03 April 2020
Amanda Beatty, Evan Borkum, William Leith, Marisa Henry, Margo Berends, Clair Null, and Nicholas Ingwersen
MCC Indonesia Nutrition Project Impact Evaluation Final Report
09 March 2020.
Child stunting affected an estimated 36 percent of children under age 5 in Indonesia in 2013. To address this problem, the Millennium Challenge Corporation and the Government of Indonesia implemented a $120 million project that combined 1) a health and education-focused community-driven development program, 2) intensive training for health providers on infant and young child feeding, 3) training for sanitarians on a local variation of community-led total sanitation, and 4) a national communications campaign related to stunting, breastfeeding, healthy eating, and hygiene. We present the results of a randomized control trial conducted from 2014 to 2019 in three provinces in which the project was implemented. The project had a modest impact on some short- and medium-term outcomes related to maternal and child health, including iron-folic acid receipt and consumption, children receiving the number of recommended meals per day, and exclusive breastfeeding; but no effect on the number of prenatal or postnatal checkups women received, on the share of women delivering babies with a skilled provider, the share of children immunized, on children being appropriately diagnosed for stunting, the incidence of diarrhea, or villages becoming open-defecation free. Most importantly, we find no impacts on most longer-term health outcomes, especially under nutrition outcomes like stunting. We hypothesize that we fail to see impacts on many expected outcomes due to implementation delays and quality challenges and nationwide improvements that also caused positive changes in the control group. This evaluation also demonstrates the challenges in developing a realistic and evidence-based theory of change, as many expected outcomes may have been overambitious given the context and implementation conditions.
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