Community support groups effectively improve infant and young child feeding in remote communities, a new study of an Alive & Thrive supported intervention in Viet Nam shows.
Delivering health information and services poses challenges for implementers seeking to reach pregnant women, mothers, and caregivers in remote areas. Indeed, the 2020 Global Nutrition Report shows wide disparities in child feeding practices by the place of residence and income.
From November 2011 to November 2014, Alive & Thrive worked closely with partners at the national, provincial, district and village levels in Viet Nam to develop the community support group model to address this inequity.
Learn more about the IYCF Community Support Group approach:
"One of Alive & Thrive’s program components was interpersonal communication and social mobilization to improve child feeding practices,” explained Roger Mathisen, the Alive & Thrive regional director for Southeast Asia, who has been based in Viet Nam since 2009. “At first, we focused on the Little Sun social franchise model, in which caregivers visit the nearest health facility to receive standardized counseling and support. However, the franchise model might not be very practical for women and mothers in remote areas due to the long distance from their houses to the nearest health facility.
“It’s more effective to bring the services to them. This is particularly important to reach ethnic minorities in Viet Nam because many ethnic minorities live in remote areas,” he added. “It is common for large interventions to focus on universal services or regulating the enabling environment with polices, but those usually do not have a big impact in remote areas.”
The support group model, which included training over 1,500 facilitators for support groups in 267 villages in nine provinces of Viet Nam, established three support groups in each village. Two groups met monthly – one focused on exclusive breastfeeding, the other on complementary feeding – while the third focused on shared responsibilities and targeted community leaders and members, including fathers and grandmothers, and met every other month. Ultimately, the groups reached about 70% of the pregnant women and mothers in these communities across nine provinces.
The groups met in local public spaces, like village halls or the house of the facilitator. The facilitators from the communities organized one-hour informal meetings. During a visit to a support group at the village hall, Ms. Nguyen Thi Quyen, a facilitator in Khe Ngang village, one of the nine villages of Truong Xuan commune, Quang Ninh District of Quang Binh Province, explained how the program worked.
“In our village, three community-based workers were selected and trained to facilitate the support groups. Along with myself, the vice president of the Women's Union and a health worker were selected.”
Truong Xuan commune has 850 households of nearly 2,800 people, of which 222 (26%) belong to the Van Kieu ethnic group. Khe Ngang has a high concentration of people belonging to the Van Kieu group. Most of the people in the commune work as farmers. The province is located along the north-central coast of Viet Nam, an area of small villages located among small, wooded mountains.
After supporting the monitoring and evaluation of the support group model and visiting dozens of support groups over several years, Tuan Nguyen from Alive & Thrive attributed the positive impact of the community groups to the emphasis on facilitating discussion among the participants.
“The role of the facilitators is very important,” said Nguyen, who is also a co-author of the study. “To start the session, they asked the caregivers about their experiences with the changes they agreed to try at the previous meeting and addressed questions or difficulties that caregivers brought up. They did a very good job in inspiring thinking and learning, and ended the meetings by gaining agreement from participants. People enjoyed coming to the groups because their voice was heard; their concerns were addressed; and they were a part of the solution. They had chance to discuss about other businesses after the meeting, too.”
He also cited government support as critical to the success of the groups.
“We had government involvement from the very beginning,” he said. “Once you have the government’s involvement, support and commitment, then you have everything – any difficulties that arise can be solved.”
The study, written in collaboration with the University of South Carolina and Nanjing University of Information Science & Technology, found significant improvements in breastfeeding behaviors, including early initiation of breastfeeding, exclusive breastfeeding, predominant breastfeeding under six months and no bottle feeding. However, complementary feeding behaviors did not change significantly.
“In general, when people have good knowledge, beliefs, social norms, and self-efficacy they can perform and sustain a behavior,” Nguyen said. “Breastfeeding was easier for these mothers; complementary feeding was more difficult. For example, for dietary diversity, the child needs to eat four or more out of seven food groups. The market might meet one or two times a week, and their own sources might not be very diverse.”
“The value of the community groups is borne out in their connection with the nearest health centers, local departments of health and Women’s Union – in many remote areas, the groups continue to operate with local resources despite the end of financial support from Alive & Thrive in 2014. The groups also should be of interest because of their cost,” Nguyen said.
As reported in the paper, the average project costs for supporting the meetings, compensating village collaborators, and providing supportive supervision through staff in commune health stations were USD $5 per client and USD $1 per contact. After adding expenditures for training, supportive supervision, and additional administrative costs at central and provincial levels, the average project cost was USD $15 per client and USD $3 per contact.
“As the government weighs interventions to reach the global nutrition targets and leave no one behind, community support groups should be carefully considered,” Mathisen said. “They helped to increase positive breastfeeding behaviors among families that have historically had limited access to health care services.”