Integration of maternal child health and nutrition interventions in development programs: Experiences and Best practices 1 03 February 2015 Benjamin Aisya M&E Learning Manager

Presentation Outline Description of Community Connector Integration in Community Connector CC Experience: Family Life Schools What is FLS? Why FLS? CC FLS approach Best practices 2

..a quote… 3 …acceleration of progress in nutrition will require effective, large-scale nutrition-sensitive programmes that address key underlying determinants of nutrition and enhance the coverage and effectiveness of nutrition-specific interventions Ruel M.T, Alderman H (2013), Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? The Lancet, Volume 382, Issue 9891, Pages 536–551

a five-year community-based Project, 15 districts in Uganda integrates nutrition and agriculture interventions is funded under Feed the Future initiative FHI360 is prime partner in a consortium of eight partners (two are Universities)FHI360 designed to support the Uganda Nutrition Action Plan & Agriculture Sector Plan C LAdesigned against the Collaborating, Learning and Adapting approach IR 1: Improved nutritional status of women and children IR2: Improved livelihoods of vulnerable populations Poverty reduced among vulnerable households USAID/Community Connector …

CC: Framework for integration 5 Nutritional status WASH and health environment Diet diversification and quality Household food access Child care aspects Nutrient value crops Market value agriculture produce Household disposable incomes Interaction with markets Household savings and credit access Gender Issues and Concerns Behavior Change Communication

CC experience: Infusing group activities 6 Financial literacy WASH Gender VSLA Grants for Enterprise All the CC groups receive these services Agriculture Enterprises Business development Self financed & administered Enterprise selection Community group dialogues (Gender, Family Planning, nutrition, livelihoods and [Social] Behaviour Change Communication) Nutrition & food security Start End

Family Life School: What is it? An approach to disseminate multi-sectoral interventions [evidence-based nutrition interventions integrated with agriculture and livelihoods] to a targeted group of parents, primarily mothers, during the first 1000 days of the child’s life. 7

Family Life School: What is it? 8 Cohorts of learners register in FLS depending on the stage within the 1,000 days: when they are pregnant--mama class; when the baby is between 0 and 6 months of age- Baby class; and when the baby is between 6 and 24 months of age--family class. Learners graduate from one level to the other. Supports 1,200 FLS across 15 districts FLS have reached over 11,000 women Collaborating with 180 health workers and 300 community health teams (volunteers)

Why Family Life Schools? 9 Improve targeting in a bid to strengthen nutrition knowledge and practice Use [same] conditions to stimulate participation Optimize women's time, available health workers Then Now

Family Life Schools: CC approach 10 5.Encourage members to save money weekly or monthly 4.Create a nutrition learning site where FLS members are taught to grow nutrient rich fruits and vegetables for family use. 3.Hold classes for FLS members at least monthly, depending on stage in the 1000 days 2.Hold community outreach events for health and nutrition services three times a year. 1.Mobilize pregnant and postpartum women [and their partners] to join FLS 6.Hold periodic dialogues/meetings to discuss gender equity and family planning topics.

11 Milly Odongo, 24 years old, is married to Brian Odongo. They have two children aged 4 years, and 5 months. “Each time I returned home, my husband would ask me what I learnt. I was happy to explain to him. There was a session were husbands [and men] were invited. My husband, Brian had not accompanied me for Antenatal care during my first pregnancy but after attending FLS, he did come with me for two of the visits. For me, the most significant change I got from the Mama Class was my husband’s support. He became concerned about the amount of work I was doing. He wanted me to take rests in the afternoon.”, Milly narrates her experience We learned together how to hold and place the baby on the breast. It was fun for all of us even for the other men who attended. Milly is still breastfeeding and not giving the baby any other foods. The baby doesn’t fall sick as often and he is healthy”, Brian interjects. Case story: of change

FLS: Best Practices Use local structures, networks and systems to implement initiatives such as FLS; CC uses health workers and community health teams. Advocate for the policy framework to favor/incorporate what is already working; Aspects of FLS considered for the Maternal Infant and Young child road map 12

…a quote… 13 …to eliminate stunting in the longer term, these [nutrition-specific] interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment. Zulfiqar A Bhutta, Tahmeed Ahmed, Robert E Black, Simon Cousens, Kathryn Dewey, Elsa Giugliani, Batool A Haider, Betty Kirkwood,Saul S Morris, H P S Sachdev, Meera Shekar (2008), What works? Interventions for maternal and child undernutrition and survival? The Lancet, Volume 371, Issue 9610, Pages 417–440

Ahsante Sana (Thank you) This presentation is made possible by the generous support of the American people through the support of the United States Agency for International Development (USAID) to FHI 360 contract # AID-617-C The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government. 14