Lessons Learned at Helen Keller International

Core Group Spring Meeting Pre-SessionMonday April 26, 2010

Core Group QuestionsWhat is the largest barrier that prevents better

integration of maternal anemia control interventions within your programs?

What change do you feel will make the largest difference in improving the integration of anemia control interventions?

Essential Nutrition Essential Nutrition Actions (ENA):Actions (ENA):

The Framework forHKI’s Nutrition Programs

Essential Nutrition Essential Nutrition Actions (ENA):Actions (ENA):

The Framework forHKI’s Nutrition Programs

The ENA approachThe ENA approach Focuses on women and under-twosFocuses on women and under-twos

Integrated package of proven Integrated package of proven preventativepreventative actionsactionsIn 7 areas covering IYCF In 7 areas covering IYCF andand micronutrients micronutrients andand

women’s nutritionwomen’s nutrition

Behavior change communications Behavior change communications techniquestechniques

Objective to “go to scale” to reach over 80% Objective to “go to scale” to reach over 80% coverage to achieve public health impactcoverage to achieve public health impact

The ENA approachThe ENA approach Focuses on women and under-twosFocuses on women and under-twos

Integrated package of proven Integrated package of proven preventativepreventative actionsactionsIn 7 areas covering IYCF In 7 areas covering IYCF andand micronutrients micronutrients andand

women’s nutritionwomen’s nutrition

Behavior change communications Behavior change communications techniquestechniques

Objective to “go to scale” to reach over 80% Objective to “go to scale” to reach over 80% coverage to achieve public health impactcoverage to achieve public health impact

1. Health facility level: integrate ENA actions into existing health contacts at all health services;

2. Community-level: work with community-based organizations & networks from all sectors; and

3. Behavior change: reinforce ENA actions through behavior change communication at all levels, including inter-personal communication, mass media and community mobilization.

Three cornerstones of ENA programsThree cornerstones of ENA programs

Complementary

Feeding

Feeding of sick childrenBreastfeeding

Control of iodine deficiency disorders

Control of vitamin A deficiency

Women’s nutrition

7 Proven Nutrition Actions7 Proven Nutrition Actions7 Proven Nutrition Actions7 Proven Nutrition Actions

Integrated control of anemia

6. Integrated 6. Integrated Control of Control of AnemiaAnemia

De-worming for pregnant women and children

Malaria prevention and control

IFA supplementation

Promotion of iron-rich foods

VAS

Fortification of staples

DELIVERY/EARLY NEO-DELIVERY/EARLY NEO-NATAL:NATAL: safe delivery, early BF & EBF, pp vitamin A, iron/folic acid, diet, FP, STI prevention

PREGNANCY:PREGNANCY: TT, antenatal visits, iron/folic acid, de-worming, anti-malarial, diet, EBF, risk signs, FP, STI prevention, safe delivery, iodized salt

POSTNATAL AND POSTNATAL AND FAMILY PLANNINGFAMILY PLANNING :: EBF, diet, iron/folic acid, diet, FP, STI prevention, child’s vaccination

WELL CHILD AND GM/P:WELL CHILD AND GM/P: monitor growth, assess and counsel on BF and CF, iodized salt, check and complete vaccination Vitamin A, De-worming

SICK CHILD:SICK CHILD: monitor growth, assess and treat per IMCI, counsel on BF & CF, assess and treat for anemia, check and complete vitamin A Immunization/ de-worming

IMMUNIZATION:IMMUNIZATION: vaccinations, vitamin A, de-worming, BF, CF, assess and treat infant’s anemia, FP, and STI referral

Six critical life cycle contact points Six critical life cycle contact points

OutcomesOutcomesHKI Mali CSP- Koulikoro RegionHKI Mali CSP- Koulikoro Region

Mali - Achievements & ChallengesMali - Achievements & ChallengesComprehensive training of CSCom staff to improve nutrition servicesWidespread knowledge of key messages, especially IYCNSIAN reach >80% coverage (deworming PPW)Flour fortification multi-partner consortium (80% production)

Supply of free IFA and SP sporadicSub-optimal attendance at ANCTurnover of trained staffCommunity BCC needs reinforcementMaternal nutrition received less emphasis

OutcomesOutcomesHKI Niger CSP-Diffa RegionHKI Niger CSP-Diffa Region

Indicators Baseline value Endline value Target

Indicator 3 % of pregnant women who took iron/folic acid tablets acid during the last 24 hours

60% 87% 80%

Indicator 16 % pregnant women attending IHCs and health posts receiving SP as a component of malaria control package

N/A 82% 100%

Indicator 20 % women in the 2nd and 3rd trimester attending IHC and health posts will receive all components of the anemia control package

0 68% 50%

Indicator 21 Anemia prevalence among pregnant women in the project area reduced

62% 7% 30%

Niger - Achievements & ChallengesNiger - Achievements & ChallengesComprehensive ENA training at health facilities and communitiesSaturated communities with key messagesCMAM services increased health seekingWomen reported high compliance with IFA and knowledgePPVAS

IFA supplies inadequate until year 5«Gratuité de soins» (April 2006) undermining stocks of essential

medicines

Most significant needsMost significant needs

Supplies of key inputs (IFA, SP, ITNs)Food securityEffective BCC (interpersonal

negotiations)Improved family planning (including

adolescents)