and they used to go to Nsipe where there was a paying facility belonging to CHAM. Even though the health centre is now available at Champiti men in an FGD said that nurses refused to work there because there was no electricity. THP has constructed the health facility at Champiti and this has addressed problems relating to access to health services in the area. Members of a support group at Champiti even added that they can now access ART because the facility is near. In Ligowe in an FGD with women participants said that they experience diseases such as cholera and malaria. For those who are far from hospital they may even die before they get help. They also added that women deliver on their way to the hospital because of the long distances to get there. Even when they get to the health facility there is no health personnel who can help them. While distance is an issue women also said that there are some women who are reluctant to go to the hospital when they are about to give birth and hence they deliver in the village. In terms of follow up there are community volunteers in the village such as those in Champiti who follow up cases but these need to be trained. These volunteers give reports at end of every month on number of children vaccinated and those not vaccinated among other things.

The Hunger Project OEPP 127 6/20/13 While people around Champiti appreciated the construction of the facility and they were now able to access ART very near they complained that they were now suffering from other diseases frequently because of lack of medicines at the facility especially bactrim. THP is also helping PLHIVs through CBOs by supporting the provision of HBC but the type of support given was not specified. The construction of the health facility has been very helpful to members of the community as such a facility was not there before but the major challenge is lack of medicines. Previously women also used to go to distant facilities to deliver but with the construction of the facility at Champiti maternal health services are easily accessed. At this health centre pregnant women also access PMTCT services and these services are provided at community level: different villages have been allocated days when services are provided in that particular village. In the area around Champiti for example people again appreciated the construction of the facility because before this women used to give birth on the way to the hospital since Nsipe was situated very far. As a result of this facility the proportion of women giving birth at home has significantly been reduced. Maternal health groups have also been introduced which among other things teach pregnant women to deliver at health facilities and chiefs ensure that this is done. It was however not specified what these chiefs do to ensure that this is done.

While people appreciated the establishment of epicenters, in some cases for example in an FGD with farmers and business men in Mpingo participants said that there is inadequate staff in the facilities and the existing workers are overburdened to the extent that they are unable to attend to cases at the weekend. In this FGD participants added that if a person went to the health facility with a big health problem instead of referring the patient to the hospital they just send him or her home where he or she dies. They complained that this was a big problem in their area and that instead of calling for an ambulance they do not. Where epicenters were available access to health care improved significantly. In some places such as Majete participants said that such health facilities were not available and their nearest health facility was some 15 km away; hence access to health care was quite difficult. This was particularly difficult for pregnant women. While clinics have been constructed in some places in Champiti an HSA reported that there is no shelter where they can provide services such as family planning and vaccination as such they provide these services under trees and on the ground.

One of the major challenges experienced by members of the community is that in some cases they are very rude and may not offer any help. If they go to the homes of health workers to seek assistance in the morning they may be told that they are very early and that they should go back because it is not time to visit someone. And then women sometimes go back to their homes without being helped. . In some cases these health workers just write referral letter for patients to go to the big hospital because they cannot come very early to the health facility. They open the clinics quite late around 9am. Even though chiefs are sometimes aware of such problems with health workers. In Kachindamoto the problem is that the area is surrounded by a CHAM facility so a lot of people complain that Mtakataka where they get free services is very far and people do not have money to go to the paying hospital as a result they give birth in homes. The maternity wing at Kachindamoto is not yet operational. But they promised to build one as bricks have already been moulded. People in Champiti reported that they had access to safe and clean water. There was piped water in the area as well as boreholes. Not every area in Champiti however had a borehole. They reported that in such areas when the taps run dry they went to draw water from rivers and their perception was that such water can cause diarrhea and the experience of such diseases tends to delay implementation of development activities in the home and the community. The Hunger Project OEPP 128 6/20/13 In some places for example as mentioned by men in an FGD in Majete the major health problem they were experiencing was the lack of safe and clean water in the area and as a result they experienced water borne diseases such as diarrhea and cholera. In Kachindamoto it was also reported that they lacked medicines in the health facility, nutritious foods and inadequate wells and boreholes and the road network was poor. In order to address these problems they have village health workers who help them to address health problems and they also encourage each other to have sanitary facilities such as toilets, managing water points well and ensuring hygienic storage of foods.

In order to address some of the health problems that they experience for example in Majete it was mentioned that community members encourage each other to observe cleanliness for example by having rubbish pits, toilets and bathrooms. In other places where THP is supporting the implementation of development activities people have toilets. In one of the FGDs conducted in Mpingo participants mentioned that people do not dig toilets even after being encouraged by health workers. In Mpingo again one of the problems they experience, as mentioned by men in an FGD, was that they lacked foods rich in protein such as meat and beans in their diet as these are expensive. They were however grateful that the Government was digging fish ponds for people in their community and once this is completed they will be able to eat fish from the ponds.

In order to overcome the health problems that people experience at community level people have lobbied for health facilities including maternity clinics and that health personnel are encouraged to hold civic education on water treatment and related sanitation issues. For maternal health services there are women who have been trained by THP on these issues who are called upon to go into the village to tell people to deliver at the hospitals. An epicenter clinic has been established at Ligowe and other epicenters. Before the construction of a facility at Ligowe people used to go very far at Chikonde but now they do not travel that far. It was also learnt that this facility is generally small and it was constructed in order to dispense drugs and not delivery of babies. After seeing that people in the area had problems as to where pregnant women would deliver THP has since given MK2.5 million to build a maternity wing.

Around Mpingo area in an FGD with women participants said that an epicenter clinic has been established in the community but that this is only for women because it provides postnatal care, family planning and other maternal health services. When a person is sick the hospital is still situated very far. Since the health facility where they can access treatment is still very far they still carry patients on stretchers, bicycles and men are the ones who usually carry the patients and one can meet them at Sikoti’s village going to Mpemba. Sometimes patients die on the way because of long distances.

“As for us people from this area, women are satisfied with it, women are delivering well even for the girls as they are having their first child. They used to go to Queens but now they are delivering right here, the doctor is really helping us. There are a lot of girls been helped at this place and also the doctor is receiving enough. We are really thankful because all the girls from Chamba, Khudu, Tambala, Sikoto, their first child is not born at Queens but here”, [FGD with women, Mpingo].

In Majete they said that the hospital was situated very far at Mtolankhondo in Mwanza. They were happy with the project of building a clinic at Majete and they were busy moulding bricks. Their focus The Hunger Project OEPP 129 6/20/13 was to build the clinic as it will be easy for them to access treatment when ill. Even TA Champiti in Ntcheu did acknowledge that they have a maternity wing and women are treated nicely when they go there. This has reduced maternal and infant deaths and they won a certificate on maternal health in Ntcheu.

Quality of services provided by the epicenters In general members of the community appreciated the availability of health centres in the community as these were not there before THP started working in their areas. The health services were easily available, accessible and of relatively high quality. In the past they used to walk long distances to access health services which is not the case any longer. Around Mpingo farmers and businessmen in an FGD said that health personnel including nurses were well behaved and they are in a good relationship with people as they help even at odd hours for community members. While this was the case in some epicenters such as Kachindamoto participants in an FGD with students, farmers and casual labourers said that they were particularly satisfied because when one suffered over the weekend and they would wait till Monday hence they thought that the addition of more staff to work over the weekend would help as diseases can attack anytime. They claimed that over the weekend health workers only help sick children. Expectant women for example in Champiti now access services at the epicentre compared to the past when they went to Ntcheu District Hospital. Community members appreciated the establishment of epicenters community members but said that there was a problem of shortage of medicines at the epicenter clinics. The other problem was that there were a few occasions when doctors could just write prescriptions and tell you that there was no medicines. While they appreciated the establishment of epicenter clinics there were also some problems associated with them.

Livelihood and microfinance Participants in this study said that THP provides loans to people. As a result of the loans that people get from THP families in the areas are doing well and have started businesses. Even if they may not have business but the same maize they harvest some can be kept while the extra can be sold and the money one gets can use it for business. A key informant in Champiti mentioned that the businesses that people have include grocery shops, selling fish, tomatoes, beans. This business has intensified because of the interventions by THP. These businesses are thriving because Champiti is peaceful and there are no thieves. These businesses have also started in other epicenters such as Kachindamoto. Members of a support group in Champiti said that some of them have benefited a lot from such loans as demonstrated below:

“I have benefited from the hunger loan, I have a business and at the moment am building a house, I bought goats that are about to multiply”. [A participant in an FGD with members of a support group]

“I have also benefited from hunger, my husband died while children were still in school but with the loan that I got from hunger, I started a business that is able to pay the fees of the children. There is benefit, we are not even complaining that we are single ladies because with the business, children are going to school and food is available”. [A participant in an FGD with members of a support group].

The Hunger Project OEPP 130 6/20/13 The benefits of the loans that THP provides to members of the community were also mentioned by others in for example Ligowe and Mpingo Epicentres:

“As for me, I have developed; I have seen the stages where I have been. I wasn’t in a state where I can pay school fees, was ready to stop my children to g to secondary. But when they came all my htree children are completing their secondary education. It has develop my life from where I was, now am thinking of a house because of the money loan. Food is also available compared to the past because of this loan” [Participant, FGD with women, Ligowe].

“It is not working for some, but as for me I have been able to buy a radio and a battery from my beer business, I can brew 2 to 3 drums of beer and it doesn’t last for 3 days, it gets finished. So when it is time to give back the loan, I return it in time. In addition, I have pigs that have just given birth, they are now five, I also have enough food and clothes which shows that our lives are developing. In the near future we are thinking of buying iron sheet if God blesses us” [FGD with women, Mpingo].

These loans are being appreciated by members of the community including those who initially lived away from the villages in the epicentres. One participant said that he used to live in Nchalo for about five years, but he never saw the improvements in his life. He then went back to the village and he has seen that God has helped him and his family: he has bought three goats and a pig which he never had when he lived in Nchalo. Since the business they have started are thriving have started businesses people are now able to pay school fees and buy school materials including the construction of iron roofed houses. In general there was an improvement in the livelihoods of the people where THP is working. This was mainly because within households there was improved understanding between spouses, they planned together and they made decisions on agricultural activities together including what to grow which was not the case previously.

Community members also received training on issues such as food security, gender based violence and they were also implementing a livestock pass on project program supported by THP. Because of such program there were few people for example around Champiti who did not have any livestock but they have managed to have domesticated animals such as pigs, chickens and goats. It was further mentioned that families were generally becoming more self reliant as mentioned in an FGD with farmers, businessmen and chiefs in Majete:

“There is also hope that people’s livelihood will continue improving. Poverty was extremely high in our area, but its decreasing. For instance, we used to go all the way to Mwanza just to buy maize, but now we have it amidst. Fertiliser loans are changing us greatly, and we hope in the near future, the livestock we were promised, will arrive soon. When such a time comes we shall live happy lives”.

On their own, members of the community have also tried to improve their livelihoods by implementing other initiatives. For example in Mpingo it was mentioned by men an FGD that they have tried to grow crops such as pigeon peas and cotton. They however said that even though the Government is encouraging them to grow cotton the market and price is not that good. If they have surplus maize this

The Hunger Project OEPP 131 6/20/13 is also sold in order to earn an income as has also been mentioned earlier. One of the things that was stressed about livelihoods and microfinance issues, for example by participants in an FGD with women in Ligowe, was that women are independent and they are able to buy things such as salt at the house rather than begging from the men and they are no longer begging because of the loans they get from THP.

“Previously, we would ask anything from the man, in my case, my husband stopped working long time ago before the children went to secondary school, but I have sent to school four children on my own because of hunger. I have taken the loan eight times, this one will be my ninth. If it was before I would have finished my livestock to find money for fees but I still have them. What I do nowadays is to buy a crate of eggs for my children to enjoy. To those that are afraid of the loan are just delaying themselves” [Participant, FGD with women, Ligowe]

“I just want to thank the hunger project, even though I took a small amount of money but am able to run properly the business without the help of my husband, things like salt, sugar, the man is able to provide which means my money is for business alone. I took K5000 only and am a bit happy but I know that if I can get K10000, I will be more happy [FGD with women, Majete].

Women who got the loans to start businesses said that they were somehow liberated as previously it was hard to ask their husband all the time for money to buy for example a wrapper but they are now able to buy the wrapper on their own and decide what to do with the money they make including how much should be paid back to THP. Another participant in an FGD with women in Majete said that in the past the pounded maize used to get rotten in the house because the woman was busy asking for money from her husband to go to the maize mill. The man would say he has no money families would sleep without eating just because the man is refusing to give you the money. Women are also able to buy good relish, which they eat in their homes. They are able to buy clothes on their own, While these loans were appreciated there were complaints that the money is inadequate and there was a need for THP to consider raising the amount.

In addition to getting loans from THP, one initiative at community level is that people in some areas such as Champiti have established groups and they save money. When the money accumulates they borrow from the group and repay with interest and then share the profits. These services are being accessed by people with disabilities as well as PLHIVs and there is no discrimination.

While most people appreciated the loans they got from THP there were others who said that these loans did not help them in any way. For example in an FGD with women in Majete participants said that the loan they got was inadequate:

“We took the loan but it did not really help because it was not enough, for example you get K10000 and you will find a small pig at K150000 because things are now expensive. If you decide to cut it into pieces and sell it, you don’t get much profit. This is because of the inadequacy of the money, but if it’s enough, we would really benefit”.

The Hunger Project OEPP 132 6/20/13 There were some people however who said that the problem with the loans and the busineses they have established is the lack of markets which needs to be addressed. This explains why some people after getting the loans did not benefit much.

The role of THP on community environmental issues In this evaluation participants were also asked about the things that can destroy the environment and several things were mentioned for example in an FGD with members of a support group in Champiti participants mentioned that livestock can destroy the environment especially during a time when everyone is busy planting in their gardens and if one hasn’t found a boy to look after the garden, someone will let loose his goats and destroy plants. If one reports to the owner, he or she will just look at it without doing anything else. As a result you lose a lot when you consider the fertilizer, money, time and the resources you have used on the garden. The other thing that was commonly mentioned as destroying the environment in the Champiti area was the cutting down of trees to make charcoal. Bushfires have also destroyed the environment. In an FGD with men in Champiti participants did mention that there used to be a lot of trees in the hills around the area but these have since been cut down. The major problem was that while there was wanton cutting down of trees no one was replanting these trees. In Champiti coal business is good and people need the money hence this problem is quite big. The cutting down of trees was a major problem in all the areas visited. In Majete trees were also being cut for sawing purposes. In Kachindamoto participants in this study also mentioned that overpopulation also contributed to the wanton cutting down of trees to meet domestic requirements. In Ligowe participants also mentioned the cutting down of trees as destroying the environment. This problem of cutting down of trees was also mentioned in Mpingo and they use these for making charcoal as well. Generally it was explained that people cut down trees because of lack of employment and poverty. They also said that there was a problem of overpopulation and even slopes which never used to be cultivated are now being cultivated. Other threats to the environment and as mentioned by participants in an FGD with students, farmers and casual labourers in Kachindamoto were burying of dead animals such as dogs, factory emissions, defecating in the bush and overflowing of toilets. In the Kachindamoto epicenter participants in an FGD with women added that there are some men who go to hunt for mice and in the process they set the whole bush on fire. Farming along the river banks was also destroying the environment.

In order to address these problems the community where available is being helped by people from Forestry Department. In some places such as Champiti committees have been set up which have been charged with the responsibility of looking after the environment and ensuring that it is protected. While this is the case people however may sneak out and cut trees for example to make charcoal without being caught. In some places such as Majete they were informed that a committee on forestry issues would be established which will distribute free seedlings to replant but this is yet to be established. They also plan to establish a club to take care of forestry issues including wanton cutting down of trees. In addition around Champiti area people are also encouraged to plant trees. In an FGD with men in Champiti participants also mentioned that many village headmen coordinated and formed a local police forum to control deforestation and charcoal burning. When people are caught the charcoal is snatched away from them. While this is being done many people however fear that such a practice may ignite hatred among community members and some people felt that the best way is to encourage people to replant trees. In addition to this civic education is being conducted at community level in some of the The Hunger Project OEPP 133 6/20/13 epicenters. Forestry committees have also been established in other epicenters such as Kachindamoto which have also been charged with the responsibility of protecting forests and chiefs are also sensitising people on the importance of protecting the environmental resources and passing by-laws which penalize people found burning bushes.

In order to address this problem some villages for example in Mpingo are planting nurseries for tree seedlings to replant the trees and form woodlots. In Kachindamoto during an FGD with students, farmers and casual labourers participants also mentioned that THP initiated the establishment of a committee to oversee the replanting of trees and which acts as a watchdog over environmental resources. Chiefs are also encouraging reforestation programs and those that understand are replanting. If people are found cutting down trees they are taken by the forestry department and put on trial till they confess they will not do it again. Charcoal sellers if they meet the police the charcoal is confiscated, but even if they do this you will find they still engage in charcoal business. This is mainly because jobs are not available. One of the major issues that participants in FGDs mentioned was that THP has created awareness among members of the community and have advised them to plant trees when they cut down some including mango trees and they should also do this in order to prevent soil erosion. Some of the community members are doing this.

Sources of water Around Champiti area the main source of water are taps and drawls. When taps run dry they draw water from boreholes for those areas where these are available. Where boreholes are not available and taps have run dry people draw water from the rivers. Tap water in Champiti is not free and each household pays about MK50 per month. When communities do not pay for water it is disconnected. When water is disconnected people draw water from boreholes if available. In some cases people will go to other villages to fetch water where they make them pay for water again if there is tap water. Around Champiti area participants said that in the past there were no taps and boreholes and they used to go to the wells, but they are happy now that they easily access safe water. They further explained that after the construction of the Mpira Dam by the Government of Dr. Kamuzu Banda, there are taps in almost all the villages. Around Champiti the boreholes were constructed by Concern Universal. Some said that some boreholes were constructed by people who were conducting political campaigns. In some villages there are people who are responsible for maintenance of these boreholes and not in others.

In Champiti and Mpingo participants said that THP has not done anything as far as water provision is concerned. They claimed that THP policy is that they only bring water in an area where there is no any other source of water such as taps and boreholes. In addition to this, THP was coming to places such as Champiti when people in the area already had piped water. In Kachindamoto participants said that THP drilled boreholes in 2006 which have helped to improve access to quality drinking water but some community members still walk long distances to fetch water. People in this epicenter appreciated that these boreholes were drilled there is still a shortage.

In Ligowe in an FGD with women participants said that since THP came into the area there have been a lot of changes. For example THP sank 8 boreholes in the area where there were no other sources of water hence these boreholes are helping quite a lot. Before this they walked long distances to get water:

The Hunger Project OEPP 134 6/20/13 “They had to walk long distance to get water but now these problems are over. If you are to go that mountain side, women would sleep at the well to have access to water especially now when rivers are dry. In addition this problem was bringing problems in the family since the woman would sleep at the well and the man would stay at home with the children. But now things changed, everyone is sleeping in the house and in the morning they all go to the farm” [Participant, FGD with women, Ligowe]

As a result of this people in Ligowe are no longer drinking water from wells. One participants in the FGD with women however said that the borehole is working but that in the rainy season the place becomes dumpy and when they draw water it is dirty but they still drink as they recognize that this is a big problem. In Mpingo participants said that there was a certain village which was very big and they only had one borehole and that thieves stole some parts of this borehole during the night making it not operational; hence instead of people having access to clean water they get water from unsafe wells because boreholes are dysfunctional since spare parts were stolen. In some cases in Mpingo boreholes are shared among 5 chiefs and when women go to fetch water they spend a lot of time there, some even fighting.

In Majete in an FGD with women: water is a problem and if one went to the water source it is like a gathering as there are many people. It was learnt that women go to the well early in the morning and sometimes if they have to wash properly they have to go all the way to Mwanza which is very far; hence in an FGD with women in Majete participants said that they were requesting that THP should construct a borehole for them. At the time of data collection people in Majete were moulding bricks but the major challenge they were experiencing was that of water. In Majete the availability of water has not changed with coming of THP as people are still using water from unprotected sources

Impact of THP work In general participants in areas where THP is working appreciated the work that has been done by THP. In an FGD with students, farmers and casual labourers in Kachindamoto participants said that poverty levels have generally gone down because of the loan facilities that are being provided. Around Champiti in Ntcheu in an FGD with members of a support group for women participants said that previously people were afraid to go for testing but now with the councilors that they have, the animators, they move in the villages teaching people, as a result people now are bold to go for testing. While animators are doing an important job the concern however is that they do not go for training as narrated by an animator in an FGD with women in Mpingo:

“As for me, I am an animator; our concern is that we don’t go for trainings. We have only gone once and the whole of last year we didn’t go for training, this year as well. We wanted if we can be trained frequently because we do a very big job, sometimes we don’t even go. Sometimes it looks like we are not doing a big job but the trainings encourage us to continue”.

Where clinics have been constructed with the help of THP, people appreciated because the health services were close and they do not carry children and other patients to a distant health facility. PLHIVs who are on ARVs also do not have to travel long distances. These facilities are always full and people’s

The Hunger Project OEPP 135 6/20/13 health is improving and they are not dying as they used to do because they are getting medical support quite easily. It was also reported that the number of people who are going for HTC has since increased and this is because of the health education sessions that is being done at community level by employees of THP and volunteers. The Project has introduced animators who go and counsel people. Previously this was not the case and promiscuous behavior was quite common. Things have changed as a results of animators who are conducting a lot of campaigns. A number of clinics have been constructed and people do not have to walk over long distances. In Majete however the clinic is yet to be constructed.

It was also mentioned by participants that community members have benefited quite a lot from the fertilizer loans that are being given by THP and this is accompanied by agriculture advice. Through this as well as cash loans with which some have established businesses they are able to send their children to school and at the same time ensure that they have food at home. Previously they did not have businesses and would look for a piece of work to do to find money. If they run out of food they buy maize from food banks that have been established at community level. Previously they used to buy maize from ADMARC where some experienced maize running out while they were on the queue. At a time when they were buying maize from ADMARC they would spend some money on food when they were waiting to purchase maize; as a result they would buy less maize. Because of different interventions supported by THP people can now afford food and own livestock and some have good houses. For example in an FGD with students, farmers and casual laborers in Kachindamoto participants said that there was a reduction in food insecurity as people have assets such as livestock which has enhanced their capacities to cope with shocks.

In terms of education THP has helped in the establishment of nursery schools in the areas where children learn. They have also introduced adult literacy classes and most people who never used to know how to write they are now able to do this. Literacy levels were reported to have increased due to various interventions by THP. One of the impacts that THP has made in the area is the trust that THP has built in the area. For example in an FGD with men in Majete one of the participants said that:

“I appreciate THP works. In the past we had no trust in any NGO which could fulfill its promise. That is why people initially doubted THP, but now people are now convinced because some of the issues are now visible and tangible. We can actually see our vision being fulfilled. This is also encouraging people to take an active role in THP projects like molding bricks”.

Other NGOs have worked in the areas where THP is working but people in these areas appreciated the work of THP as it has lived up to its promises unlike other organizations.

Things that people would like THP to address During the FGDs people were also asked what issues they would like THP to address. In Champiti people said that they would like THP to introduce more water sources in their area. They added that they would also like THP to help them with a maize mill from which they would generate a lot of money that they can use to support themselves and other members of the community. They argued that there is no any other maize mill in the area and if they were supported with a maize mill they would make a bit of money and stop relying on others. This was also mentioned in an FGD with men in Champiti who added

The Hunger Project OEPP 136 6/20/13 that in their area the only source of income was the growing of maize and selling it. They further said that considering climate change that is occurring currently if they experienced poor rains they will not be able to have an income. They further suggested that they can complement their main source of income by installing a maize mill.

In addition, other issues that they wanted THP to address included: training in agriculture so as to improve their farming; training on cooking and how to take care of their marriages. While people in Champiti asked for these things they also added that it was imperative that as communities they should own these projects and work hand in hand with the THP. They also were grateful that women who never used to stand in front of men and lead people are now bold enough to stand in front and even be initiators of things than men. In an FGD with members of a support group in Champiti participants said that even though the project of bringing electricity was there they just wanted THP to continue considering supporting the project ‘because they really need it especially at the maternity wing where they use candles because there is no electricity. While loans have been quite useful there was a please that the amounts should be revised as things have become very expensive. They also requested for an under-five shelter. They also wanted to be taught how to prepare nutritious foods using local resources.

In Mpingo in Blantyre there was a suggestion that a demonstration garden should be established in their area. They also wanted THP to provide loans on maize treatment chemicals such as actellic. They envied the pesticides used by THP in preserving the food banks. They said that if possible the pesticides should be tied to the agriculture input loans. In certain areas such as Majete there are no safe sources of water. They used to rely on the river previously but it dried up a long time ago as mentioned in this FGD by a participants:

“The biggest problem in our village is that of lack of clean water because the river we used to rely on dried up a long time ago. Women wake up at 2 a.m. to draw water so if THP can hurry up and drill boreholes for us, we shall be grateful and rescued”.

The lack of water was a major problem in Majete and they wanted THP to help in addressing this water. People claimed that it’s difficult to exercise their conjugal rights in bed because women spend most of the time there. This was also mentioned in Kachindamoto where they also wanted boreholes as water was a major problem in the area. In Kachindamoto participants said they also wanted a maternity wing as pregnant as women travelled long distances to get these services. In Mpingu a request was made for a dispensary as there is none as of now.

Conclusion As has been mentioned earlier this study was done in order to field-test newly selected outcome indicators and a standardized set of data collection tools. Two data collection tools were used in this case: namely the guide for FGDs and a guide for key informant interviews. Generally the results demonstrate that THP is have a very positive impact on the lives of people in the different epicenters where it is working. As has been demonstrated due to the interventions that THP is implementing poverty levels have decreased and people are able to own and run businesses, they own livestock and have been able to construct iron roofed houses. Access to health services has improved and interventions are being implemented to address the environmental challenges that are being

The Hunger Project OEPP 137 6/20/13 experienced. People are participating in development projects and even villages, which never used to work together things have changed. It has also been demonstrated that where there are challenges in terms of accessing health services community members are prepared to for example mould bricks so that a clinic can be constructed with support from THP. The tools for data collection are therefore effective in terms of bringing out information that can be used to measure the progress that THP is making in addressing the development challenges that communities experience. However FGDs need to be carefully designed so that they bring very clear information. Attempts should be made to have FGDs with one target group for example students. In several FGDs students were missed together with adult members of the community which is not encouraged as they may not be able to speak freely. The good thing is that key informant interviews were conducted with various stakeholders at community level including community leaders and extension workers.

GHANA QUALITATIVE ANALYSIS OF KII/FGD

Module 1: Community Mobilization and Gender Equality The most significant change in the communities in the past year and what contributed to the change were analyzed based on the Community Mobilization and Gender Equality module as applied to five Epicenters. During in-depth interviews with key informants at Banka, it was observed that access to pre- school education through the support of The Hunger Project (THP) and intense campaign against gender inequality by animators that resulted in the spread of HIV and AIDS had resulted in a positive behavioral change in the lives of their people change. Similarly, people at Kyempo said equal involvement of women and men in community development through THP’s empowerment programs had quashed gender disparity in their community. Nkawanda women are now allowed to take up leadership positions basically due to educational sessions on gender equality and HIV and AIDS. Nsuta-Aweregya people said unity now exists between partner communities due to THP’s educational activities. In Odumase-Wawase epicenters;

“THP programme brought great unity and solidarity among the partner communities, resulting in shared responsibilities for development”.

People from different communities worked together to successfully complete projects in the following ways. Respondents from Banka said the people happily and gladly came together to strengthen love and unity among themselves whenever there was a communal work to be done. The unity of purpose, communication, love and consensus building among the chiefs and people of Kyempo brought about faster development of their area. The people of Nkawanda formed project committee comprising of members from all partner communities who met regularly to evaluate on-going projects and strategized to complete them by calling on all community members to put their hands on deck. Similarly, people of Nsuta-Aweregya selected community leaders who met regularly to discuss development initiatives through association of chiefs, communal mobilization, labour and harvest. People of Odumase-Wawase were able to harness resources from the various epicenter communities (e.g. labour and raw materials) and shared project experiences among partner communities for others to do the same. All these

The Hunger Project OEPP 138 6/20/13 strategies were put in place by different communities to encourage working together to successfully complete projects.

Women participated in Epicenter committees, community-led project and other decisions made about epicenter activities in the following ways. It was observed that more women were given opportunity to lead projects and take part in major decisions affecting their communities now than formal days. In Banka epicenter, women participated in leadership training and learned to take up and play leadership roles in the community. Similarly women were said to be part of decision making bodies at both home and community levels and as a result do experienced love, unity and willingness now than former days. According to respondents from Nkawanda, women were given the opportunity to also educate others and therefore now found themselves in more leadership positions than in former days.

“Most women are now freely involved in the community decisions and activities because they had the inspiration and support from fellow women having that privilege”.

In Nsuta-Aweregya, women now take active part in all community activities and projects as a result, most women are part of the epicenter committees. Similar situation was found in Odumase-Wawase where more women engaged men in more constructive debates during active meetings and workshops organized by THP.

The community perception about women’s participation in leadership roles changed in the following manner. Before THP projects people in Banka community did not encourage girls to attend school or allowed women to take up leadership position, but with the help from THP and their trainings, girls are now taken to school and given equal opportunities as boys and therefore now allowed to take up leadership roles. In Kyempo community, chiefs approved for women to be in leadership positions. Also in Nkawanda, women leaders were successful in their leadership styles. They were allowed to speak in public and share their ideas. They are no longer ignored. People of Odumase-Wawase observed a drastic change as a result of the influence THP has had on both men and women through the WEP program by the community animators. Both women and men equally play key roles to bring about development.

Module 2: Agriculture and Food Security Most significant change in the community during the past year and what they thought contributed to the change were analysed for each epicenter on the basis of Agriculture and Food Security module. People in Banka community saw an increase in agricultural yields that was attributed to good farming practices such as planting in rows, timely planting, right application of fertilizer and maintenance of farm as taught by the THP. As a result they had abundance of food in the dry season. Similarly, people from Kyempo, Nkawanda, Nsuta-Aweregya and Odumase-Wawase communities said

“they observed a significant increase in Agricultural yield as a result of the workshops organized by THP on improved farming practices such as line planting, fertilizer application, storage of agricultural produce in cribs provided by THP to ensure all year round food security”.

Agricultural yield was observed to have increased over the past year and some reasons were numerated by the people of Banka as due to fertilizer application, provision of good seedlings for planting by THP

The Hunger Project OEPP 139 6/20/13 and good farming practices (e.g. Planting on time, weeding and harvesting). . Similarly other epicenters (Nkawanda, Nsuta-Aweregya and Odumase-Wawase) attributed increase in agricultural yields over the past year to the crop improvement training workshops organized by the THP. According to them, the THP helped them to grow crops in lines and provided farm inputs (e.g. fertilizers) on time. They were motivated to expand their farm sizes for more yields, and to mob up excess farm produce for storage. Therefore, waste was minimized and their profit margins has increased for Agricultural produce over the past year.

Module 3: Literacy and Education The most significant change observed in relation to Literacy and Education at epicenters in the past year and what has contributed to this change were a bit different across Epicenters. Banka epicenter has noticed a tremendous increase in school enrolment and punctuality of students which had positively correlated with an increase in Literacy and Education currently than it was previously, because more parents now understood importance of education and were encouraging their wards to go to school. The school management also introduced speech and prize-giving day to motivate deserving pupils good in drumming and dancing and poetry recital to attract more school drop-outs. Most of the teachers had established good rapport with the pupils, thus serving as role models. According to people in Banka community,

“The continuation of education by BECE leavers to the SHS was as a result of trainings the parents received from the THP on the importance of education”.

Such trainings included signing of their own signatures, which has resulted in having their own bank accounts and easily withdrawing of money from the bank. Also in Nkawanda community, there was a tremendous improvement in education because they were advised by THP to educate their kids. At Nsuta-Aweregya epicenter, most children especially girls were encouraged to achieve higher academic laurels beyond primary and secondary schools as a mark of rapid personal development. The people have accepted the teachings giving to them by THP. However, Odumase-Wawase had falling educational standards as revealed by poor BECE results. The children’s interest in learning has dropped so drastically. Either parents failed to provide their children with the necessary materials for school or pupils lacked parental discipline and monitoring at School.

Banka community now value education and literacy more than previously and as a result, there has been an increase in their contribution to education. In Kyempo community, the majority of the community members value education since they now know the benefits of educating their children who can grow up and become more responsible personalities. Members in the community, especially the young ones were motivated by the houses and vehicles the THP workers and Parliamentarians sometimes used on TV. This throws a challenge to them to value education to be able to become doctors, lawyers etc. to buy some on their own. At Nkawanda, there was percentage increase in the number of children attending secondary school based on the awareness creation. Standard of living has improved and farmers were encouraging their wards to go to school because farming is becoming unpopular. At Nsuta-Aweregya, the people now value education than previously. Formally, parents sent their children to farm during school days but now the need to send their children to School is high on their priority list. At Odumase-Wawase, most people did not value education because they were

The Hunger Project OEPP 140 6/20/13 illiterates. A woman said, “there aren’t enough teachers’ quarters to accommodate the teachers to keep their eyes on the learning ability of their children and parenthood to have much impact; and as a result, there was no competition for education among children or parents”.

The biggest barrier that prevents boys and girls from completing primary and secondary education according to Banka community was Teenage pregnancy. This was orchestrated by lack of role models on the part of the girls and lack of knowledge about the essence of education and the need for children to be in school. Changes that have been made to improve school enrolment and attendance were public educating of people in the community to understand the importance of education and the need for parents to send their children to school. People of Kyempo said disobedience on the side of boys and girls was the biggest barrier that prevented boys and girls from completing primary and secondary schools. Children showed lack of respect for parents by running to “village cinema”. This leads to most of them losing interest in their studies. Unlike Banka communities, the people of Kyempo did not make much changes for better improvement but some parents were still advising their children especially their girls on the “teenage pregnancy”. Nkawanda community also said, most young girls prefer to seek for quick money since education at the lower level is not lucrative so they embark on businesses that can bring them money. Secondly, due to migration, many young men fall victims to peer influence etc because perhaps they do not get access to good parental supervision. The females who did not get financial support for school, wanders after their brothers in the cities, and sometimes engaged themselves into sexual activities for their daily bread. Since they did not acquire skills for official employment, they do not make much change for better living. In the Nsuta-Aweregya community, financial problem, teenage pregnancy, lack of knowledge and interest in education were rated very high. In Odumase-Wawase community, the boys took to small scale mining activities because their parents do not take good care of their needs. The girls got pregnant and then stopped schooling. To manage this social canker, the communities have been advised to invest in their children’s education and also the Education Office is ensuring that they assist the children with some learning materials.

The people of Banka said lack of support on the part of the community is also a major challenge to education in their area. Kyempo community said lack of committed teachers due to poor school buildings, poor communication networks and no lighting system was a major challenge.

“They pleaded to The Hunger Project (THP) and government to provide them with learning materials like text books, pencils etc., adequate teachers to be posted to the school, light in the community and computers to be used to teach students.”

In Nkawanda community, they needed government intervention for improvement on social amenities and personalities who would serve as counselors and role models to the children. They would need subsidy on education. In the Nsuta-Aweregya community, they were appealing to THP to increase the loan amount, since increasing it will mean expanding farm, more yields and more money. Also in Odumase-Wawase, they would like to plead that the community is provided with teachers’ quarters to serve as accommodation in the communities for teachers to stay and monitor children at prep hours in the evening to curtail teenage pregnancy.

The Hunger Project OEPP 141 6/20/13 Module 4: Health and Nutrition There was no significant change in the lives of people in the Banka community in the past year. The people of Kyempo had an epicenter clinic with maternity which helps them to solve problems related to health and delivery of babies. People in the Nkawanda community now patronise their epicenter clinic to seek medical treatment. There has also been improvement in nutrition because of the trainings provided by the THP and their follow ups to the community. People of Nsuta-Aweregya said they had a reduction in malaria and cholera cases due to the presence of a community clinic as compared to previous years. This is as a result of free distribution of mosquito nets and also advising community members to keep the community and their surroundings clean. In Odumase-Wawase, there was an increase in attendance to the health facility and this has resulted in a drastic reduction in malaria cases and impressive improvement in personal hygiene of clients.

The major health problems facing people in the Banka community were Malaria, Diarrhea and Cholera. Some of the actions taken in the past year to address these problems included advising the community members to sleep under mosquito treated net provided to them by health workers. Also, activities such as clean- ups were organized to ensure clean surroundings. Again, the people are taught to eat warm food and also wash their hands before eating. In the Kyempo community, malaria has been identified as a major illness and this was due to the bushy surroundings. Similarly, actions been taken in the past year to address these problems included sleeping in mosquito nets, wearing cover cloths in the night and keeping clean surroundings. In the Nkawanda community, the main health problem facing this area was malaria and THP is still educating them to sleep in mosquito nets which was freely distributed across the nation by the government. In Nsuta-Aweregya community, acute respiratory infection, home occupation incidents e.g. Cuts and burns, malaria and diarrhoea were the most recorded cases. They organized outreach talks, community health durbars and health talks mostly on one to one basis. Odumase- Wawase was free from malaria problems however they complained of an increase in snake bites. It was very rampant to such an extent that most security men were unable to work at night. Ambulance or vehicles to convey patients, especially pregnant women was also lacking.

The people of Banka definitely had some reservations when it comes to issues bothering on comfortability of their epicenter clinic in terms of health assurance but were not ready to divulge it. However, the people of Kyempo were comfortable because health delivery is now closer to their door step than previously, as health attendants took very good care of them, gave them medicine and entreated them to take their medicines on time. The people of Kyempo said

“Their clinic was more comfortable here than the bigger hospitals”.

The people of Nkawanda felt more comfortable because conditions were created to make them relax while waiting for their turn. At Nsuta-Aweregya, the people felt very comfortable using the epicenter health services because the nurses talked and treated them as “Kings and Queens” at the clinic and this love for patients compelled them to visit the clinic again after their discharge. It was obvious that the people of Odumase-Wawase were very comfortable because of good personal relation with clinic staffs. Patients were reassured of their total healing and well catered for even as their “patient's strength ebbed away". They were punctual and ensure them of very good quality health delivery.

The Hunger Project OEPP 142 6/20/13 Some of the greatest advances in maternal and child health in the community according to the people of Banka was the ability of the residence nurse to provide treatment for those who needed maternity care and safe child delivery. This was due to the closeness of health facility and availability of nurses in the community. Unfortunately, there was no mid-wife at the clinic to take care of increasing maternal health cases and this resulted in rushing some pregnant women on foot to the nearest hospital which is very far. This had resulted in the death of some pregnant women before they reach the hospital and sometimes losing their babies as well. They therefore appealed to THP to provide them with the services of a professional mid-wife. THP promised to train a woman to be in charge of delivery in the community but they have not yet seen such in the community. Secondly, they are appealing to THP to come to their aid and improve upon their roads for safe transportation of pregnant women.

“People of Banka communities agreed that a good road is needed to boost productivity and facilitate even distribution of medical and food products across communities to remove hunger.”

In Kyempo community, pregnant mothers had child health education about immunization against the six childhood killer diseases before and after birth due to availability of the clinic. However the people of Kyempo need a midwifery to deal with childbirth and care of the mother and electricity in their epicenter. Certainly, they were very grateful for THP’s assistance with the epicenter building complex and the services provided to them. In Nkawanda community, it was observed that maternal and child health education had increased due to presence of residence mid-wife who took care of delivery of children and also educated mothers and school children on how to live a healthy lifestyle. Nkawanda community however, appealed to THP to assist them with electricity to help the clinic to operate some machines to assist in health delivery.

“There was an increase in antenatal care (ANC) services at Nsuta-Aweregya leading to improvement in child health, as mothers now practice exclusive breast feeding for at least six months. Moreover, there is reduction in delivery complication as a result of the trained traditional birth attendants (TBA) who responded to a lot of pregnant women in the community”.

However, the health centre at Nsuta-Aweregya faces the challenge of referring people to major hospitals. Most cases like snake bites, poison, epilepsy, anaemic, unconsciousness which were very common here were most often referred to hospital due to lack of medication. At Odumase-Wawase, the level of personal hygiene practices among pregnant women was observed to be quite impressive. The health centre was kept very neat and tidy. Staff were very receptive, patient and also hardworking. The children in the community now look healthier. Most pregnant women now attend clinic for antenatal and post-natal care as compared to previous years because of sensitization and educative programmes organised by NGOs and Ghana Health Service (GHS) on maternal health. The attendance of clients or patients has increased because they accepted NHIS cards from all regions. Unfortunately, they had problem with lack of drugs and the National Health Insurance scheme's inability to pay on time.

The Hunger Project OEPP 143 6/20/13 Module 5: Livelihood and Microfinance The most significant change in Livelihood and Microfinance observed in the community in the past year and what they thought had contributed to this change were community dependent. In the Banka community, there had been an improvement in road network leading to the community and this had led to improved trading between communities. In Kyempo community, there was poverty reduction through the loan facility from THP. Households now enjoy three square meals a day and this had positive effect on the dressing appearance of people in the community and the ability to educate the children. Nkawanda community was able to set up a poultry farm because of the financial supports of THP. Nsuta-Aweregya community traders used to have smaller capital but had improved loans from THP to improve upon their farming activities. As a result, they have seen an improvement in health, education and the general well-being of the people. Odumase-Wawase community had a significant improvement in trading. Trading has moved from table-top selling to kiosk. Farmers have improved on their farming activities due to the availability of loans. Farm produce or yield has also increased and therefore increasing the profit made by farmers. These changes had also improved upon their health. People can now afford medicine and good health care. Also there has been improvement in people’s nutritional needs. What they could not afford before, they can now afford. There was enough money to send children to school and provide them with school supplies. These changes occurred because of the teachings offered to the community members and by the loans provided by THP. Parents who could not afford secondary education are now able to do so because of the loans given them.

People in the communities have been taking actions to improve their lives. Banka women traders are now taking micro loans from financial institutions to invest in their small businesses. This has resulted in the expansion of most small scale businesses to raise their standard of living. Farmers were improving on their farming methods for better yields and income. In Kyempo, loan and land to work were available and as a result people were contributing to help build infrastructure. Houses of people have been improved. In Nkawanda, the community members have now inculcated the habit of saving instead of buying unnecessary things that will contribute to the collapse of their business. In Nsuta-Aweregya, the community mobilization to resolve community problems was carried out and the people were working harder on their jobs. When the people of Odumase-Wawase saw the need to take action, they called on community leaders to express opinions on the solution. Individuals are also working hard on their jobs.

Types of financial services available to the Banka people in the area included the provision of loan to trader groups by micro-finance groups especially women groups. . Their services are now available to all people (especially women, people with disabilities, people with HIV/AIDS or other segment of society which may be discriminated against). At Kyempo, loans were available to all. Nkawanda people said the Hunger Projects savings and loans project is available to all women irrespective of their physical challenges in the community. People of Nsuta-Aweregya also said the people did not get the concept of revolving fund and therefore taking back the loans given to them was very difficult. Odumase-Wawase community observed that the loan facility was not available to everyone. It was a revolving fund and therefore only those who contribute to it can take money from it. If a disabled person contributes to it, then he/she can take money from it.

The types of businesses being created in the community and the important factors that helped to make these businesses become successful were discussed across epicenters. In Banka epicenter, small grocery The Hunger Project OEPP 144 6/20/13 shops and stationary shops in the community are now mostly operated by women. Access to small loans has helped these businesses to expand. Also, most people also sell produce from their farms and shops. They however advised that, hunger project activities should be publicised. Some people in Kyempo said household soap factory has started. Some said they did Tie and die whilst others did powder, cream making and oil production. In Nkawanda, people have opened stores for trading, some bought foodstuffs and sell them by the road side and these businesses have become successful because they have learnt the habit of saving with the help of the Hunger Project or through the loans. They suggested that the loans should be given to individuals who are serious and ready to pay back, instead of the groupings which delayed the loan process when others do not pay their loans back within the time frame. In Nsuta-Aweregya, some community members said artisans, baking and table top selling has improved. Farmers were now getting high yields as a result of the teachings they receive from THP. They suggested that the people should be educated on the concept of the revolving fund to help in the process of paying back the loans . In Odumase-Wawase, there have been an increase in retailing. Table top selling has now graduated to kiosk. Farmers now have barns where they store farm produce for longer periods. There are now emerging private primary schools. Others are engaging in baking bread and in building (masons). They explained that there was a problem with the initial processing of the loans and advised the THP to make it less cumbersome.

Conclusions based on the Key Informant Interview The Hunger Project (THP) had influenced all aspects of development of communities through five Epicenters established in Ghana. Most epicenters had significant impact on their communities in the past year. These positive developmental changes brought by THP were related to five modules: Community Mobilization and Gender Equality; Agriculture and Food Security; Literacy and Education; Health and Nutrition; and Livelihood and Microfinance. It was observed that access to pre-school had increased. Intense campaign against gender inequality had resulted in a positive change in the behaviour of people across all aspects of the girl child communal involvement of women and issues related to the spread of HIV and AIDS across epicenters. There was a general increase in agricultural yields as a result of the workshops organized by THP on improved farming practices such as line planting and fertilizer application. THP helped communities to expand their farms and storage of excess agricultural produce in available cribs provided by THP to ensure food security all year round. The positive impact of THP in terms of Literacy and Education was observed to vary from epicenter to epicenter in the last year. Some communities noticed a tremendous increase in school enrolment and punctuality of students. The continuation of education by BECE graduates to the SHS was also observed to increase as a result of trainings the parents received from the THP on the importance of education. There was no significant change in the lives of people in the Banka community in the past year in terms of Health and Nutrition but other communities which had midwives among the general nurses in their clinic had positive remarks about safe child delivery. Some communities were proud of their clinic whiles others lamented about habits of nurses. For example, the people of Kyempo said their clinic is more comfortable than the bigger hospitals. The people of Banka communities agreed that a good road is needed to attract qualified medical personnel to their community and also to facilitate the distribution of medical and food products across communities. They also pleaded with authorities to hook them on to the National grid. The most significant change in Livelihood and Microfinance across communities in the past year was related to the improvement in road network leading to the communities and this had led to

The Hunger Project OEPP 145 6/20/13 improved trading between communities. As a result, farmers and women traders are now taking micro loans from financial institutions for expansion of their small scale businesses. People are now willing to contribute towards community development than previous years. In all, THP has educated and supported communities to improve upon their businesses, and save surplus and as a result, most table top selling has now graduated to kiosk and farmers now own barns for storing excess farm produce against hunger periods.

THE RESULTS OF THE FOCUS GROUP DISCUSSION This is a focus group discussion of women from Nsuta-Aweregya and Odumase-Wawase epicenters based on seven modules: 1. Community Mobilization; 2. Gender equality; 3. Agricultural and food security; 4. Literacy and education, 5. Health and Nutrition, 6. Livelihoods and Microfinance; 7. Water, Sanitation and Environment. In addition, the overall outcome and impact was accessed and conclusions were drawn with necessary recommendations.

Module1: Community Mobilization With regards to the focal group discussion on Community mobilization organized in Nsuta-Aweregya, it was clear that the communities were working together to solve common problems that affect the entire epicenter in the following ways. These problems varied from ailment to lack of togetherness. In Nsuta- Aweregya epicenter, the community mobilization and gender equality module was used in relation to education problems. Women of Nsuta-Aweregya mobilized Parent Teacher Association (P T A), SMC and other knowledgeable people to assist in solving school problems. According to a member,

“Am part of the water committee so whenever someone does something wrong, we approach the person and when s/he refuses to heed to the warnings or advice, we summon the person to the chiefs”.

Some individuals like P1 said

“I sometimes personally clean the surroundings of the bore hole at Kwaku Muni without the help of anyone, but when the need arises , l do inform the chief to summon the community for a communal labour”.

The chief summoned the entire villagers to discuss the problem and they willingly came together to provide communal labour to solve problems concerning development in the village.

At Odumase-Wawase, the Community Mobilization program revealed that chiefs beat the gongon to assemble everyone so as to find a common solution to issues at stake. So the village solved common problems by coming together to share their ideas. Assuming there was a fire outbreak affecting someone, they all came together and helped the victim to put out the fire. When the village got a visitor, the chief summoned all to receive him or her depending on the purpose of visit. When the community, assuming faced common problems such as lack of electricity, good water (their two boreholes were spoilt, so they now drink from the stream) and toilet facility or even sanitation, the community discussed with the district chief executives (DCE) and when the DCE is ready to help them with the items, they complement the effort of the government by providing communal labour. For example, a lady from Wawase said

The Hunger Project OEPP 146 6/20/13 “One major challenge we are facing is lack of enough public toilet. Children cross the road to the other side of the village to visit the toilet and this is very dangerous so the leaders have discussed it and the construction of new one at the other side is still in the pipeline”.

Another woman from Sitey Kese village also said

“Our lands are waterlogging, so anytime we build a local toilet, it gets full quickly. So we wish to have KVIP just as the people of Wisiwisi have. The chiefs organized us to put up another KVIP”.

Although one can see beautiful street lights in the village, the problem is that solar light was the only source of light in the community and it does not stay on for long before it goes off by 9 pm. This is because there was not enough solar energy to fully charge the solar lights. These street lights were donated by Ghana Cocoa Board. In Wawase village, their street lights were all spoilt, so the leaders have sat for a meeting as to how to solve that issue. In addition, they organized an advocacy program in their community on NHIS when they realised they were unable to afford the cost of their medical care. Out of that, a woman who said had 25 children registered for the NHIS card in order to have access to medical treatment. This indicates that the dependency ratio in this village was so high. Another woman said they do encounter frequent road accidents because of over speeding on the major road that pass through it.

“We mobilised ourselves and created speed ramps on the road, but the drivers reported us to the police and when they came to inspect it they had no course but to congratulate us and advised the drivers to stop over speeding”.

So they can now cross the road with ease. There was also a problem of leaking classrooms. For two years now the chiefs had tried solving the leakage but to no avail. A woman who worked at Besease school said the school collapsed some time ago leaving just the nursery. She told the chief to enforce a rule to insist that every parent bring his or her child to the nursery in order to build up the school again. The nearest school was about one and half kilometers and she suggested that because it is risky for the kids to travel that far, they should all come back to their community school and they did. This was how they helped to solve the problem.

“THP brought a positive change in the level of collaboration between villages and village leaders at Nsuta-Aweregya, and now the relationship with their village heads has improved.”

Another woman from Nsuta-Aweregya epicenter, also observed a tremendous change in their relationship with the chiefs. Women easily see the chiefs to report any issues bothering them. The epicenter community chiefs are more united and they usually met in the epicenter building to discuss issues that would promote development in their villages. After THP teachings and training, they now enjoy peace and harmony among villages. As a result, the recent relationship between the heads of Kwame Omari village and that of Kwahu Oda is very good. By popular acclamation, the people of Nsuta- Aweregya raised their hands to signify the support for strong positive relationship among village heads.

The Hunger Project OEPP 147 6/20/13 In Odumase-Wawase epicenter, their community had experienced some developments ever since the THP came in partnership with them. This had promoted good relationship amongst them and their village leaders and instilled peace and security in the community . They had to travel long distances to access health care but for the timely intervention of the Epicenter clinic. Also, sanitation has improved in these communities since the intervention of THP. The relationship between the communities and village heads improved positively. They were in good relation with their leaders such that when they encountered any problem they could rush to them and inform them and they also listen to them with good hearts. All participants rose their hands up in support of the increasing positive collaboration with their leaders, ever since THP came to Odumase-Wawase.

Module 2: Gender Equality In a focal group discussion held at Nsuta-Aweregya on Gender equality, it was clear that the extent to which men and women shared the responsibility of making decisions about the household in terms of financial, health and education was observed to have changed. These changes with regards to responsibilities among men and women increased since they started interactions with THP. There has been improvement in shared responsibilities among the men and women ever since THP came to the Nsuta-Aweregya communities.

“The teaching they had received from THP had taught them that the upbringing of children in terms of health and education was not just a burden to only men alone but a shared responsibility of parents”.

Initially, women could not share their views even in public with regards to certain issues but today, it is not so. WEP had empowered the women to take up positions and duties in the building of the family. Before THP’s educations, most couple hid their monies from each other, but thanks to THP they had learnt that when they came together and join their ideas, monies and strength together they could build a better family together. They were grateful to THP for this teachings and enlightenments. One woman said

“Initially we keep our monies under our beds and the earth for ants and mouse to chew but now we have banks for savings which also enables us to take loans. Today we are enjoying from such loans and this enables us to take decisions and responsibilities together with men without running away from them.”

Another woman said THP’s education had really changed her husband. She was a food trader and her husband assisted her countless times in home chores like sweeping, cooking and preparing the children for school.

In a focal group discussion on Gender equality held at Odumase-Wawase, it was clear that women in Odumase-Wawase community now share responsibilities equally with their husbands. Now the men help them a lot in their domestic duties. When she was not at home or sick, her husband could cook and served her and the children. So their husbands have really changed and they help them a lot. Another woman said she had a solid marriage now and she was always happy. At first women did all the home and farm works. From farm they shared what to carry together. At home she prepared palm oil for sale, and her husband even assist her to prepare it at home. This is because of the THP teachings and training. The Hunger Project OEPP 148 6/20/13 The extent to which boys and girls (children) share household chores and responsibilities at Nsuta- Aweregya was observed to improve for Odumase-Wawase community. At Nsuta-Aweregya, both boys and girls worked together in the house. A woman in Nsuta-Aweregya said she had no female child but had trained the males to take up all the house chores as if they were females. Education from THP is helping them to train their children and their men now understood them better. A woman said her husband never allowed their son to dump refuse at the dumping site whiles alive because he believed that he will grow to become a foolish man in future if he continued to do female work. But after THP’s education she informed him that the house chores must be shared equally amongst them. This will help relieve the traditional female of many years by realities of modernisation and democracy. Girls could now have more time to compete with boys in studies. My husband understood this and it really helped my daughter in her studies.

“First the house chores were shared according to gender but now based on understanding that it is the responsibility of both gender to learn how to do it together.”

She later sent her daughter away so that it would pave way for the boy to learn house chores very well, and today she could boost that her boy had picked up and could prepare sumptuous meal for the family without any supervision. All participants raised their hands in support for an increased in boys and girls equality in doing house chores (100%).

In Odumase-Wawase, a woman said she woke all her kids at the same time to begin the house chores together before they go to school. Whiles Kwame fetched water, Amar would complement her brother’s effort by sweeping and this was how she shared the chores equally amongst them. P5: THP has educated us in such a way that we now understand the importance of female education, so we make sure that our female children are equally educated as men are. This means that what men can do, women can also do it, and even better. All participants raised their hands in support of the fact that there has been tremendous change in the allocation of house chores among their children ever since THP came to educate them.

Module 3. Agriculture and Food Security In Nsuta-Aweregya focal group discussion on Agriculture and food security, it was clear that the term “hunger” was explained by women as when one had no food to eat at home in the morning or when one did not have anything to eat, wear, nor any work to do. Some women said “hunger is for lazy people”, “when one has a lazy attitude and refuses to work in order to earn some income, s/he would starve at the end of the harvest season”. This implies that laziness was a contributing factor to hunger”. Other contributing factors to hunger include poverty because when someone has no money s/he would starve. These definitions of hunger were related to the community and the kinds of jobs they do. So hunger is not the lack of everything necessary for one to live a comfortable life, such as good health, clothes, electricity, sanitation etc. but these are some factors contributing to hunger. Poverty and laziness were factors. Lack of proper storage facility for the remaining yields, most at times also contributes to lack of food security and hunger. Even if you do not use the proper farming methods or plant at the right time in the raining seasons, it can cause crop failure and this in turn would bring about hunger. When the weather fails, that is assuming it never rained or the sun never shinned, then that could be a contributing factor to hunger. The Hunger Project OEPP 149 6/20/13 This is true because no matter how big the size of the farm or the amount of fertilizer applied, crops can fail us without good weather.

In Odumase-Wawase focal group discussion on Agriculture and food security, it was clear that Odumase- Wawase community knew when hunger showed up its ugly head. To them hunger occurs when they do not have enough food to eat. When they do not harvest maize farm early enough to store in cribs or cool dry place, there would be infestation with weevil and one might end up losing everything and this could contribute to hunger. So hunger is when they did not get any food to eat and have to starve with their family. Women were able to harvest higher yields as compared to last year because the fertilizer and row planting assisted them. Some women engaged in modern farming practices which helped them to improve upon cassava and maize yields this year and that made them very happy.

Women from Odumase-Wawase said, “hunger exist because they lacked the modern knowledge required to improve their chances of getting better yield over the same piece of land for mitigating hunger in hard times.”

The agriculture training of trainers (TOT) programme taught them how to farm and advised them on the need to visit their farm regularly in order to harvest in time. Ever since THP education started in Odumase-Wawase community, women now know how to plant in lines and when to apply fertilizer to maize and cassava for improved yield and how to improve upon storage of farm produce at all times. One of their brothers won an award as the best farmer in their district. Another woman said they process cassava into ‘gari’ to reduce hunger during the peak season because ‘gari’ could store more than un-processed tubers. Also, hunger could be promulgated by bad roads because it could make even distribution of farm produce across communities difficult, thus, resulting in a lack or glut at some markets. Another woman said the extreme weather conditions could force people into hibernation and this could cause an increase in the rate of poverty; so weather conditions and poverty could also be contributing factors to hunger.

“Hunger is quashed when food is evenly distributed and families always have enough to eat but could be promulgated by drought”.

Odumase – Wawase women were very hard working and always have enough food to eat with surplus to spare to others but few others were very lazy to the core and would not want to work harder, they were always pretending to be sick with many unwarranted barrages of excuses. Lazy women always have hunger driving them to commit all sorts of social vices.

“In farming communities, hardworking is a key factor for reduction of hunger while laziness is a key factor for extension of hunger”

Hard workers who used the right planting methods taught by THP always had enough food for their families to enjoy. Lazy ones complained about farming as time consuming and how tedious the line planting methods could be. They therefore abandoned their maize and cassava farms and when they are very old they would come back to it. “Procrastination is the thief of time”. The source of enough food for some families was based on principles of hard work, fair distribution of food and judicious use of surplus. Hard working people were prepared to practise new ideas. Some Odumase-wawase people had a break-through with line planting although it was more tedious than haphazard planting; they practise The Hunger Project OEPP 150 6/20/13 harvesting on time with excess kept in silos or cribs whilst lazy ones harvest the infested produce late. In addition, lack of capital for investing in farming could also make a chief farmer a beggar in his own kingdom because he might have strength to cultivate bigger plots but if he has no money to purchase farm inputs, his farm will be at the mercy of numerous pests and diseases.

“Women of Odumase-Wawase community have agreed that giving financial assistant to successful farming households who are willing to expand their farm business based on modern farming method is a panacea for removing hunger.”

Agricultural yields changed in Odumase-Wawase community over the past year because they engaged in row/line planting and fertilizer application for their maize farm. They were able to harvest higher yields as compared to previous years. A woman from Odumase-Wawase community also said she engaged in modern farming practices to boost her cassava and maize yields this year and she had a good harvest. Another woman said, she did not farm this year, but a friend of hers told her that the modern farming practices she learnt from THP had really increased her yields this year.

In Nsuta-Aweregya community, women said their families have enough to eat and example of any changes in these conditions over the past year were discussed below. A woman said most families got enough to eat, there were left overs and no one complained about hunger ever since the THP came to teach them the modern farming methods. For a year now there had been tremendous change. Initially, most families were taking one square meal a day but now, because of the new farming interventions, they had more than enough to eat a year round. Also, those who were procrastinating the adoption of new techniques of farming or had no interest in farming have hope that they could do better. The chiefs announced that THP had brought those fertilizers for all farmers in the villages whether active or not in THP activities. They were to come for them, apply them on their farms and pay later because the fertilizer application would support better yields.

“Agricultural yields changed over the past year because the chief got involved in promoting the use of fertilizer”.

The agriculture TOTs educated them on how to plant in lines and this had really helped them. A woman from Nsuta-Awaregya for instance, heeded to theadvice given by trainers and had a bumper harvest for storage and for the market. She said

“We were all informed about how to apply fertilizer brought by the THP. When it came we all applied it according to instruction of the THP and we had a bumper harvest needed to eradicate hunger”.

According to this woman, it was exciting seeing most fertilized farms with big crops in lines because they were going to yield a better harvest than small crops without fertilizer. A lot of bigger and fresh (double double) cobs could obtain its market worth.

Module 4. Literacy and Education In a focal group discussion on literacy and education held at Nsuta Aweregya, it was clear that the perception of quality education in Nsuta-Aweregya community was a topic women folks of the

The Hunger Project OEPP 151 6/20/13 community examined thoroughly. The classification of school as good or better one could be based on the performance of the students at WAEC, their punctuality and regularity at school, students’ attitude or respect towards the elderly in the community. Another woman said it could be based on the state of the school building as to whether the shape of their school is in good condition without any drainage problems, the way teachers teach them and their students' performance. A woman used her son as an example; she said, ‘’as a secondary lad at Kukuratumi, he read the tribute of his grandmother so well that I dashed him money in public just as some people were also doing. I was very proud of him that day and the school that trained him to be a good reader. In addition the students performed well at WAEC’’. Another woman believed that the quality of a good school would also depend on the parents and teachers. If parents provided their children’s needs, they would always be neat and happy to be in school and this could help them concentrate very well at school and even continued their studies at home. Most parents ignored the need of their children at school, they did not buy them books, pens, pencil and others and this could affect their performance in school. Even their school fees was also not paid and the child was always sacked from school.

The perception of quality education in Odumase-wawase community by women was based on the performance of both teachers and pupils, for example, a woman said she maintained her daughter in the Besease community school until she sent her to Accra to continue her education. To her surprise she sat with her seniors in a school at Accra and she came out third. This means the school at Besease was very good. Another woman said Wisiwisi pupils do attend school very early in the mornings and were respectful. Good schools trained pupils to do very well at WAEC and parents are direct beneficiaries. The community thanked THP for assisting the children and their parents to understand the importance of education. Other women said good schools should train children to be disciplined and respectful, have high qualified and committed teachers who sometimes would show their commitment by moving from house to house to sack all the children to school. . So in Odumase-wawase community, women rated the quality of the schools in their community on several factors including the performance of teachers and students. Pregnancy was rated highest among barriers that could prevent girls from completing primary and secondary schools in Nsuta-Aweregya community. In a practical instance, a teenage girl who needed some support for school materials found solace in a guy because her parents refused her request and this resulted in her getting pregnant.

“So refusal of parents to provide needs of students at school forced some to become school dropouts and prostitutes”.

Another woman said some children preferred collecting cola nuts on the farm to going to school only to be sacked home for school fees and other schooling materials; this is because their parents have refused to provide them with their needs due to that fact that most don’t regard education at all. Another mother said, some parent do not regard their children’s education. For instance in the morning that a child had to prepare for school, a parent can ask the child, “Akua what will you do in school today?’’ Immediately she responds to it by saying, “I don’t really know’’, then her mother shouts, “forget about school and escort me to the farm. What have this girl and that girl gained from schooling?”. In this case obedience is better than sacrifice could be used in perverse ways. A blind couple could easily lead a household into a ditch in times of emergency.

The Hunger Project OEPP 152 6/20/13 “Women of Nsuta-Aweregya community now agreed that some derogatory remarks of parents about school to their children gradually shift their focus on education to things their parents prefer in order to please them”.

A mother said some parents do not provide ample time for their children to study. Some children after all the house chores were demanded to stay awake to sell at night. This would make the child dull, sleepy, less focus and lazy about studies at school. This would also take interest of the child away from studies, making him/her always running away from classroom. If s/he cannot concentrate to pass his exams, to avoid being teased by her/ his colleagues s/he would then abort his schooling.

Another woman from Nsuta indicated that sometimes some parents do not check the sleeping hours of their children, so the kids take a French leave to night clubs and funeral wake-keepings whiles their parents are sleeping. This could affect their schooling because the females amongst them could be wooed by the males to bed with them and this might lead to pregnancy. Another adult woman said some of their children were very bad and disrespectful to their parents, no matter the advice, warnings and even the love showed them, they would still stay out of school and got themselves pregnant. No matter what her mother bought for her, if she burnt on sneaking out at night to meet her boy lover or girl lover they would go out to ‘chill’ and get themselves in trouble. Some children were bad and they needed to be disciplined and carefully controlled. Another woman said, this reminds her of an incident that happened to her daughters. She ignored school and started flirting around with boys. I reported her to a police who arrested her and threatened her of arrest anytime she goes to see the man or is found with him. She got scared and concentrated on her studies. She is now a well educated lady in the community. This woman also said

“In these communities, THP teachings is really helping us a lot to train our children and it is the parents’ duty to inspect their daughters’ monthly menstruation cycle”.

In Odumase-wawase, a focal group discussion on literacy and education indicated that the perception of quality of education in this community or what would demand praise for their community school was examined by women folks only. Most of the school children engaged in premarital sex, so before they could finish basic school, most of them became nursing mothers and fathers at the tender age, resulting in school dropout. Another woman from Odumase –wawase said some parents were very irresponsible. Parents have no interest in girl-child education and this has resulted in many incidence of school drop- outs. She once attended a seminar and educated the children to be responsible and go to school, even when their parents cannot afford it. She also admonished the parents to be responsible enough to educate their children. After the seminar, one young girl approached her and told her that her father had not been giving her enough money for school but after speaking to her father and handing an assignment to him, he now gives her enough money to school and she is now a happy student. So in her view, the reasons for school drop-outs were due to irresponsible fatherhood and laziness on the part of pupils. Initially, some parents were not willing to support their female daughters in school because they think they would soon end up in the kitchens as nursing mothers and be taking care of their new found families; so this is one big challenge to me as my parents also had refused to allow me to further my education but did that for my brothers. In another mother’s view, some children were very disrespectful and they escaped classes. So one man in her village took it upon himself to sack the children who run

The Hunger Project OEPP 153 6/20/13 away from school back to school but they still face some of these challenges. Whether the availability of the good school and finance was also not a problem, a woman had this to say. “Fortunately for the Odumase –wawase community, all the villages have schools now with the exception of one village which is not part of the epicenter community without a school and even with that, they do attend that of the nearest villages.

In Nsuta-Aweregya, women observed that there were some differences in the challenges of both boys and girls. Assuming a boy gets a girl pregnant, he can further his education but the girl will have to suspend her schooling for about a year or two or even stop. Another woman said since the girl child will be burnt flirting around, there is therefore the need to teach them the use of condom and other contraceptives just as THP training has taught them. If a family is financially handicapped, they cannot educate their children. Also in Odumase-wawase, women thought that most challenges would be the same except the level of financial problems and the fact that if a boy should get a girl pregnant, she cannot go to school with the pregnancy as well as the boy.

Module 5. Health and Nutrition In Nsuta-Aweregya, a focal group discussion on health and nutrition indicated that the main health problems facing these areas were malaria, lack of immunization etc and this has being a treat to the community. Most women agreed that their major treat was malaria because of the frequent mosquito bits. THP and many other organisations had distributed mosquito nets to them but they realised that lots of people continued to get sick because they stayed out late to be bitten by mosquitoes in the evenings before sleeping in nets. However, the sickness had now reduced a bit. Another woman reported sand wining as a major treat because the holes left behind continued to breed anopheles mosquitoes that serves as a vector for spreading malaria parasites that caused malaria, and this has been a reason behind most of the malaria complains and reports at the clinic. The community spoke to the chiefs and the land owners to stop or reduce the selling of lands for sand winners no matter the hardship to curb the spread of malaria.

In Odumase-wawase, focal group discussion on health and nutrition was based on the presence of bad drainage system and improper dumping of canes which had been breeding mosquitoes. Ever since they were educated by THP, their chiefs had putting measures in place to stop improper disposal of garbage and have reserved a particular place for dumping of rubbish. Spies and task council forces were put in place to enforce the law and charge anyone found breaking the law. They now have mosquito nets. Another woman said, they were suffering from stench emanating from dirt and improper defecation by the kids around drainage system, but after the education they have stopped. Those who sold their lands for the sand winning contract for a period of time were advised to stop. The open pit was left because they were far from town so they could not use it as a dumping site. Even if they use the site, it would take years to get filled. Another woman said fatigue is another problem they faced because they worked all the time on their fields and got tired and even felt sick sometimes, so fatigue is a health threat to them. Some went to the clinic or drug stores to buy pain killers for relief. They were advised that the best way is to rest for some time after working. In odumase-wawase community, they do not have water pollution since their environment is clean. The town councils came around for inspection and they

The Hunger Project OEPP 154 6/20/13 testified that their environment was very clean. To maintain a cleaner environment, some women burnt their rubbish at good places and buried their cans.

A woman said, “they formed a committee responsible for educating everybody about new knowledge and skills acquired from the THP. Since they have carried everybody along in solving their environmental problems, their sanitation problems had reduced”.

This is because she had taken it upon herself to threaten and report to the inspection team about anyone who does not check his or her drainage system properly.

In Odumase-wawase, the focal group discussion on health and nutrition revealed that food diseases was minimum. They do not have problem with toilet challenges in this community because the town council officers really charged offenders to promote cleanliness in the villages. The town council either arrest or prosecute offenders in court or fine offenders. A woman from Wisiwisi community said now they have individual toilets in their homes and even a public toilet so when they get a visitor he or she can feel comfortable. They have someone taking care of their new ventilated toilet facility. A woman from Sitey- kese village said they were formally drinking clean stream water from the rocks but now they have good water from bore holes. They are now contributing towards the repair of some of their old bore-holes.

The availability and quality of the health services provided by the Epicenter health clinic could be rated very high because the clinic has really been of good use to them. Formally, they had to hire a car before carrying the sick to the hospital . The nurses worry is that some people do visit the clinic very late i.e. after 4pm when the nurses have closed to see to their own activities. So they keep on complaining and people would say the nurse was not treating them well but according to her their complaints were not different from any other clinics that have limited time of attending to patients. Another woman said the clinic helped them a lot, because they had been carrying pregnant women who were in labour to other towns for treatment but now that they had a clinic, their burden is reduced. The nurse do give first aid treatment before transferring the patient to a bigger hospital and this was in agreement between the chiefs, the nurses and the doctor of the other hospital. They have the phone numbers of certain taxi drivers we call in times of emergency. Another woman said the clinic is good and close to them but one could be sick at any time so she would rather appeal to the nurses to attend to the sick whenever they come despite the closing time because it was not intentional and that she would be happy if the nurses stop that attitude. Recently her sister brought her child and the nurse complained that the village like coming to the clinic in the evenings so she would prefer that the chief announced to change the consulting time from morning(8am-4pm) to evening so that she can relax during the day. . Some said the attitude of the nurse was very bad claiming that there were instances where someone had an attack from the farm and when she was brought to the clinic the nurse told the mother of the child to carry her back home and bathe her before bringing her there. They also said she sent back a woman who was in labour, so the municipal head and the chiefs sat her down, and so now there had been a positive improvement in her services. Another woman said it was not solely her fault, because some of the people she sent away had to be operated on at the hospital, which she couldn’t have done here because there was no operation room. She came to the clinic some time ago for treatment but was referred to Atibia hospital where she finally got better. the same thing applies to one pregnant woman who came here, so she thought the referral was not bad sometimes; it was for their own good.

The Hunger Project OEPP 155 6/20/13 In relation to the conduct of nurses, it was obvious that the nurse here is very good. She would quickly attend to patients no matter their conditions. Even if you do not have money to pay for a card before proceeding for treatment, she could ignore that and attend to you and later asked you to pay up your debt.

“ In Odumase-Wawase community, women are very fond of their nurses because they are “down to earth” to such extend that people from Pankease village do not hesitate to visit their clinic even though their village is not part of this epicenter. And people from other far epicenters feel more comfortable visiting this clinic than their own”.

Another woman from Besease village said whenever she realised someone was feeling reluctant to come to the epicenter clinic, she advised them to come because their nurse is welcoming and good. Another woman praised this community nurse because the nurse “is down to earth” and even joins them to educate the community especially on health issues.

Module 6. Livelihoods and Microfinance During the focal group discussion held at Nsuta-Aweregya on Livelihoods and Microfinance module, it was obvious that families in the area have been able to improve their living conditions in terms of home improvements, sending children to school, expanding businesses, etc. One wonders what facilities or resources were available for improving their living conditions. A woman told audience that their standard of living had changed positively because they had THP loan facility that had been very beneficial to them and they had learnt to save the little monies they had. Even though the loan they received was not that much, it was better than none and it had brought positive impart into her family’s life. Another woman said initially when she had not received any education on how to manage her money, she was extravagant in spending on funeral clothes and shoes until she had THP training. She became very guilty of ignoring her children and grandchildren’s need for school which could be of benefit if she educate them very well. Today, there had been improvement in their lives and she had realised that the shoes and dresses will be of no use to them in future.

According to another lady in Nsuta-Aweregya community, when she had not received any financial training from THP, her business was not doing well at all. She was neither taking notes of what she bought nor sold, neither was she noting the names of her creditors. She was not calculating the cost price, selling price and profit but after her note taking training from THP, she now started doing things right and it had helped her to minimise her loss and maximize her profit margins. She now sold and calculate her profit even before paying of her debts. Before, she did not own anything, but now she could boast of clothing, shoes and even a house. They had enough to eat and even her last child is now in the secondary school, so she could testify that there had been improvements in her life.

Women of Odumase-wawase also had focal group discussion on Livelihoods and Microfinance module, and they thanked THP for the loan facility received because it helped them to improve on their children’s education, expand their business and farming activities. A woman from Wisiwisi village said, “a couple used to fight a lot over their child’s school registration fee. The man used to beat his wife for their children’s school fees all the time and on one fateful day, their daughters’ teacher came to meet one of the fighting incidents and advised him on the importance of girl child education and the need for

The Hunger Project OEPP 156 6/20/13 understanding in marriage. The couple do not fight again and there has been an improvement in the education of their female children and in addition enjoyed peace and love”.

“Another woman said Initially women could not refuse their husbands’ sex even when they were sick or not in a better mood, but the WEP education has enlightened her to an extent that she now know that there should always be an agreement between a couple before having sex but not force’’.

Another woman said THP education taught her the importance of animal farming, now she engaged in raising sheep and goats with the loan she took and she is making profit from the animal farming. She have been able to further her children’s education.

Module 7. Water, Sanitation and Environment Some of the major threats to maintaining a quality environment (i.e. air, water, sanitation (rubbish), soil quality, vegetation) were discussed under Water, Sanitation and Environment model, together with some actions needed to be taken by the people in the villages to address these concerns. According to women in Nsuta-Aweregya, specifically from “Kwame –Omari village”, they lacked good drinking water. Their leaders sort assistance from an NGO and finally had a bore hole. A woman said she was in charge of the water committee. She made sure the surrounding of the bore hole was always clean and she enforced this rule to the latter: Neither dirt nor weeds could be found around. Those who could not comply became her enemies, especially among the youth. They called her all sort of names and even told her ‘the one who brought hygiene into the world died of it’. She turned deaf ears to them and encouraged her partner to continue with the good work and as a result, the village was rewarded for having the cleanest borehole. Thanks to THP enlightenment. She have even been able to stop them from stepping around the borehole pipe with slippers. Another woman narrated that parents sent young children to dump rubbish, but because they were kids they dumped it along the road instead of the prescribed place for all and this act became a threat to their health. The chief and his people set up spies to report any culprit and they were charged so as to put an end to such a behaviour. Another woman said her village was facing water problem, their stream was very bad because the colour was red, but now they have about six boreholes. They do not have any problem with improper disposal of toilets in this epicenter community.

According to women in Odumase-wawase community, “galamsy operations”are being undertaken in the environs of Besease and that is affecting their water situation. A woman from Wawase village said they do not have any problem in terms of water and refuse dumps, due to THP training and assistance. A woman said they need a toilet facility at Sitey Kese because the old one spoilt due to the bad nature of the land.

“It was generally agreed across both Nsuta-Aweregya and Odumase-wawase epicenters that there has been an improvement in access to safe water and basic sanitation facilities since THP began working there. “

The Overall Outcome and Impact of THP based on Focus Group Discussion The overall analysis of in-depth interviews with focal groups showed a positive impact of THP across Nsuta-Aweregya and Odumase-wawase epicenters. Women from Nsuta-Aweregya said in general, The Hunger Project OEPP 157 6/20/13 they thought about activities of THP in Nsuta-Aweregya as very good. Today the voices of women could be heard in public which was not so in the past. When they talk, the men listened to them and made use of their suggestions. Also, THP had assisted them to obtain a nursery school. Initially, the school was in a bad shape but they now have a new one. Another woman said she had been able to buy her children’s school uniform even before they resumed school which was not so initially so she will say THP teachings have saved her from borrowing money. Another woman was able to establish a business from the loan and she now own a house and her daughter is now attending a private school at Nkawkaw. Others said they benefited from the clinic, increased farm, a lot of knowledge and ideas as to how to run their family and the development of their village. Another woman said

‘I have also learnt how to prepare gari and many other foods as a result of THP trainings; I have also been able to build a toilet facility in my house”.

The activities of THP need improvement in some areas. A woman from Nsuta-awaregya said, her plea was that the loan be increased a little bit for them.

Women from Odumase-wawase said in general, they thought about activities of THP in this community as excellent. The rate of education had increased, the women now had liberty to talk and over talked at times, a better place for medication, now both parents had been caring for their children, they had better drinking water in the community, they had education on maintenance of good sanitation which reduced the rate of illness. A woman said

“Now a widow has the right to continue living with his family and the community at large without any maltreatment”.

The biggest change in the community as a result of THP’S work was school. In Nsuta-Aweregya, The Nsuta-Aweregya Epicenter credit union gave villages GHC400.00 each to put up school buildings. They used the money for the school roofing. THP has helped “Kwame Omari village to establish gari, soap, pomade processing business in the village. According to the women of Nsuta-awaregya

“The epicenter building and the activities of THP amongst the villages had brought the people and their chiefs together”.

Villages assisted each other with communal labour for their common interest in building schools in their villages. But when there was nothing in common unifying the villages most projects were difficult to complete. So THP united villages to become as brothers and sisters and peace is now reigning. Women from Nsuta and Kwahu-Oda were facing challenges with their toilet facility. Most women were shy to visit the place because it was not in good shape and was also close to the males so most people preferred to use the bush. Today THP has provided them with new toilet facilities with lots of rooms, good drinking water in addition to soap, pomade, tie and die clothes and many more technologies .

In Odumase-Wawase community, the most exceptional charge associated with the THP’s activities was liberation of women from atrocious men with regards to equality. As a result, husbands now help them in their duties. Now both sexes receive equal educational support of parents. There is a clinic to provide assistance to the sick, they now have sanitary professionals to take care of sanitation in the village and

The Hunger Project OEPP 158 6/20/13 they wished, facilitators’ training could continue. In addition, they expect continued assistance from the micro finance group of the THP.

The Hunger Project OEPP 159 6/20/13 Contributions and Suggestions Women from Nsuta-Aweregya suggested refreshment from the organisers anytime they have such meetings to attract more participants. Women of Odumase-Wawase suggested that THP should please increase the quantum of loan facility. In addition, they wished to have it before the beginning of their farming season, for purchasing farm inputs on time. Another woman contributed that a borehole should be extracted at Besease. In conclusion, the THP officer said THP is always ready to empower and train people through Epicenters, to be self-reliant, so long as development gap exist. They suggested to members to continue speaking to their officers in charge of the epicenter to assist them in cases related to “item 13’’.

LESSONS LEARNED ● Outcome evaluations conducted by THP staff greatly contribute to THP’s overall M&E strategy: Historically, THP has relied primarily on the regular collection and reporting of output- level indicators. With the introduction near and mid-term outcome evaluations at each epicenter/cluster of communities (ideally conducted every 2-3 years), THP is able to better understand the changes occurring at the household and community level and how THP’s programs are contributing to that change. Results allow a space for critical thinking and decision making by program staff on which areas (ie. WEP, health, sanitation) need increased focus. Because each epicenter has a different set of socio-economic and cultural challenges, outcomes and the general progression through THP theory of change will occur at different rates. By deepening the understanding of the challenges faced and understanding of perceptions/achievements, staff is able to further engaged with epicenter leadership to set priorities about which programs might be most beneficial for that particular epicenter.

RECOMMENDATIONS 1. The analysis process should be automated as much as possible. The manual analysis conducted for the OEPP requires far too much time. 2. With support from the GO, THP-Ghana and THP-Malawi should finalize a strategy for sharing results with key stakeholders, most importantly with with Epicenter Committees so they may take corrective action and set priorities based on key findings. 3. Through the evaluation implementation and data analysis phase, THP M&E staff has learned that some corrective actions are should be taken for improving the tools and methodology before the OEPP is adapted across other THP Africa Programs. ● Evaluation methodology: The evaluation methodology proved to be successful in the implementation phase, however a clear data analysis plan should be outlined before the evaluation is replicated or scaled-up. - Staff capacity for qualitative data analysis should be strengthened further through workshops with local universities. In both Ghana and Malawi staff contracted a local university professor to perform the qualitative data analysis of the FGDs and KII. Going forward it is recommended that in additional seeking support for the final report, staff participate in a refresher course on qualitative research methods and receive training on a qualitative analysis software package (such as Nvivo which was used in Malawi). - Ensuring country offices have the appropriate technology (iPods, battery cradles, mobile wifi devices, laptops, data analysis software) is absolutely critical

The Hunger Project OEPP 160 6/20/13 to the successful implementation of the OEPP. The use of iPods was clearly a time saver, but issues with short-battery life and limited wireless connectivity proved to be a challenge in both Ghana and Malawi. - The sample size for this survey was not large enough to yield statistically significant results. It is recommended that when this evaluation is replicated, sample sizes be carefully selected so that they may yield statistically significant results from the household survey. - Considerations should be taken to determine if the evaluation methodology should include a counterfactual control group. ● Selected outcomes and indicators: Further analysis is needed to determine if selected outcomes and indicators were sufficiently tested in the OEPP and how they might be further revised before replicating this evaluation across other THP program countries. ● Data Collection Tools: The use of both quantitative and qualitative data collection tools has provided a rich picture of the surveyed populations. It is recommended that an external research institution review the data collection tools further to determine if the intended results were achieved. ● Enumerator Training: The feedback from enumerators was overwhelmingly positive and the ease of use of iPods contributed to the rate at which a large number of households could be surveyed in a relatively short period of time (on average household surveys lasted 50-110 minutes). An anonymous exit survey was conducted in which enumerators in both Ghana and Malawi reported that they were extremely impressed with the training they received as well as the management of evaluation by THP staff. Most enumerators suggested the training be extended from 3 days to 4-5 days to allow for additional practices with the iPods before data collection begins. ● Increased resources for M&E at the program country and global office level are needed in order to improve and scale-up outcome evaluations across all THP epicenters. In order for this type of evaluation to be fully integrated into THP’s M&E system, additional financial resources must be allocated in order to support staff capacity, the purchase of recommended technology devices, and to ensure that community feedback sessions can take place at each epicenter (where results can be shared by with community partners).

The Hunger Project OEPP 161 6/20/13 Annex 1: Theory of Change

The Hunger Project Sustainable, vibrant, healthy rural communities free from Africa Program Theory of Change hunger & poverty 4/15/11

Long-Term Impact

End Poverty Universal Gender Healthy Healthy Reduced Environmental Global and Hunger Education Equality Children Mothers HIV/AIDS Sustainability Partnership

Formation of Country-Led Strategies

Gender-based, Public policies reflect Replication and Strengthened Strengthened Strengthened E"ective donor/ rights-based THP values/approach support of THP's partnerships with multilateral partnerships with investor country (national, international approach to civil society collaborations government cultivation strategies level) development

Sustainable Community Impact -- Within 8 Years

2. Women's Empowerment 3. Food Security 4. Literacy and Education 5. Health and Nutrition

Reduce Movement Violence Women participate People in partner More children People, Good hunger and toward against in decision making communities have Literacy & in school especially health care Good extreme gender women processes at all access to nutritious numeracy (especially children, are incl. HIV/ nutrition poverty equality reduced levels food girls) healthy AIDS

Phase 6. Water, Environment & Sanitation 7. Income Generation 8. Good Governance 9. Public Awareness, IV Wealth in village Wide access to/ Advocacy, & Alliances Sustainable Good Good through use of social Government Collaboration & environment: Many small sanitation sanitation investments in goods: health, accountability ~ partnerships with civil water, soils, businesses practices practices better homes, education, Less corruption society groups at all woodlots livestock, etc. water, etc. levels

Shifts in Community Capacity and Conditions -- Within 6 Years

2. Women's Empowerment 3. Food Security 4. Literacy & Education Increased adult Visible Increased Increased Larger, Increased access Increased access Proper food Increased Improved literacy, ! women- gender equity women's more to nutritious food to quality storage crop agricultural increased initiated within the family participation in productive at household & education for all facilities diversity systems access to/use of projects & community decision making farms community levels skills training children

5. Health and Nutrition 6. Water, Environment & Sanitation Epicenter Construction Increased Increased Increased Improvements Improvements Increased Communities Epicenter awareness of Improved legal awareness Epicenter access/use of in maternal in HIV/AIDS access to clean initiate and committees health & protection and about built and health and child prevention and water & complete are nutrition access to land environmental operating services health treatments sanitation projects functional Phases sustainability issues II & III

7. Income Generation 8. Good Governance 9. Public Awareness, Advocacy, & Alliances Advocate with Increased awareness Women have Partners are Improved savings & Better material Increased Collaborations government aid of political, social, continued access engaged in viable credit services conditions and local & partnerships agencies, investors to economic rights to financial economic available to poor in economic government with civil support and replicate (especially women's services ventures THP communities opportunities accountability society groups the THP model rights)

Shifts in Community Capacity and Conditions -- Within 2 Years

1. Community Mobilization More e"ective Stronger Increased agency: Communities community collaborations/ Phase I Mind-shift from organize Epicenter leadership alliances within Epicenter "I cannot" to regular (specifically by and among "I can" meetings Strategy women) communities Strategy

Deploy Form Vision Education & animators, Local community Establish partnerships Commitment Gender HIV/AIDS Advocate for Leadership participatory development local Micro- with local Action equity awareness government action (health, education, governance finance training NGOs/CBOs workshops work accountability researchers agriculture) structures training

THP Africa Strategies EMPOWERING PARTNERING Government builds & MOBILIZING equips schools, WOMEN, WITH LOCAL health facilities, latrines, COMMUNITY CREATING AGENCY GOVERNMENT & other infrastructure

The Hunger Project OEPP 162 6/20/13 Annex 2: Core Outcomes and Indicators

These core indicators where used as a framework for the OEPP. Indicators highlighted in orange where not thoroughly addressed in the evaluation because of the nature of the question or lack of supporting data available. It is recommended that these indicators be addressed in a follow-up survey and/or through the collection of secondary data.

Program Expected Outcomes Program Goals # Core Indicators Areas & Impacts

• More effective Number of community community 1.1.1 initiated projects (led by THP leadership Volunteers/Animators) To increase (specifically by leadership, women) Percentage of women in capacity, • Increased agency: 1.1.2 leadership roles within the knowledge, mind shift from “I community confidence and cannot to I can” infrastructure • Stronger Percentage of THP partners collaborations and Community within the are more confident, 1 alliances within Mobilization community so knowledgeable and aware of among communities 1.2.1 that community • Community their rights than they were partners are mobilizes in before THP entered the better equipped partnership with THP community to be the authors in the construction of of their own needed infrastructure (i.e. Percentage of community development "epicenter buildings" 1.4.1 members involved in schools, libraries, resource mobilization community centers, health posts, etc.) Percentage of community • Increased awareness members (both men and of political, social and women) have a clear economic rights understanding of their rights (specifically women’s 2.1.1 (social, political, economic) To increase right) and a clear understanding of Gender gender equality • Increased gender 2 Equality and human rights equality within the women's rights as human awareness family and rights community • Improved legal Percentage of women protection and seeking redress when their 2.1.2 access to land for civic, legal or sexual rights women are violated

The Hunger Project OEPP 163 6/20/13 Program Expected Outcomes Program Goals # Core Indicators Areas & Impacts

Ratios of girls and boys share 2.2.2 household responsibilities equally

Percentage of women with 2.3.1 access to secured land rights

Percentage of households are eating a diverse diet that 3.1.1 To ensure • Increased availability meets their daily nutritional availability and of and access to needs access to nutritious food at the household and Percentage of underweight Food nutritious food 3 community level 3.1.2 children (boys and girls) Security and improved • Improved agricultural under the age of five years agricultural systems and animal systems in partner husbandry practices Percentage of partners communities participating in THP who 3.2.4 demonstrate an increase in average yield per acre

Increased access Percentage of girls and boys 4.1.1 to quality • Increased access to enrolled in primary school quality education for Literacy and education for all 4 all children Education children and Percentage of women and • Increased adult 4.2.1 men who are literate and increased rates of literacy (particularly adult literacy women) numerate

Rate of malaria cases among 5.1.2 men, women and children (boys and girls) • Increased access Percentage of pregnant To increase access to/use of health services 5.2.2 women choosing to give to health services Health and • Improvements in birth at a health facility 5 raise awareness of Nutrition maternal and child health and health 5.2.6 Child mortality rate nutrition issues • Improvements in 5.2.7 Maternal mortality rate HIV/AIDS prevention and treatments Number of people (men and 5.3.2 women) receiving voluntary counseling and testing (VCT)

The Hunger Project OEPP 164 6/20/13 Program Expected Outcomes Program Goals # Core Indicators Areas & Impacts

Percentage of households 6.1.1 using an improved drinking water source To increase access Water, to clean water • Increased access to Percentage of households clean water and Environment and sanitation and 6.1.2 with access to an improved 6 sanitation and awareness about sanitation facility • Increased awareness Sanitation environmental about environmental Percentage of population sustainability sustainability aware of environmental 6.2.1 issues such as biodiversity loss

Number of women and men are applying new skill(s) 7.1.1 learned from THP to improve their livelihood

Percentage of women and men using capital to expand 7.2.1 • Community partners an existing business or start To create better Livelihoods are increasingly a new business material applying new skills to (and 7 conditions and improve their On average, families have Microfinance economic livelihoods 7.2.2 increased the value of their in Africa) opportunities • Families are better household assets by x%* equipped to meet household needs Average annual household 7.2.3 income (has increased by x%)

Percentage of households 7.2.4 with improved living conditions*

To increase local • Local Government is Percentage of community government responsive to members (men, women) Good accountability and community needs who are satisfied with the 8 8.2.1 Governance transparency • Increased level of partnership between transparency and communities and local accountability of government agencies local government

The Hunger Project OEPP 165 6/20/13 Program Expected Outcomes Program Goals # Core Indicators Areas & Impacts

To strengthen Local and national multilateral governments are collaborations and • Strengthened 9.3.1 increasingly adopting THP's Multilateral partnerships with approach into their Collaborations civil society development plans/policies Advocacy • Strengthened 9 organizations partnerships with and Alliances THP is receiving increased civil society financial and technical • Strengthened partnerships with 9.3.2 support from local and government national government agencies

The Hunger Project OEPP 166 6/20/13 Annex 3: Household Surveys (see 2 attached PDF files)

Annex 4: FGD (see attached PDF file) Annex 5: KII (see attached PDF file)

References

- Ghana Living Standard Survey (GLSS5): http://www.statsghana.gov.gh/docfiles/glss5_report.pdf - Malawi Core Welfare Indicators Questionnaire 2002, Malawi National Statistics Office 2002http://www.nsomalawi.mw/index.php/publications/welfare-monitoring-surveys-wms/50- 2002-core-welfare-indicators-questionnaire-cwiq-survey.html - Integrated Household Survey (IHS2): http://www.nsomalawi.mw/index.php/publications/integrated-household-survey/200405- integrated-household-survey.html - MoWAC & Unicef 2011: http://www.mowacghana.net/REPORT%20xxx.pdf - Progress out of Poverty Index (PPI), 2011: http://www.progressoutofpoverty.org/

The Hunger Project OEPP 167 6/20/13