1. 7/9/2010 1 Addressing Behavior Change at Scale Lessons from the Mat Troi Be Tho Public Sector Social Franchise in Viet Nam 2014 Global Conference on Social Franchising for Health October 22–24, 2014, Cebu, Philippines

2. 22-24 Oct 2014 2 A&T Viet Nam Franchise Model In Viet Nam, 1 out of 3 children under five is stunted * Key contributor is poor infant and young child feeding practices (IYCF) Research Question  Can large scale behavior change for improved IYCF be delivered by institutionalizing standardized counseling services using social franchising principles? * Data Source: Nutrition Surveillance 2010, National Institute of Nutrition

3. 22-24 Oct 2014 3 A&T Viet Nam Franchise Model From 2010-2012, ~800 social franchises were established through the public health system across 15 of 63 provinces to provide good quality infant and young child feeding (IYCF) counseling services From 2011-2013, the Mat Troi Be Tho website, Fanpage and Mobile Application were launched

4. 22-24 Oct 2014 4 Methodology Design – Determine feasibility of delivery, identify priority behaviors, develop a standardized IYCF service package Start-up – Co-franchising arrangements established at the outset ensured government stewardship of the model Measurement, Learning & Evaluation – Rigorous monitoring systems and process evaluation enabled continual refinement of the model and measurement of metrics

5. 22-24 Oct 2014 5 Advocacy Strategic use of data Partnership & Alliances for Strategy, Scale and Sustainability Interpersonal Communication & Social Mobilization Mass media Alive & Thrive program components for improving Infant and Young Child Feeding (IYCF) practices 2 1 3 4 SUB-NATIONALNATIONAL 5 Improved knowledge, beliefs, skills and environment Improved breastfeeding & complementary feeding practices Improved health outcomes Findings (1) – Multi-pronged approach critical for change at scale

6. 22-24 Oct 2014 6 Findings (2) – Franchise model can deliver preventive services 1. EBF Promotion 3 rd Trimester Pregnancy 3 Contacts - 7 th, 8 th, and 9 th month of pregnancy 2. EBF Support Delivery 1 Contact - At delivery and during stay at health facility 3. EBF Management 0–6 months 4 Contacts - One contact 2– 4 weeks post delivery; 3 between 1– 6 months 4. CF Education 5–6 months 1 Contact - 5–6 months 5. CF Management 6–24 months 6 Contacts - Between 6 to 24 months of age 15 contacts over 27 months (minimum = 9 contacts) 8 contacts7 contacts Create behavior change materials and products to support face-to-face counseling

7. 22-24 Oct 2014 7 Findings (3) – Linkage with Public Health System Linkages with the public health system at various levels promote the long-term sustainability of the model Linkages created from the commune to the national level (horizontal and vertical linkages) This has encouraged government stewardship, facilitated ownership over the model, and fostered IYCF champions (at all levels of engagement) Sustainability and replication plan is in place and handover is currently underway

8. 22-24 Oct 2014 8 Performance Metrics Coverage: Reached more than 80% of mothers with children under 2 years in catchment area Reached a total of ~600,000 unique clients (January 2012 to July 2014) Volume: ~100,000 counseling contacts delivered per month across the network ~2,000,000 counseling contacts (January 2012 to July 2014) > 1,500,000 unique visitors to the website, 30,000 forum members Source: A&T Monitoring Data

9. 22-24 Oct 2014 9 Performance Metrics: Outcome 21% Data Source: Process Evaluation 2010 & 2013 Data n=2042n=2,045 Exclusive breastfeeding more than tripled

10. 22-24 Oct 2014 10 Performance Metrics: Sustainability & Replication In 2014-2015, approximately 250 more franchises will be set up, bringing the total to >1000 franchises Replication and sustainability financed primarily by provincial government resources

11. 22-24 Oct 2014 11 Lessons Learned Feasibility Assessment – A critical, but often overlooked step Social franchising design – Provider and client behavior change strategy Models are not static – Continuous monitoring and documentation with modification

12. 22-24 Oct 2014 12 Acknowledgements Alive & Thrive in Viet Nam is funded by the Bill & Melinda Gates Foundation The Mat Troi Be Tho Social Franchise Model in Viet Nam is managed by FHI 360 and implemented by Save the Children in close partnership with the National Institute of Nutrition, Ministry of Health and Provincial Departments of Health

13. 22-24 Oct 2014 13 For more information, visit www.aliveandthrive.orgwww.aliveandthrive.org and www.mattroibetho.vnwww.mattroibetho.vn