Credit with Education Strategy for Improving Nutrition Security: Impact Evaluation Results from Ghana

© 1998 Freedom from Hunger, P.O. Box 2000, Davis, CA 95617


Since 1989 Freedom from Hunger has worked with local partners to develop and disseminate a cost-effective integrated program strategy called Credit with Education, with the goal of improving the nutritional status and food security of poor households in rural areas of Africa, Latin America and Asia. In collaboration with the Program in International Nutrition at the University of California, Davis, Freedom from Hunger undertook a multi-year study in Credit with Education program sites in Bolivia and Ghana. Financial support for this collaborative research was provided by an Innovations Grant from the Thrasher Research Fund, with supplemental funding from the Nutrition Division of UNICEF/New York.

The evaluation research was designed to test hypotheses of positive program impact on children's nutritional status, on their mothers' economic capacity, women's empowerment and mothers' adoption of key child survival health/nutrition practices. This report presents the results from the evaluation research conducted in the Lower Pra Rural Bank Credit with Education program area in coastal Ghana. Two major survey and anthropometric (heights and weights) data collection rounds were carried out-a 1993 baseline and a 1996 follow-up-with different mother/child pairs participating in the two time periods. A quasi-experimental design was applied at the community level to minimize possible bias. Following baseline data collection, 19 study communities were assigned to either a "program" or "control" group, with the latter not to receive Credit with Education until after completion of the evaluation research.

Three sample groups of women with children under three years of age were included in the follow-up research: (1) Credit with Education program participants of at least one year, (2) nonparticipants in program communities and (3) residents in control communities selected not to receive the program for the period of the study. Women for the two nonparticipant groups were randomly selected from comprehensive lists of all women with children under three years of age.

Program impact is evaluated by comparing the differences between the responses and measurements in the two data collection rounds (1993 and 1996) for program participants versus nonparticipants in program communities and residents in control communities. Different sets of women were included in the two data collection rounds, because few women had under-three-year-old children in both 1993 and 1996. Baseline respondents in the program communities were later reclassified on the basis of whether they ever joined the program when it was ultimately offered in their community. Consequently, baseline respondents in the study communities that received the program are classified either as "future participants" or "future nonparticipants." By comparing the 1993 baseline measures of "future participants" to actual participants in 1996, the difference between years can better be attributed to the impact of the program and not to inherent differences between women who self-select to join the Credit with Education program and those who do not.

There was no statistically significant difference in the socioeconomic status of households (as measured by consumer assets) or women's education and literacy across the three sample groups in either of the time periods. However, participants in the follow-up period were significantly older, had more children and were more likely to have recently engaged in a nonfarm enterprise than nonparticipants or residents in control communities.

Impact on Women's Economic Capacity

The vast majority of 1996 participants (90%) felt that their incomes had "increased" or "increased greatly" since they had joined the Credit with Education program. Most commonly, participants attributed this improvement to expansion of their businesses, reduced input costs as a result of buying in bulk or with cash, and new activities or products made possible by access to credit. There was a significantly greater increase between years for participants' monthly nonfarm earnings as compared to nonparticipants and residents in control communities. The increase in net nonfarm monthly income (revenue minus costs) was $36 for participants, $18 for nonparticipants and $17 for residents in control communities. While the 1996 participants overall exhibited significantly greater improvement in their nonfarm earnings, there was considerable range in monthly profits. Some participants had net monthly enterprise incomes as high as $200 to $300 per month, but 10% had net incomes of $10 or less. Diversity of income impact was clear even within the same Credit Associations, with some women enjoying considerable improvement in their economic activities and others experiencing little change. A better understanding of the factors that allow some women to be relatively more successful-individual attributes, entrepreneurial skill, specific loan activities or program loan terms-could stimulate changes in program implementation, such as incorporating basic business management education, which might enhance the economic impacts for less successful borrowers.

There was evidence that the program was fostering the entrepreneurial skills of participants. Between years, participants were significantly more likely to consider demand and profitability when deciding upon income-generating activities. There was also a significant difference in the percentage having savings and the value of cash savings between years for participants versus controls and participants versus nonparticipants.

Although nonfarm incomes had increased, there was no significantly different change in participants' assessment of their relative contribution to their households' total income as compared to the two nonparticipant groups. There were also few significant differences across the groups in change of household expenditures on food, clothing, medicine, school expenses, house repair or business assets. It is possible that substitution of responsibility for food purchases within participant households might be undermining program impact on per capita food expenditures.

Impact on Mothers' Health/Nutrition Practices

Among women who had more than one child, participants in 1996 were significantly more likely to report positive change in how they breastfed or fed their younger children included in the study than were nonparticipants or residents in control communities.

Relative to nonparticipants and/or residents in control communities, participants reported significantly greater positive change in a variety of the health/nutrition practices promoted by the Credit with Education program:

  • Giving newborns the antibody-rich first milk (colostrum).
  • Introducing liquids and first foods (in addition to breastmilk) closer to the ideal age of about six months.
  • Not using feeding bottles.
  • Enriching the traditional complementary food, koko, with bean/cowpea, egg, fish, groundnut, milk and palm oil.
  • Enriching Weanimix (a complementary food promoted and distributed by the Ministry of Health) with fish powder.
  • Rehydrating children who had diarrhea by giving them either ORS (made from the packets) or home liquids (like tea or rice water).
  • Not "treating" children who had diarrhea by giving them enemas.
  • Knowing ways to prevent diarrhea, such as "covering food to avoid flies" and "keeping food clean."

Despite involvement in their loan-financed activities, participants did not wean their children any earlier than did nonparticipants and were just as likely to breastfeed their babies into the child's second year of life. However, no statistically significant difference was found in the following areas, indicating a need for greater nonformal education in these topic areas:

  • Other diarrhea prevention practices promoted by the program, such as hand washing, reheating cooked food before serving/not keeping cooked food long before serving, and using clean water.
  • Limiting or withholding food from children with diarrhea, as reported by the majority of women in each of the three groups.
  • Immunization coverage.

The children of participants also experienced significantly greater improvement in feeding frequency as compared to the children of the two nonparticipant groups, with a marginally significant difference in egg and meat/fish consumption.

Impact on Women's Empowerment

Indicators of women's empowerment were developed to evaluate program impact on women's self-confidence and vision of the future, their status and bargaining power within the household, and their status and networks in the community. Compared to the two nonparticipant groups, the 1996 participants rated themselves as being significantly more confident that they would be able to:

  • Feed their child the good foods that they know they need.
  • Prevent their child from getting diarrhea and other illnesses.
  • Earn more money next year than this year.

However, they were not more confident that they could educate their children to their children's full potential.

At the level of the household, participants' bargaining power did not significantly improve as compared to the other two groups in decisions regarding a number of household investments, such as how much to spend on clothing, medicine, agricultural inputs or fixing the house. However, there was a significant increase in participants' "say" in whether or not children went to school as compared to nonparticipants, and a marginally significant difference as compared to residents in control communities.

Participants' husbands were significantly more likely to have offered to help their wives with child care and with their income-generating activities during the previous six months as compared to nonparticipants' husbands; however, there was no significant difference between participants and residents in control communities. There was also no significant difference across the groups in women reporting they had discussed family planning with their husbands.

At the level of the community, the program seemed to have positively affected women's participation in the community and their helping contacts with family and friends. There were significantly greater changes between the years for participants as compared to the two nonparticipant groups, in that participants were more likely:

  • To be members of a community group beyond their families.
  • To have helped a friend with his/her work.
  • To have offered health/nutrition advice to others.
  • To have offered business advice to others.
Participants were also contributing more money to non-kin funerals, which is important to an individual's social status and to the reputation of one's family. Using these three aspects of women's empowerment, participants were significantly more "empowered" than the two nonparticipant groups, especially at the individual and community levels. However, it is interesting to note that residents in control communities were more confident and enjoyed relatively greater assistance from their husbands than nonparticipants in program communities. It is possible that the decision of nonparticipants not to join the program in their community itself reflects an initial lack of self-confidence and greater degree of inequity in marital relations.

Impact on the Ultimate Goals - Nutritional Status and Food Security

Participant households reported a reduced vulnerability to the "hungry season" relative to the baseline period as compared to the two nonparticipant groups. The nutritional status of participants' one-year-old children-both in terms of weight-for-age and height-for-age-was also significantly improved between the years relative to the children of residents of control communities. For example, the mean height-for-age z-score (HAZ) for participants' one-year-olds was almost 0.3 greater than the baseline HAZ of future participants' one-year-old children. The mean HAZ for children in control communities was 0.2 less for the same period of time. A similar positive effect was not found for maternal nutritional status as measured by women's body mass index (BMI).


The impact evaluation research in Ghana provides evidence that credit and education services, when provided together to groups of women, can increase income and savings, improve health/nutrition knowledge and practice, empower women, and ultimately improve household food security and children's nutritional status. Further analysis is planned to examine the relationship between the various intermediate impacts and their relative contribution to children's better nutritional status.

Although not a focus of the impact research, it is also important to note the program's performance in terms of financial sustainability. In the six-month period from October 1996 through March 1997, the program had an operating self-sufficiency ratio of 81%, meaning that the interest paid by borrowers covered 81% of the Lower Pra Rural Bank's costs of delivering the credit and education, covering all operating costs including financial costs such as interest on debt, but not loan loss reserve. While not yet fully financially sustainable, this represents a much higher level of cost recovery than most income-generation interventions and certainly more than traditional health/nutrition education programs. The combination of positive impact and financial sustainability makes Credit with Education a strategy with exciting potential for widespread and sustainable impact on nutrition and food security.

For further information, please contact, Natasha Wiegand at Freedom from Hunger - nwiegand@freefromhunger.org

Hari Srinivas - hsrinivas@gdrc.org
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