A Study On Care Indicator Methodology Social Policy

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In Bangladesh, as elsewhere, many rural households are confronted with a regular seasonal period of stress. The occurrence of seasonal stress is usually related to the cropping cycles (food stocks from previous harvest are low, but current crop is not yet ready) or to seasonal fluctuations in the rural employment market. In Bangladesh the lean period is a commonly-recognized component phenomenon of food insecurity, and it is measured in terms of the specific months of the year that a household is forced to alter the quantity and quality of food that it consumes. More food secure households have a reduced lean period or none at all, while severely food insecure households may constrict consumption all year long. This indicator is measured directly in a questionnaire format, and assumes that the information reflects a normal year.

Quantity of food consumed per day during the lean period:

This indicator reinforces the first one and provides a more in-depth assessment of household food security. It measures the quantity of meals consumed per day during the lean period and identifies the months in which the amount of food prepared per meal is reduced. While the first indicator measures the number of "problem-months", this indicator provides a more refined measure of severity of food insecurity. It is measured directly in a questionnaire format.

Share of household budget spent on food items:

It has been well-documented in the development literature that as a households increases its income, a smaller share of the household budget is spent on food items. Following this logic, the household budget share allocated to food becomes a proxy variable of food security. In other words, the household that spends less of total annual income on food is considered to be more food secure relative to one that spends more. This indicator is measured in a standard questionnaire format that asks for estimated percentage allocations of household expenditures within a small set of budget categories (food, health, education, production inputs, shelter, etc.). It is assumed that this information represents a normal year.

Quality of the diet:

Frequently, food security does not result from inadequate quantities of food, but from a lack of protein, vitamins, and minerals. This indicator is a proxy variable of diet quality in two ways. First of all, vegetable oil is a major source of calorie intake in the diet; second, in Bangladeshi homes, oil is used to fry protein and vitamin-based foods. Since soybean oil is more expensive and nutritious than mustard oil, the consumption of both is measured, under the assumption that a family consuming larger amounts of soybean oil (per capita) has a higher quality diet-thus more food secure-relative to households with a lesser per capita oil consumption.

Diet diversity by type of household member:

This indicator records the number of days in which meat, fish, eggs, and dhal were consumed during the past month or week by four categories of households members-male adults, female adults, male children, and female children. This indicator is, in effect, a proxy variable that measures both food utilization, particularly the intra-household distribution of food, and quality of diet. The underlying assumption is that the household with the greater diversity of diet and more equal distribution of food among individual members can be judged more food security relative to a household with less diet diversity or with certain categories of members regularly excluded from the consumption of quality foods. Information for this indicator, as in the case of oil consumption, is measured in a standard questionnaire format.

Nutritional Security

Nutritional security is a livelihood outcome closely related to food security, particularly the food utilization component. The conventional components of nutritional security are child and maternal nutritional status, since these are two of the most vulnerable groups in Bangladesh (and elsewhere in the world) and because of the long-lasting damage that even temporary malnutrition can cause in child-bearing women and children. The indicators that measure nutritional security in women and children are well-known and widely-accepted (Table 2).

Stunting and wasting among children 6-59 months of age:

This indicator is the commonly used measure of moderate and severe malnutrition in a population. Children whose ages fall within the range of 6-59 months are weighed and measured for height. The three variables-weight, height, and age-are then used to create ratios of height to age (stunting) and weight to height (wasting), which are compared with a reference population to establish the incidence of severe or moderate malnutrition. Weight and height are recorded using specialized equipment, and field staff require substantial training. In some parts of Bangladesh, the age of children may not be readily known.

Body mass index for women of reproductive age:

This indictor is equally robust and widely used in measure maternal nutritional status for women between the ages of 14 and 50 (estimated reproductive age). Height and body weight are used to calculate a body mass index that identifies severely underweight (i.e., malnourished) mothers. This indicator also requires specialized equipment and trained field staff.

Economic Security

Although economic security is intimately related to household livelihood security, the economic status of poor households is notoriously difficult to measure directly. Household income among poor families is often derived from multiple informal sources, and labor is sometimes compensated in non-monetary units (such as food). Wage work itself is irregular and sporadic, making wage income difficult to remember and measure. Moreover, income from agricultural sales is equally resistant to regular accounting. To evaluate economic security, three components of economic security are addressed.

First, annual household income, if available, is a valuable measure of economic security. In most cases, however, the sales of agricultural and animal products occur over multiple events; wage labor is similarly irregular; and because households must struggle to obtain cash in many different ways, diversity of income sources is an uncertain measure of security. Second, the value of key household assets can serve an effect proxy variable. In rural Bangladesh, the ownership of land and livestock tend to be effective measures of the comparative economic status of households. But even if land and livestock are not considered, there are key durable consumer goods, such as radio, jewelry, and bicycles which reflect economic differences in a robust way. Third, levels of savings and debt can effectively establish the economic status of households. Within these components of economic security, the following indicators were chosen (Table 3).

Annual household income stream: This indicator assumes that the more economic secure household will have a greater annual cash income stream. It is acknowledged that the actual overall income stream will tend to be underestimated due to several reasons, including recall, but that the error will be randomly distributed across the sample. Thus, small changes in this indicator through time cannot be interpreted as significant change in the economic status. This indicator is measured as part of a household survey, and the data should include the estimated cash income earned by every member of the household. When one member has engaged in several wage-earning episodes, the annual value of each should be computed. Only the value of agricultural and livestock sales, not consumed products, should enter into the calculation. Questionnaire tables organized by income-earning episode throughout the year have proven to be an effective measurement strategy.

Household asset index: The assumption underlying this indicator is that households with a greater investment in key consumer durables are more economically secure, i.e., they have access to more income. The set of key assets can change from one rural context to another, but generally it includes means of transportation, agricultural equipment, fishing equipment, televisions, radios, sewing machines, jewelry, etc. The final composition of the asset list should reflect distinct consumer preferences for items that are expensive enough that not all households can obtain them. Once the list is compiled, a monetary unit values is attributed to each of the assets, then the index is calculated as the total value of all assets owned by the household. It has been argued that the value of land and livestock should be included in this calculation; however, in a society where many households are landless, the high value of land (and livestock) may overwhelm the overall index, creating a bimodal distribution of index values between landed and landless. Household asset lists can be gathered as part of a household survey.1

Household debt levels: Household debt is an important indicator of economic security only when compared to other household characteristics. The level of debt for one household may represent an important investment in rural infrastructure, such as the purchase of land or equipment; the same level of debt for another household may indicate an excessive financial burden and a situation of dependency. Debt is an indicator that is easily measured in a survey format, but it should be calculated against a comparative base, such as a debt/asset ratio or a debt/annual income level.

Household savings levels: The level of savings of a household is an effective indicator of economic resiliency to contextual shocks and stresses. The households with higher levels of savings demonstrate a higher level of economic security. Savings information is normally gathered in a household survey.

Shelter/Water and Sanitation Security

This livelihood category is considered critical in the context of Bangladesh due to the high population density, the lack of sanitation infrastructure, particularly in rural areas, and the high levels of arsenic intrusion in wells. The components of this category include the quality of housing, access to latrines, and access to drinking water that is safe from both bio-contamination and arsenic (Table 4).

Housing condition: This indicator is measured by a proxy variable: the type of roofing material used in the residence. More permanent roofing, such as zinc sheeting, reflects a better standard of housing relative to grass roofing materials. Another aspect of this indicator is the presence of electricity in the house.

WATSAN infrastructure: This is a key indicator that includes the type of latrine used by the household, ranging from no latrine (open defecation) and hanging latrines (unsanitary) to covered pit latrines; and the type of drinking water system, ranging from an open water body (e.g. river or pond) to a community well or an individual deep tubewell. Other aspects of indicator quality include the distance to the water source and the number of families that share the source. Finally, the indicator captures whether the water source is arsenic-free.

Health Security

Several components of health security are considered to be critical in livelihood security assessment. The first is the frequency of illness among all household members. In highly vulnerable households, illness episodes can severely compromise the productiveness of family members, reducing already-low levels of incomes and production, thereby affecting food and nutritional security. The second component is access to primary health care. The health security of rural families is directly related to their level of access to appropriate medical care. In Bangladesh, a third component of health security is the incidence specifically of diarrhea episodes, particularly among children. Diarrhea is, in fact, a proxy variable of the quality of the health and sanitation environment in which the family resides, and it is highly responsive to development interventions (e.g., ORS treatments), thus eminently treatable. The indicators of health security are summarized in Table

Family illness episodes over last month: This indicator measures the number of illness episodes over the last month, recording the type of illness, days sick, days of productivity lost, and type of treatment sought-for every member of the household. This information is gathered during the household survey. It is a strong indicator of health security, if it can be assumed that illness does not have a strong seasonal pattern. If so, then the period of recall will have to be expanded.

Incidence of diarrhea episodes over last month: this indicator is also gathered during the household survey, and it includes detailed information on the length of sickness, the days lost to work (if applicable), and the form of treatment.

Educational Security

This livelihood category is comprised of several components, including the overall level of education of the household, gender differences in educational access, and the overall literacy rates of adults in the household. Workshop participants acknowledged that educational quality, while important, is a component that is generally overlooked in livelihood assessments, usually due to the difficulty of measurement. The education security indicators are summarized in Table 6.

Family members with completed primary: This indicator, combined with the following one, is a measure of the amount of education in the household. The highest educational level for this indicator is the situation in which all members within the appropriate age category have completed primary school. This information is gathered in the demographic section of the household survey questionnaire.

Family members with completed secondary: This indicator, when taken with the first, provides a measure of the level of education within the household. Again, the highest educational level for this indicator is all members of the appropriate age category having completed secondary school.

Adult literacy rates: This indicator is often used to measure the lowest level of educational achievement-adult illiteracy. This information is gathered in the demographic section of a household survey questionnaire.

Gender Status

One of the critical categories of household livelihood security in Bangladesh is the status of women. Gender status in Bangladesh is part of the livelihood focus on basic rights and justice, since women have been traditionally cloistered and their movement in society highly restricted. Moreover, women have been the victims of structural oppression, including violence. The major components that reflect gender status include the incidence of violence against women, the participation of women in household decision-making, marriage age for girls, and dowry levels. The relevant indicators are presented in Table 7.

Violence against women reduced: Structural violence against women, especially husbands against wives, is a critical problem in Bangladeshi rural society. The livelihood approach places great emphasis on justice and physical security, and reduction in violence is a strong livelihood goal. Measurement of this highly sensitive indicator is very difficult, just as the interventions designed to reduce violence toward females produce only gradual change. Household surveys are not the appropriate strategy of investigating violence against women, and it is suggested that tools of community analysis be employed. These include focus group discussions with men and women, key informant interviews with salish members, local political leaders, and local NGOs.

Female participation in household decision-making: It is assumed that as women obtain more voice with households (and within village society) that their status will improve. This indicator must be measured through a series of proxy variables, such as questions regarding participation in specific decision contexts (e.g., land purchase, migration, marriage of children, dowry, etc.) or questions regarding freedom of movement to particular places (market, relative's home, etc.).

Age at marriage: Traditionally women are obliged to marry very young, often forcing them to abandon their studies. This indicator compares the ages at marriage of the adult females in the household with the ages at marriage of their sons and daughters. Indications of a pattern toward marriage at later age are assumed to represent an improved status for women.

Dowry: Dowry is considered to be a symbol of the oppression of women and is often associated with violence against young wives. The absence of dowry at marriage and symbolically low values of dowry are considered indicators of improved status for women. Again, the dowries of the adult females in the household are compared with those of their sons and daughters.

Community Participation

This livelihood outcome category focuses on the level of participation of households in wider village society. In essence, this category attempts to assess the flows of social capital within a village and how individual households are able to mobilize and access these networks. In Bangladesh, village society is organized around traditional and formal social groups. In the former category are such institutions as local samities, mosque committees, and other informal associations. The more formal groups include the union parishad, NGOs, and CBOs. It is assumed here that household livelihood security is enhanced by the density of social relations, i.e., the amount of social capital available to households, especially the vulnerable ones. While fairly subtle and elusive, the following indicators (in Table 8) are designed to capture this livelihood dimension.

Effective presence of village groups: This indicator seeks to measure the amount of nature of social relations in the village as determined by the number and type of social groupings. The roles of the respective groups are also assessed. It is assumed that a village with a more numerous and diverse set of social groups will enjoy higher levels of social capital.

Participation of vulnerable households in community activities: As a complement to the previous indicator, this one focuses on the inclusiveness of the village groups. It seeks to assess if vulnerable households (such as female-headed or lower-caste households) actively participate and benefit from participation. Both these indicators are measured through a combination of community-level inquiry (FGDs and other qualitative tools) and household-level inquiry. Furthermore, in the household surveys, men and women are interviewed separately in order to capture gender differences in participation.

Access to Institutions

Household livelihood well-being is influenced by extent to which a household is integrated into a wider socio-political system. In Bangladesh, most rural villages are serviced by various types of external agents, who represent wider public or private institutions. For example, there are government representatives that serve local populations, including health agents, rural extensionists, local NGO staff, school teachers and so forth. The access of individual households (and within households of men and women) to such external services have an impact on livelihood security, and it is assumed that livelihood well-being is enhanced by more effective access patterns. Also, where a larger number of institutions are present, the resource flow to the village is assumed to be greater. The relevant indicators are summarized in Table 9.

Uses of external services: This indicator measures the number of external agents in the village and the use of their services by individual households. It includes government offices, NGOs, and, in some cases, representatives of private institutions. This information is gathered through the household survey.

Evaluation of external services: This indicator elicits the household's evaluation of the value of the external service. If the previous indicator seeks to evaluate the intensity of the external presence in the village, this indicator seeks to assess the impact of this presence, from the household perspective. Men and women in the households are interviewed separately for these indicators.

Concluding Observations

The result of the livelihood indictors workshop demonstrated that a consensus around a core set of livelihood indicators is possible. It further reinforced the argument that the holistic household livelihood framework is a useful, integrative one for assessing change among the target populations where development programs are operative. The list of 26 indicators that was generated during the workshop is comprehensive and realistic, but it reveals many the gaps that still challenge our understanding of household dynamics and well-being. For example, the dynamic discussions that characterized the workshop underlined how difficult it is to measure some of the more subtle forms of livelihood change, such as the status of women or the participation of vulnerable households. One might wish that these concepts could be measured as easily as a baby is weighed, but it would be wrong to assume that difficulty of measurement makes the indicator less important or less insightful. To measure the process of change is a daunting order, especially the type of change that can slip by unperceived. The success of this workshop notwithstanding, there is still much work to be done in refining the indicators and in adapting appropriate and effective methodologies.

A second gap that the workshop could not address was that of the relationship between different livelihood outcome categories and indicators. The group did not have the time to ask if economic security always meant food security, or health security. How these component parts interrelate is ultimately a critical piece of the livelihood puzzle. At some point in time, the LMP team will need to address how the livelihood components reinforce one another. Does increasing women's economic security change their status?

Finally, this final set of indicators, while robust and refined, should be considered as prototypes, waiting to be tested and ready to undergo another round of modifications. As livelihoods change, so will the set of indicators have to adjust. For now, they are an improved version, not yet perfect, but one that can be distributed and set to the test.

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