A&T response

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Alive & Thrive (A&T) aligns with both the National Nutrition Program and the Health Extension Program of the Government of Ethiopia to strengthen service delivery and those institutions responsible for nutrition policy and program implementation.

Strengthening the Health Extension Program. The Health Extension Program posts two salaried female health extension workers (HEWs) in each ward (kebele). With assistance from voluntary community health workers and supervisory support from health centers, HEWs are responsible for implementation of 16 preventive health ‘packages’ across the life cycle, including promotion of optimal IYCF. A review of the training and performance of HEWs indicates their strong commitment to work in rural communities but also highlights the need for strengthening the technical capacity in IYCF, supervision, and general support systems for the HEWs. A&T will address this gap.

In close collaboration with partners, A&T is working the:

  • Federal Ministry of Health
  • Ministry of Women’s Affairs and Women’s Associations
  • The USAID funded Integrated Family Health Program, which covers over half of the population of Ethiopia
  • Donors engaged in nutrition
  • NGOs implementing Productive Safety Net Programs and Community-based Management of Acute Malnutrition Programs

Implementing a comprehensive program. The Ethiopian A&T program model is based on a comprehensive approach used successfully in other countries to improve IYCF. This includes policy dialogue at the national and regional levels, enhanced interpersonal communication and community support for IYCF, and increased supply, demand, and use of fortified complementary foods. A&T will test strategies at scale and introduce innovations to address barriers and generate learning.

Addressing key questions. A&T’s advocacy, behavior change, and private sector activities are designed to answer the following key questions:

  • To what extent do advocacy and partnership building shift norms from an emergency to a preventive focus in Ethiopia?
  • Operationally, what is the best way to streamline IYCF counseling within the Health Extension Program?
  • What is the role of community engagement strategies for improving support for IYCF?
  • What’s necessary to incentivize the private sector to develop, produce, and market a lipid-based nutrient supplement for the Ethiopian market?

 

Strategy 1. Policy dialogue

A&T seeks to heighten attention to and resources for IYCF at the federal, regional, and district levels; build partnerships to advance infant and young child nutrition; and engage the media to improve awareness and coverage of nutrition and IYCF.

Action

  • Launch an advocacy campaign around stunting reduction
  • Engage women’s associations as IYCF champions
  • Develop and disseminate an advocacy video and related materials to build support for nutrition within the Federal Ministry of Health

 

Strategy 2. Community-based activities

Coverage will be achieved through community-based interventions implemented at scale by the Integrated Family Health Program (IFHP) and in collaboration with other organizations in support of the government delivery system. The aim is to reach approximately 5.4 million children under two years of age in the four most populous regions (and the chartered cities) in more than 360 districts (woredas). Alive & Thrive will work primarily in two regions: SNNP and Tigray. Media and technical materials developed through A&T will be shared for wider dissemination.

Community model. A&T will strengthen the government’s community-based Health Extension Program by improving the ability of health extension workers and volunteer community health workers to mobilize their communities, deliver key IYCF preventive messages, and counsel/negotiate optimal IYCF practices.

Action plan

  • Enhance supervision of health extension workers
  • Improve the communication and counseling skills of HEWs through enhanced counseling tools and capacity building
  • Engage family and community members through “community conversations”
  • Reinforce messages through the radio
  • Use mobile phone technology to refresh and motivate HEWs
  • Conduct operations research by World Vision of timed and targeted counseling by HEWs and peer mothers

Community model in food security programs. Nutritional interventions are commonly equated with distribution of food aid. A&T will seek opportunities to improve nutrition through behavior change strategies. In 2010 A&T issued a grant to the Relief Society of Tigray (REST) and a grant to Concern to integrate optimal, preventive IYCF practices into existing efforts of their Productive Safety Net Programs.

Action plan

  • Develop and test models that incorporate an IYCF preventive component in Productive Safety Net Programs through the two A&T grants
  • Share results and identify a strategy for expanding successful models

Emergency nutrition programs. Care and rehabilitation of children is the primary objective of emergency nutrition programs in Ethiopia. A&T awarded a two-year grant in early 2011 to identify best strategies for integrating good IYCF practices to prevent malnutrition in community-based management of acute malnutrition (CMAM) programs. The partnership receiving the grant comprises Save the Children, the Emergency Nutrition Network, Nutrition Policy and Practice, and World Vision Canada.

Action plan

  • Develop and test models that incorporate an IYCF preventive component in CMAM programs through an A&T grant
  • Document and diffuse learnings

 

Strategy 3. Fortified complementary foods and related products

Local foods often do not meet all of the nutritional requirements of children between the vulnerable ages of 6-24 months when stunting occurs. 

Action plan

  • Conduct stakeholder analysis and qualitative research on eating and consumer purchasing habits
  • Test acceptability of a lipid-based nutrient supplement (LNS) and consumers’ willingness to pay for the product

 

Strategy 4. Measurement, learning, and evaluation

A&T will evaluate the impact of the program strategies as well as the process for delivering the interventions.

  • Conduct a baseline survey in 2010 of 3,000 children less than 5 years old and an endline survey in 2013 to evaluate the impact of the community component on IYCF practices and stunting
  • Assess the impact of A&T on the policy process, from agenda setting to policy formulation and change to policy implementation

Read about our expected results