Creating Evidence for Policy Reform SBCC on Nutrition Creating Evidence for Policy Reform Lessons Learning on Intensive Nutrition BCC combined with Livelihood Interventions: Transfer Modality Research Initiative (TTMRI), Bangladesh Experience Author: Monira Parveen (WFP, Bangladesh) Presenter: Pontsho Sepoloane

Project location and description Overall Objective Provide evidence that can be used to enhance the social safety net system in Bangladesh to cost-effectively improving food and nutrition security and livelihoods among the food insecure. High food insecurity Easy access to markets (offer wide range of foods & non-foods) Good road infrastructure Measure the impact and cost-effectiveness of different transfer modalities on Household Income; Household Food Security; Child Nutrition (especially stunting) Evaluate the process of delivering benefits; solicit feedback from participants Explore different transfer modalities Food or cash; combined with behavioural change communication (BCC) on nutrition Explore innovative approaches Intensive Nutrition Training (BCC) ; Mobile banking for cash transfers Under the initiative, 4,000 ultra-poor women and their 21,600 family members in the northwestern and southern regions of Bangladesh received a monthly transfer for 24 months from May 2012 to April 2014. Low food insecurity compared to North Prone to floods Poor road infrastructure Poor access to markets Period: May 2012- April 2014

Food & Nutrition BCC (South) Project specific objectives 1. Which kinds of social safety net transfers are most effective for the rural food insecure? Specific objectives 2. Explore different transfer modalities 5 ‘arms’ Cash Cash & Nutrition BCC (North) Food & Nutrition BCC (South) Food Food & Cash Transfer impact on food security and income was evaluated at HH whilst on nutrition was at individual level. Cash transfers were 18.66 US Dollars and the value of food provided was equivalent to the cash transfer amount. Food transfers entailed Rice, cooking oil and pulses Cash allowed for consumers to buy diverse foods which included dairy and vegetables Participants: Women with children U-2 3. Explore innovative approaches

One topic/m and each repeated twice/yr Nutrition BCC: Objective To improve Nutrition, Care & Hygiene (relevant) behaviors of Mothers/Caregivers leading to improved nutritional status of young children. Practice Motivation Awareness One topic/m and each repeated twice/yr 7 Modules In two ‘arms’ 1,000 women with children < 2 years received intensive, holistic Nutrition BCC Services Transfers were conditional on the women’s engagement in the Nutrition BCC Group/Individual sessions This messages were given by Community nutrition workers receiving stipend from WFP CNW were trained and had 2 years experience prior to being recruited Behaviours that were targeted were (1) Diet diversity practice by the family; (2) Recommended IYCF practice;(3) Recommended Essential Health care during pregnancy and lactation; (4) Handwashing at critical times, use of sanitary latrine & food hygiene at consumption Importance of nutrition and diet diversity for health Micronutrients: diversifying diets - Vitamin A Micronutrients: diversifying diets - iron, iodine, and zinc IYCF: Breastfeeding IYCF: Complementary Feeding Maternal Nutrition & Health Care Essential Hygiene Practices (relevant to Nutrition: e.g. Hand- washing, Sanitary Latrine) Each month, each direct beneficiary had at least 4 contacts on a single topic

BCC Training strategy (TMRI) Training duration for frontline staff Initial 5 Days fundamental , 1 day refresher bi-monthly and Continued Coaching as and when needed Communication techniques Issue and beneficiary based communication principles, techniques, steps were explained (including role play) Understanding/learning of frontline staff on good and poor quality of implementation Continuous monitoring feedback system allowed them to understand on the quality aspects of BCC delivery. WFP’s role in the training Lead Technical Role: WFP had strong input in the design of the training strategy, facilitation of BCC Training, mentoring and monitoring on BCC service delivery

Delivery Method Improved Nutrition <2s Locally recruited Community Nutrition Workers (CNWs) delivered messages to: Monthly Group Meetings Improved Nutrition <2s 1. Primary Audience: mothers 2. Influential household members 3. Influential community members Fundamental 5 days long training included In depth Internalization on messages/subjects of BCC; IEC/Job Aids/Tools/Checklists to be used Communication and Counselling techniques/steps for various audiences Practical Demonstration on the various forms of BCC (Group meetings, court yard sessions, individual counselling) ; Field Practices Interactive and participatory approach; open discussion, role play, case study, trouble shooting Internalization on the Weekly/Monthly BCC delivery Schedule (in various forms); Reporting on BCC (BCC conduction, HHs visits observation, counselling) CNW were capacitated using various methodologies such as lectures,role play, field visits, demostrations groupwork, etc. Weekly Group Meeting, Individual Counselling & HH visits Monthly Group Meetings Reviewed and reinforced BCC after initial period

Impact on Nutritional status of children in the North Cash +BCC reduced stunting by 7.3 percentage points

Impact on Nutritional status of children in the South

Impact of TMRI on Maternal Knowledge on breastfeeding The was significant diference between mother’s knowledge on what not to feed baby below 6 months water in the cash and SBCC group Reviewed and reinforced BCC after initial period

Impact of TMRI on Maternal Knowledge on breastfeeding The was significant diference between mother’s knowledge on what not to feed baby below 6 months water in the Food and SBCC group Reviewed and reinforced BCC after initial period

Impact of TMRI on Maternal Hygiene Practices

Best Practices/ Key lessons (TMRI) Intensity of the communication & coverage (SBCC) Monitoring system and feedback loop (SBCC) Capacity Enhancement for the Service providers including Motivational communication, offering encouragement and mitigating challenges Linkage with transfers ensures active/enthusiatic participation and immediate practice Intensity of the communication & Coverage at the field level: convenient ratio of CNW vs participant (1:20 at Max) Well defined monitoring system, tools and feedback loop : for both the delivery and training Intensive investment in continuous Capacity Enhancement for the Service providers (CNWs) as the change agents and their supervisors: capacity gap assessment, fundamental 5 days training, bi-monthly refresher sessions Motivational communication encouraging for adopting change, mitigating challenges Linkage with transfer offering participation and involvement, providing means for immediate practice (cash) Improved food consumption leading improved nutritional staus reflected in childhood stunting reduction by three fold of nations rate/yr Target of Influential members including male, Peer networks to create inclusive environment and support . Addressing challenges Messaging: Keeping it simple for understanding, familiar, expressing appealing benefits , relevant to their daily life Service provider (CNW) - participant relationship of trust Follow-up/Household visits; observing the actual practice Sustaining behavior change beyond BCC : encouraging positive behaviors, continuing peer interaction etc.

Conclusion Well define and comprehensive Nutrition BCC integrated in livelihood/food security transfers, in particular (cash transfers): Improves dietary diversity (food consumption scores) specially animal foods (dairy, meat, eggs, fish) leading to reduction in undernutrition Can improve maternal knowledge on Breastfeeding Can result in significant improvements WASH practices Intensity of the communication & Coverage at the field level: convenient ratio of CNW vs participant (1:20 at Max) Well defined monitoring system, tools and feedback loop : for both the delivery and training Intensive investment in continuous Capacity Enhancement for the Service providers (CNWs) as the change agents and their supervisors: capacity gap assessment, fundamental 5 days training, bi-monthly refresher sessions Motivational communication encouraging for adopting change, mitigating challenges Linkage with transfer offering participation and involvement, providing means for immediate practice (cash) Improved food consumption leading improved nutritional sttaus reflected in childhood stunting reduction by three fold of nations rate/yr Target of Influential members including male, Peer networks to create inclusive environment and support . Addressing challenges Messaging: Keeping it simple for understanding, familiar, expressing appealing benefits , relevant to their daily life Service provider (CNW) - participant relationship of trust Follow-up/Household visits; observing the actual practice Sustaining behavior change beyond BCC : encouraging positive behaviors, continuing peer interaction etc.

Thank you! For additional information contact: Monira Parveen at Monira.parveen@wfp.org