Multi-Sectoral Integration: Graduation Model
This is one of 50 Harvesting Nutrition project case studies. Harvesting Nutrition was a contest held in 2012 and 2013 that showcased active projects working to improve the impact of agriculture and/or food security on nutrition outcomes. Co-sponsors were SecureNutrition, Save the Children UK, and the Global Alliance for Improved Nutrition (GAIN). Learn More.
The Graduation Model meets families where they are on the economic and nutrition scale to tailor interventions enabling graduation from one living standard segment to the next, as well as enabling improved nutrition. Families with malnourished children are identified and supported with appropriate nutrition interventions, in addition to tailored economic interventions focusing on increasing diet diversity and livelihoods. Nutrition is the common objective for WV Lanka’s economic, agricultural, health, and nutrition programmes. Partnership with government is a key component.
Graduation Model components are sequential and focused on families:
- Participatory Living Standard ranking (PLSR) identifies living standards of families
- Nutrition assessment/growth monitoring identifies nutritional status of children and families
- Family Development Plan prepared for all households and family members (incorporates Sustainable Livelihood Framework, WV Child Well-being Outcomes, and health and nutrition indicators).
- Positive Deviance (PD) Inquiry used to identify positive behaviors in poor families with well-nourished children.
- PD/Hearth programme for all caregivers with malnourished children (12-day session where mothers meet together and prepare local foods + two weeks home practice, with follow up).
- Regular growth monitoring promotion with government health services, follow up by WV volunteers/ facilitators.
- Graduation Model framework tailored to living standard category identified in PLSR process, through four graduation approaches. Interventions include combination of home gardens, business training, pre-microfinance (savings clubs), skills/technical/asset transfer and microfinance, depending on PLSR ranking. Economic development support is not dependent on nutritional status of children.
Impact of project:
WV’s Koralaipattu Area Development Programme (ADP), in the Eastern Province of Sri Lanka, started in 2010. From 2011 baseline to September 2013, underweight decreased from 32% to 27% and wasting decreased from 17% to 16% among children under 5 in 874 vulnerable households.
In WV’s Rideegama ADP, in the North Western Province, underweight decreased from 25% to 23%, stunting from 27% to 25% and wasting from 20% to 14% among children under 5 in 735 vulnerable households (2011 baseline to March 2013).
These preliminary results indicate that integrating agriculture, nutrition, health, economic development and partnership with government programmes is effective at bringing about sustained change in child well-being. Key factors for success include the multi-sectoral approach, and the focus to improve equity and to move the most vulnerable out of poverty with reduced duplication of efforts.
Why this project is a Good Practice example:
- The integrated Graduation Model helps to identify and develop appropriate interventions
- It optimizes the resource allocation of the ADPs as well as defines its priorities.
- Future evidence-based learning based on the outputs
- Beneficiary families will be assisted in identifying their own status through nutrition assessments and the participatory living standard ranking. -Empowering families to sustainably improve their own standard of living by themselves.
- Integrated and multi-sectoral approach contributes to address undernutrition.
- In the future, Education and Water, Sanitation and Hygiene (WASH) sectors to be included as well.
Impact evaluation in progress
- Community acceptance and staff motivation were high
- National level prioritization of three-year Multisector Action Plan for Nutrition (MsAPN). Sri Lanka joined the Scaling Up Nutrition movement in October 2012.
- Close monitoring system in collaboration with MoH
- Follow-up and monitoring
- Necessity for sensitivity to culture and religion in various diverse communities
- Low staffing numbers for capacity building required
- Involvement of Poorest of the Poor and Poor families
- Families unfamiliar with use of Family Development Plan as a guide to improve living standards
- Integration with government economic development initiative
- Full collaboration of Public Health Midwives
- Communities adopted and fully participated in the integrated approach
- Synergy in World Vision Area Development Programme (ADP) teams – working together towards a common goal and indicators. Use of a common problem tree for child well-being (instead of by sectors) identified areas for integration. Training and capacity building took place together (sector integration training).
- Direction to reduce number of activities – discussed integrating to avoid duplication, with focus on well-being of children.
- Conducted zonal workshops with ADP managers; programme coordinators; Design, Monitoring & Evaluation coordinators; and operational managers to share the approaches.
- Incorporated in to ADP designs and redesigns
Funders: World Vision
Primary Contact: Dilka Peiris, Health and Nutrition Sector Specialist World Vision Lanka
Country: Sri Lanka
Project Dates: Implementation of the Graduation Model began in 2011 in two pilot Area Development Programmes (ADPs). Currently activities are ongoing and scaling up to 10 ADPs.
Interventions: Incorporate explicit nutrition objectives and indicators, Target the vulnerable and improve equity, Collaborate and coordinate with other sectors,
Target Population: Children under 5, Women, Rural households,
Project Stage: Ongoing activities
Geographic Coverage: Village/Municipality