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Alive & Thrive: “Can we scale up nutrition?”
1 Designing the Future of Nutrition SBCC | Bethesda, MD | November 2014
Can we scale up infant and young child
feeding programs?
2
Yes! We can scale up
Bangladesh ~6.5 million
Ethiopia 2 million
Interpersonal: 3.7 million mothers Mass media:
4
Yes! We can change behaviors
*A&T intensive areas only
Increased exclusive breastfeeding
5
More diverse complementary feeding
Yes! We can change behaviors
Perc
ent c
onsu
min
g fr
om 4
or m
ore
food
gro
ups
*A&T intensive areas only
Overview
• A&T Framework for scaling up nutrition • A&T design for measurement, learning &
evaluation • Early results: What we’ve learned about what
it takes to be: – Scalable – Effective
6
A&T Framework for scaling up
7
Changing social norms, engaging people throughout society
8
Changing social norms, engaging people throughout society
9
Changing social norms, engaging people throughout society
10
A&T measurement, learning & evaluation
(MLE)
11
Key research questions
• What impact did A&T have on IYCF practices and stunting? – A&T-intensive vs. mass media only
• How was this impact achieved? – Reach – Quality – Intensity – Cost
12
Measurement, learning & evaluation at a glance: Viet Nam
Measurement, learning & evaluation at a glance: Viet Nam
Measurement, learning & evaluation at a glance: Viet Nam
Measurement, learning & evaluation at a glance: Viet Nam
Measurement, learning & evaluation at a glance: Viet Nam
Overall A&T evaluation, Bangladesh Cluster randomized design (cRCT)
18
What have we learned?
SCALABLE EFFECTIVE
19
What we’ve learned about how to reach
SCALE
SCALE: Think big, really big
21
BRAC contacts in a single month, Bangladesh
Viet Nam
Reach varied in different contexts Interpersonal counseling
Mass media
92% 73% 45%
62% 30% 85%
Bangladesh Ethiopia
2013 data
What we’ve learned about how to be
EFFECTIVE Intensity matters
More than mothers Focus on drivers of behavior
What we’ve learned about how to be
EFFECTIVE Intensity matters
25
Intensity matters
Source: Nguyen PH, et al. Program impact pathway analysis of a social franchise model shows potential to improve infant and young child feeding practices in Viet Nam. Journal of Nutrition (in press).
Preliminary findings, Viet Nam
Dramatic increase in exclusive breastfeeding
Intensity matters
26
Perc
ent e
gg c
onsu
mpt
ion
Number of A&T activities Ethiopia
What we’ve learned about how to be
EFFECTIVE More than mothers
Changing social norms, engaging people throughout society
28
29
Bangladesh TV spot
What we’ve learned about how to be
EFFECTIVE Focus on drivers of behavior
Behavior change model, Viet Nam
31
Supportive environment
What we’ve learned about effective: Changing behavioral determinants
• Beliefs about outcomes – Does not believe exclusively breastfed infant will
be thirsty (OR=1.54) • Perceptions of social norms
– Most women like me feed their infants only breastmilk (OR=1.77)
• Self-efficacy – My breastmilk is good enough to nourish my
infant for 6 months (OR=1.78)
32
33
Viet Nam TV spot
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Aug-11 Feb-12 Aug-12 Feb-13 Aug-13
Trends in behavioral determinants
Believes her BM is enough Believes EBF for 6m is the norm Does not believe exclusively BF infant will be thirsty
Behavioral determinants have improved
34
n=2,305 (Aug 11); n=2,065 (Oct 12); n=2,321 (May 13); n=2,593 (Oct 13)
Viet Nam
Self-efficacy
Social norm
Belief about outcome
SCALABLE
Intensity
More than mothers Behavioral determinants
EFFECTIVE
At the deep dive… How can we help countries scale up NOW?
36 Designing the Future of Nutrition SBCC | Bethesda, MD | November 2014
Alive & Thrive:�“Can we scale up nutrition?”Can we scale up infant and young child feeding programs?Yes! We can scale upYes! We can change behaviorsSlide Number 5OverviewA&T Framework for scaling upChanging social norms, engaging people throughout societyChanging social norms, engaging people throughout societyChanging social norms, engaging people throughout societyA&T measurement, learning & evaluationKey research questionsSlide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Overall A&T evaluation, Bangladesh�Cluster randomized design (cRCT)What have we learned?What we’ve learned about how to reach�SCALESCALE: Think big, really bigReach varied in different contextsWhat we’ve learned about how to be�EFFECTIVEWhat we’ve learned about how to be�EFFECTIVEIntensity mattersIntensity mattersWhat we’ve learned about how to be�EFFECTIVEChanging social norms, engaging people throughout societyBangladesh TV spotWhat we’ve learned about how to be�EFFECTIVEBehavior change model, Viet NamWhat we’ve learned about effective: Changing behavioral determinantsViet Nam TV spotBehavioral determinants have improved�SCALABLE�At the deep dive…�How can we help countries scale up NOW?