Santhia Ireen Senior Technical Advisor Alive & Thrive, FHI 360 Bangladesh Program

1. DELIVERING FOR NUTRITION IN SOUTH ASIA
Implementation Research in the Context of COVID-19
December 2, 2021
Santhia Ireen
Senior Technical Advisor
Alive & Thrive, FHI 360
Bangladesh Program
COVID-19 adaptions in
implementation of a MIYCN
counseling intervention in
urban Bangladesh
Speaker
picture-in-picture

2. ▪ In 2020, A&T initiated an Implementation Research (IR) to understand the feasibility of integrating
Maternal Infant and Young Child Nutrition (MIYCN) counseling services in selected urban Maternal
Neonatal and Child Health facilities run by NGOs
Background
▪ Objectives
• Improve coverage and quality of MIYCN services by integrating MIYCN
counseling into existing MNCH health facilities
• Improve nutrition indicators (e.g., early initiation and exclusive
breastfeeding, complementary feeding, IFA/Ca, diet diversity of women)
• Understand the processes related to, and factors affecting implementation
of the MIYCN counseling services
▪ Partnerships
• Government: National Nutrition Services
• Implementation: NGOs: RADDA and Marie Stopes Bangladesh (MSB)
• Evaluation: IFPRI MIYCN counseling room

3. ▪ The IR started in April 2020. The Government enforced nation-wide lock
down and shut down during March – May 2020 and April – August 2021.
There were intermittent restrictions and relaxations in between. These
restrictions caused disruptions of several of the planned interventions
Background
▪ The intervention package consists of facility based MIYCN counseling service
by MIYCN Counselors (MCs) and a community mobilization components
▪ The community mobilization part has three elements:
• Household visits by the Community Workers (CW)
• Mobile follow up with clients by MCs
• Community-based events
▪ An adaptation of planned interventions had to be made to continue MIYCN
counseling service provision
Household visit by CW
Facility based counseling
Community based event:
World Handwashing Day

4. Sl Core interventions Covid -19 disruptions
1 Trainings of MC, CW and Managers on
MIYCN SBCC, counseling skills, and
supportive supervision (managers only)
Only MC received complete in-person training before
pandemic. CW training was disrupted and CWs could
receive only basic training
2 Standardized MIYCN counseling rooms Implemented as planned
3 SBCC materials and job aids Developed and utilized as planned
4 MIYCN counseling services MC provided routine MIYCN counseling services. In
absence of them, existing NGO counselors continued the
service
5 Social mobilization and community
events
MIYCN fairs and film shows were permanently suspended
6 Household visits Suspended in accordance with government directives and
restrictions in the community
7 Supportive supervision of MC and CW Suspended during strict restrictions and resumed
intermittently
Covid-19 Disruptions

5. Intervention Adaptations
Trainings Virtual trainings, orientations and technical periodic refreshers were
provided. Newly recruited (due to high staff turnover) MCs and CWs
received peer-to-peer training with existing trained counselors
Household
visits
Mobile MIYCN (m-MIYCN) education was provided by CW via mobile
phones to pregnant women and mothers in place of home visits
Supportive
supervision
Supportive supervision of MCs and CWs were conducted via phones
and included listening in on mobile counseling sessions, using a
checklist to assess quality of counseling, and providing feedback
Community
demand
generation
Light community-based efforts included satellite clinic outreach
(RADDA facilities only) and MIYCN flyer distribution, distribution of
MIYCN flyers to community referrers (MSB facilities only), and
monthly ANC camps for pregnant women (MSB facilities only)
Covid-19 Adaptations
MIYCN flyer
Virtual training

6. Adaptations Results
Remote training All partner staff related to the project received trainings
m-MIYCN outreach Till September 2021, the community workers
disseminated MIYCN messages to 49,403 mothers
through mobile phones
Supportive
supervision
During August 2020 to July 2021, a total of 47 remote
supportive supervision sessions were conducted
Community
demand generation
During August 2020 - September 2021, a total of 26,220
flyers have been distributed. A total of 2,040 new clients
receiving MIYCN counseling service reported to have
been informed about the service by the flyer during the
same period
▪ Monitoring tools and processes were in place to monitor and measure the progress
▪ Regular data review and performance management meetings with implementing partners
were conducted
Results
Distribution of flyer by referrers

7. ▪ Non-governmental organizations providing essential primary care services aligned with
government can potentially address the urban healthcare gap and advance health sector
improvements
▪ Adaptations based on use of mobile phones, online platform and information flyer distribution
are effective approaches to continue MIYCN counseling service provision in a crisis situation in
the urban context
▪ The adaptations sustained the service provision in the pandemic situation without any
unintended consequences
▪ In the perspective of Covid-19 pandemic, these approaches can potentially be adopted to
continue MIYCN service provision in similar settings
Conclusion and Policy Implication