Evaluation of use of IFE training materials
By Chloe Angood
Chloe has a Bachelors degree and a Masters degree in Development Studies, with an emphasis on HIV/AIDS, nutrition and agriculture. Following 3 years as a programme co-ordinator for the NGO, Viva Network, in Zimbabwe, she worked for the HQ offices of Viva Network (programme management and training) and for Mango (recruitment). She is currently studying for a MSc in Public Health Nutrition at the University of Southampton and working part-time for the ENN.
An evaluation was recently conducted of two training modules (Module 1 and 2) on Infant Feeding in Emergencies (IFE) developed by the IFE Core Group (UNICEF, WHO, WFP, UNHCR, IBFAN-GIFA, CARE USA, Fondation Terre des hommes and ENN) and produced by the ENN1. The purpose of the training modules is to prepare emergency relief staff to safeguard maternal and child health in emergencies by ensuring appropriate infant feeding. Module 1 is aimed at emergency relief staff while Module 2 is more specifically designed for health and nutrition workers directly involved with caregivers and infants. Both modules are available in print, online and on CD.
The evaluation was conducted between February and May 2006 and covered the period April 2005 - April 2006. It involved an analysis of ENN's distribution database, downloads from the ENN website, and an email survey targeting 100 recipients. Thirty-four recipients responded to this email (one third of all recipients). Answers were clarified through further emails and telephone calls.
Distribution of training materials
The print materials and CDs were distributed on request by the ENN. A discretionary subsidised charge was applied, although the materials were available free to individuals or agencies who could not afford to pay for them.
Overall, 169 copies of Module 1 and 826 of Module 2 and 47 CDs were distributed to 28 organisations (including UN organisations, local and international NGOs, training and research institutions) and 13 individuals in 46 different countries. In addition, 1755 items were downloaded from ENN's website between December 2005 and April 2006. The relatively small number of CDs requested may be due to lack of marketing as the CDs had been developed and produced by the ENN inhouse on a 'shoe-string' budget, with no funding for larger scale production and distribution.
The majority of the materials (90%) were distributed to IFE Core Group members, mainly UNICEF, UNHCR, IBFAN-GIFA and CARE USA. The materials were mostly used internally by these organisations, in regional and field centres, or were distributed to partners. In some instances, the materials were shared with donors to highlight the work of the IFE Core Group and in one case cited, to successfully fundraise for continued agency participation in the IFE Core Group.
Only 10% of the print materials were disseminated directly to recipients outside of the IFE Core Group. Donor agencies did not feature on the print distribution list but were targeted by some IFE Core Group members and at the launch of the materials at the UN SCN meeting in 2005.
Downloading Module 2 from ENN's website may well be a more practical means of access for agencies - web access was identified as a significant access point in a previous evaluation of Module 1. However, even allowing for that, a more proactive targeting of field level operations is needed.
Uses of materials:
The materials have been used in a variety of ways (See figure 1) in different contexts. These include:
- Training field practitioners. For example, UNHCR in Ethiopia used Module 2 to train field personnel in seven refugee camps, including doctors, nurses, midwives, community health agents and traditional birth attendants.
- Producing other training courses and materials. For example, IBFAN-Asia Pacific used Modules 1 and 2 to develop guidelines for their partners in how to survey calamity struck areas following the Asian tsunami.
- As an advocacy tool for policy change (see box 1).
The materials have been used more broadly than intended - half of respondents used the materials in non-emergency contexts. Only one quarter used them to train practitioners - this may reflect alternative uses, the need for more specific targeting of the materials, or a lack of training skills amongst the users.
Content of materials
The survey confirmed that the materials provide previously unavailable technical information to field practitioners. A number of respondents described some of the content as 'unique' and filling a gap in information. However, there was a call to further simplify the text. A number of respondents also raised the appropriateness of the materials (particularly pictorial representation) in places where cultural taboos around breastfeeding exist.
Respondents highlighted gaps in information not covered by the materials. Infant feeding in the context of HIV and AIDS, and complementary feeding were considered priority areas. Other suggestions included:
- Practical advice on how to handle organisations handing out infant formula/baby milk
- Include a section '20 frequently asked questions' on infant feeding in emergencies
- Community preparedness for emergencies in terms of infant feeding (considered par ticularly relevant for Latin America)
- Related human rights and humanitaria laws.
Accessibility of materials
The survey revealed the need to make the materials accessible to a wider audience. There was clear demand for the modules to be translated into other languages (including French, Spanish and Italian). Other formats that may be more easily distributed were suggested, e.g. as a power point presentation and as a book. Although CD format could improve access considerably, it has been under utilised as a means of distribution1. Respondents also suggested holding training workshops.
Planning, Monitoring and Evaluation
Analysis of the project as a whole revealed a lack of clearly defined targets and indicators. The distribution of materials was adequately monitored by ENN, however the system to monitor web downloads needs improving. There is also no system to track dissemination by IFE Core Group members other than ENN. It is still early days but subsequent evaluations may reveal more about the long term impact of the training modules.
Specific recommendations from the evaluation include:
- Marketing the materials to a wider range of organisations, including international NGOs and donors, technical and nontechnical staff.
- Revision of the materials on the basis of new evidence in priority areas, such as infant feeding in the context of HIV and AIDS and the management of severely malnourished infants.
- Future updates should consider the adapted materials developed by users in future versions of the modules, refine the text, and develop versions applicable where cultural taboos may exist.
- Highlight resource gaps that do not fall within the remit of the IFE Core Group to other partners and organisations that might be willing to produce them.
- Consider developing new materials on priority areas, such as complementary feeding in emergencies. Engage in a deeper process of consultation with stake-holders to decide on priority areas.
- Translation of the materials into other lan guages, develop and market the CD format more widely, and consider producing future drafts of the modules in a more cost-effective format.
- Hold regional workshops to orientate users on applying the modules.
- Define plans, including targets, objectives, outputs and indicators for the next stage of the project.
- Set up systems to monitor downloads from the ENN website and to track the secondary dissemination of materials through IFE Core Group members.
Since the evaluation, the ENN has begun to address a number of the recommendations, including developing a better system to monitor downloads from the ENN's website, and direct 'marketing' of the materials to NGOs and donors. A number of the issues highlighted in the evaluation, such as developing training materials on complementary feeding in emergencies, updating the materials to reflect developing areas like infant feeding in the context of HIV and AIDS, and translation of the materials, have long been identified as priority work areas by the IFE Core Group. Aperquisite to seeing these recommendations through is the identification of resources to support IFE activities. This will be one of the main outcomes sought at of the IFE orientation workshop scheduled in November 2006 (see news section in this issue).
Afull copy of the evaluation is available from the ENN. For further information on the training modules or the November meeting, (see news piece, p14) contact the IFE Core Group c/o Marie McGrath, ENN, email: firstname.lastname@example.org
"At the end of 2005 I was informed that a church organisation had written a letter to the Ministry of Health (MOH) offering to provide free infant formula to distribute to all artificially fed infants in country starting from 9 months of age. I spoke on the phone to the head of the MOH department and reminded her of the previous experience in our country when breastfeeding rates decreased 3 times because of the free formula supply, and I also reminded her of the provisions of the International Code. She suggested that I write a statement to this effect to the MOH, so that they could use it when answering the letter, which of course I did. I referred to Module 1, section 2.4 'Donations of infant formula in emergencies can be dangerous', Section 3.1 'The International Code of Marketing of Breastmilk Substitutes (BMS)' and Annex 1 'The International Code of Marketing of BMS - summary of portions relevant to emergencies'. I was told informally that my letter was shown to the deputy minister and was used while answering the letter of the church organisation. Their answer was negative. The church organisation also intends to change its practices and in future support breastfeeding. So you can see that the materials were quite useful."
1Large sections of Modules 1 and 2 have been included on the recently completed TALC CD on community nutrition. For details, see www.talc.org
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Reference this page
Chloe Angood (2006). Evaluation of use of IFE training materials. Field Exchange 28, July 2006. p20. www.ennonline.net/fex/28/useofife