The document summarizes an integrated nutrition program in Bangladesh called Jibon o Jibika that targeted 200,000 children under age 2. It showed that reducing undernutrition was more effective when all program components, such as food production, marketing, health, water and sanitation, were implemented together. Stunting, wasting, and being underweight declined more in areas where all components worked together. Dietary diversity and income also increased more in integrated areas. The document discusses proven interventions to reduce undernutrition and calls for more evidence on how best to integrate different sector approaches, prioritize interventions, and strengthen programs targeting mothers and children under age 2.

1. The PepsiCo Foundation Meeting March 31, 2008 Boosting Nutrition Impact via Integrated Program Strategies Presentation CORE Spring Meeting Save the Children April 30, 2010 Heather Danton and Paige Harrigan

2. Undernutrition Magnitude of the Problem Over 178 million children under age 5 stunted Undernutrition is the largely preventable cause of 35% of child deaths (3.5 million annually) and 20% of maternal deaths Poor fetal growth or stunting (low height for age) during pregnancy and the first 2 years of life leads to irreversible damage, with permanent reductions on physical growth, intellectual development, and economic productivity Proven maternal and child nutrition interventions are available to reduce undernutrition childhood illness, and deaths in poor communities. We seek the most effective and sustainable strategies to reduce undernutrition. Integration recommended.

3. Outline Boosting Nutrition: Integration Review select program results SC portfolio Present some SC standard practices in program design Identify gaps in our knowledge Discussion

4. Jibon o Jibika (Life and Livelihoods Program) Bangladesh 2004-2009 Implemented in collaboration with Helen Keller International (HKI), the NGO Forum for Water and Sanitation, the Cyclone Preparedness Programme (CPP) of the Bangladesh Red Crescent Society and 14 local NGO partners with offices in Barisal Division, Bangladesh. Jibon o Jibika explicitly directed at reducing high levels of food insecurity and malnutrition and is being implemented in 13 upazilas in three districts of southwest Bangladesh. Targeted 200,000 children U2

5. AN INTEGRATED PROGRAM DESIGN Jibon-O-Jibika Decreased household food insecurity in three districts of Barisal Division SO1: Food availability and purchasing power at the household level will have increased SO2: Health and nutrition of pregnant women and children under the age of two will have improved SO3: Communities and households will be more resilient to shocks that threaten their livelihoods IR1.2: Improved marketing practices adopted and utilized IR 2.1: Increased adoption of key MCHN practices and utilization of key MCHN services IR 3.1: Improved community response and preparedness to natural disaster IR 3.2: Improved agency response to natural disaster IR 1.1: Improved household level food production practices adopted and utilized IR 2.2: Improved access to safe water and sanitation facilities

6. Key Program Results: Integration Disaggregated data show that reduction of prevalence in stunting, wasting and underweight is much higher in unions where all program components were implemented.

7. Key Program Results: Integration The median dietary diversity score improved in unions where all program components were working together.

8. Key Achievements JOJ Production of vegetables in home gardens and consumption of vegetables and poultry increased. 78% of HFP HHs have successfully increasing egg production 34% of HHs have adopted improved production techniques. The end line survey shows that the adoption increases over time. Income increased, Women gained more access to income, Consumption increased

9. Reduced incidences of dehydration and ARI ANC visits (3) increased <20% baseline to 85% Exclusive breastfeeding increased from 30% BL to 64% EL Complementary foods in addition to breastfeeding at >6 months increased from 50% BL to 94% EL Continued feeding child when sick increased from 60% BL to 80% EL Key Achievements JoJ

10. Bolivia Integrated Food Security Initiative

11. Key Achievements Integrated FS Initiative Bolivia Reduction in stunting (low height for age): among children 3-35 months from 37 percent in 2002 to 23.3 percent in 2008. Reduction in underweight (low weight for age): among children 3-35 months from 16.7 percent in 2002 to 9.7 percent in 2008. Improved exclusive breastfeeding from 75.4 percent in 2002 to 85.1 percent in 2008 i. Improved access to water : the proportion of households with year-round access to new or improved safe water sources increased from 59 percent in 2002 to 88 percent in 2008. Increased income : on average, beneficiary households experienced a three-fold increase in annual earnings from $513 in 2002 to $1,673 in 2008.

12. Integrated Food Security Program Stunting

13. Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Increased Use of Key Livelihood Practices and Services Increased use of key DRR Practices and Services Intended Impact: Reduced Malnutrition in Children Reducing Malnutrition The SC Approach Intermediate Result 1: Increased Access to, & Availability of, food and health services Intermediate Result 3: Improved Knowledge, Attitudes, and Skills Intermediate Result 4: Enabling Social & Policy Environment Intermediate Result 2: Increased Quality Of Services

14. Addressing Malnutrition The Window of Opportunity Source: Shrimpton et al., 2001 We target children under the age of two

15. Reducing Malnutrition Proven Interventions We focus on proven interventions

16. Enhanced focus on Cross-Cutting themes integration Child Focus Community mobilization Gender Equity Monitoring and Evaluation Extending BCC and Formative Research beyond MCHN Documenting Program Experience E.g., Breastfeeding promotion, complementary feeding, CMAM, income generation/child well-being

17. GAPS/Questions How to define integration (program and to larger scale) How to balance high coverage with highly integrated multi-sector approaches (and cost per beneficiary) How does one prioritize interventions within an integrated strategy? How can we strengthen the evidence base to determine strongest (livelihoods) determinants to reducing undernutrition? To what degree does one need to prioritize HHs with PLW and Children U2 for optimal and sustained results?

18. Discussion: If you want to go fast, go alone. If you want to go far, go together. African proverb (from Ellen Piwoz):

19. Thank You