Regarding the adverse effects of chronic malnutrition (stunting), Partha Dasgupta in his An Inquiry into Well-being and Destitution states that beyond efforts to provide emergency and food relief …...

"Much the harder problem, in intellectual design, political commitment, and administration, is to ensure that those who remain alive are healthy. It is also a problem whose solution brings no easily visible benefit. But the stunting of both cognitive and motor capacity is a prime hidden cost of energy deficiency and anaemia among children and, at one step removed, among mothers. It affects learning and skill formation, and thereby future productivity. The price is paid in later years, but it is paid." ¹

Context and rationale for evaluation

IFAD's Office of Evaluation and Studies, in October 2000, per agreement with the Government of Papua New Guinea undertook a Country Programme Evaluation (CPE) in Papua New Guinea. IFAD has funded three projects in PNG: the Artisanal Fisheries Project (AFP) closed in 1991, the South Simbu Rural Development Project (SSRDP), closed in 1995 and the North Simbu Rural Development Project (NSRDP), scheduled to be closed in 2002.

Evaluations of programme impact need to reflect an understanding of the variations in agro-ecology, living standards and institutional support systems within and across provinces. It is vital that staff in implementing organisations and local stakeholders participate in evaluations. In the current case, project staff in Kundiawa in Simbu themselves assessed their performance and that of government funding and support systems. Moreover, the mission undertook PRAs and formal surveys to shed light on the extent of nutrition security and emerging solutions.

The IFAD mission visited four provinces (Simbu, East Sepik, Eastern Highlands and Madang), including the project area of North Simbu Rural Development Project. Moreover, the mission undertook a formal survey of CBOs across these four provinces. An in depth survey was conducted in Simbu and East Sepik. In total, mission members interviewed 310 households and 112 community-based organisations.

The Foreign Aid Management Division of the Department of National Planning & Monitoring (DNPM) facilitated the mission. The IFAD Mission conducted two workshops with the PNG Government representatives and other stakeholders. The Government endorsed the workshop recommendations. Finally, IFAD (OE) conducted a final Round Table Workshop in August 2001: the IFAD team presented findings and lessons learned.²

The evaluation team intends this assessment for use by the wider community of partners in the PNG rural development effort. The evaluation to this end explored possibilities and institutional solutions with which to raise effectiveness and sustainability of efforts by the Government and donors alike in promoting better living standards in the rural areas. Findings are intended to be useful for assessing performance with different institutional approaches and types of interventions. The several lessons learned from this evaluation and the in depth surveys conducted support the need to shift the development focus away from mere "hardware". The case is strong for building up the management capabilities of community-based organisations – not least the Wok Meris - through empowerment and diffusion of relevant organisational skills.

Vicious circles

The rural population studied in PNG is faced with a breakdown in the delivery of essential social and economic services. The impact is serious: children face prospects of receiving less schooling and health outreach compared to the previous generation. Road and market access is not improving in line with expectations. In the absence of markets, there is little possibility for households to pay for essential inputs such as improved seeds and fertiliser with which to intensify production. Fertile land is becoming scarcer in line with increasing population density. Declining soil fertility is associated with lower productivity of land and labour. Especially women work longer hours to maintain previous levels of production.

Vicious circles operate. The maintenance of livelihood standards is at stake. Higher labour loads at declining productivity in the face of common food insecurity, are coupled with declining services for large segments of the rural population. The break down of services is worrisome given already high levels of chronic malnutrition. In the final analysis, low or deteriorating living standards fuel conflict, strife and more violence.

Problems and prospects from Simbu and other provinces

Simbu

The mission used a Project Performance Measurement Matrix to assess the outcomes of the two area development projects implemented in Simbu Province (i.e. SSRDP 1987-94 & NSRDP, 1995 - 2000). The mission conducted this assessment with present and past project personnel. Five important lessons emerged from this exercise.

1) Management capabilities and ownership: Management systems in the public sector and provincial operations in PNG are not performing in line with expectations. Line agencies at the national level do not define spending priorities in consultation with provincial governments. In the absence of consultation and devolution of power to provincial governments, provincial level authorities do not assume "ownership". In combination, this translates into delayed implementation, low impact and limited sustainability.

2) Dissemination and service delivery systems: SSRDP used the government line departments to deliver services such as health, formal education and agriculture extension. The impact and sustainability of such efforts were not in line with expectations. Nevertheless, during the course of implementation, NSRDP management shifted to increasingly use voluntary village level based agents: in health and MCH (birth attendants). Moreover, very praiseworthy is the shift that has taken place to seek to use ward extension agents and village informal education agents. The efforts are laudable, but so far they have not attained required impact.

3) Micro-credit: The NSRDP design provided a framework for mobilising farmers to form groups and to deliver credit to these groups. Yet, the design did not set out a process with which to mobilise and empower groups, develop skills, and generate trust and social bonding within groups as a prerequisite prior to credit delivery. The group approach to credit delivery was not effective. On the other hand, successful results were obtained with the credit provided to individuals.

4) Multi-sectoral area development project: Multi-sectoral area development projects are complex. Implementation capacity at the provincial level to implement such projects is limited. Projects that seek to address deprivation in PNG, regardless of domain, need to focus on two core activities. Two activities that will only minimally stress the human and financial resource capacity at the provincial level are: (i) community development activities and (ii) creating a community based financial service delivery system. The communities themselves would plan, prioritise, implement and supervise the activities.

5) Participatory methodology: SSRDP used a sectoral/top-down approach to implement the project. Project management programmed each activity and put it in place without consulting local communities, or intended beneficiaries. Not surprisingly, the provincial staff rated the sustainability of most project interventions as "low". The NSRDP has begun to support communities to become more involved in decision-making. Yet, promoting sustained efforts has been thwarted by the absence of a consistent participatory methodology and the limited and fluctuating government funding to wards and LLGs.

Other provinces

In East Sepik, Eastern Highlands and Madang, the mission assessed performance in rural development as against institutional constraints and decentralised governance structures. The Organic Law with reforms was initiated precisely to start the devolution of power to the provinces. The machinery and the capabilities with which to ensure steady progress in such devolution are not yet in place.

Across provinces, two issues stand out. First, there is little or no data available with which to demonstrate that progress-monitoring systems have become operational, let alone that data on impact at household and community levels are collected and analysed. Second, even when directors, managers and project staff report that they perceive, or rate impact to be high, sustainability of interventions is rarely if ever assured.

Three factors that explain this situation prevail. First, assured funding to maintain the activities beyond the date when the project will close is very rare. Second, ownership of the interventions at ward and LLG levels is rare, even in the primary health service sector. Third, the delivery system are high cost, vide the case of the UNDP supported micro credit schemes in Eastern Highlands, as well as the NSRDP supported scheme in Simbu. The former lends at a rate of 30%, whilst the Wok Meri groups lend at a far lower rate, or at 14% (on an annual basis).

Four dimensions were explored:

First, programme management capacity is limited. The Government' capability to service the rural poor remains limited. The line departments are being restructured and downsized to reduce government expenditure on staff costs. Such downsizing generally starts with closure of offices and staff working in remote locations. This reduces further the access to services of already deprived families in remote locations. Withdrawal of aid posts in the remote locations illustrates the point.

Second, sustainability of service delivery to rural communities is at risk. Three factors contribute to this situation. First, the delivery cost of institutions involved in providing services to rural communities is high. Staff costs and overhead are high. Law and order problems and difficulty to access rural communities compound problems. Second, the government resource allocations to deliver services to the rural communities are low and are declining over time. Third, cost efficient community owned models for delivery of such services are yet to emerge.

Third, community participation remains at its infancy. Community participation in providing primary health care services is increasing. Reduction in the size of the government makes it all the more urgent to enhance community participation in a wide array of service delivery ranging from primary health, non-formal education, micro-finance to maintenance of access roads. But community participation and community level planning are yet to become the building blocks of bottom-up planning as enshrined in the reformed Organic Law. Most donor interventions remain sector specific and physical output oriented. The stakeholders have limited exposure to the concept of participatory development.

Fourth, the efforts in the formal development sector towards building social capital in PNG remain at an "infancy stage". Four factors contribute to limited efforts in creating much needed social capital, or trust and "bonding". First, formal programme interventions in PNG typically have not recognised the untapped resource base provided by the indigenous networks and social systems of rural women, despite the diversity of the latter in faith, clan and political affiliation. Second, the directive planning processes combined with top down service delivery have created dependency of the community upon government handouts (the "cargo cult"). Third, the social capital is further eroded when communities do not own the interventions. Fourth, most women groups at the rural community level are not supported with the exception of assistance inter alia from AusAid and Save the Children funded by the GONZ. Even in these cases, the support remains sector specific without a step-wise process of "graduation" for women to assume leadership roles.

Analysis of survey data: little progress in reducing malnutrition

Hidden poverty is rural PNG is high and not decreasing. The prevalence of chronic malnutrition is a precise indicator for endemic poverty at community level. It is reliably measured by the prevalence of stunted children in the age group up to five years. In PNG, in 1982/83, stunting at the national level was estimated at 43%. This level represents a hidden poverty: it is a cause of concern. This concern is heightened. The most recent survey was conducted in 1996: it recorded over not less than a fifteen year period no progress or reduction (World Bank 1999).

The current year 2000 IFAD-OE surveys in Simbu and East Sepik provinces demonstrated that children were more likely to be chronically malnourished (stunted) in Simbu (46%) than in East Sepik (30%). By contrast, the prevalence seasonal malnutrition (wasting and underweight) was higher in East Sepik (20%) than in Simbu (4%). Preliminary results of the determinants of child nutritional outcomes suggest that, in areas that have received no assistance (from PNG Government, NGOs, International Organisations), measures that significantly improve child nutrition status comprise improving the safety of the drinking water, supporting savings and credit groups, improving access to land, and improving access to health services.

The IFAD-sponsored NSRDP targeted the most deprived households in Simbu province, but the survey data do not demonstrate that the intervention was successful in reducing stunting among children. On the other hand, better-educated group leaders were able to attract external programs to support their CBOs. Yet, such training did not have a significant impact in reducing child malnutrition.

These findings contrast with results of another recent IFAD-OE study conducted in Nepal (2000-2001); this study confirmed that training on nutrition contributed to reduced malnutrition. An important difference was that training package in the surveyed district of Nepal included regular child growth monitoring. This was not the case in Simbu: growth monitoring (especially height for age) was not conducted on a regular basis. Without regular monitoring and associated interactions with parents, it is difficult to diffuse knowledge, awareness and improved practices among beneficiaries.

Emerging longer term solutions: suggested framework for strengthening community capabilities

Community-based organisations (CBOs) have capabilities for becoming focal points for broad participatory-based development to reduce deprivation or chronic malnutrition³. The mission suggests a `Four-Pronged Approach`:

`Four-Pronged Approach`

Focus on sub-ward level women organisations: Creating raised capabilities of community level women organisations: support with which to raise capabilities of Wok Meris, similar organisations, and women church groups.

Providing a component with which to raise awareness and knowledge of women organisations about causes of chronic malnutrition and household and community level solutions in reducing malnutrition.

Micro-finance: Provision of small equity funding for creating and strengthening community (self-administered) revolving funds to raise individual household food and nutrition security.

Community development fund (CDF): Providing funds for micro projects at community level for improving infrastructure with self-help to go hand in hand with gradual improvement of capabilities – an important incentive mechanism.

A supporting national strategy for communication, awareness and knowledge generation is well justified. Normally of value is to use radio to diffuse relevant knowledge about causes to chronic malnutrition, growth promotion and associated solutions. Female village level volunteers are supported to become "focal points" for radio listening groups.

Moreover, training infrastructure: units need to be set up for curriculum and content development with which to train female volunteers. A training of trainers' approach is required. Relevant approaches need to be defined for training of trainers so as to widen outreach and programme impact.

Learning and diffusion of applied knowledge

The several lessons learned from this evaluation and the surveys conducted support the need to shift the development focus from mere emphasis on "hardware" towards diffusion of relevant knowledge. Development programmes need to focus more than in the past on developing a proper content prior to training and diffusion to rural women. It is critical in PNG to empower rural women and their organisations to demand the services and the skills required with which to improve their standards of living, especially to reduce high levels of socially non-acceptable chronic malnutrition.

Malnutrition in rural PNG reflects combined energy and animal protein deficiencies. The report contains solutions in this area. Development of small stock in PNG represents a promising avenue with which to raise protein supply and reduce prevalence of chronic malnutrition (Chapter IX).

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1/ Partha Dasgupta, Oxford, Clarendon Press, 1996.
2/ Per Eklund, Sr. Evaluation Officer together with Fabrizio Felloni (consultant) and Ms. Rhonda Eva (consultant) facilitated this workshop that took place at Vulupindi Haus on August 3, 2001. Dr. Oruve Sepoe (consultant) produced the workshop proceedings.
3/ Field surveys suggest that CBOs in PNG can be classified into three categories: (i) Wok Meris, mothers' groups; (ii) religious groups; (iii) externally supported (by Government, credit programs, or NGOs).