boosting nutrition impact via integrated program strategies

The PepsiCo Foundation MeetingMarch 31, 2008

Boosting Nutrition Impact via Integrated Program Strategies

Presentation

CORE Spring Meeting

Save the Children April 30, 2010

Heather Danton and Paige Harrigan

UndernutritionMagnitude 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.

Outline Boosting Nutrition: Integration

• Review select program results SC portfolio

• Present some SC standard practices in program design

• Identify gaps in our knowledge

• Discussion

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

AN INTEGRATED PROGRAM DESIGN

Jibon-O-Jibika

Decreased household food insecurity in three

districts of Barisal Division

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

IR1.2: Improved marketing practices adopted

and utilized

IR 2.1: Increased

adoption of key MCHN

practices and utilization of

key MCHN services

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 3.1: Improved

community response and preparedness

to natural disaster

IR 3.2: Improved agency

response 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 1.1: Improved household level food production practices

adopted and utilized

IR 2.2: Improved access to

safe water and

sanitation facilities

IR 2.2: Improved access to

safe water and

sanitation facilities

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.

The median dietary diversity score improved in unions where all program components were working together.

Key Program Results: Integration

Median Dietary Diversity Score

1

2

3

4

5

6

7

Baseline Endline

SO1 & SO2 Unions Non SO1 Unions

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

• 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

Bolivia Integrated Food Security Initiative

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.

Integrated Food Security Program Stunting

24.9

31

0

5

10

15

20

25

30

35

40

45

BL 02 MT 04 FE 08

Intervention

Control

Strategic Objective Increased Use of Key Health and Nutrition Practices and Services

Increased Use of Key Livelihood Practices and ServicesIncreased use of key DRR Practices and Services

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

Intended Impact: Reduced Malnutrition in Children

Reducing MalnutritionThe SC Approach

Addressing MalnutritionThe Window of Opportunity

Source: Shrimpton et al., 2001

We target children

under the age of two

Reducing MalnutritionProven Interventions

We focus on proven

interventions

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

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?

Discussion:

If you want to go fast, go alone. If you want to go far, go together.

African proverb (from Ellen Piwoz):

Thank You

boosting nutrition impact via integrated program strategies

Health & Medicine