Doer/non-doer surveys can help identify the most significant barriers to ENA practices and inform BCC strategies.
The CG approach works well as an organizing framework for community volunteers.
1. Steps for adapting generic ENA tools1. Understand as menu, science-based2. The key messages booklet3. Training plan4. BCC channels5. Partnerships and harmonization
2. Customizing ENA messages with local partners…Literature review; identifying existing toolsFormative research to identify prioritypractices for context as well as barriers tothem & practical solutions to facilitatebehavior changeDoer/Non-doer commonly used to identifytarget groups and communications strategiesUndertaken with partners in their projectsitesTailor “Key ENA Messages” booklet to localcontext & terminology
3. Formative research approachesOptimal Current Barriers Appeals/ Messages StrategiesPractice Practice Motivators Benefits Designing for Behavior Change (DBC) Framework* Priority Group or Bridges to Behavior Influencing Groups Determinants Activities Description Activities To promote this among this audience: we will research these and achieve these by implementing these behavior: (circle one) determinants: bridges to activities activities: *These can only be Priority Group: (priority benefits and 1. determined after conducting 2. Influencing Groups: research studies priority barriers): 3. 1. 2. 3. *Adapted from BEHAVE framework by TOPS
4. Training Plan• Training (often cascade) • Master trainers • Health workers - Child Survival/IMCI (Niger, Mali) - HIV (Ethiopia) - CMAM (Liberia) - Hygiene (Bangladesh) • Community volunteers - Care Groups (mothers) - Agriculture extension agents
5. Emphasizes building technical and counseling skills of providers Possible to customize training for:  Health managers  Health agents  Baby-Friendly Hospitals  NGO staff  Emergencies HIV/AIDS• Short-term, skills-based training,• Heavy on counseling/negotiation and communication skills (Lots of practice with real mothers)
6. Ethiopia: Customized ENA Courses Trainer’s Guide Using the Essential Nutrition Actions to Improve the Nutrition of Women and Children in Ethiopia Trainer’s Guide A Four Day Training Course Using the Essential Nutrition Actions to for Health Managers and Program Staff Improve the Nutrition of Women and Children The Ethiopian Public Health Training in Ethiopia Initiative February 2004 A Four Day Training Course for Health Staff and Managers at PMTCT Sites on Infant Feeding and Women’s Nutrition in the Context of HIV & AIDS June 2004
7. Community level training• Community volunteers - Community health workers - Mothers groups (Care Groups) - CMAM screening groups - Village Model Farmers (EHFP) - Primary schools (teachers, students) - Micro savings & loan groups
8. Care Groups to structurecommunity-level activities
9. BC more than messages…• Knowing the right practice does not guarantee we will do it• Negotiation skills and multi-channel strategies• Common Barriers to address: – “Insufficient breast milk” (lactation management) – Food access (HFP) – Soap & water access (Tippy-taps) – Child care challenges (rotating day care) – Labor saving devices (mills, improved stoves)
10. Forge partnerships to harmonize approaches across different groups… Many groups using same messages & IEC materialsGet all partners to focus on targeted concise messages that promote “small do-able actions” Everyone sings the same “nutrition” song to the same tune… Objective to reach > 80% coverage
11. Advantages of the ENA frameworkMaximizes the delivery of nutrition byintegrating into existing services (not a newor separate intervention)Platform to scale up the promotion andsupport of adequate nutrition & feedingpractices...Pulls together existing vertical programs ina sensible “action-oriented” way... Greatly expands coverage to multi level,multi contacts, multi channels… Provides a solid, science-based frameworkfor training service providers
12. Thank youGrateful acknowledgement to Dr VictoriaQuinn & Shawn Baker (HKI) and Meera Shekar(WB) for selected slides