Scaling up nutrition works: Three strategies for success

JEAN BAKER, project director, ALIVE & THRIVEFHI 360

Can interventions be delivered at scale to improve nutrition during a child’s critical first two years? That is the question we set out to answer more than six years ago. And now the evidence is in—rapid, large scale increases in infant and young child feeding practices are feasible.

Earlier this week, the Alive & Thrive initiative shared endline survey results from Bangladesh and Viet Nam at the Experimental Biology 2015 annual meeting in Boston. Findings showed dramatic improvements in some key breastfeeding and complementary feeding practices critical for child growth and development. Read our announcement for more on the results.

Mom breastfeeding - BangladeshIn both countries, we reached millions of mothers, children, and communities with comprehensive behavior change programs. Along the way, we learned a lot about what it takes to scale up. At every stage, data drove our decisions and helped us understand whether our approach was working or not.

Our mandate is to share what we have learned with other programs that are poised to scale up nutrition. A&T’s results should assure countries, donors, and practitioners that there is no need to hesitate: impact at large scale is possible.

Here are three strategies that helped us succeed.

Get ready! Set your mind for scale. From the outset, we had an at-scale mindset. We asked ourselves: How can we reach large numbers of mothers of children under two to improve feeding behaviors and shift social norms? We set ambitious, measurable goals in each country. Then we worked together with governments and partners to achieve our targets, adapting our approach as needed.

Emphasize quality, not just quantity. The concept of quality of scale was always at the forefront of our program design—and it helped us make a measurable impact on infant and young child feeding outcomes. In Viet Nam, we used a social franchising approach to standardize high quality interpersonal counseling for mothers in health facilities. The approach enabled rapid expansion to more than 1,000 health facilities and resulted in more babies receiving only breastmilk during their first six months.

Take a comprehensive approach. Not only did we vary the ways in which we delivered support and messages to mothers, we also made sure to reach all members of society who can influence feeding decisions. The framework we applied in each country has four interrelated components: advocacy; interpersonal communication and community mobilization; mass media; and strategic use of data. Results tell us that the components achieved a mutually reinforcing impact that helped shift child feeding norms more quickly. Taking a comprehensive approach was key to achieving scale and impact in Bangladesh, where we ultimately reached 1.7 million mothers of children under two through interpersonal counseling and millions more through a national mass media campaign.

Watch over the coming months, as we publish additional results from our endline surveys and lessons from our programs in Bangladesh, Ethiopia, and Viet Nam.

How can we provide specific guidance or assistance to help your program scale up? We look forward to hearing from you. E-mail us with your questions, requests, and ideas at aliveandthrive@fhi360.org.

Read our announcement: Alive & Thrive releases endline survey results from Bangladesh and Viet Nam

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