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Results from a Study of Sustainability and Exit Strategies Among Development Food Assistance Projects Kenya Country Study

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Results from a Study of Sustainability and Exit Strategies Among Development Food Assistance Projects Kenya Country Study Sustaining Development: Results from a Study of Sustainability and Exit Strategies among Development Food Assistance Projects Kenya Country Study Jennifer Coates Elizabeth Kegode Tina Galante Alexander Blau Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University February 2016 This study was made possible by the generous Recommended Citation support of the American people through the support Coates, Jennifer; Kegode, Elizabeth; Galante, Tina; of the Office of Health, Infectious Diseases, and and Blau, Alexander. 2016. Sustaining Development: Nutrition, Bureau for Global Health, and the Office of Results from a Study of Sustainability and Exit Food for Peace, Bureau for Democracy, Conflict and Strategies among Development Food Assistance Humanitarian Assistance, U.S. Agency for Projects—Kenya Country Study. Washington, DC: FHI International Development (USAID), under terms of 360/Food and Nutrition Technical Assistance III Cooperative Agreements GHN-A-00-08-00001-00, Project (FANTA). AID-OAA-A-11-00014, and AID-OAA-A-12-00005 through the Food and Nutrition Technical Assistance Contact Information III (FANTA) Project, managed by FHI 360. Food and Nutrition Technical Assistance III Project The contents are the responsibility of FHI 360/FANTA (FANTA) and do not necessarily reflect the views of USAID or FHI 360 the United States Government. 1825 Connecticut Avenue, NW Washington, DC 20009-5721 February 2016 T 202-884-8000 F 202-884-8432 [email protected] www.fantaproject.org Results from a Study of Sustainability and Exit Strategies among Development Food Assistance Projects: Kenya Country Study Acknowledgments We would like to extend our sincere gratitude to the many individuals who contributed to the success of the Kenya Exit Strategies Study. Gilles Bergeron and Megan Deitchler from the Food and Nutrition Technical Assistance III Project (FANTA) at FHI 360 provided us with direction and insight over the 4 years of the study. Diana Stukel from FANTA provided us with sampling advice, and Zeina Maalouf- Manasseh and Wendy Hammond reviewed an earlier draft of the report. We are grateful for all their support. Our core qualitative study team in Kenya—Connie Otwani, Fred Ole Pertet, and Rhoda Mulinge— demonstrated extraordinary professionalism, endurance, and humor during 3 consecutive years of qualitative fieldwork and contributed substantial analytical insight to the report findings. Samson Okumu facilitated the study at the U.S. Agency for International Development (USAID)/Kenya, provided a historical perspective on the Title II Program, and remained a valuable contact and source of information during all 4 years of the study. At Adventist Development and Relief Agency (ADRA)/Kenya, Peter Mwangi was a remarkable community mobilizer, bringing together former ADRA beneficiaries for the qualitative work despite logistical and other constraints. Tabitha Dulo at the ADRA/Kenya office provided very smooth logistical support. At Food for the Hungry (FH)/Kenya, Philip Mato and Shep Owen from the FH Nairobi Office were critical to the planning and implementation of the study in Marsabit. They both remained extremely responsive by email in clarifying questions related to FH/Kenya’s project design, exit plans, and the endline survey. We extend a special “thank you” to the entire team in Marsabit whose assistance over many years made this study possible. We are especially grateful to Pastor Sammy Moga and the accomplished team of drivers who carried the team safely through some of the roughest terrain in the country. At CARE/Kenya, Maina Njorge and Walter Ong’enga played a very important facilitative role in planning the research in former project sites while contributing their special knowledge of the Dakachana project and clarifying our understanding of CARE’s exit strategy. The CARE/Kisumu field staff was extremely supportive of the research, accompanying the qualitative study team on all three rounds of qualitative data collection. We would like to thank everyone at Kimetrica for their work in undertaking the quantitative survey. Technical Director Ben Watkins was instrumental in the success of the survey, and we thank him for his responsiveness. Last but not least, we would like to acknowledge the contributions of community members throughout the former ADRA, FH, and CARE sites that gave generously of their time to participate in the study for 3 consecutive years. Some walked great distances to participate in focus group discussions, while others welcomed us into their homes. We are indebted to them for sharing their perspectives on what Title II development food aid projects meant to their lives and the constraints and opportunities related to the continuation of benefits several years after the end of external support. Any errors are the sole responsibility of the authors. i Results from a Study of Sustainability and Exit Strategies among Development Food Assistance Projects: Kenya Country Study Contents Acknowledgments ........................................................................................................................................ i Abbreviations and Acronyms ................................................................................................................... iv Executive Summary .................................................................................................................................... 1 1. Study Overview and Objectives ........................................................................................................ 10 2. Conceptual Framework and Hypothesized Factors Predicting Sustainability ............................. 14 3. Research Methods and Analysis Approach...................................................................................... 16 3.1 Overview of Data Sources and Timeline .................................................................................... 16 3.2 Qualitative Methods .................................................................................................................... 19 3.3 Quantitative Methods .................................................................................................................. 20 3.3.1 Adventist Development and Relief Agency: Kitui District ............................................. 20 3.3.2 Food for the Hungry ........................................................................................................ 21 3.3.3 CARE .............................................................................................................................. 21 3.4 Data Analysis Methods ............................................................................................................... 22 3.5 Limitations .................................................................................................................................. 23 4. Project Descriptions and Operating Context ................................................................................... 25 4.1 Food for Peace Programs in East Africa and Kenya ................................................................... 25 4.2 Awardee Projects ........................................................................................................................ 25 4.2.1 Adventist Development and Relief Agency: Kitui District ............................................. 25 4.2.2 Food for the Hungry/Kenya ............................................................................................ 26 4.2.3 CARE: Nyanza and Western Provinces .......................................................................... 26 5. Results: Maternal and Child Health and Nutrition Sector ............................................................. 27 5.1 Maternal and Child Health and Nutrition Sector Sustainability Plans and Exit Strategies ......... 27 5.2 Sustainability of Maternal and Child Health and Nutrition Service Delivery ............................ 28 5.2.1 Resources ........................................................................................................................ 30 5.2.2 Capacity........................................................................................................................... 31 5.2.3 Motivation ....................................................................................................................... 33 5.2.4 Linkages .......................................................................................................................... 34 5.3 Sustainability of Maternal and Child Health and Nutrition Service Use .................................... 35 5.4 Sustainability of Recommended Maternal and Child Health and Nutrition Practices ................ 38 5.4.1 Sustainability of Health and Nutrition Practices ............................................................. 38 5.4.2 Sustainability of Recommended Water, Sanitation, and Hygiene Practices ................... 40 5.5 Sustainability of Maternal and Child Health and Nutrition Impacts ........................................... 41 5.6 Maternal and Child Health and Nutrition Sector Sustainability: Lessons Learned .................... 43 6. Results: Water and Sanitation Sector ............................................................................................... 46 6.1 Water and Sanitation Sector Sustainability Plans and Exit Strategies ........................................ 46 6.2 Sustainability of Water and Sanitation Service Delivery ...........................................................
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