Steps for adapting generic ENA tools

1. Understand as menu, science-based2. The key messages booklet3. Training plan4. BCC channels5. Partnerships and harmonization

Customizing ENA messages with

local partners…Literature review; identifying existing toolsFormative research to identify priority practices for context as well as barriers to them & practical solutions to facilitate behavior changeDoer/Non-doer commonly used to identify target groups and communications strategiesUndertaken with partners in their project sitesTailor “Key ENA Messages” booklet to local context & terminology

Optimal Practice

Current Practice

Barriers Appeals/MotivatorsBenefits

Messages Strategies

Formative research approaches

Behavior

Priority Group or Influencing Groups

DescriptionDeterminants

Bridges to

ActivitiesActivities

To promote this

behavior:

among this

audience:

(circle one)

Priority Group:Influencing Groups:

we will research

these

determinants:*These can only be determined after conducting research studies

and achieve these

bridges to

activities

(priority benefits

and priority

barriers):

1.2.3.

by implementing

these

activities:1.2.3.

Designing for Behavior Change (DBC) Framework*

*Adapted from BEHAVE framework by TOPS

• Training (often cascade)• Master trainers • Health workers

- Child Survival/IMCI (Niger, Mali)- HIV (Ethiopia)- CMAM (Liberia)- Hygiene (Bangladesh)

• Community volunteers- Care Groups (mothers)- Agriculture extension agents

Training Plan

Practicum vital

Possible to customize training for: Health managers Health agents Baby-Friendly Hospitals NGO staff Emergencies HIV/AIDS

• Short-term, skills-based training, • Heavy on counseling/negotiation and communication skills (Lots of

practice with real mothers)

Emphasizes building technical and counseling skills of providers

Ethiopia: Customized ENA CoursesTrainer’s Guide

Using the Essential Nutrition Actions to Improve the Nutrition of Women and

Children in Ethiopia

A Four Day Training Coursefor Health Managers and Program

StaffThe Ethiopian Public Health Training

InitiativeFebruary 2004

Trainer’s GuideUsing the Essential Nutrition Actions to Improve the Nutrition of Women and

Children in Ethiopia

A Four Day Training Course forHealth Staff and Managers at PMTCT Sites on Infant Feeding and Women’s Nutrition in the

Context of HIV & AIDSJune 2004

Community level training

• Community volunteers- Community health workers- Mothers groups (Care Groups)- CMAM screening groups- Village Model Farmers (EHFP)- Primary schools (teachers, students)- Micro savings & loan groups

Practicum vital

Care Groups to structure community-

level activities

BC more than messages…

• Knowing the right practice does not guarantee we will do it

• Negotiation skills and multi-channel strategies• Common Barriers to address:– “Insufficient breast milk” (lactation management)– Food access (HFP)– Soap & water access (Tippy-taps)– Child care challenges (rotating day care)– Labor saving devices (mills, improved stoves)

Forge partnerships to harmonize approaches across

different groups…

Many groups using same messages & IEC materials

Everyone sings the same “nutrition” song to the same tune…

Get all partners to focus on targeted concise messages that promote “small do-able actions”

Objective to reach > 80% coverage

Maximizes the delivery of nutrition by integrating into existing services (not a new or separate intervention) Platform to scale up the promotion and support of adequate nutrition & feeding practices...

Pulls together existing vertical programs in a sensible “action-oriented”' way...

Greatly expands coverage to multi level, multi contacts, multi channels…

Provides a solid, science-based framework for training service providers

Advantages of the ENA framework

Thank you

Grateful acknowledgement to Dr Victoria Quinn & Shawn Baker (HKI) and Meera Shekar (WB) for selected slides