Mesfin Beyero June 12, 2012 Addis Ababa

1. Alive & ThriveWorld Vision Operations Research project on Timed and Targeted CounselingTOPS East Africa Knowledge Sharing Meeting MesfinBeyero June 12, 2012 Addis Ababa

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

3. 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.

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

5. 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

6. 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.

7. 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.

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

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

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

11. Progress to date…cont’d • The ToT 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 1st year and 38 have been refreshed in the 2nd year.

12. 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 1st year and refreshed in the 2nd year.

13. 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.

14. 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. • 9th month of pregnancy 2. Delivery 3. 2ndday 4. 1stweek 5. 4th week 6. 3rdmonth 7. 6thmonth 8. 8th month 9. 12thmonth 10. 18thmonth

15. 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?

16. Results from midterm evaluation…cont’d • Day of delivery and 2nd 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

17. 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.

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

19. 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”

20. Questions?