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Alive & Thrive World Vision Operations Research project on Timed and Targeted Counseling TOPS Alive & Thrive World Vision Operations Research project on Timed and Targeted Counseling TOPS East Africa Knowledge Sharing Meeting Mesfin Beyero June 12, 2012 Addis Ababa

Presentation outline: • • • Program overview Core intervention Progress to-date Mid-term evaluation and Presentation outline: • • • Program overview Core intervention Progress to-date Mid-term evaluation and lesson’s learnt Monitoring mechanisms The way forward

Program overview Alive & Thrive, launched with a grant from the Bill & Melinda Program overview Alive & Thrive, launched with a grant from the Bill & Melinda Gates Foundation, is an initiative to improve infant and young child feeding in Bangladesh, Ethiopia, and Viet Nam, reduce stunting and inform policies and programs around the world. Alive & Thrive is managed by FHI 360 with consortium members including: BRAC, GMMB, International Food Policy Research Institute (IFPRI), Save the Children, University of California – Davis, and World Vision.

Program overview…cont’d village household HEWs training super Kebele (sub-district) Peer mothers Mothers, fathers, other Program overview…cont’d village household HEWs training super Kebele (sub-district) Peer mothers Mothers, fathers, other caregivers • 10 Counseling sessions • Home visits Timed and Targeted Counseling training super Woreda HEW supervisors/PHCU (District)

Why Stunting! • • Reduced physical stature (short) Reduced cognitive development Delays in starting Why Stunting! • • Reduced physical stature (short) Reduced cognitive development Delays in starting school (7 months) Losses of schooling (0. 7 grades) Reductions in lifetime earnings Overall reduced economic productivity, wages, income Smaller babies, inter-generational transmission of malnutrition and poverty

The core intervention: • The core intervention for the community-based program is the ‘Timed The core intervention: • The core intervention for the community-based program is the ‘Timed and Targeted Counseling’ (TTC) approach. • Peer Mothers are the primary counselors.

The core intervention …cont’d: Why Peer Mothers (PMs)? • IYCF counseling at the household The core intervention …cont’d: Why Peer Mothers (PMs)? • IYCF counseling at the household level is very weak because Health Extension Workers (HEWs) are busy with the 16 packages of the health extension program, and other engagements, • The PMs work to improve IYCF counseling at the household level focusing on the mother and other influential family members.

The core intervention…cont’d: Do mothers prefer to be counseled by Peer Mothers? Yes, because… The core intervention…cont’d: Do mothers prefer to be counseled by Peer Mothers? Yes, because… • • • Coalition Building Shared Message They belong to the community the mothers Platform Cross-sector Outreach Information They are experienced (have children), & Materials Champion Identification Advocacy Training Are trusted by the community, Media Outreach Media Training Events are living, • The community value both formal training and experience rather than just training alone. Opportunities for Cross-sector Cooperation Developing Media Coverage

The core intervention…cont’d: • Timed – information given when behaviors can best be put The core intervention…cont’d: • Timed – information given when behaviors can best be put into practice, • Targeted influence Coalition Building Shared Message Events – information given to both those Platform Cross-sector who. Outreach the recommended. Opportunities for practice Information & Cross-sector Materials behaviors and those who Cooperation Champion Identification Advocacy Training Developing Media Coverage adoption of the behaviors Media Outreach Media Training (mother +), and • Counseling steps need to be followed.

The core intervention…cont’d: • Research has shown that caregivers require skilled support to adequately The core intervention…cont’d: • Research has shown that caregivers require skilled support to adequately feed their infants, Coalition Building Shared Message Platform Events Cross-sector • Inappropriate. Outreach practices are&often. Opportunities for feeding a. Cross-sector Information Materials greater determinant of inadequate intakes Cooperation Champion than the availability of foods in the Identification Advocacy Training Developing Media Coverage households. (WHO) Media Outreach Media Training

Progress to date…cont’d • The To. T Guide for health workers (HWs) has been Progress to date…cont’d • The To. T Guide for health workers (HWs) has been developed, and are trained on IYCF in the context of TTC, - 50 HWs have been trained in the 1 st year and 38 have been refreshed in the 2 nd year.

Progress to date…cont’d • The HWs then trained the Health Extension Workers (HEWs) using Progress to date…cont’d • The HWs then trained the Health Extension Workers (HEWs) using the training manual developed in Amharic - 259 HEWs have been trained in the 1 st year and refreshed in the 2 nd year.

Progress to date…cont’d • The HEWs in turn trained the Peer Mothers (PMs) using Progress to date…cont’d • The HEWs in turn trained the Peer Mothers (PMs) using the 15 TTC counseling cards (Ten cards for the 10 visits and 5 for the cross-cutting issues, ) – 2303 PMs have been trained so far.

Progress to date…cont’d • Peer Mothers make a series of 10 visits, the message Progress to date…cont’d • Peer Mothers make a series of 10 visits, the message at each visit being TIMED (the right message for the particular contact point) based on scientific evidence and experience from the field. 1. 9 th month of pregnancy 2. Delivery 3. 2 nd day 4. 1 st week 5. 4 th week 6. 3 rd month 7. 6 th month 8. 8 th month 9. 12 th month 10. 18 th month

Results from midterm evaluation • Peer Mothers’ visits (11 indicators) – Are the PMs Results from midterm evaluation • Peer Mothers’ visits (11 indicators) – Are the PMs conducting the visits on the specified schedules? • IYCF practices by mothers (16 indicators) – Have mothers adopted the optimal infant and young child feeding (breastfeeding and complementary feeding)practices?

Results from midterm evaluation…cont’d • Day of delivery and 2 nd day visits were Results from midterm evaluation…cont’d • Day of delivery and 2 nd day visits were poor: - Difficult to catch mothers - Guests not allowed to come into the room during delivery • Suggestions for improving the visits: - More than one visit during pregnancy

Results from midterm evaluation…cont’d • Breastfeeding: - early initiation of breastfeeding - good - Results from midterm evaluation…cont’d • Breastfeeding: - early initiation of breastfeeding - good - feeding of colostrum - poor - avoidance of pre-lacteals - good - continuation of breastfeeding - good Why good? • The expulsion of the placenta as the result of the early initiation of breastfeeding has encouraged mothers to adopt the behavior.

Results from midterm evaluation…cont’d Complementary feeding: - timely introduction of CF - good - Results from midterm evaluation…cont’d Complementary feeding: - timely introduction of CF - good - frequency - good - dietary diversity – poor

Results from midterm evaluation…cont’d Why poor? • Expensive, unavailable, causes tapeworm even if cooked, Results from midterm evaluation…cont’d Why poor? • Expensive, unavailable, causes tapeworm even if cooked, ignorance on how to prepare meat for the baby (“Meat powder”) • Seasonality, • Available in most households; tendency to sell; not used to buying eggs from market, • Mainly sour skimmed milk or “Arera”

Questions? Questions?