SESSION 2: Field Program Examples
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Transcript of SESSION 2: Field Program Examples
SESSION 2: Field Program Examples
OBJECTIVES• Discover what types of integrated programs are
feasible, especially at scale• Identify challenges and opportunities in
integration
OUTPUT• A list of challenges and a list of opportunities
Bangladesh| Alive & Thrive, FHI 360
Represented by Tina Sanghvi, Alive & Thrive, FHI 360
Communication Campaign for Reducing Stunting through IYCF + Handwashing
Program aims• Prevent stunting– Complementary feeding practices,
especially nutrient-dense foods and animal source foods (existing program)
– Handwashing to decrease infection, allow for better use of nutrients
• Create intervention that WASH sector will pick up, including nutrition
Areas of integration• WASH:
– Wash hands with soap:• Before mashing child’s food• Before feeding child
– Wash child’s hands• IYCF:
– Feed right quantity, frequency– Feed 4 varieties of foods/day, focus on animal
source foods• ECD:
– [Responsive feeding]
Constraints & Motivators• Make it convenient: HW station
(water and soap) near feeding area• Shift social norms: Engage
community members, make the practices seem normal, expected
• Make health benefits credible: Stress protection from illness, germs
The intervention
Social mobilization guidelines
Results from Trial Phase• Increased HW with soap before
preparing food and feeding – Presence of handwashing station at
feeding place increases HW at key times• Increased feeding of right quantity and
frequency family food• Little impact on feeding 4 varieties of
foods• Little interest from WASH colleagues
South Africa| MAMA
Represented by Kirsten Gagnaire, Global MAMA
MAMA, South AfricaMobile Alliance for Maternal Action
Program aims• Deliver vital health information to
new and expectant mothers through mobile phones
• Inform and empower low-income, expectant mothers who are at risk of complications and death during pregnancy and childbirth, and new mothers caring for their infants
• Encourage care seeking behavior and regular clinic visits for immunizations and check ups
Areas of integration• WASH: – Handwashing, food safety, safe water
• IYCF:– Exclusive breastfeeding, appropriate
complementary feeding• ECD: – Early stimulation, appreciation of
developmental stages
The intervention
Results•Targeting health information to user’s gestational age or the age of child markedly increases acceptability of the service and user retention•Mothers appreciate the opportunity to connect with other mothers and feel empowered by the feeling of belonging to a community•Project implementation best done through consortium of partners: with technical and content expertise, access to clinical services, and experience in monitoring and evaluation
Video: MAMA South Africa Mashup
https://www.youtube.com/watch?v=2RmIwr0dpmE
Johns Hopkins University Ministry of Health, Dept. La Libertad
Represented by Rebecca Robert,Catholic University of America, visiting investigator with Instituto de Investigación Nutricional
Educational intervention delivered through health services to improve child nutrition
Peru | Instituto de Investigación Nutricional
Program aims• Prevent stunting through
improved feeding practices• Design and test
educational intervention (not providing food) (cluster RCT)
• Raise profile of nutrition in health centers, strengthen existing government health services without increasing personnel or costs
Areas of integration• WASH:
– [Wash hands, food, plate when preparing food]• IYCF:
– Give thick puree– Give animal source foods (liver, egg, fish)
• ECD: – Interactive (responsive) feeding:
• [Teach baby to eat]• [Help baby to eat by himself]• [Eat as a family]• [If child won’t take food, wait, offer again]
3 Key Messages1. At each meal give
thick puree first
2. Add special food: liver, egg or fish
3. Teach your child to eat with love, patience, and good humor
The intervention
Percentage of children with stunting by age and intervention group
02468
1012141618
0 3 6 9 12 15 18Age in months
% C
hild
ren
InterventionControl
Results“Before, only the nutritionist gave
messages. Now, we all give messages because we all speak the same language (of key messages), we all say the basic messages.”
Bangladesh | Save the Children
Represented by Ivelina Borisova, Save the Children
Early Stimulation and Nutrition Program in Rural Bangladesh
Program aims• Growth and development– Height for age–MUAC (mid- to upper-arm
circumference)– Cognitive and language development
• Sustainable and scalable model for improving stimulation and nutrition caregiving practices
Areas of integration• WASH:
– Wash hands with soap before feeding– Wash child’s hands before s/he eats
• IYCF:– Feed a variety of nutritious foods, especially animal
source foods– Feed with patience and good humor; encourage self
feeding • ECD:
– Give child affection, show love, every day– Play games every day and let the child play with
playthings– Talk to and with your child; respond to child’s
sounds
The Intervention Save the Children &
Department of Health and Family Planning
Family Welfare Assistants
Parent education support through home visits,
community and satellite clinics
Mothers of children 0-3 years
25
Child Development Card
Child Development Card
Results from first phase• Impact on growth and development– No impact on height for age (short
intervention period,10 months)– Large impact on language and cognitive
development (d=1.52 and 1.04 respectively)• Household practices– Improved caregiver-child interactions at home– Increased breastfeeding rates – Little impact on feeding animal source foods
• Some impact on diarrhea rates
Zambia| Nepal| Indonesia| India
Zambia|
Presented by Val Curtis, London School of Hygiene and Tropical Medicine
Changing multiple behaviours
physicalenvironment
bio-logical
setting
body
behaviour
social
physicalenvironment
bio-logical
setting
motivated
executive
reactivebrain
Evo-Eco model
Settings • Kitchen
makeover parties
Manners
Brand
Nurture
Video: SuperAma animation
• http://www.youtube.com/watch?v=J3FiIQQuiQw
SESSION 3: Shared Indicators
OBJECTIVE• To identify impact indicators of growth and
development that could be used in a coordinated program
OUTPUT• List of impact indicators
SESSION 4: Household PracticesOBJECTIVES• To review the household practices (or behaviors) critical to
child growth and development, as currently articulated by each sector - ECD, Nutrition and WASH
• To develop a (preliminary) comprehensive list of priority household practices for use across sectors
• To identify feasible opportunities for program integration, promoting key household practices from each sector
OUTPUT• A matrix of key behaviors by age cohort• Ideas for integrating key behaviors into sector programming• List of challenges to integration, with possible solutions
SESSION 5: Future Actions
OBJECTIVES• To identify specific opportunities for moving forward with
collaboration to advance child growth and development• To allow participants to make a public commitment of
resources to specific collaborative actions• To identify ways to share the spirit and outputs of this
meeting with the broader community – the three sectors and the child health and education communities
OUTPUT• List of potential collaborative actions, with names of
people and/or organizations attached