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Optimal Infant & Young Child Feeding In Ethiopia
Experiences of the Alive & Thrive Project
Yewelsew Abebe, PhDPresentation for ENACT Workshop
Accra, Ghana, 16-20 July 2012
Presentation Outline
1. Program background
2. A & T’s _IYCF interventions
3. Challenges
4. Lessons
Program BackgroundA & T is an initiative launched in 2009 with agrant from Bill & Melinda Gates Foundation(3 countries: Bangladesh, Ethiopia, Vietnam)
The project aim to improve IYCF/N:By increasing exclusive breastfeeding rates &Improving complementary feeding practices
Project areas: 4 regions withhigh rates of malnutrition:
Amhra , SNNPROromia , & Tigray
Alive & Thrive Program Components
1. Advocacy & Behavior Change Communications
2. IYCF Community Interventions
3. Private sector partnership
4. Monitoring, Learning & Evaluation
1. IYCF Advocacy & Policy DialogueCreating a favourable policy environment for IYCF through:
Advocacy & Policy Dialogue
Parliamentarians workshops for increased nutr. budget
National & regional meetings for multi sectoral linkagesIYCF trainings for :
Women’s Association leaders to be champions for
IYCF at different levels
Journalists & media officials & sustain media support
1. IYCF Advocacy & Policy DialogueAssist the FMOH and Regional Health Bureaus in the effort to accelerate the reduction of stunting
“ Stunting didn’t decrease significantly in the last 5 years b/c we didn’t focus on the first 2 years of life”
Deputy Head of SNNPR Regional health Bureau
1. IYCF Advocacy: Journalists TrainingWomen Associations TrainingJournalists Training
IYCF focused training was the means to display harmful IYCF practices, misconceptions & the need
for optimal IYCF
1. IYCF Advocacy: Regional Women’s Association
“Why we were not told about the adverse impact of stunting before?”
Chair of the WCY Affairs Standing Committee of the Parliament, SNNPR
IYCF Training & BCC Tools Development Process
6Advocacy video
5. IYCF electronic media
4.CF protocol, training manual, QRB, BCC tools , SSF packages
3.IYCF gap identified, need for optimal CF
2. Inventory of exiting IYCF training materials
1. Review of policy, programmatic documents & research findings
Note: A & T IYCF materials are developed based on evidence based needs
A & T Developed IYCF Materials
CF Protocol & CF training manual
IYCF QRB
Developed based on international guidelines butadapted to meet local needs
Smart & Strong Family IYCF Packages
SSF model works through community based organizations
A & T Developed IYCF Audio & video, Cont.Radio & TV Spots1 Initiation of colostrums within 1st hr/birth
2 Exclusive breast feeding of children3 Complementary feeding_Variety4 Complementary feeding _Thickness5 Complementary feeding_ ASF
6 Complementary feeding _Frequency7 CF_Feeding during sickness
IYCF Counselling Tools
Developed based on identified IYCF gaps
Films, advocacy &music video & radio drams on IYCF
Radio DramaCF
Instructional Video
Participants /communities are awarded certificates of success when they achieve
planned IYCF interventions/targets
2. IYCF Community Interventions
2A. HEP/IFHP Partnership
Training of PHCU s. on CF
IYCF s. supervision
Post training follow up
Pro IYCF_ Mobile van
sessions
2B. Community Partnership
Women's Associations
Amhara, SNNPR, Tigray
Faith based organizations
Orthodox C.: Amhaha, Tigray
Evangelical C.: SNNPR
NGOs : Concern Rest, ORDA, WV
IYCF Capacity Building at Community level
2A. Training of Health Staff on IYCF
Approach
Training of Trainers on IYCF ( PHCU )
Based on adult learning principles
In class & community set ups
IYCF Action plan development
Supportive supervision
Review meetings
2A. Training on CF focused ENA-BCC
IYCF awareness creation for office heads is important to obtain sustained support for IYCF
IYCF Training of Health program heads
Discussion with mothers in Communities
2A. Community Interventions: CF focused Trainings
Health Extension Workers
A mother feeding enriched complementary food to her baby
Community Interventions: CF focused Training
Head of a District Health Office head giving explanation on how to integrate IYCF activities with HEP
2 B: IYCF: The Smart & Strong Family Approach (SSF)
Purpose: Increase number of families that carry out Key optimal IYCF actions “7 Excellent Actions’’
Three guiding principles:1. 7 Excellent feeding Actions’’, addressed:
4 for mothers, 1 for fathers and 2 for both
2. Small do-able actions 3. Benefit a family will accrue by carrying out
Excellent Actions Families reached through :
House visit , Group discussion, and School approach
Smart and Strong Families: Community Conversation Cycle
Kebele SetsTarget
Celebrates Success
ImplementationGroup Meetings
and Home Visits
KebeleReaches Target
7 Excellent IYCF Actions: BF
Mothers,Exclusivelybreastfeedyour baby for the first 6 months
Mothers,begin breastfeedingwithin 1 hourof yourbaby’s birth
1
2
3. Complementary Feeding
Mothers, at 6 months feed your baby thick porridge
3
Mothers, at 6months,add a special food like: eggs or milk to baby’s porridge.
4
Fathers, it’s your job to make surethat baby has special foodsadded to hisporridge.
5
Mothers & fathers, at 6 months in addition to breast feeding make sure that your baby finishes 3 meals every day.
6
- Mother and fathers, when your baby is sick continue to breastfeed and give your baby extra food.
- After your baby is better give an extra meal every day for at least 7 days.
7
Launch Through Short Skill-based Trainings
Practice
Lessons Learned
School-based Activities
Celebrate Success at Every Level
Smart & Strong Certificate Makes Family Success Visible
3. Private Sector
Aim: To attract the private sector promote IYCF interventions
Concept testing and willingness to pay study for a nutrti-butter CF product
Training for health workers in Corporate Sectors( Tele, EEPCo, EAL, etc)
Plan for training private Health Facilities with IYCF
3. Private Sector, contd.
Implementing IYCF activities in the Corporate Sector
Major corporate sectors ( Tele, EEPCo, EAL, etc) have been identified to approach their health
departments
To discuss about possible partnershipImplementing IYCF issues in the sector through their health workers
1.Sentinelal surveillance survey: First phase is completed
Breast feeding:99.0% breastfed70.5% were put to breast within 1 hr of birth
Complementary feeding:59.7% of infants aged 6-8 months, had started CFOf children aged 6-23 months
Minimum meal frequency was only 57.8%, Minimum diet diversity was 7.5%, Minimum meal frequency was 5.2%Consumption of iron rich foods 8.0%
4. Monitoring, Learning & Evaluation
Rapid assessment on community based IYCF Interventions (SSF & ABC models)
53%
96%
44%
39%
35%
39%
77%
24%
15%
20%
2%
35%
18%
13%
8%
Who practiced the 6 or 7 IYCF actions
Who know that at six months, egg/milk/meat can be
added to baby’s porridge
Who know that in addition to BF, a baby should eat three meals
and two snacks every day
who know that breastfeeding should be continued when a baby
is sick
Who know that extra food should be given when a baby is sick
None to both
ABC model
SSF plus ABC model
IYCF related Knowledge & practices among mothers, 0– 23.9 months aged of children
Media Reach Assessment: Radio & TV media IYCF spots reach
60%
63%
65%
40%
16%
37%
9%5%
Amhara Oromia Tigray SNNP
% of Estimated Radio Audience Reach% of Estimated Audience Reach through IYCF radio spots
% of Radio Audience & IYCF radio spots reach: Diary Week
Partnership Development
FMOH, UNICEF
SAVE US, ENGIN project
SAVE UK
CARE, CONCERN
REST, ORDA
Faith based organizations
Women’s Associations
Partnership :- could be being a sub grantee
to promote A & T mission
- use of A & T developed IYCF training and BCC materials
3. Challenges Faced
1. Changing IYCF attitudes at scale will require time
2. Insufficient multi sectoral efforts to address chronic malnutrition
3. Limited standard IYCF indicators to track IYCF
intervention impact
4. Low private sector interest for fortified CF production
5. Conflicting program priorities ( HEP) for IYCF trainings
Lessons1. Advocacy & partnership at all levels is important to
promote optimal IYCF & make a mind shift
2. Developing IYCF messages & materials based on community needs is very effective
3. Involving fathers/male caregivers is possible to improve IYCF
4. Media plays a powerful role in reinforcing IYCF messages & community practices
5. Powerful synergy b/t mass media & community based activities is producing change
Thank you
Optimal IYCF is Critical for Children’s Holistic Development
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