**Policy, Research, and External Affairs**

**Population, Health, and Nutrition**

# WPS 706

This papera product off ihc Population, Health, and Nutrition Division, Population and Human Resources Department --- is part of a larger effort in P.ZE to identify "best plractices" in program implementation in thc population, hicalth, and nutrition scctors. Copies ae available free fromii thc World Bank, 1818 I-I Street NW, Washingtoni, DC 2(A33. Plcase contact Otilia Nadora, room S6-065, cxtension 31091 (50 pages).

Little of thc literature on nutrition between 1960 and the 1980s included asscssments of effective nutrition programs. **i** . this important study, Kennedy focuses on factors associated witli successful nutritioni programs in Alrica.

In 1 989 thc World Ban;k ma.iled a suirve to 330 feople: I 10 respon(led, and 66 nutrition programs were identif'ied as succcsses. Keniiedy) includes case studies for six ol these (two in Mali and onc cach in Ghanat, Nigeria, Togo, and Zaire) in the report.

Seven factors (whicih Kennedy discusscs at length, with illustrations from **tlhc** case studies) werc mentioned repeatcdlv as important to the success of nutritionl pro(grams: _- Community p)articipationa._ For communitybased programs to bc successful, even with active local inivolvement, some implementors suggest that therc necds to be awareness and commitment of the leadership at higher levels of government.

_* Programnflexibdility._ Donors should commit themsclves to a project long enough that approaches that don't work in certain areas can be modified, _* Institutional structure._ It is more important to usc an existing institutioni, even if it is not ideal, ttian Io create a new institution. Donors arc typically interested in working **witli the** public sector, but many of the success storics had strong tics to thc private sector.

> * _RecoverY of recurrent costs._ A contcntious issue, Some responidenis claimed that it cost recovcrv is an indicator of succcss. thicr are **no** success stories. 'Thc extent and depth of poverty in Africa will necessitate external financing for x'ears to come.

_* Multijceted programn activ'ities._ **In** the more effective programs, nutritionl is linike(i to broader activities involvingg food security anid income-generatinlg activities.

* _Well-treiined antd qualified stqff_ Projects cannot create thc charismatic leaders associated with many successful projects but inadequate supFport can stifle them.

* _Infrastructure._ Programs and projects work better in areas where thcrc is physical inf rastructure and an adequate hcalthi care delivery system.

Kcnncdy concludes that tlhese l-indiings arc preliminary and recluire furlher validationi on **the** ground. Il wc are to understand what works, programs need to be evaluated better not only lor outcomiles but also for design anld Imanagemlieiti.

And all evaluations --- initcnial and external -should focus oni process as well as outconies.

The l'RE Working lPaper Series disseminatecs thl findings of \vork undcr v, ay in tde Bank's Policy, Rcsailcti alid E\ternat AftfairsCoiiptex. An ohj.2ctiv\ of thesericc is toget thesefindingsout cuieklv, even ifprecentations are lecs tian fult\ tstishCd The f-indings, interpretations. ind **conclusions** in tl ese papers (lo not rtceessaTiit **rTeprewnt** ofhialt anBak poic\ Produced by **the** PRE Dissemination Centcr