Growth through Nutrition Program Review May 7, 2020 OUTLINE - - PowerPoint PPT Presentation

Growth through Nutrition

Program Review May 7, 2020

OUTLINE

• Background and Approach
• Thematic Highlights
• Challenges, Way Forward and Legacy
• Financial Overview

Background and Approach

WHY GTN IS IMPORTANT PROJECT FOR ETHIOPIA

Growth through Nutrition Activity (GTN) Profile

• USAID’s flagship multi-sector nutrition and WASH project to improve

nutritional status of women and children

• Supports GoE Food and Nutrition Policy, National Nutrition Program, and

Seqota Declaration ( Zero stunting by 2030)

• System strengthening and capacity building of GoE sectors: Agriculture,

Health, Water, Education- USAID Journey to self-reliance

• Five-year (Sept 2016 – Aug 2021), $73M USD
• Builds on USAID ENGINE (2011-2016)
• Save the Children is the prime and five INGOs and five local partners

Implementation Area: 110 woredas in four regions Targets: 14M population

• 5.2M children <5
• 1.1M pregnant women
• 28,000 vulnerable HHs
• 300,000 access to water &

sanitation

• 551 health centers
• 73,000 professional graduates

Result Framework

PURPOSE: Improve Nutrition Status of Women and Young Children IR 2: Improved Nutrition, Ag and WASH Related Behaviors IR 3: Increased Utilization of Quality Health and Nutrition Services IR 4: Improved Access to WASH Products and Services IR 5: Strengthened GOE Leadership Capacity IR 1: Improved Access to Diverse and Quality Foods MOA, Land O’Lakes, SCI MOH, MOAL, MOWIE,MOE SCI, TMG, PSI MOH SCI MOWIE, MOH SCI, PSI, World Vision NNCB/NNTC, OWNP, SCI, Jhpiego Cross Cutting: Research and Learning (Tufts), Gender, and Convergence/layering (SCI)

GTN PROGRAM IMPACT PATHWAY

PARTNER LOGO GOES HERE (click slide master to add)

Thematic Highlights

• Policy
• Quality Improvement
• Enhanced Community Conversations
• mNutrition
• 1000 Days MVHH
• Private Sector Sanitation
• Grants under Grants
• Implementation Research
• Performance Indicators

Enabling Nutrition Policy Environment

Supporting Nutrition through the Health Sector Increased Utilization of Quality Nutrition Services

WHY support to the health system is CRITICAL

Nutrition- Specific Interventions require HIGHER coverage for max effect. Nutrition services already institutionalized but in need of better integration. QUALITY of nutrition services key for effective coverage: National Priority

Reduced Stunting

UCL LCL 0% 20% 40% 60% 80% 100% 1/1/18 2/1/18 3/1/18 4/1/18 5/1/18 6/1/18 7/1/18 8/1/18 9/1/18 10/1/18 11/1/18 12/1/18 1/1/19 2/1/19

Perce Mont h Mean

• PDSA1. Demonstrate

MUAC measure and orient HWs on how to utilize counseling card PDSA 2. peer supervision PDSA3. monitor data regularly

Pregnant women who were screened and counselled on maternal nutrition at Yetmen HC Amhara region

UCL LCL

0% 20% 40% 60% 80% 100% 120% 140% 160% 180% 200%

7/1/17 8/1/17 9/1/17 10/1/17 11/1/17 12/1/17 1/1/18 2/1/18 3/1/18 4/1/18 5/1/18 6/1/18 7/1/18 8/1/18 9/1/18 10/1/18 11/1/18 12/1/18 1/1/19 2/1/19 3/1/19

Percen

• PDSA2. Re-
• rient QI team

through review meeting

Month

Goal

PDSA3. Improve HEWs and HDAs linkage

• PDSA1. HDAs

mobilized the community

QI improved quality and utilization of services

Vitamin A Supplementation among Children Age 6-59 months in Yefereziye HP, SNNPR

Social and Behavior Change Communication

ADOLESCENCE

1000 DAYS PLUS; THE WINDOW OF OPPORTUNITY

WHOLE-HOUSEHOLD APPROACH

School radio Adolescents In and out

• f school

M-nutrition Model family Enhanced Community Conversation Counselling Religious leaders 1000-day radio

ENHANCED COMMUNITY CONVERSATIONS

• Discuss integrated nutrition issues

(IYCF, WASH, NSA, gender)

• Identify barriers and develop plans to

bring about positive change

• Interactive with games, dialogue, role-

play, take-homes and HH level follow-up visits

• Implemented via LNGOs and savings

groups / frontline workers with different packages

• Both approaches proving effective (OR)
• Groups of 20 mothers, fathers and grandmothers of children under 2 meet
• ver a series of 10 sessions

ECC MATERIALS

ECC IMPROVED NUTRITIONAL OUTCOMES

10 20 30 40 50 60 70 80 90 Early initiation of BF within 1 hour Minimum dietary diversity (child, m 4 and more food… Age appropriate minimum meal frequency Minimum acceptable diet Women dietary diversity ( 5 and more food groups) Four ANC follow-up (Yes) Duration of IFA intake (3 months and more) Hand washing facility (Yes) Hand washing material (water + soap/ash)

Impact of ECC on MIYCN and WASH

Endline (%) Baseline (%)

Source: ECC evaluation for two approaches by Tufts, 2029.

INNOVATIVE PARTNERSHIPS

mNutrition ~225,000 DAs & Farmers Orthodox Church (Fasting and Nutrition) 30,000 HHs SCHOOLs ~170,000 Adolescents School Radio ~14,000,000 students

M-NUTRITION WITH ATA

• Piloted mNutrition for frontline

workers during ENGINE, but couldn't scale.

• GTN worked with GoE (MoA and

ATA) to include nutrition messages into existing Ag info system: SMS and Audio.

• GTN reached 19k DAs with SMS.

ATA scaled via SMS 157k and audio to 50k farmers

• Initiating was challenging
• Scale and sustainability (225k

farmers)

1000 DAYS MVHHS APPROACH

• MVHHs supported with agro-ecological

based NSA training and inputs

• Organized into savings groups & linked

with micro-finance

• Integrated HH level support by health

and ag frontline workers

• Platform for behavior change

interventions (ECC)

85.5 cm Age: 2 93.3 cm Age: 5

MVHH’S INTERVENTIONS SHOWED PROGRESS IN KEY INDICATORS

Source: MVHHs survey, 2017&2020

98.5 12.4 70 61 94.3 33.7 76 89

20 40 60 80 100 120 EBF rate (0-5 months) Minimum dietary diversity Minimum meal frequency households with litle or no hunger 2017 2020

WASH

• 1. Increased Access to Safe, Adequate and

Sustainable Water Supply

• 2. Increased Demand and Access to improved

WASH Products & Services

WASH products and services

PRIVATE SECTOR SALES TREND

GRANTS UNDER GRANT

• Sub-grants (fixed amount awards) and financial

support through MOUs to GOE woredas

• Increase ownership and capacity of government at

woreda and community level to deliver quality services to households = journey to self-reliance

• Support health and agriculture system to find local

solutions for local problems.

• Prioritize support for implementation of the Seqota

Declaration; the GoE’s commitment to end stunting by 2030

GUG EXPERIENCE

Launched the first three GUGs to woredas one year ago (~$330k)

• Woredas analyzed local data from their own woreda to identify problems

and solutions

• Enhanced leadership and engagement of the woreda and zone
• Woredas implemented activities as planned, including:
• Local complementary food recipe development
• Improved fish production practice and promoting consumption
• Resource intensive at startup to develop and issue the sub-awards.
• Structure of benchmarks essential to ensure all activities are prioritized
• Multi-sectoral coordination enforced
• Woreda budgeting for sustainability

GENDER AND WOMEN’S EMPOWERMENT

Agriculture and Livelihoods WASH SBCC & Health Agricultural input provision

• Accessibility
• Feasibility of water

points Better decision-making power

• Improved dietary

diversity

• Access to health

facility Gender-sensitive technologies

• Operations Research
• Assessing Multisectoral Coordination for Nutrition Policy Effectiveness
• The role of Quality Improvement Initiatives Supported by GTN to Improve Quality of

Nutrition Services at PHCUs

• The added value of virtual facilitator as an SBCC Communication approach to

improve IYCF, women’s diet diversity, women’s empowerment and WASH practices: a quasi-experimental design study

• Small Grants for local researchers
• Barriers and facilitators of nutrition service utilization among adolescent girls in

Wolaita and Hadiya zones, Southern Ethiopia

• 8 online courses via Tufts University: https://gtn-learning.org/online-trainings
• Learning and KM website : www.gtn-learning.org

IMPLEMENTATION RESEARCH

PROJECT PERFORMANCE

Indicator LOP Target

• Achv. as of

March, 2020 % LOP Adopted Nutrition, WASH & Agriculture behaviors Participants attended Enhanced Community Conversation (ECC) session 41,096 40,877 99% Mobilized religious leaders to address fasting and nutrition issues 810 932 115% Increased access to diversified foods Agriculture Extension Workers trained on nutrition sensitive intervention 6,413 8,437 131% Model Farmers trained on package of nutrition-sensitive agriculture 12,550 10,641 85% MVHHs received technical and input support 28,000 24,768 88% Increased Utilization of Quality Nutrition Services Percentage of PHCUs with Model QI services established 75 94 125% Number of children under five reached with nutrition-specific interventions 5.2 million 3.9 million 74% Number of pregnant women reached with nutrition-specific interventions 1.2 million 715k 62% Increased access to WASH services People accessing basic drinking water services 200,000 115,660 58% People accessing basic sanitation service 96,000 55,754 58%

Challenges, Way Forward & Legacy

CHALLENGES & MITIGATION

• External/GoE:
• Insecurity & political changes, functionality of systems, COVID-19
• Adaptation of approach, use of crisis modifier and relationship with

GoE at all levels

• USAID:
• Access to funding early in project delayed scale-up
• Slow follow-up by USAID: cost extension, agriculture waiver, mid-term

evaluation, etc.

• Engaging USAID at all levels with CD/DCD support. Recent progress
• n cost-extension with engagement of USAID FTF Coordinator
• Save the Children:
• Scale vs intensity
• Assessing and testing diffusion models. Effective engagement with

GoE to influence systems

WAY FORWARD

• Currently working on adaptation and response to COVID-19

pandemic

• Anticipate 6th year extension with $5M cost increase
• Next 6 - 12 months:
• External factors: COVID 19 and elections
• Adaptation based on MTE, OR and changing context
• Focus on institutionalization of key activities [ECCs, QI, WASH

private sector, NSA in MoA, GUGs]

GTN LEGACY

• Multi-sectoral and integrated nutrition programming is possible and

has significant impact on child and maternal undernutrition

• Creating government ownership and PHCUs capacity for nutrition by

both health and agriculture sectors and higher institutions

• Standardized and endorsed training materials & QI approach at PHCU
• Pre-service and research capacity of higher institutions
• Introduced and programmed innovative and challenging but effective

approaches

• Innovative and effective ECC approach and capacity at regional and local level
• Introduced 1000 Days MVHHs approach and integrated interventions for NSA
• Grant under grant funding mechanism for nutrition

Thank You!

https://gtn-learning.org/

THANK YOU!