Quinn ena 3

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CORE Group Fall Meeting 2010. The Essential Nutrition Actions Framework: More than Just Seven Actions. (Part 3 of 3) - Agnes Guyon, JSI Research and Training & Victoria Quinn, Helen Keller International

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  • # In Madagascar, the partnership was done through the GAIN( ….), non formal mechanisms that allowed exchange, standardization, development of guidelines and strategies, and finally development of the National Nutrition Policy # In Ethiopia, similarly, a non formal group meet quarterly to exchange experience, standardize approach, particularly the ENA approach and establish Guidelines # In both country, Profiles evaluated the consequences of malnutrition, was used as a key tool for advocacy , used as “ Why Nutrition Matters?” in Ethiopia… # The roll-out was faster in Ethiopia with (…..), as we know better how to used Profiles at each event and don’t miss opportunity for an advocacy event. #
  • The first strategy is partnerships. LINKAGES partnered with diverse organizations and institutions to promote optimal infant and young child feeding around the world. These included NGOs and PVOs, international organizations, bilateral organizations, ministries, radio and television networks, print media, and academic institutions. This partnering enabled: Coordinated strategies Collaboration in designing workplans Consensus on strategies at national level Leveraging of human and financial resources Expanded coverage Opportunities for scale up at national level Feedback from multiple partners
  • Regarding the in-service training, manuals from Madagascar were adapted to Ethiopia and for both countries were Customized to target groups and needs…(….) They are (…) Lots of practices, with mothers and babies as much as possible… and outside the classroom # Enrollment of large partners was an important startegic element to go to scale such as USAID bilateral (up to 6 millions in Madagascar and 15 millions in Ethiopia), also the work bank GMP food security project, UNICEF and large NGOs) And estimated of > 4000 health professional were trained in Madagascar, with Various training courses, and more than 5000 in Ethiopia, where many partners Carried out cascade training in their target areas #
  • Here some example of training courses in Madagascar
  • Here some example from Ethiopia
  • Here in Madagascar, where various BCC materials were developed with the same messages and the same pictures. Job Aids were developed and distributed to health workers In addition, Poopy, the number 1 pop singer in Madagascar became in 2000 the BF then the ENA Ambassador with 7 songs on BF, CF, WN, NSC, etc… Poopy sings during concert, make CDs, does press conferences… songs were also distributed to transporters #
  • Here some example of community activities in Madagascar 1) 2) 3) 4) 5) #
  • Quinn ena 3

    1. 1. Key steps for implementing ENA framework at large scale…
    2. 2. … improved advocacy leading to better national policies, strategies and guidelines and increased investment in nutrition … support to community for improved family actions on nutrition … strengthened health & agricultural systems for nutrition … improved service provider capacity through training & supervision <ul><li>Health Workers, </li></ul><ul><li>Agriculture extension workers </li></ul><ul><li>School teachers </li></ul><ul><li>Etc.. </li></ul>1. Work at all levels across sectors Health Agriculture Education Finance Trade
    3. 3. 2. Assess current situation and develop a plan: use participative methods to build ownership
    4. 4. Step 1. Gather and Synthesize Information on the Nutrition Situation Step 2 . Determine Initial Program Goal and Objectives Step 3 . Review Health and Nutrition Services Step 4. Preliminary Program Design: Prevention Step 5. Preliminary Program Design: Recuperation Step 6. Putting It All Together
    5. 5. 3 . Enhance partnerships for Advocacy & Policy <ul><li>Advocate for nutrition (Why Nutrition matters? Analysis – Assessment – Actions) … Journalists; Members of Parliament; Pre-service institutions; Baby Friendly Hospitals; NGOs … </li></ul><ul><li>Facilitate National & regional Coordination </li></ul><ul><li>(Madagascar: 50 partners; Ethiopia: 60 partners) </li></ul><ul><li>Ensure up-to-date National Guidelines </li></ul><ul><li>(IYCF, MN, CMAM, etc..) </li></ul><ul><li>Harmonize implementation … </li></ul><ul><li>ENA messages; BCC strategy; training... </li></ul>
    6. 6.
    7. 7. <ul><li>Burkina : 29 partners </li></ul><ul><li>Mali : 21 partners </li></ul><ul><li>Niger : 69 partners </li></ul><ul><li>Senegal : 19 partners </li></ul>* Potential partners are defined as groups currently active in nutrition field programs, representing government offices, donors and international & local NGOs. Most have been in contact with HKI as per the Repositioning IYCN Initiative in the Sahel. Numbers would increase with inclusion of local university groups and mass media groups (journalists, radio announcers, etc…). Thus, these numbers should be considered conservative as more groups likely to exist. Preliminary Inventory of Potential Partners in Sahelian countries for rolling out ENA framework*
    8. 8. 4. Build on what already exists at all levels <ul><li>Existing systems & interventions, partners, donors, NGOs, associations, institutions, etc.. </li></ul><ul><li>Traditional community groups & systems </li></ul><ul><li>People </li></ul><ul><li>Health contacts </li></ul><ul><li>Outside the health sector </li></ul>
    9. 9. <ul><li>Madagascar Breastfeeding </li></ul><ul><li>Senegal GM/P </li></ul><ul><li>Nigeria, Benin Vitamin A supplementation </li></ul><ul><li>Ethiopia Emergency </li></ul><ul><li>Bangladesh Homestead food production </li></ul><ul><li>… CMAM, etc… </li></ul><ul><li>Partners on the ground: </li></ul><ul><li>Government, NGOs, UN agencies, World Bank, USAID bilateral, etc… </li></ul>New country initiatives: start with existing program entry points…
    10. 10. <ul><li>Customized training targeted to: </li></ul><ul><li>Health managers </li></ul><ul><li>Health professionals </li></ul><ul><li>Baby-Friendly Hospitals </li></ul><ul><li>NGO staff </li></ul><ul><li>Adapted for emergency and HIV/AIDS </li></ul><ul><li>Short-term, skills-based training, </li></ul><ul><li>Heavy on counseling/negotiation and communication skills (Lots of practice with real mothers) </li></ul><ul><li>Madagascar 6 years 4 ,000 people trained </li></ul><ul><li>Ethiopia 3 years > 5,000 people trained </li></ul>5. Build technical and counseling skills of providers Madagascar over 6 years: 4,000 health workers trained in ENA Ethiopia over 3 years: 5,000 health workers trained in ENA
    11. 11. Madagascar: Customized ENA Courses
    12. 12. Ethiopia: Customized ENA Courses Trainer’s Guide Using the Essential Nutrition Actions to Improve the Nutrition of Women and Children in Ethiopia A Four Day Training Course for Health Managers and Program Staff The Ethiopian Public Health Training Initiative February 2004 Trainer’s Guide Using the Essential Nutrition Actions to Improve the Nutrition of Women and Children in Ethiopia 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
    13. 13. New Generic ENA Behavior Change Training for Community Level (English and French)
    14. 14. 6. Promote small do-able actions to demystify nutrition Use same key messages through various IEC tools Formative Research to help to o vercome family and community obstacles Job aids Health booklet Counseling cards Poopy and radio/TV Newsletters Posters
    15. 15. <ul><li>Promote action oriented ENA messages </li></ul><ul><li>Use all contacts across the life cycle </li></ul><ul><li>Use multiple channels: home visits, </li></ul><ul><li>traditional meetings, community events </li></ul><ul><li>Emphasize inter-personal communication (IPC) </li></ul><ul><li>Reinforce IPC with local radio spots in local languages </li></ul>Behavior Change Communication Madagascar over 6 years: 15,000 community volunteers trained in ENA Ethiopia over 5 years: 54,000 community volunteers trained in ENA
    16. 16. <ul><li>Follow-up to training and supportive supervision using standard checklist </li></ul><ul><li>Making standard job aids, guidelines and references available </li></ul><ul><li>P erformance review meetings </li></ul>7. Strengthen the delivery System
    17. 17. 8. Ensure adequate and effective supply <ul><li>Breasts are always there … </li></ul><ul><li>Food availability, access and utilization </li></ul><ul><li>Supply of Vit A, de-worming, ITN </li></ul><ul><li>(Child health events) </li></ul><ul><li>Is the routine system for Vit A, iron/folate, zinc, RUTF, etc… weak? </li></ul><ul><li>Is salt iodized? </li></ul>
    18. 18. 9. Monitoring & Evaluation <ul><li>Process Indicators </li></ul><ul><li>Integration/infiltration </li></ul><ul><li>Guidelines </li></ul><ul><li>Partners </li></ul><ul><li>Training </li></ul><ul><li>BCC materials </li></ul><ul><li>Annual assessments </li></ul><ul><li>RAP </li></ul><ul><li>LQAS </li></ul><ul><li>Projects </li></ul><ul><li>Baseline – End line surveys </li></ul><ul><li>Special surveys </li></ul><ul><li>Nutrition survey </li></ul><ul><li>Emergency </li></ul><ul><li>Micronutrients (Iode, Vit A, etc) </li></ul><ul><li>Nutrition surveillance </li></ul><ul><li>Demographic & health survey </li></ul>
    19. 19. Community volunteers supporting women at chance encounters (market, fields, collecting firewood) Community health festivals Community volunteer making home visits Community volunteers assisting at health clinic Ultimate goal: saturate the environment with improved ENA practices Enroll a large number of volunteers across sectors Agricultural extension workers supporting mothers Health workers supporting mothers
    20. 20. Some pressing issues to address… feedback from the field Inadequate local adaption of ENA training modules Lack of emphasis on practical sessions (counseling/negotiation) in training No systematic system or forum to share or access ENA materials (e.g. training modules or IEC tools) l
    21. 21. By the end of this session, you will have an understanding of… <ul><li>the difference between the 7 ENAs as compared to the ENA Framework? </li></ul><ul><li>what are the many missed opportunities for promoting the Essential Nutrition Actions? </li></ul><ul><li>what are the key steps for implementing the ENA framework at large-scale? </li></ul><ul><li>what role can NGOs play (but not according to Piglet!) </li></ul>
    22. 22. Thank you!
    23. 23. The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, please visit: www.coregroup.org/resources/meetingreports

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