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