Alive & Thrive: “Can we scale up nutrition?”

1 Designing the Future of Nutrition SBCC | Bethesda, MD | November 2014

Can we scale up infant and young child

feeding programs?

2

Yes! We can scale up

Bangladesh ~6.5 million

Ethiopia 2 million

Interpersonal: 3.7 million mothers Mass media:

4

Yes! We can change behaviors

*A&T intensive areas only

Increased exclusive breastfeeding

5

More diverse complementary feeding

Yes! We can change behaviors

Perc

ent c

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g fr

om 4

or m

ore

food

gro

ups

*A&T intensive areas only

Overview

• A&T Framework for scaling up nutrition • A&T design for measurement, learning &

evaluation • Early results: What we’ve learned about what

it takes to be: – Scalable – Effective

6

A&T Framework for scaling up

7

Changing social norms, engaging people throughout society

8

Changing social norms, engaging people throughout society

9

Changing social norms, engaging people throughout society

10

A&T measurement, learning & evaluation

(MLE)

11

Key research questions

• What impact did A&T have on IYCF practices and stunting? – A&T-intensive vs. mass media only

• How was this impact achieved? – Reach – Quality – Intensity – Cost

12

Measurement, learning & evaluation at a glance: Viet Nam

Measurement, learning & evaluation at a glance: Viet Nam

Measurement, learning & evaluation at a glance: Viet Nam

Measurement, learning & evaluation at a glance: Viet Nam

Measurement, learning & evaluation at a glance: Viet Nam

Overall A&T evaluation, Bangladesh Cluster randomized design (cRCT)

18

What have we learned?

SCALABLE EFFECTIVE

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What we’ve learned about how to reach

SCALE

SCALE: Think big, really big

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BRAC contacts in a single month, Bangladesh

Viet Nam

Reach varied in different contexts Interpersonal counseling

Mass media

92% 73% 45%

62% 30% 85%

Bangladesh Ethiopia

2013 data

What we’ve learned about how to be

EFFECTIVE Intensity matters

More than mothers Focus on drivers of behavior

What we’ve learned about how to be

EFFECTIVE Intensity matters

25

Intensity matters

Source: Nguyen PH, et al. Program impact pathway analysis of a social franchise model shows potential to improve infant and young child feeding practices in Viet Nam. Journal of Nutrition (in press).

Preliminary findings, Viet Nam

Dramatic increase in exclusive breastfeeding

Intensity matters

26

Perc

ent e

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mpt

ion

Number of A&T activities Ethiopia

What we’ve learned about how to be

EFFECTIVE More than mothers

Changing social norms, engaging people throughout society

28

29

Bangladesh TV spot

What we’ve learned about how to be

EFFECTIVE Focus on drivers of behavior

Behavior change model, Viet Nam

31

Supportive environment

What we’ve learned about effective: Changing behavioral determinants

• Beliefs about outcomes – Does not believe exclusively breastfed infant will

be thirsty (OR=1.54) • Perceptions of social norms

– Most women like me feed their infants only breastmilk (OR=1.77)

• Self-efficacy – My breastmilk is good enough to nourish my

infant for 6 months (OR=1.78)

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33

Viet Nam TV spot

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Aug-11 Feb-12 Aug-12 Feb-13 Aug-13

Trends in behavioral determinants

Believes her BM is enough Believes EBF for 6m is the norm Does not believe exclusively BF infant will be thirsty

Behavioral determinants have improved

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n=2,305 (Aug 11); n=2,065 (Oct 12); n=2,321 (May 13); n=2,593 (Oct 13)

Viet Nam

Self-efficacy

Social norm

Belief about outcome

SCALABLE

Intensity

More than mothers Behavioral determinants

EFFECTIVE

At the deep dive… How can we help countries scale up NOW?

36 Designing the Future of Nutrition SBCC | Bethesda, MD | November 2014

Alive & Thrive:�“Can we scale up nutrition?”Can we scale up infant and young child feeding programs?Yes! We can scale upYes! We can change behaviorsSlide Number 5OverviewA&T Framework for scaling upChanging social norms, engaging people throughout societyChanging social norms, engaging people throughout societyChanging social norms, engaging people throughout societyA&T measurement, learning & evaluationKey research questionsSlide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Overall A&T evaluation, Bangladesh�Cluster randomized design (cRCT)What have we learned?What we’ve learned about how to reach�SCALESCALE: Think big, really bigReach varied in different contextsWhat we’ve learned about how to be�EFFECTIVEWhat we’ve learned about how to be�EFFECTIVEIntensity mattersIntensity mattersWhat we’ve learned about how to be�EFFECTIVEChanging social norms, engaging people throughout societyBangladesh TV spotWhat we’ve learned about how to be�EFFECTIVEBehavior change model, Viet NamWhat we’ve learned about effective: Changing behavioral determinantsViet Nam TV spotBehavioral determinants have improved�SCALABLE�At the deep dive…�How can we help countries scale up NOW?