boosting nutrition impact via integrated program strategies
DESCRIPTION
Boosting Nutrition Impact via Integrated Program StrategiesHeather Danton and Paige Harrigan, Save the ChildrenCORE Group Spring Meeting, April 30, 2010TRANSCRIPT
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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
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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.
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Outline Boosting Nutrition: Integration
• Review select program results SC portfolio
• Present some SC standard practices in program design
• Identify gaps in our knowledge
• Discussion
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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
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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
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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.
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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
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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
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• 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
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Bolivia Integrated Food Security Initiative
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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.
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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
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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
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Addressing MalnutritionThe Window of Opportunity
Source: Shrimpton et al., 2001
We target children
under the age of two
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Reducing MalnutritionProven Interventions
We focus on proven
interventions
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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
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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?
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Discussion:
If you want to go fast, go alone. If you want to go far, go together.
African proverb (from Ellen Piwoz):
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Thank You