session 2: field program examples objectives discover what types of integrated programs are...

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 Messages

1. 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 18

Age 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

settin

g

body

behavio

ur

social

physicalenvironment

bio-logical

settin

g

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 Practices

OBJECTIVES• 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