Leadership and Learning

Global Leadership
MCHIP was a global contributor and a member of the Secretariat for the Anemia Task Force with USAID, Strengthening Partnerships, Research, the Innovations Globally (SPRING) Project, and CORE Group. Program staff led global symposia, expert panels and present innovative work globally on stunting, maternal nutrition and anemia prevention and control at international conferences, including:

  • International Congress of Nutrition Conference, Granada Spain. MCHIP presented eight e-poster and oral presentations, and participated in an expert panel on giving iron supplementation to children. General conference information can be found here.
  • Preliminary analyses of Trials of Improved Practices (TIPs) data on MCHIP study “Examining Factors Associated with the Rise in Stunting in Lower Egypt in Comparison to Upper Egypt” Nutrition and Nurture during Infancy and Childhood Conference in Grange-over-Sands, England.
  • Asia Regional Meeting on Guidance on Implementing Effective Programs to Prevent Preeclampsia and Eclampsia and Anemia to Improve Maternal and Newborn Outcomes, 2012 – Dhaka, Bangladesh.
  • Guidance on Implementing Effective Programs to Prevent Pre-Eclampsia and Eclampsia and Anemia To Improve Maternal And Newborn Outcomes, 2013 – Johannesburg, South Africa.

Program Learning Achievements

At the country level:

  • In collaboration with the Government of Kenya, Division of Nutrition, MCHIP was part of the solution in addressing anemia in the country, which affects about half of pregnant women. Kenya faced several challenges, including restructuring of the healthcare system, low antenatal care attendance, and lack of iron-folic acid (IFA) supplies. MCHIP worked with the Kenyan Division of Nutrition to hold an anemia control stakeholders’ meeting which resulted in a multi-year and costed plan of action for accelerating reduction of iron deficiency anemia among pregnant women. The stakeholders’ meeting stimulated the return of IFA supplements back on the Essential Drug List and transitioning from two separate pills (one for iron and the other for folic acid) to a combined single dose of IFA. This action improved compliance with IFA because one pill is easier to take than two pills. Providing a combined dose also ensured that a lower dose of folic acid was being provided, which is adequate for meeting the folic acid requirements of women and which does not interfere with the treatment of malaria with sulphadoxine-pyrimethamine (SP).Since then, UNICEF has supported the government to procure a stop-gap supply of IFA tablets targeting 410,000 pregnant women (25% of pregnant women) in specific regions of Kenya. For five years subsequently, the World Bank financed procurement and distribution costs for IFA supplements. Through this funding, Kenyan Medical Supply Agency (KEMSA) procured over 60 million combined IFA tablets – providing pregnant women with a six month supply of 180 tablets each.  The World Bank and DANIDA funding also focused on capacity strengthening of district pharmacists on forecasting of commodities, such as IFA, as part of the government strategy to scale-up the “pull system” (health centers pulling IFA based on their need from central supplies rather than central supplies pushing IFA from the central level) countrywide. MCHIP continued to work with the Kenyan Division of Nutrition to create an integrated anemia task force to further work on Kenya’s anemia control and prevention strategy.
  • MCHIP, in partnership with the Ministry of Health in Rwanda, held an Anemia Prevention and Control Consultation in September, 2013, comprised of participants representing government, development partners, and the private sector. The participants hailed from diverse fields including maternal and child health, nutrition, malaria, agriculture, education, and the private food industry. MCHIP brought together these different partners from various sectors to discuss anemia prevention and control in Rwanda and how to better target current programs to eradicate anemia, particularly in young children and pregnant women.
  • MCHIP also integrated nutrition with other sectors, like family planning and childhood illness. The MCHIP nutrition team worked closely with the MCHIP family planning team to integrate MIYCN and FP behavior change messages into counseling materials that health workers and community health workers can use during home visits or during facility based counseling. Health workers and community health workers were trained in Bondo district, Nyanza Province, Kenya, as well as ongoing supportive supervision to monitor and assess the process of integration.

How did MCHIP Nutrition address equity?
Malnutrition is highest in the poorest and vulnerable members of society. The MCHIP Nutrition team addressed equity by targeting those most at-risk for malnutrition, particularly pregnant women and children in their first 1,000 daysthe period from pregnancy through the first two years of life. MCHIP’s nutrition programs focused on the community, where malnutrition occurs, and partners with civil society, which can identify families that are poor and vulnerable to malnutrition and ensure those who need help receive the most effective interventions.

Through evidence-based programming, MCHIP used formative research to identify barriers to equitable access of services to improve maternal, infant and young child nutrition. For example, MCHIP conducted a study in Egypt to identify the determinants of stunting, including barriers to the equitable use of services, to better target interventions. Opportunistic programmingthrough the integration of nutrition with other services in the community and facilities such as family planning and diarrheal disease controlincreased the access of mothers and their children to a number of interventions that will improve nutritional status.

How did MCHIP Nutrition address community?
Across the continuum of the first 1,000 days, MCHIP worked through civil society and community-based organizations to promote improved nutrition practices. In Kenya, MCHIP supported mother-to-mother support groups and developed a monitoring tool for the Baby Friendly Community Initiative.  The Program built the capacity of community-based health workers in Egypt, Kenya and Rwanda, and worked to provide technical assistance to provide key nutrition messages through other sectors (such as a Ministry of Agriculture community-based kitchen garden programs in Rwanda).

The MCHIP Nutrition Team promoted community-based interventions to increase the equitable access of vulnerable groups to key interventions. For example, MCHIP promoted community-based distribution of iron-folic acid (IFA) supplements and developed a framework (or “decision tree”) for when community-based distribution is the most effective channel for getting iron to all pregnant women. The Program worked with community support groups and utilized formative research methodologies as a basis to develop tailored, culturally-specific messages that can be delivered at the household level by community workers in Egypt, Kenya, and Yemen.

How did MCHIP Nutrition address scale?
MCHIP engaged as a key technical leader to strengthen nutrition programming by partnering with and assisting Nutrition Divisions in Ministries of Health. The Program assisted by coordinating and stimulating dialogue at the country level to mobilize commitment, resources and supplies for an integrated approach to anemia prevention and control—one that encompasses a three-pronged approach of scaling-up IFA supplements, deworming medication, and intermittent-preventive treatment for malaria in pregnancy to address maternal anemia.

In Kenya, MCHIP led a stakeholders meeting for the Division of Nutrition and advocated for a combined IFA pill and getting IFA on the essential drugs list, and played a facilitating role in garnering support for improved procurement of IFA by partners. The Program coordinated mechanisms in the country by starting a dialogue for an integrated anemia task force to promote country ownership, as a basis for scale-up. MCHIP played a role as a member of the Secretariat for the Scaling Up Nutrition (SUN) Movement to bridge the gap between prevention and treatment, and to facilitate country-led discussions on scale-up in countries such as Yemen.

How did MCHIP Nutrition address quality?
The MCHIP Nutrition Team worked to develop relevant, evidence-based messages that led to behavior change and improve the quality of program implementation. MCHIP worked to improve both the demand and supply sides of program implementation, and ensured that service providers understand the causes and consequences of maternal and childhood malnutrition. To maximize the demand for and correct use of these interventions, health workers needed to give optimal counseling messages to pregnant women on taking IFA and other interventions and to mothers about optimal infant and young child feeding.

Operations research assisted with ensuring the quality of messages being provided and to develop integrated counseling packages on infant and young child nutrition, incorporating maternal nutrition and family planning to maximize opportunities/routine health contacts to ensure optimal nutrition for the mother and the child to prevent anemia and stunting, and to ensure adequate timing and spacing for birth spacing.

MCHIP also worked to with countries to ensure that: 1) correct supplies (packaging, formulation, color) are available properly forecasted and delivered through the  appropriate channel(s); 2) demand is generated at the country-level; and 3) program guidance is given on how an integrated package can be incorporated in country-level programming to reduce the identified causes of anemia.