INTEGRATED FAMILY HEALTH PROGRAM John Snow Inc Improving

INTEGRATED FAMILY HEALTH PROGRAM John Snow, Inc. Improving Women’s and Children’s Nutrition through Targeted Capacity Building Interventions: Experience from Ethiopia IUNS 20 th International Congress of Nutrition, Spain Medhin M. , Jirga A. and Guyon A September 19, 2013 Presented by: Agnes Guyon MD. MPH. Senior Child Health & Nutrition Advisor – JSI

Presentation Outline INTEGRATED FAMILY HEALTH PROGRAM ♣ Background ♣ Achievements ♣ Challenges/Lessons Learned ♣ Ways forward John Snow, Inc.

Trends in nutritional status of children Based on WHO reference standard Percent of children under age of 5 years 3

Trends in nutritional status of women Based on WHO reference standard 4

Integrated Family Health Project INTEGRATED FAMILY HEALTH PROGRAM John Snow, Inc. Works in 4 regions serving a population of more than 35 million people Nutrition is one component among a comprehensive mix of maternal and child health interventions. Nutrition, through the Essential Nutrition Actions (ENA) framework, allows an effective implementation of High Impact Nutrition Interventions at scale by • using all existing health contacts • enhancing community involvement And has BCC as a back bone The goal is to improve nutrition practices, targeting women (pregnancy & lactation) & children under 2 (1000 days – Window of opportunities)

Nutrition Program Components Adapted from previous success FAMILY HEALTH PROGRAM INTEGRATED (USAID-ESHE-LINKAGES projects) PO 0717 & in partnership with BMGF Alive & Thrive project John Snow, Inc. Advocacy for health managers Sensitization workshop on “why stunting/nutrition matters? ” Training for health providers. ENA/MIYCN (BCC +SAM) BCC special focused on CF Integrated Refresher Training (IRT) Post-training review meetings Integrated Supportive Supervision (ISS) & Post ISS review meeting Community mobilization by Mobile Vans

Family Health Card Radio spots To assist health providers & families to adopt small doable actions, through counseling & negotiation INTEGRATED FAMILY HEALTH PROGRAM Complementary feeding tool John Snow, Inc. To assist health providers in counseling & negotiation MCH job aides To improve quality of basic health services at each contact Food demonstration To re-enforce messages Mobile 7

Ultimate goal: saturate the environment with INTEGRATED FAMILY HEALTH PROGRAM improved MNCH-ENA practices John Snow, Inc. Enroll a large number of actors across sectors Community volunteers assist at health facilities Community health festivals HW-HEW support mothers Agricultural extension workers support mothers Community volunteer make home visits Community volunteers support women at chance encounters (market, fields, collecting firewood)

INTEGRATED FAMILY HEALTH PROGRAM ♣ Background ♣ Achievements ♣ Challenges/Lessons Learned ♣ Ways forward John Snow, Inc.

John Snow, Inc. INTEGRATED FAMILY HEALTH PROGRAM Major Achievements 2010 Advocacy “why stunting/nutrition matters? ” (ENA Technical) Health workers trained on ENA/MIYCN Health work trained on IRT Post training review meetings Integrated Supportive Supervision 2011 2012 2013 Total 31 30 229 171 416 864 1, 744 2, 878 2, 380 7, 866 - 1, 824 - - - 2, 712 84 167 200 231 682

Breastfeeding practices INTEGRATED FAMILY HEALTH PROGRAM Monthly randomized “Follow-up Surveys” among 2560 Households % *** p<0. 001 All results significantly higher in intervention area TIBF: Timely Initiation of breastfeeding EBF: Exclusive breastfeeding 0 -5 months John Snow, Inc.

Complementary feeding practices & INTEGRATED Vitamin A FAMILY HEALTH PROGRAM supplementation John Snow, Inc. All results significantly higher in Monthly randomized “Follow-up Surveys” among 2560 Households intervention area % ICF: Introduction of Complementary Foods Frq: Frequency of feeding VAS: Vitamin A supplementation

Women’s INTEGRATED FAMILY HEALTH PROGRAM micronutrient supplementation John Snow, Inc. Monthly randomized “Follow-up Surveys” among 2560 Households % *** p<0. 001 IFAS: Iron Foclic Acid Supplementation VAS: Vitamin A Supplementation 13

INTEGRATED FAMILY HEALTH PROGRAM ♣ Background ♣ Achievements ♣ Challenges/Lessons Learned ♣ Ways forward John Snow, Inc.

Challenges INTEGRATED FAMILY HEALTH PROGRAM Ø Limited resources for nutrition within a broad health project Ø High public sector staff turn over Ø Nutrition competes with other multiple responsibilities of health workers and health extension workers Ø Poor household-level practices, in particular complementary feeding for children and women’s diet John Snow, Inc.

Lessons Learned INTEGRATED FAMILY HEALTH PROGRAM Ø Delivery of nutrition can be improved through the health system contact points Ø Post-training follow-up visits and regular review meetings were important tools to fill nutritionrelated gaps Ø Use of community level opportunities were very important for nutrition implementation Ø Community level complementary feeding demonstration seems to result in improved practices John Snow, Inc.

Ways Forward INTEGRATED FAMILY HEALTH PROGRAM John Snow, Inc. Ø Support heath system strengthening, including delivery of high-impact nutrition interventions Ø Continue health managers sensitization on stunting and “why nutrition matters” Ø Integrate post-training follow-up and supportive supervision into front-line staff capacity building Ø Standardize and collaborate with partners

INTEGRATED FAMILY HEALTH PROGRAM John Snow, Inc.