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Defaulter and Access Study

Donor: OFDA

Collaborators: CDC, ACF, Concern Worldwide, Save the Children UK

ENN Project Lead: Jeremy Shoham

Timeframe: Project completed in 2011 (report forthcoming) 

Background

The Defaulter and Access study came out of a retrospective study of emergency supplementary feeding programmes (SFPs) by the ENN and SCUK (2008). This study aimed to determine the efficacy and effectiveness of emergency SFPs using a retrospective cohort.

Programme statistics at the individual level showed that, despite, 69% of children recovering overall, less than 40% of the programmes attained acceptable recovery rates if non-response is included. The main factor undermining the rate of recovery was defaulting, most often associated with seasonal and secular trends, quality of programme management and/or lack of adaptation of the SFP design to local circumstances.

The study also showed that certain contextual factors may play a significant role in determining recovery rates, notably the presence of a general ration distribution, the length of time since the start of the crisis, the chronic nature of the emergency and whether beneficiaries are displaced populations (as opposed to residents). These findings suggest that default is directly related to opportunity costs for carers. The study findings suggest therefore that the current design of SFPs may be creating a dilemma for beneficiaries, forcing them to choose between attending the SFP to obtain food for a member of the family and other activities related to the economic or food security of the rest of the group. A further study was therefore recommended, to explore further the reasons for defaulting, and how this information can be used to adapt SFPs. It was against this background that the Defaulter and Access Study took place.

Project Summary

The Defaulter and Access study aimed to improve the design of programmes working to reduce acute malnutrition in emergencies by adapting them to the constraints of potential beneficiaries. The objectives of the study were: to describe the characteristics of beneficiaries likely to default from emergency supplementary feeding programmes; to understand the determinants of defaulting from SFPs; to compare the determinants of defaulting between different emergency settings; to translate observations into strategy and policy recommendations to adapt nutrition programming in emergencies and; to develop field tools to understand defaulting in particular settings and respond with appropriate programme adaptations.

The subjects of this study were children between 6 to 59 months admitted to SFPs. This study captured frequency and baseline characteristics of patients who default (socio-demographic, nutrition status, evolution under treatment), unexpected events that trigger defaulting through change in family priorities and reasons for non-attendance of malnourished children to SFP.

Data were collected throughout 2010 from three country sites: Kenya, Sudan and Chad. Data collection involved the implementation of two questionnaires (baseline and extraordinary events) which were developed in pilot studies conducted in ACF supplementary feeding programmes in Ethiopia and Mali during 2009. Data analysis became severely delayed when the principle researcher took up a full-time post. Although the analysis has continued over the past two and a half years various difficulties with the data which determined the need for substantial ‘data cleaning’ have delayed analysis further. The ENN is now expecting a final report by the end of 2014. 

Publications

Pending completion of analysis

Reference this page

Chloe Angood (). Defaulter and Access Study. www.ennonline.net/ourwork/research/defaulter

(ENN_1024)