Government information systems to monitor complementary feeding programs for young children

Brazilian Strategy for Breastfeeding and Complementary Feeding Promotion: A Program Impact Pathway Analysis

BACKGROUND

The Brazilian Breastfeeding and Complementary Feeding Strategy (Estratégia Amamenta e Alimenta Brasil-EAAB) aims to improve Primary Health Care (PHC) workers' counseling skills to promote and support infant and young children feeding (IYCF). However, the maintenance and scaling up of the EAAB has been challenging. The theory-driven Program Impact Pathway (PIP) is recommended to assess and enhance the large-scale implementation of IYCF programs. The purpose of this study was to document barriers and facilitators to scale up the EAAB using a PIP analysis.

METHODS

First, we reviewed EAAB documents to develop an initial PIP diagram. Then, we interviewed EAAB key informants to identify Critical Quality Control Points (CCP) in the PIP. We revised and analyzed the PIP to inform the EAAB core functions and pathways.

RESULTS

Six CCPs for EAAB maintenance were identified: CCP1-Definition and strengthening of the coordination in states and municipalities; CCP2-Maintenance of tutors' work; CCP3-Feasibility of the certification process; CCP 4-Quality improvement of IYCF activities in PHC units; CCP 5-Adequate use of monitoring systems; and CCP 6-Consistent implementation monitoring. Four implementation pathways and seven core functions identified may assist with scaling up the EAAB in Brazil.

CONCLUSION

The PIP analysis proved to be useful for documenting the factors that influence the maintenance and scaling up of the EAAB.

Accelerating progress for complementary feeding in Kenya: Key government actions and the way forward

Optimal complementary feeding practices, a critical component of infant and young child feeding, has been demonstrated to prevent micronutrient deficiencies, stunting, overweight, and obesity. In Kenya, while impressive gains have been made in exclusive breastfeeding, progress in complementary feeding has been slow, and the country has failed to meet targets. Recent 2014 Kenya Demographic and Health Survey reveal that only 22% of Kenyan children, 6-23 months, met criteria for a minimum acceptable diet. This case study describes key actions for complementary feeding put in place by the Kenya Ministry of Health as well as approaches for improving and monitoring complementary feeding within existing health platforms. Experience from USAID's Maternal and Child Survival Program and Ministry of Health on development of 23 complementary feeding recipes through application of a national guide for recipe development and Trials of Improved Practices is described. Challenges in how to prepare, modify, and cook foods, including meat, for young children 6-23 months of age was relayed by mothers. Addressing cultural beliefs around complementary feeding meant providing reassurance to mothers that young children are developmentally able to digest fruit and vegetables and ready to consume animal-source protein. Through the Baby Friendly Community Initiative platform, cooking demonstrations and key hygiene actions were integrated with complementary feeding messages. Future programming for complementary feeding should consider development of context specific counselling messages on consumption of animal source foods, strengthen production and use of local foods through agriculture-nutrition linkages, and include complementary indicators through routine health monitoring systems to track progress.

Government information systems to monitor complementary feeding programs for young children

Accelerating progress to improve complementary feeding of young children is a global priority. Strengthening monitoring through government information systems may increase the quality and implementation of infant and young child feeding (IYCF) programs. Monitoring is necessary for the effective implementation of programs as it allows program managers to assess program performance, identify problems, and take corrective action. Program descriptions and conceptual models explain how program inputs and activities should lead to outputs and outcomes, and ultimately public health impact; thus, they are critical tools when designing effective IYCF programs and monitoring systems as these descriptions and conceptual models form the basis for the program and are key for developing the monitoring system, indicators, and tools. Despite their importance, many programs do not have these documented, nor monitoring plans, limiting their ability to design effective programs and monitoring systems. Once in place, it is important to periodically review the monitoring system to confirm it still appropriately meets stakeholder needs and the data are being used to inform decision-making, and to make program adjustments as the monitoring focus, resources, or capacity may change during the program lifecycle. Including priority indicators of IYCF practices and counseling indicators in the government information systems may strengthen IYCF programs when the indicators are contextualized to the government IYCF program, capacity, and setting, and the indicators are used for decision-making and program improvement.

First foods: Why improving young children's diets matter

Globally, only 52% of children aged 6-23 months meet the minimum meal frequency and a mere 29% meet the minimum dietary diversity, with large disparities across and within regions. With most of the stunting occurring during the first thousand days-from conception to age 2 years-improving complementary feeding in children 6-23 months old is an urgent priority. With this evidence in mind, UNICEF collaborated with the governments of India and Maharashtra to convene a global meeting in Mumbai, India, under the theme: First Foods: A Global Meeting to Accelerate Progress on Complementary Feeding in Young Children (November 17-18, 2015). The global meeting provided a platform that aimed to (a) synthesize the biological and implementation science on complementary feeding; (b) review the practice and experience in improving access to nutritious complementary foods and good complementary feeding practices; and (c) consolidate a strong evidence base that can inform the development of strategies and approaches to improve complementary feeding that are fit to context. This overview paper summarizes the rationale on why improving complementary foods and feeding for infants and young children matters and what it takes to improve them. It builds on the papers presented at the First Foods Global Meeting and those commissioned as a follow on to it.

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Continual course correction during implementation of nutrition programmes is critical to address factors that might limit coverage and potential for impact. Programme improvement requires rigorous scientific inquiry to identify and address implementation pathways and the factors that affect them. Under the auspices of “The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,” 3 working groups were formed to summarize experiences and lessons across countries regarding micronutrient powder (MNP) interventions for young children. This paper focuses on how MNP interventions undertook key elements of programme improvement, specifically, the use of programme theory, monitoring, process evaluation, and supportive supervision. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that although much has been written and published about the use of monitoring and process evaluation to inform MNP interventions at small scale, there has been little formal documentation of lessons for the transition from pilot to scaled implementation. Supervision processes and experiences are not documented, and to our knowledge, there is no evidence of whether they have been effective to improve implementation. Improving the efficiency and effectiveness of interventions requires identification of critical indicators for detecting implementation challenges and drivers of impact, integration with existing programmes and systems, strengthened technical capacity, and financing for implementation of effective monitoring systems. Our understanding of programme improvement for MNP interventions is still incomplete, especially outside of the pilot stage, and we propose a set of implementation research questions that require further investigation.