Applications of Multi-Dimensional Approach to Health: Challenges and Lessons Learned

1. Applications of Multi-Dimensional
Approach to Health:
Challenges and Lessons Learned
Esther Indriani, MPH
Regional Health and Nutrition Advisor
World Vision South Asia and Pacific Region

2. Key Lessons Learned of
Multi-Dimensional Approach
•It’s complex
•It can be done
•We need to look at
intended & unintended
results

4. Asking children is a good way to start…
“If we can earn
our own income,
we can tell our
parents not to
marry us early,
because we are
self-reliant.”

5. Principles for Integrated Approach
• Issues are multi-dimensional
• Common Goal
• Common target group
• Common programme area
• Common indicator for success
• Complementary projects and activities,
efficient use of resources

6. India
• Integrated Programming for Child
Health (IPCH)
• Aim: Reduction in malnutrition
• 4 years 2012-2015
• Impacting 3,7 million people
including 350,000 children under 5
• 17 states, 72 districts
• Targeted poor and hardcore poor
with underweight child for
a package of Health, Nutrition, and
Livelihood interventions

7. Final Evaluation IPCH
(Team Leader: Dr. Marc Debay,
Loma Linda University)
Oct 2015
•Average Annual Reduction
Rate of Underweight Over 3
Years + 13.1%
•4 X faster decrease in
underweight than in 100
highest malnutrition
prevalence districts over
previous 7 years
Source: Final Evaluation Report of IPCH 2015, WV India and Loma Linda University

8. WV India’s Resolution to do
Integrated Approach

9. Bangladesh: Nobokoli Project
• 4 years 2013 – 2017
• Aim: To reduce malnutrition
• impacting 1,4 million people including
181,135 children under 5
• in 7 districts, 18 upazilla
• Focusing on pregnant & lactating women
and children under two for a package of
Health, Nutrition, and Livelihood
interventions
• Targeting poor & ultra poor HHs*:
• With underweight child under 2, or
• With Pregnant Woman
* based on income and land ownership

10. • Increased production
• Increased consumption
• Improved dietary diversity
• Improved income and savings
• Increase women’s empowerment
• Improved nutrition

11. 7, 276 children
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
November
'15
December
'15
January '16 February '16 March '16
23.8 25.1 27.0 28.1 28.9
35.0 36.6 37.5 38.4 38.4
41.2 38.3 35.5 33.5 32.7
Prevalence of underweight of ED children for Nobokoli areas
Moderate & severe Mild Normal
Integrated monitoring

12. Baseline (July-Oct 2014) Mid Term (Jan-Mar 2016) done by ICDDR,B
Underweight and Wasting Comparison between
Baseline and Mid Term Survey

13. Things We are Learning
for Multi-Dimensional Approach to Health
• COMPLEXITY
• TIME
• COMPETENCE
• PARTNERSHIP
• COORDINATION
• SCOPE

14. Untying the knot - together
Creative and innovative examples of multi-dimensional programs are changing
the lives of women, children and communities around the world.
We can no longer say that we don’t know what to do, or we don’t know how.
We need to learn, share and act TODAY.