Delivering for Nutrition in India: Insights from Implementation Research - 24 September 2019

1. Global evidence:
Summary of findings from multiple
evaluations of Social and Behavior
Change Communication (SBCC) programs
Phuong Hong Nguyen
Poverty, Health and Nutrition Division
International Food Policy Research Institute
New Delhi| September 24, 2019

2. Bangladesh: Engaging frontline workers for
delivering counseling through a large-scale
NGO platform implemented by BRAC + Mass
media + Social mobilization
Alive &Thrive – large scale SBCC to improve IYCF practices
Vietnam: A social franchise
model for delivering IYCF
counseling at government
health facilities + Mass media
Ethiopia: Nutrition counseling
through government health
extension platforms in Ethiopia +
Radio

3. It is possible to achieve large, substantial impacts on IYCF in
multiple contexts
18.9
57.8
17.8
28.4
48.5
87.6
51.2 53.5
72.4
82.8
0
20
40
60
80
100
Baseline 2010 Endline 2014
%Exclusivelybreastfed
VN - Intensive VN - Non intensive
BD - Intensive BD - Non intensive
ET
Menon et al., J Nutr, 2016; Menon et al., PloS Medicine, 2017; Rawat et al., J Nutr 2017; Kim et al, PLoS One 2016,
73.7
90.9
75.8
87.9
32.1
63.8
30.0
45.5
6.3
12.4
0
20
40
60
80
100
Baseline 2010 Endline 2014
%Achievingminimumdietdiversity

4. Implementation context/strategy and demand-side context
influences exposure to interventions
85.8
47.6 49.6
66.9
70.9
39.6
0
20
40
60
80
100
Bangladesh Vietnam Ethiopia
%
Mothers of children 0-5 mo
Exposed to interpersonal counseling in previous 6 months
Exposed to mass media
 Ethiopia: Outreach through
government health workers; mass
media through radio spots
 Bangladesh: Outreach through
NGO platform; national TV-based
mass media campaign
 Vietnam: Facility-based
counselling; national TV-based
mass media campaign

5. Utilization/household context affects ability to adopt recommended practices
26.3
87.2
73.3
97.0
0
20
40
60
80
100
Vietnam Bangladesh
%earlyinitiationof
breastfeeding
C-section Non C-section
***
***
Cesarean-section births and early
breastfeeding in Vietnam & Bangladesh
*p<0.05, **p<0.01, ***p<0.001
61.2
75.2
0
20
40
60
80
100
Back to work <6m Back to work ≥6m
%exclusivebreastfeeding
Maternal work force participation and
exclusive breastfeeding in Vietnam
**
44.1
54.8
63.5
0
20
40
60
80
100
Low SES Middle SES High SES
%achieveminimum
dietarydiversity
*
***
Household economic context and dietary
diversity in Bangladesh

6. A&T maternal nutrition interventions in Bangladesh and India
Free distribution of Iron folic acid
(IFA) and Calcium supplementation
Weight measurement in pregnancy
Counseling on hand washing (India)
Counselling on dietary diversity
& quantity
Counselling on breastfeeding
Interpersonal
counseling by
Frontline Health
Workers
Community
mobilization:
Husbands’ forums,
Community
sensitization sessions
Media events
Bangladesh –
BRAC MNCH
program
UP, India-
Government
RMNCH
program

7. Large scale SBCC has substantial impacts on improving
maternal nutrition practices in Bangladesh
Significant increases in dietary diversity
during pregnancy
Significant increases in weight
measurement during pregnancy
Significant impacts on the number of iron
folic acid tables consumed
Significant impacts on the number of
calcium tables consumed
83
140
81
88
50
80
110
140
170
Baseline Endline
NumberofCalciumused
94
139
93 92
50
80
110
140
170
Baseline Endline
NumberofIFAused
60.7
88.7
67.0 65.0
0
20
40
60
80
100
Baseline Endline
%
Intensive
Non-intensive
60.6
98.2
63.7 60.3
0
20
40
60
80
100
Baseline Endline
%

8. What are opportunities and challenges in India?
46
39
35
49
41 38
34 37
29
0
20
40
60
80
100
ANM/LHV AWW ASHA
%
Currently pregnant women Women with children 0-6 mo
Women with children 6-24 moSurvey data (NFHS) highlight that
less than 60% women had any
contact with AWW/ASHA workers
in the last 3 months
52
39
47
35
55
47 44
28
41
0
20
40
60
80
100
Food suppl Health and
nutrition
education
Food suppl Health and
nutrition
education
Food suppl
(6-35 mo)
Food
suppl
(36-59 mo)
Weighing
(<5y)
Counselling
on child
growth
Early
childhood
education
(36-59 mo)
Pregnancy Early childhoodLactation
<40% pregnant & lactating
women received health
and nutrition education; <
30% mothers received
counselling on their child’s
growth

9. What does the existing literature in India tell us?
India has a supportive policy environment for IYCF interventions
Indian policies are well aligned with global evidence on counseling
interventions.
Multiple operational platforms exist that can deliver counseling and
complementary food supplements.
Capacity, finance, and governance gaps are the primary limiting factors in
achieving full coverage of MIYCF counseling and complementary food
supplements.
A significant evidence gap exists in the research evidence base and program
experience

10. Summary
 Global evidence highlights that
 interpersonal contact is key to behavior change
 the platform chosen to deliver interpersonal contact matters in terms of reach
 responses to SBCC efforts vary by behavior because each behavior requires a set
of constraints to be removed.
 In India, evidence base on effective strategies is limited despite many programmatic
efforts
 NFHS data shows that substantial gaps need to be closed to ensure higher contact
between 1000-day households and FLWs.