1. Global Health and WASH Working in maternal and child health, nutrition, HIV and AIDS, and water, sanitation and hygiene World Vision’s “Timed and Targeted Counseling” Approach for Health and Nutrition

2. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH World Vision’s 7-11 strategy is based in part on a behavior change communication approach recognizing that the practice of key health and nutrition behaviors at the individual - household level is fundamental to achieving improved maternal and child outcomes.

3. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH TargetsPregnant Women: -9 months Children: 0-24 months Core interventions 1.Adequate Diet 2.Iron/Folate Supplements 3.Tetanus Toxoid Immunization 4.Malaria Prevention and Intermittent Preventive Treatment 5.Healthy Timing and Spacing of Pregnancy and Birth Preparedness 6.De-worming 7.Facilitate access to Maternal Health Service: ANC PNC, Skilled Birth Attendance, PMTCT, HIV/STI/TB Screening 1.Appropriate Breastfeeding 2.Essential Newborn Care 3.Hand Washing with soap 4.Appropriate Complementary Feeding (6-24 months) 5.Adequate Iron 6.Vitamin A Supplementation 7.Oral Re-Hydration Therapy/Zinc 8.Prevention & Care Seeking for Malaria 9.Full Immunization for Age 10.Prevention & Care Seeking for ARI 11.De-worming (+12 months)

4. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Individual: TTC Community Environment Where does TTC fit in the overall 7-11 strategy?

5. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Timed and Targeted Counseling refers to a CHW/Volunteer approach to extending primary health care counseling to the household level.

6. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH What does this approach entail? Cadres of volunteers who can deliver TTC include CHWs, care group / women’s group volunteers or other existing health voluntary cadre. TTC home visitors make a series of visits to households where there are pregnant women, and through infancy, organizing all of the 7-11 messages to be communicated at the most appropriate times, using a counseling and dialogue-based approach. Caregivers are provided with information, counseling and support to promote practice of a host of critical health and nutrition-related behaviors.

7. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH What does “Timed and Targeted” mean?

8. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH PMTCT

9. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH The TTC Package includes: Introductory Package TTC Programming Guidelines (TTC Toolkit) CHW AIM Assessment Tool Training TTC HVs & Job Aids Facilitators Manual for TTC TTC Workbook (for literate CHW / home visitors) Visual Aids TTC Job Aids: Flip-Book Stories (11 flip- book stories) Household Handbooks (appx. 15 pages) Training of Trainers Training of Facilitator Guidelines/Materials Training of Trainers Guidelines/Materials Other Data Collection and Monitoring System Supervision Guide (in development)

10. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Standardized Counseling Steps Step 1: Review previous meeting and actions that the household agreed to try Step 2: Problem Story and Guiding Questions (Guiding Qs lead users from analyzing as outsiders, to personalizing the issues) Step 3: Positive Story and Guiding Questions (Guiding Qs lead users from understanding the benefits of the actions, to personalizing) Step 4: Dialogue and “Negotiation”, using Household Handbook

11. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Stories at heart of counseling/dialogue Stories written to cover all messages for each household counseling visit Stories told through use of visuals Normally 1or 2 problem stories, and 1or 2 positive stories per visit A structured process for telling stories, asking Guiding Qs, praising existing behaviors, negotiating new behaviors

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17. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Example Guiding Questions 1.At the end of the story, Biba’s baby died. What happened in the story that might have caused that? 2.Can you tell me about pregnant women in this area, about the work that they do and how much they push their bodies when they are pregnant? Is it similar to Biba’s situation, or different? How? 3.Is it common for people to sell nutritious crops because they need the money, instead of eating them? Explain.

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20. EMPOWER, EQUIP, ADVOCATE GLOBAL HEALTH & WASH Thank You ttC/CHW evolved from USAID-funded Pragati Child Survival Project implemented in India (1998 and 2007) Drew on external resources: WHO/UNICEF CHW Curricula (Caring for the Newborn at Home and Counsel the Family on Feeding), American College of Nurse Midwives Home Based Life Saving Skills (counseling methodology), USAID/Health Care Improvement Project CHW- AIM (functionality assessment), and UNICEF Facts for Life Key contributors: Michele Gaudrault, Danielle Chekarou, Dan Irvine, and Fe Garcia M&E package and database – above authors and Beulah Jayakumar, Annette Ghee, and Polly Walker For more information: www.wvi.org/health