Which kinds of Social Safety Net Transfers Work best for the Rural Ultra Poor? OVERVIEW ON NUTRITION BEHAVIOURAL CHANGE COMMUNICATION COMPONENT Dhaka, 03 December 2013 Jessica Staskiewicz WFP

Nutrition Behavioural Change Communication 1,000 female participants (with<2s) receiving intensive, holistic Nutrition BCC in two treatment arms: 1. Food & BCC (in south only) 2. Cash & BCC (in north only) Transfers are conditional on the female participants engagement in the nutrition behavioural change communication sessions

Design of the Nutrition BCC Aim : to improve the nutritional status of women and young children Training Modules: 1.Overall importance of nutrition and diet diversity for health; 2.Micronutrients: diversifying diets - Vitamin A 3.Micronutrients: diversifying diets - iron, iodine, and zinc 4.Feeding young children: breastfeeding 5.Feeding young children: complementary feeding 6.Maternal health care and nutrition 7.Hand-washing/hygiene for improving nutrition and health

Improved Nutrition <2s 1. Primary Audience: mothers 2. Influential household members 3. Influential community members Delivery Method Locally recruited Community Nutrition Workers (CNWS) deliver messages to: Group Meeting & 2 HH visits/month Monthly Group Meetings

Ensuring quality in implementation 5 days initial training and orientation of Community Nutrition Workers  Training Aids: nutrition manual, posters, and flash cards independent consultant identified gaps and appropriate follow-up measures: 1.Regular refresher training for CNWs scheduled over project period  Training tailored to need  Improving knowledge, delivery, and interpersonal communication  Exchange visits by high-performing CNWs 2.Improved supervisory support to the CNWs  Training of direct supervisors - Field Facilitator Officers  Cooperating Partner (ESDO) recruited nutritionists in north and south 3.improved monitoring strategy and tools

Revisiting the Nutrition BCC Strategy: Year 2  Efforts undertaken to avoid training fatigue by CNWs and participants;  Transition from group based instruction towards participatory approaches at the household level  Revision to the modules- remove reference to jargon and technical terms (i.e. simplified message on diet diversity instead of references to iron, iodine, zinc to)  Focus on HH visits – CNWs trained in HH level counselling, identifying issues and applying practical real-life examples  A core team was also established in each upazila, including 1-2 competent CNWs and one Field Facilitation Officer to lead the training-of-the-trainers refresher sessions.

Challenges  CNWs: work long hours, receive inadequate supervisory support, and are underpaid  Require incentives to encourage on the job learning, and improve performance.  Difficulty mobilising the community elites to support change in social norms  Require complementary interventions that include broader communication strategies incl media.  The nutrition BCC is intensive and subsequently expensive. It may not provide a replicable model for the Government.  Require cost-benefit analysis. The relative impact of BCC (determined at 2 year endline) may yet prove that nutrition BCC is a cost-effective approach to preventing child undernutrition.