In recognition of the growing interest in the benefits of a multisectoral approach to addressing global nutrition issues, the Society for Implementation Science in Nutrition (SISN) and International Food Policy Research Institute (IFPRI), USA jointly organized a symposium at the International Union of Nutritional Sciences – International Congress of Nutrition (IUNS-ICN) 2017 on October 17 in Buenos Aires, Argentina entitled “Using implementation research (IR) to build better multisectoral programs for improving maternal and child nutrition outcomes”. The symposium started with the session chair, Dr Marie Ruel, SISN Board Member and the Director of Poverty, Health and Nutrition Division in IFPRI, stating “Implementation research can help address the gaps and challenges we face in achieving impact in nutrition”. Dr Ruel introduced a panel of speakers who reported their recent experiences of utilizing IR in strengthening and scaling-up multi-sectoral programs.
The case study presentations included:
- The process evaluation of Helen Keller International’s (HKI) homestead food production program in Burkina Faso, Jennifer Nielsen, Senior Nutrition Advisor, HKI
This evaluation identified several pitfalls that was impeding the predicted impact of the nutrition sensitive agricultural model. The major challenges identified were 1) water shortage due to fragile infrastructure, 2) high poultry mortality, and 3) lack of community volunteer engagement. To address the constraints imposed by water shortage the project team supported reparations to water points, promoted additional water conservation techniques, the planting of more drought resistant garden vegetables, and the expansion of vegetable production to the rainy season. To improve the health and survival of poultry, they strengthened links to the government veterinary health services. Finally, volunteer engagement was encouraged by providing volunteers with additional training to strengthen their interpersonal, counselling and group facilitation skills; providing them with incentives in the form of small gifts, and publicly recognizing their contribution to the project. Thus, this case study demonstrated how data arising from process evaluation can be used to adapt and strengthen the program ensuring that it is embedded into the local context.
- Alive and Thrive’s Implementation Research agenda, Tina Sanghvi, Nutritionist, Alive and Thrive
This presentation shared how Alive and Thrive is applying their IR agenda to inform the design of more effective nutrition programs. Choice of program design is based on the priority behaviors that have the greatest potential to change, identifying and targeting the specific drivers of these behaviors, the key influentials and the choice of program platforms. Furthermore, engagement with stakeholders, donors, and other relevant sectors are key to successful program design and delivery.
- Lessons learned through evaluation of large-scale behavior change interventions that aimed to improve infant and young child feeding (IYCF) practices in Bangladesh, Vietnam and Ethiopia, Purmina Menon, Senior Research Fellow, IFPRI
The methodological approach that guided all process evaluation activities included four components: 1) developing detailed program impact pathway models, 2) linking data collection to program impact pathways (PIPs) utilizing mixed methods, and multiple data sources, 3) linking evaluation timelines with program implementation timelines, and 4) engagement with the program implementation and management teams. Intervention impacts on infant and young child feeding practices were largely positive, but mixed. Behavioral impacts were greater with intervention platforms that were able to reach higher coverage and where the population context was conducive to behavior change. There was no impact on child growth in any of the contexts, although impacts were seen on motor and language milestone achievement in Bangladesh.
- Lessons learned through designing and implementing an integrated nutrition, livelihood and early childhood development project in Malawi, Natalie Roschnik, Senior Nutrition Advisor, Save the Children UK
The qualitative results showed that community capacity in terms of leadership, coordination and communication is key, and that training improved community participation in food contribution. Aulo Gelli, Nutritionist, Poverty Health and Nutrition Division, at IFPRI further elaborated on this evaluation, demonstrating that despite a short time-frame positive effects were observed across diets, nutrition and agriculture, possibly due to improvement of caregiver’s knowledge of IYCF practices and on strategies to improve diets. Together this evidence suggests that preschools could provide an effective platform to scale up nutrition interventions. Models driven by contributions by parents and community may provide a financially sustainable option for government scale-up. The study however highlighted the need for further research to simplify the training package and prioritize messages across the sectors before proceeding to nationwide scale up.
These informative case studies and subsequent discussions highlighted the complexity of implementing multisectoral programs. The conduct of IR in this context is new; consequently, understanding the pathways by which such programs achieve impacts, and how these pathways can be leveraged to optimize impacts and coverage is not yet well understood. However, as summarized by Purnima Menon at the end of the discussion “We CAN make an impact. It IS possible. There is still a tremendous amount of learning for all involved”. Some of the knowledge gaps can be addressed by working with program implementers as early as possible in the program cycle to design a program theory framework and the hypothesized pathways by which the program is expected to achieve impact, and embed data collection along these pathways as an integral part of the overall evaluation process.
We thank Morseda Chowdhury, SISN member and Programme Coordinator at the Health Nutrition and Population Programme, BRAC for thoughtfully preparing this blog. Morseda was the recipient of the $700 SISN Early Career/Student Travel Award, supporting her attendance at ICN. As a Society, we are keen to engage with our members and support participation at such events. To take advantage of such opportunities apply for membership here.