The document summarizes an impact evaluation of a fresh food voucher pilot program in Ethiopia. The program aims to improve dietary diversity for young children and women by providing vouchers that can be redeemed for fruits, vegetables, and animal source foods. The evaluation will use a cluster randomized controlled trial across 60 villages to compare changes in dietary outcomes between groups receiving social behavior change communication only, versus also receiving vouchers of different values. The goal is to understand the program's impact and cost-effectiveness to inform potential scale-up. Planning began in advance and involves multiple stakeholders for buy-in and approvals.

1. Impact Evaluation of WFP’s Fresh Food
Voucher Pilot Program in Ethiopia
Kalle Hirvonen
International Food Policy Research Institute, Addis Ababa
1

2. Background: High chronic undernutrition...
Born
small
Period of intensive
breastfeeding
Introduction of solid foods
• Chronic under-nutrition among
young children remains a serious
health issue, especially in rural
Ethiopia where 40 % of children
under 5 are stunted (= short for
their height).
• Stunting-age relationships reveal
that most of the ‘growth faltering’
in Ethiopia occurs at the time
when children are introduced to
complementary foods (~ 6 mo).

3. ...linked to hidden hunger?
Source: Demographic Health Survey (DHS).
Latest available data used for each country
(Ethiopia = 2011 DHS).
• Ethiopian children consume one of
the least diversified diets in Africa
• Poor dietary diversity is a risk
factor for serious macro & micro-
nutrient deficiencies and
consequently associated with
chronic under-nutrition (stunting)
and non-communicable diseases.
➢Finding ways to improve
children’s diets is a top priority
for the government of Ethiopia
and its development partners.

4. Fresh Food Voucher Pilot Programme (1/3)
• Focus on pregnant and lactating women and households with children
under 2 years of age (6-23 months).
• Objective is to improve dietary diversity:
o Minimum acceptable diet score for children aged 6-23mo (MAD)
o Minimum dietary diversity for women of reproductive age (MDD-W)
• This is a pilot: a strong emphasis is on learning
• Geographical focus:
o 3 districts (woredas) in the Amhara region
o Localities in which Productive Safety Net Program (PSNP) operates
• Timeline: 12 months, intervention starts in January 2018
• The plan is to scale-up if the intervention works

5. Fresh Food Voucher Pilot Programme (2/3)
• Beneficiaries receive a voucher that can be used to purchase fruits,
vegetables and certain animal source foods (such as eggs and milk).
• The pilot will experiment with two transfer values (USD):
Group 1 Group 2
Household size up to 2 12 21
Household size 3 to 5 14 23
Household size 6 above 17 26

6. Fresh Food Voucher Pilot Programme (3/3)
Additional elements:
• Social behavioral change component (SBCC):
o Caregivers receive information about the importance of a diverse
diet, + other SBCC such as practical demonstrations on how to
cook nutritious foods.
• Market development:
o To ensure that the markets are able to respond to the increased
demand, the FFV pilot will actively engage with fresh food traders
in the intervention areas.

7. Three districts:
Dessie Zuria, Habru
& Kobo

8. What is the purpose of the evaluation?
• The goal of the evaluation is to understand whether the FFV program
leads to positive change; improvement in dietary quality.
o And if yes, what are the costs relative to the benefits?
• Remember:
o This is a pilot: strong focus on learning
o Strong external demand: massive hidden hunger problem
• What is the most-cost effective solution?
• Well aligned with government objectives:
o Dietary diversity strong on the agenda
o A strong emphasis on evidence-based policy-making
o See National Nutrition Program, Nutrition-Sensitive Agriculture
Strategy, Seqota Declaration

9. What is the evaluation approach? (1/3)
• A cluster randomized controlled trial (RCT)
o Feasible because the number of eligible households exceeds the number
of intended beneficiaries of the pilot program
• Villages randomly allocated into 3 different study arms:
1. Group that receives SBCC
2. Group that receive SBCC + a voucher worth of 12-17 USD
3. Group that receive SBCC + a voucher worth of 21-26 USD
• Number of villages: 60 (20 to each study arm); Number of households: 580
households:
o Group 1: 7 households per village
o Groups 2 & 3: 11 households per village
o 10 % allowed for attrition
• Data collection: baseline (before) and follow-up (during/after)

10. What is the evaluation approach? (2/3)
• With two rounds of data we will compare the changes in dietary
diversity between the 3 groups; difference in difference
3.6 3.2 3.5
13.2
25.5
43.2
SBCC group SBCC + voucher 1 SBCC + voucher 2
baseline endline
(25.5-3.2) - (13.2-3.6) = 12.7 %p
SBCCSBCC + v1
Difference in difference:

11. What is the evaluation approach? (3/3)
• Differences with the full program:
o Only one district (woreda): Habru
o Focus only on households with children 6-18
months and their mothers (most of which are
still lactating) –> no pregnant women

12. Some notes from evaluator perspective
• Start planning well ahead – it takes time to set up an IE!
o Involve a lot of planning
o Bureaucracy always takes more time than expected
(budgets to be approved, ethical clearances, etc).
• From day 1, get buy-in from:
o Local and national governments
o Implementing partners
o Your own colleagues!