iycf support in emergencies mother-to-mother support groups in the dadaab refugee camps

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IYCF Support in IYCF Support in EmergenciesEmergencies

Mother-to-Mother Support Mother-to-Mother Support GroupsGroups

in the Dadaab Refugee Campsin the Dadaab Refugee Camps

IYCF Support in IYCF Support in EmergenciesEmergencies

Mother-to-Mother Support Mother-to-Mother Support GroupsGroups

in the Dadaab Refugee Campsin the Dadaab Refugee CampsTOPS FSN Network Regional Knowledge Sharing

MeetingWashington, DC: November 2012

Mary Lung’aho for CARE, UNHCR and Partners

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Partners in IYCF Support in Partners in IYCF Support in DadaabDadaab

• UNHCR• UNICEF• CARE• GTZ• IRC• NCCK

• IMC• ACF• SAVE UK• MSF• KRCS

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Emergency Contexts: Population on Emergency Contexts: Population on Move Move

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Emergency Contexts: Congested Emergency Contexts: Congested SettingsSettings

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Emergency Contexts: Disrupted Emergency Contexts: Disrupted Families Families

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Emergency Contexts: Defensible Emergency Contexts: Defensible Living SpaceLiving Space

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Emergency Contexts: Organized Emergency Contexts: Organized CampsCamps

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Dadaab Refugee CampsDadaab Refugee Camps

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Creating a System of IYCF Creating a System of IYCF SupportSupport

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MtMSG ObjectivesMtMSG Objectives

Share experiences Ask questions and exchange

information Examine values and attitudes, discover

patterns of behavior Encourage women and communities to

identify and solve their own problems Make better decisions about feeding and

care of their children Provide SUPPORT for each other Build self-confidence

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Camp-level Support StructureCamp-level Support Structure

Health Post

Health Post

Dadaab IYCF Team UNHCR—CARE—GTZ—NCCK

AAH—Save UK

Hagadera Hospital Ifo Hospital Dagahaley Hospital

Health Post

IYCF Coordinating Team:

IYCF Health Post Team

IYCF Community Workers

Health Post Staff ANC consultant Under five consultant HIS staff EPI staff SFP and OTP staff

UNHCR Nutritionist CARE IYCF Supervisor GTZ Nutrition Coordinator NCCK

Community Workers CHWs- Community Health Workers TBAs- Traditional Birth Attendants CDWs- Community Dev Workers RHMs- Repro. Health Motivators CPWs- Children Protection Workers

Community Volunteers-IYCF Counselors

Mother-to-Mother Support Groups

Secondary Targets Men’s support groups School clubs Youth groups etc.

IYCF Officer. Maternity staff Pediatric staff Under five

consultant HIS staff SC staff PMTCT etc.

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Capacity-Building: Knowledge & Capacity-Building: Knowledge & SkillsSkills

• Training materials for Community Workers in Dadaab based on competencies outlined in: WHO counselling courses IFE Core Group Modules 1 & 2: for

health and nutrition workers in emergency situations, including:

Assessment of infant feedingPractical help with breastfeeding

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13

Experiential Learning Cycle: SkillsExperiential Learning Cycle: Skills

Supervised field practice and feedback

Discuss skill

Demonstrate

Practise in classroom

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Capacity-Building: IYCF Support Capacity-Building: IYCF Support ActivitiesActivitiesWith:• Field Practice• Supportive supervision/mentoring• Referral• Routine programme monitoring • Periodic refresher training• Exchange visits• Quarterly meetings: share

experiences, discuss ‘cases’ (‘peer’ mentoring)

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Field PracticeField Practice

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Counselling Cards that can be used in Counselling Cards that can be used in MtMSGMtMSG

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Impact ???Impact ???

• Much of the impact is often assumed• Impact evaluation usually not possible:

often no population level baseline or endline in emergencies

• Thus: heavy reliance on monitoring data

• But: lack of agreement on routine monitoring indicatorsQ: Possible to adapt or build upon

indicator categories suggested for development programming?

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IYCF Routine Programme IYCF Routine Programme MonitoringMonitoringQ1: How much did we do?

• Implementation of activities:# Training events# / % MtMSG facilitators trained# / % MtMSGs active# / % MtMSG facilitators mentored

# Communications activities (videos, drama, IEC materials)

Monitoring records (pictorial)

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Activities: MtMSG Facilitator Activities: MtMSG Facilitator TrainingTraining

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Activities: MtMSG MeetingsActivities: MtMSG Meetings

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Activities: Video Presentations Activities: Video Presentations (Messaging(Messaging))

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Activities: Pictorial Activities: Pictorial ‘record-keeping’/monitoring‘record-keeping’/monitoring

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IYCF Routine Programme IYCF Routine Programme MonitoringMonitoring

Q2: How well did we do it?• Coverage: geographic/spatial coverage

(MtMSGs per camp, health post, block)• Coverage: participation of target

population (in MtMSGs)

• Quality: % MtMSG facilitators who meet quality benchmarks

• Quality: caregiver knowledge and attitudes

• Quality: client satisfaction

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Coverage: Camps Blocks showing Coverage: Camps Blocks showing MtMSGsMtMSGs

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Quality: Supportive Quality: Supportive Supervision/MentoringSupervision/Mentoring

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IYCF Programme ResultsIYCF Programme Results

Q3 (RESULTS - survey): Is anyone better off?• IYCF Practices (WHO indicators)• Health & nutritional status

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Exclusive Breastfeeding & Population Exclusive Breastfeeding & Population GrowthGrowth

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Results: Exclusive Results: Exclusive BreastfeedingBreastfeeding

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

2005 2006 2007 2008 2009

Exclusive BF Dadaab 2005-2009

Percent EBF Dag Hag Ifo

Projected EBF Rate from Baseline

IYCF Program

Start

Influx of New Refugees

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0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

2005 2006 2007 2008 2009

Global Acute Malnutrition Dadaab 2005-2009

Percent GAM Dag Hag Ifo

Global Acute Malnutrition Global Acute Malnutrition (GAM)(GAM)

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Issues: IncentivesIssues: Incentives

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Men’s InvolvementMen’s Involvement

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Creating ExcitementCreating Excitement

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Charismatic LeadershipCharismatic Leadership

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THANK YOU!THANK YOU!