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: IR 3: IR 1: Improved IR 4: Increased IR 5: Improved Nutrition, Ag Improved Access Utilization of Strengthened and WASH to WASH Access to Quality Health GOE Leadership Related Products and Diverse and and Nutrition Capacity Behaviors Services Quality Foods Services MOWIE, MOH NNCB/NNTC, MOA, MOH, MOAL, MOH OWNP, MOWIE,MOE SCI, PSI, World Land O’Lakes, SCI SCI, Jhpiego SCI SCI, TMG, PSI Vision Cross Cutting : Research and Learning (Tufts), Gender, and Convergence/layering (SCI)
GTN PROGRAM IMPACT PATHWAY
Thematic Highlights - Policy - Quality Improvement - Enhanced Community Conversations - mNutrition - 1000 Days MVHH - Private Sector Sanitation -Grants under Grants - Implementation Research - Performance Indicators PARTNER LOGO GOES HERE (click slide master to add)
Enabling Nutrition Policy Environment
Supporting Nutrition through the Health Sector Reduced Increased Utilization of Quality Nutrition Stunting 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
QI improved quality and utilization of services Percen 200% 180% 160% 140% 120% UCL 100% Goal LCL 80% 60% PDSA2. Re- PDSA3. PDSA1. HDAs Perce 40% orient QI team Improve mobilized the through review UCL 100% 20% HEWs and community meeting 0% HDAs linkage Mean 80% 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 LCL PDSA3. 60% Month PDSA 2. monitor peer data 40% supervision regularly Vitamin A Supplementation among Children Age 6-59 months PDSA1. Demonstrate MUAC measure and orient 20% in Yefereziye HP, SNNPR HWs on how to utilize counseling card 0% 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 Mont h Pregnant women who were screened and counselled on maternal nutrition at Yetmen HC Amhara region
Social and Behavior Change Communication
1000 DAYS PLUS ; THE WINDOW OF OPPORTUNITY ADOLESCENCE
WHOLE-HOUSEHOLD APPROACH Enhanced Community School radio Conversation Adolescents Counselling In and out of school Religious leaders M-nutrition 1000-day radio Model family
ENHANCED COMMUNITY CONVERSATIONS • Groups of 20 mothers, fathers and grandmothers of children under 2 meet over a series of 10 sessions • 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)
ECC MATERIALS
ECC IMPROVED NUTRITIONAL OUTCOMES Impact of ECC on MIYCN and WASH Hand washing material (water + soap/ash) Hand washing facility (Yes) Duration of IFA intake (3 months and more) Four ANC follow-up (Yes) Women dietary diversity ( 5 and more food groups) Minimum acceptable diet Age appropriate minimum meal frequency Minimum dietary diversity (child, m 4 and more food… Early initiation of BF within 1 hour 0 10 20 30 40 50 60 70 80 90 Endline (%) Baseline (%) Source: ECC evaluation for two approaches by Tufts, 2029.
INNOVATIVE PARTNERSHIPS School Orthodox Radio Church ~14,000,000 (Fasting and students Nutrition) 30,000 HHs mNutrition SCHOOLs ~225,000 ~170,000 DAs & Adolescents Farmers
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) 93.3 cm 85.5 cm Age: 5 Age: 2
MVHH’S INTERVENTIONS SHOWED PROGRESS IN KEY INDICATORS 120 98.5 94.3 100 89 76 80 70 61 60 33.7 40 20 12.4 0 EBF rate Minimum dietary Minimum meal households with (0-5 months) diversity frequency litle or no hunger 2017 2020 Source: MVHHs survey, 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 WASH Agriculture and Livelihoods SBCC & Health Agricultural input • Accessibility Better decision-making provision power • Feasibility of water Improved dietary points o diversity Access to health o facility Gender-sensitive technologies
IMPLEMENTATION RESEARCH • 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
PROJECT PERFORMANCE Achv. as of Indicator LOP Target % LOP March, 2020 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
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