1. Experience from Ethiopia
Improving Women’s and Children’s Nutrition through Targeted Capacity Building Interventions:
Experience from Ethiopia
Medhin M., Jirga A. and Guyon A
IUNS 20th International Congress of Nutrition, Spain September 19, 2013
Presented by: Agnes Guyon MD.MPH. Senior Child Health & Nutrition Advisor – JSI

2. Presentation Outline Background Achievements
Challenges/Lessons Learned
Ways forward

3. Trends in nutritional status of children
Based on WHO reference standard
Percent of children under age of 5 years

4. Based on WHO reference standard
Trends in nutritional status of women
Based on WHO reference standard

5. Integrated Family Health Project
Works in 4 regions serving a population of more than 35 million people
Nutrition is one component among a comprehensive mix of maternal and child health interventions.
Nutrition, through the Essential Nutrition Actions (ENA) framework, allows an effective implementation of High Impact Nutrition Interventions at scale by
using all existing health contacts
enhancing community involvement
And has BCC as a back bone
The goal is to improve nutrition practices, targeting women (pregnancy & lactation) & children under 2
(1000 days – Window of opportunities)
Works in 4 regions (Amhara, Oromia, SNNP, Tigray) –more than 35 million people
Nutrition is one component among other maternal and child health interventions (EPI, Sanitation, FP, RH, ENC, IMNCI, Community-MNCH), done in partnership with BMGF Alive & Thrive project.
Nutrition, through the Essential Nutrition Actions approach, allows an effective implementation of High Impact Nutrition Interventions, at scale by
using all existing health contacts
enhancing community involvement
And has BCC as back bone
The goal is to improve nutrition practices, targeting women (pregnancy & lactation) & children under 2 (1000 days – Window of opportunities) 5

6. Nutrition Program Components
Adapted from previous success (USAID-ESHE-LINKAGES projects) PO 0717 &
in partnership with BMGF Alive & Thrive project
Advocacy for health managers
Sensitization workshop on “why stunting/nutrition matters?”
Training for health providers.
ENA/MIYCN (BCC +SAM)
BCC special focused on CF
Integrated Refresher Training (IRT)
Post-training review meetings
Integrated Supportive Supervision (ISS) & Post ISS review meeting
- This 4 key elements were presented before and are summarized on this slide: #
The first one forming partnerships at all levels, from the community up to the national level, so a united front is promoting nutritional improvements,
- The second. carrying out skills-based training, both in-service as well as pre-service.
- The third, promoting community action to disseminate messages and based on negotiation with mothers and family members to adopt new improved practices, and
- Fourth, using Behaviors change communication approach using support and mass media to reinforce those messages and actions
Community mobilization by Mobile Vans 6

7. Radio spots Family Health Card
To assist health providers & families to adopt small do-able actions, through counseling & negotiation
Complementary feeding tool
Radio spots
To assist health providers in counseling & negotiation
Food demonstration
MCH job aides
To improve quality of basic health services at each contact
To re-enforce messages 7
Mobile vans 7

8. Ultimate goal: saturate the environment with
improved MNCH-ENA practices
Enroll a large number of actors
across sectors
HW-HEW support mothers
Community volunteers assist at health facilities
Community volunteer make home visits
Here some example of community activities in Ethiopia 1) 2) 3) 4) 5) #
Community volunteers support women at chance encounters (market, fields, collecting firewood)
Community health festivals
Agricultural extension workers support mothers 8

9. Background
Achievements
Challenges/Lessons Learned
Ways forward

10. Major Achievements
2010
2011
2012
2013
Total
Advocacy “why stunting/nutrition matters?” (ENA Technical) 31 30
229
171
416
Health workers trained on ENA/MIYCN
864
1,744
2,878
2,380
7,866
Health work trained on IRT -
1,824
Post training review meetings
2,712
Integrated Supportive Supervision 84
167
200
231
682
The expansion of MNH activities will be tailored to each region’s context and request for assistance in specific sites and in accordance with each RHB and IFHP’s resources. The program sticks to its principles of working within the existing public health system framework, the primary health care unit approach, comprehensive intervention, stepwise activity implementation, engagement of the local community and partnership with other implementing agencies. The main objective remains to be promoting the health center (HC) as the best place to provide delivery services and Basic Emergency Obstetric Care (BEmONC) and the primary hospital to provide Comprehensive Emergency Obstetric Care (CEmONC). Additionally, the health extension workers (HEWs) (either in rural or semi-urban areas) are the entry point for pregnant women and their newborns to access services.

11. Breastfeeding practices
Monthly randomized “Follow-up Surveys” among 2560 Households
All results significantly higher in intervention area %
As you can see on the left of this graph, in the original program on which this present study was based, exclusive breastfeeding went from a baseline level of 46% to 68% in the first 10 months, then thereafter to a peak level of 83% after 22 months. This original program covered a population of over 6 million people living in 10 districts located in two highland regions of the country.
The present study, shown on the right side, showed increases from 29 to 52% in exclusive breastfeeding levels over a period of 9 months.
As mentioned before, one reason for the quickness of our Study’s results was that the field approach existed and just needed fine-tuning before being used in the two new coastal regions.
TIBF: Timely Initiation of breastfeeding
EBF: Exclusive breastfeeding 0-5 months
*** p<0.001

12. Complementary feeding practices & Vitamin A supplementation
Monthly randomized “Follow-up Surveys” among 2560 Households
All results significantly higher in intervention area %
As you can see on the left of this graph, in the original program on which this present study was based, exclusive breastfeeding went from a baseline level of 46% to 68% in the first 10 months, then thereafter to a peak level of 83% after 22 months. This original program covered a population of over 6 million people living in 10 districts located in two highland regions of the country.
The present study, shown on the right side, showed increases from 29 to 52% in exclusive breastfeeding levels over a period of 9 months.
As mentioned before, one reason for the quickness of our Study’s results was that the field approach existed and just needed fine-tuning before being used in the two new coastal regions.
ICF: Introduction of Complementary Foods
Frq: Frequency of feeding
VAS: Vitamin A supplementation

13. Women’s micronutrient supplementation Monthly randomized “Follow-up Surveys” among 2560 Households%
As you can see on the left of this graph, in the original program on which this present study was based, exclusive breastfeeding went from a baseline level of 46% to 68% in the first 10 months, then thereafter to a peak level of 83% after 22 months. This original program covered a population of over 6 million people living in 10 districts located in two highland regions of the country.
The present study, shown on the right side, showed increases from 29 to 52% in exclusive breastfeeding levels over a period of 9 months.
As mentioned before, one reason for the quickness of our Study’s results was that the field approach existed and just needed fine-tuning before being used in the two new coastal regions.
IFAS: Iron Foclic Acid Supplementation
VAS: Vitamin A Supplementation
*** p<0.001 13 13

14. Background
Achievements
Challenges/Lessons Learned
Ways forward

15. Challenges
Limited resources for nutrition within a broad health project
High public sector staff turn over
Nutrition competes with other multiple responsibilities of health workers and health extension workers
Poor household-level practices, in particular complementary feeding for children and women’s diet

16. Lessons Learned
Delivery of nutrition can be improved through the health system contact points
Post-training follow-up visits and regular review meetings were important tools to fill nutrition- related gaps
Use of community level opportunities were very important for nutrition implementation
Community level complementary feeding demonstration seems to result in improved practices

17. Ways Forward
Support heath system strengthening, including delivery of high-impact nutrition interventions
Continue health managers sensitization on stunting and “why nutrition matters”
Integrate post-training follow-up and supportive supervision into front-line staff capacity building
Standardize and collaborate with partners

18. Thank You!!!!!!