Training and workshop to integrate IYCF in CMAM
Summary of report1
Between 23 and 31 August 2010, World Vision International (WVI) and the Emergency Nutrition Network (ENN) held a six day training of trainers (TOT) and two day companion planning workshop in Ethiopia on integration of infant and young child feeding (IYCF) activities into community based management of acute malnutrition (CMAM) programmes. The training took place in Shone ADP2 and the workshop in Hawassa Region.
The aim of the TOT workshop was to strengthen the technical capacity of World Vision country, regional and headquarters (HQ) staff. The aim of the companion workshop was to contribute to WV's strategic planning to integrate IYCF support into its CMAM programmes at country, regional and global level. The companion workshop paid particular consideration to locating integration within the Ethiopian Governments policies and programmatic guidance.
ENN consultants from Nutrition Policy and Practice (NPP) led the training, supported by the ENN and WVI headquarter- Nutrition Centre of Expertise (NCOE) technical staff.
Fourteen WV programme staff from Sierra Leone, Zimbabwe, Zambia, Ethiopia, Rwanda, Kenya and Uganda participated in the TOT. They were joined by staff from regional and global NCOE who support Eastern and Southern Africa, and WV support office staff from Canada and the US. An additional five participants participated in the two day planning workshop from WV regional offices, the Sudan Ministry of Health (MoH), and Concern Worldwide.
Five day TOT
The five day TOT used the 'Integration of IYCF Support in CMAM'3 training materials as the technical content. It was a competency based 'hands-on' training built around adult learning principles. The approach used the experiential learning cycle (a learning cycle of experience, reflecting, thinking and acting), employing a variety of training methods. Two days of practice sessions (Days 4 and 5) took place in health facilities within a half-hour's drive of the Shone ADP.
The end of training evaluation was positive. Participants highlighted sessions on behaviour change, counselling skills, forming action and support groups, the 'adult learning' approach to the workshop facilitation, and the practical sessions as especially helpful. Recommendations for future TOT were more practical field sessions, more preparation for field sessions to include orientation of managers of CMAM programmes, and more practical application of HIV and infant feeding recommendations. Competency ratings (self assessment) increased significantly pre and post training.
Two day planning workshop
The specific objectives of the two day companion workshop were to share cross country/agency experiences on IYCF and CMAM, develop WV action plans to rollout the 'Integration of IYCF Support into CMAM Programming' training material, define operational research questions and explore WV monitoring and evaluation (M&E) around IYCF in CMAM. The 2 day planning benefitted from the presence of Ethiopian university staff to consider Ethiopia-specific recommendations.
Appreciative Inquiry (AI) methodology4 was used to explore how IYCF can best be integrated into existing CMAM programmes through working groups. Integration was considered for key contact points in community mobilisation, Outpatient Therapeutic Programme (OTP), Supplementary Feeding Programme (SFP), Stabilisation Centre (SC), and other community services. Integration was also considered for national level pre-service and in-service training, and by international agencies and local partners.
Participants envisaged good synergy and many benefits of IYCF integration in CMAM including improved acute and longer term nutrition and developmental outcomes for children, reduced relapse amongst treated children, and strengthened community component of CMAM programming and continuity of care. There were many suggestions for integration at contact points. Specific to Ethiopia (detailed in the report) priority actions suggested to enable IYCF in CMAM in Ethiopia included training community volunteers on implementation of action-oriented group sessions and support groups, revitalising the Health Education Talks at OTP with action-oriented group sessions and support groups and, researching breastfeeding counselling feasibility at a designated OTP follow up visit. Additional areas identified for action included advocacy for IYCF integration with the existing NNTWG (National Nutrition Technical Working Group) in Ethiopia, development of refresher training (in-service), and embedding IYCF into CMAM in pre-service training.
Participants considered baseline IYCF information was needed to inform integrated activities and may involve surveys of Knowledge, Attitude, Practice (KAP), KAPB (behaviour), KPC (coverage) and community led assessments, ideally prior to setup.
A brief session on M&E discussed the benefits of disaggregating programme age data in programmes and the potential to include IYCF process indicators in the WV CMAM database. Participants considered a simplified measurement approach of IYCF assessment may be more realistic for programmes; a simplified methodology should be consistent over time and the results not compared to those obtained using globally- agreed indicators and measurement guidance.
Action plans were developed for six countries (Ethiopia, Kenya, Rwanda, Sierra Leone, Uganda and Zimbabwe), the Africa region, two training contexts (SNNP Sudan and Hawassa University, Ethiopia), and for WV Support Offices and Global Health Offices. Training of community based staff featured strongly in plans, in addition to policy/strategy updates at country level, engaging in operational research, and documentation of best practice and lessons learned to inform programming.
At an agency level, opportunities for strengthening technical capacity identified were WV country office assistance through WV-NCOE/Regional Office, development of institutional capacity in Hawassa University, developing linkages with UNICEF, and undertaking operational research.
Throughout both the training and workshop, participants identified many constraints to integrating IYCF in CMAM. The lack of a defined operational model for integrated programming limited scale up of integration in action plans. Key operational research needs identified were around impact on nutritional and programme outcomes, effect on IYCF integration on programming caseload, feasibility of integration at key contact points, how to monitor and evaluate programming within the existing CMAM framework and cost-benefit analysis.
Given the gaps in operational guidance, the importance of capturing experiences on integration to inform programming and the need for collaboration and partnership were highlighted. Participants suggested it may benefit to learn by small scale integration, e.g. integrate in one geographic area, or focus on strengthening IYCF with one key contact point.
The facilitators concluded that to move forward on IYCF in CMAM at a national level, it is essential to identify key government and agency partners, as well as seek to locate interventions within national strategies and priorities. In future research, the operational model (or models) for consideration should comprise a multi-component intervention including interpersonal IYCF counselling and negotiation, action-oriented group education, peer support and targeted, context specific messaging.
As a next step, an initiative that looked to address more closely the integration of IYCF in CMAM in the Ethiopian context could draw on Ethiopia's considerable lessons to date from both OTP scale up and IYCF programming. Such an initiative(s) should include experience documentation, operational research and rapid dissemination of lessons learned.
For more information, contact: Sarah Carr, World Vision Canada, email Sarah Carr.
1WORLD VISION International-ENN. Collaborative project to enable Integration of IYCF Support into CMAM Programming at Agency and National Levels. Ethiopia. 23- 31 August, 2010. Final Report. 25 September 2010
2Area Development Programme (World Vision)
3Developed by the ENN in collaboration with the partnership Nutrition Policy and Practice Group (NPP) in 2008, funded by the GNC. Available in English and French at: http://www.ennonline.net/resources/722
4This comprised four 'D's: discovery (whtat are the benefits of implementing IYCF and CMAM), dream (what do we expect to acheive through integration of IYCF in CMAM), design (how to integrate IYCF into CMAM contact points) and delivery (action plan development).
5This comprised four 'D's: discovery (whtat are the benefits of implementing IYCF and CMAM), dream (what do we expect to acheive through integration of IYCF in CMAM), design (how to integrate IYCF into CMAM contact points) and delivery (action plan development).
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Reference this page
Training and workshop to integrate IYCF in CMAM. Field Exchange 40, February 2011. p81. www.ennonline.net/fex/40/training