Preventive versus Recuperative Nutritional Intervention Approach

In the early 2000s, the joint work of USAID, the USAID- funded Food and Nutrition Technical Assistance (FANTA) project, and IFPRI influenced the global approach to nutrition interventions. Traditionally, nutrition programs administered interventions to children under age five only after they became undernourished—the recuperative approach. Although new scientific evidence was surfacing that children under the age of two were more responsive to nutritional interventions, evidence was still lacking that this preventive approach would   work in large-scale programs. To dig deeper, IFPRI, in collaboration with Cornell University, USAID, and World Vision in Haiti, examined maternal and child health and nutrition programs in Haiti from 2002 to 2006. The 2007 report “Prevention or Cure? Comparing  Preventive and  Recuperative  Approaches  to  Targeting  Maternal and Child Health and Nutrition Programs in Rural Haiti” revealed that children who received the preventive approach experienced less stunting and wasting. The strong evidence from this study contributed to global acceptance of this new approach to combating child undernutrition. In fact, all organizations that were part of the 2008 USAID Title II Program adopted the preventive approach  recommended  by  the  study.  The  evaluation also encouraged World Vision to modify its programs in Central America and Ethiopia to adopt the new approach. This research, along with an IFPRI study in Guatemala, helped  convince  the  global  nutrition  community, including the Scaling Up Nutrition (SUN) Movement, to adopt a child’s first 1,000 days as the critical window of opportunity for improving nutrition.

USAID, FANTA, and IFPRI teamed up again in 2009 to conduct two evaluations to address several design and operational questions left unanswered by the earlier study on the preventive approach. Two programs that aimed at enhancing the health and nutritional status of children under two and pregnant and lactating women were evaluated: one in Burundi and one in Guatemala. IFPRI  assessed  the  USAID-funded  program  Tubaramure in Burundi, and the Programa Comunitario Materno Infantil de Diversificación Alimentaria (PROCOMIDA), implemented by Mercy Corps, in Guatemala. Through IFPRI’s analysis, it was found that Tubaramure improved household food security, advanced complementary feeding and hygiene practices, and reduced stunting. Assessment of PROCOMIDA showed that the program effectively improved breastfeeding and complementary feeding practices as well as hygiene practices and  reduced stunting for children receiving nutrition interventions before the age of two. Together, the two studies further solidified the effectiveness and merit of the  preventive approach.