Case Studies Scale: The ENA Framework

Understanding the ENA Framework Pre-session GHPC - May 5th, 2014

Jennifer Nielsen, PhD - HKI Agnes Guyon, MD, MPH - JSI

Health sector The ENA Framework

Mali & Niger – CSHGP

• Supported development of national ENA policy statements & training • Collaborated with MOH at regional, district, and health

facility levels to improve quality of nutrition content in health services

• Community volunteers at village level were linked as extension of health system

• Project supervisors reinforced capacity & ownership of local partners

• HKI had strong political and technical support from both countries

Mali & Niger – CSHGP

• Formative research simple: Mali used Barrier Analysis; Niger used long-time expert • Cascade training with one refresher mid-term:

– MTOT 10 days (HKI & MOH at national, region, district) who then trained

– Health workers (5 days), who then, with support of MT trained

– Community volunteer groups (3 days) • Multichannel SBC emphasized IPC (TIPS)

reinforced by group discussions at health centers and community level and radio messages.

USAID bilateral (RBHS) & UNICEF Liberia

• Messages developed from formative research & harmonized • Training materials developed based on generic ENA materials • Master trainers carried out cascade training of selected health

providers and community volunteers • SBCC strategy finalized • Update IMCI with ENA and CMAM • Integrate ENA into community strategy

• Assist the MOHSW in advocacy, the promotion and the roll-out of high impact nutrition interventions through the Essential Nutrition Actions (ENA) framework

LAUNCH project Liberia

USAID/Food For Peace Multi-Year Assistance Project – FFP/MYAP by ACDI/VOCA with PCI, JSI & Making Cents

• Use MOHSW materials and assist in TOT and roll-out

training (HW, CHW, Care Groups) • Carry-out survey post-training on HW practices • Initiate TTM to promote ENA at community level • Draft and use a supportive supervision checklist to

mentor HW and organize review meetings with volunteers (GCHV and TTM)

• Monitor programs and nutrition practices using mobile phone

Across sectors The ENA Framework

SPRING/Bangladesh

2 sectors :Agriculture & Health

2 Divisions - around 5.7 million Work with GoB structure, NGOs, Feed the Future

partners Essential Nutrition Actions and Essential Hygiene Actions Homestead Food production using the Farmer Field School model and 1000 days Messages developed from formative research from

A&T Training materials based on ENA generic and HKI-HFP

Draft

SPRING/Bangladesh

Cascade training GoB front line health providers trained GoB Agriculture Extension and community partners HFP-FFS Facilitators Multi-platformand multi- contact Monitoring & Supervision at all levels Communications

Draft

Peace Corps West Africa Food

security Partnership

Draft 4 sectors :Agriculture/Environment, Education, Health,

Small Business

TOT PC staff in March 2013 Benin, Senegal, Guinea, The Gambia & Sierra Leone French & English Development & testing of training materials based on

ENA generic materials, EHA and HFP Training roll-out with Peace Corps Volunteers Monitoring & Supervision

Reference Booklet on key ENA, EHA HFP practices For all PCV regardless of their sectors

Community Training guide

Orientation guide

Health Volunteers Training guide

Nepal and Burkina E-HFP Platform

• ENA promoted within in ag-nut strategy (Enhanced Homestead Food Production)

• Behavior change through community volunteers (FCHV-Nepal; Grandmothers & Village Health Committees-Burkina) with support of local NGO partners

• Village model farms/community gardens were meeting venue for ENA discussions and provided ingredients for enriching complementary foods

Nepal and Burkina HFP Platform

• Formative research in Nepal used in-depth interviews, focus group discussions and the DBC framework; in Burkina a community participatory rural appraisal approach

• MOH district staff supported training & supervision; MOA & livestock, local development received ENA orientation • BCC also emphasized IPC

reinforced by radio & community events • Nepal governance component

strengthened multi-sectoral planning and financing at national, regional and VDC levels.

Monitoring The ENA Framework

QUARTERLY MONITORING : • Breastfeeding practices • Mother and child feeding

practices/nutrition • Hygiene practices • Food preparation and

storage • Time travelled to FDP • Participation in Care Groups

& Farmer Groups

Liberia-quarterly monitoring surveys are conducted at distribution sites

Use of mobile phone improves transfer of beneficiary information

By Paper By Mobile Phone

10.6

13.9

21.4 20.5

10.7

5.9 5.1

3.6 4.1

0

5

10

15

20

25

Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12

WEE

KS

Burkina & Nepal • In Burkina, a round of operations research

was conducted with mixed methods: survey, in-depth interviews and observations; weaknesses identified for correction (anemia, home visits)

• In Nepal bi-annual surveys and observations were conducted using LQAS

to identify areas for strengthening (poultry management)

Thank you!