Alive & Thrive: “Can we scale up nutrition?” · Nguyen PH, et al. Program impact pathway...
Transcript of Alive & Thrive: “Can we scale up nutrition?” · Nguyen PH, et al. Program impact pathway...
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Alive & Thrive: “Can we scale up nutrition?”
1 Designing the Future of Nutrition SBCC | Bethesda, MD | November 2014
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Can we scale up infant and young child
feeding programs?
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Yes! We can scale up
Interpersonal: 3.7 million mothers Mass media:
Bangladesh ~6.5 million
Ethiopia 2 million
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Yes! We can change behaviors
Increased exclusive breastfeeding
*A&T intensive areas only
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More diverse complementary feeding
Yes! We can change behaviors
Perc
ent c
onsu
min
g fr
om 4
or m
ore
food
gro
ups
*A&T intensive areas only
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Overview
• A&T Framework for scaling up nutrition • A&T design for measurement, learning &
evaluation • Early results: What we’ve learned about what
it takes to be: – Scalable – Effective
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A&T Framework for scaling up
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Changing social norms, engaging people throughout society
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A&T measurement, learning & evaluation
(MLE)
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Key research questions
• What impact did A&T have on IYCF practices and stunting? – A&T-intensive vs. mass media only
• How was this impact achieved? – Reach – Quality – Intensity – Cost
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Measurement, learning & evaluation at a glance: Viet Nam
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Overall A&T evaluation, Bangladesh Cluster randomized design (cRCT)
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What have we learned?
SCALABLE EFFECTIVE
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What we’ve learned about how to reach
SCALE
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SCALE: Think big, really big
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BRAC contacts in a single month, Bangladesh
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Viet Nam
Reach varied in different contexts Interpersonal counseling
Mass media
92% 73% 45%
62% 30% 85%
Bangladesh Ethiopia
2013 data
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What we’ve learned about how to be
EFFECTIVE Intensity matters
More than mothers Focus on drivers of behavior
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What we’ve learned about how to be
EFFECTIVE Intensity matters
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Intensity matters
Dramatic increase in exclusive breastfeeding
Preliminary findings, Viet Nam
Source: Nguyen PH, et al. Program impact pathway analysis of a social franchise model shows potential to improve infant and young child feeding practices in Viet Nam. Journal of Nutrition (in press).
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Intensity matters
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Perc
ent e
gg c
onsu
mpt
ion
Number of A&T activities Ethiopia
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What we’ve learned about how to be
EFFECTIVE More than mothers
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Changing social norms, engaging people throughout society
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Bangladesh TV spot
http://aliveandthrive.org/resources/tv-spot-perception-of-insufficient-milk-bangladesh/
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What we’ve learned about how to be
EFFECTIVE Focus on drivers of behavior
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Behavior change model, Viet Nam
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Supportive environment
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What we’ve learned about effective: Changing behavioral determinants
• Beliefs about outcomes – Does not believe exclusively breastfed infant will
be thirsty (OR=1.54) • Perceptions of social norms
– Most women like me feed their infants only breastmilk (OR=1.77)
• Self-efficacy – My breastmilk is good enough to nourish my
infant for 6 months (OR=1.78)
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Viet Nam TV spot
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Aug-11 Feb-12 Aug-12 Feb-13 Aug-13
Trends in behavioral determinants
Believes her BM is enough Believes EBF for 6m is the norm Does not believe exclusively BF infant will be thirsty
Behavioral determinants have improved
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n=2,305 (Aug 11); n=2,065 (Oct 12); n=2,321 (May 13); n=2,593 (Oct 13)
Viet Nam
Self-efficacy
Social norm
Belief about outcome
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SCALABLE EFFECTIVE
Intens ity More than mothers
Behavioral determinants
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At the deep dive… How can we help countries scale up NOW?
30 Designing the Future of Nutrition SBCC | Bethesda, MD | November 2014
Alive & Thrive:�“Can we scale up nutrition?”Can we scale up infant and young child feeding programs?Yes! We can scale upYes! We can change behaviorsSlide Number 5OverviewA&T Framework for scaling upChanging social norms, engaging people throughout societyA&T measurement, learning & evaluationKey research questionsSlide Number 11Overall A&T evaluation, Bangladesh�Cluster randomized design (cRCT)What have we learned?What we’ve learned about how to reach�SCALESCALE: Think big, really bigReach varied in different contextsWhat we’ve learned about how to be�EFFECTIVEWhat we’ve learned about how to be�EFFECTIVEIntensity mattersIntensity mattersWhat we’ve learned about how to be�EFFECTIVEChanging social norms, engaging people throughout societyBangladesh TV spotWhat we’ve learned about how to be�EFFECTIVEBehavior change model, Viet NamWhat we’ve learned about effective: Changing behavioral determinantsViet Nam TV spotBehavioral determinants have improved�SCALABLE�At the deep dive…�How can we help countries scale up NOW?