multi-dimensional programming the rubik's cube challenge to community health ester indriani

Applications of Multi-Dimensional Approach to Health:

Challenges and Lessons Learned

Esther Indriani, MPH Regional Health and Nutrition Advisor

World Vision South Asia and Pacific Region

Key Lessons Learned of Multi-Dimensional Approach

• It’s complex • It can be done •We need to look at intended & unintended results

Asking children is a good way to start…

“If we can earn our own income, we can tell our parents not to marry us early, because we are self-reliant.”

Principles for Integrated Approach

• Issues are multi-dimensional • Common Goal • Common target group • Common programme area • Common indicator for success • Complementary projects and activities,

efficient use of resources

India • Integrated Programming for Child

Health (IPCH) • Aim: Reduction in malnutrition • 4 years 2012-2015 • Impacting 3,7 million people

including 350,000 children under 5 • 17 states, 72 districts • Targeted poor and hardcore poor

with underweight child for a package of Health, Nutrition, and Livelihood interventions

Final Evaluation IPCH (Team Leader: Dr. Marc Debay, Loma Linda University) Oct 2015 • Average Annual Reduction

Rate of Underweight Over 3 Years + 13.1%

• 4 X faster decrease in underweight than in 100 highest malnutrition prevalence districts over previous 7 years

Source: Final Evaluation Report of IPCH 2015, WV India and Loma Linda University

WV India’s Resolution to do Integrated Approach

Bangladesh: Nobokoli Project

• 4 years 2013 – 2017 • Aim: To reduce malnutrition • impacting 1,4 million people including

181,135 children under 5 • in 7 districts, 18 upazilla • Focusing on pregnant & lactating women

and children under two for a package of Health, Nutrition, and Livelihood interventions

• Targeting poor & ultra poor HHs*: • With underweight child under 2, or • With Pregnant Woman * based on income and land ownership

• Increased production • Increased consumption • Improved dietary diversity • Improved income and savings • Increase women’s empowerment • Improved nutrition

7, 276 children

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

November'15

December'15

January '16 February '16 March '16

23.8 25.1 27.0 28.1 28.9

35.0 36.6 37.5 38.4 38.4

41.2 38.3 35.5 33.5 32.7

Prevalence of underweight of ED children for Nobokoli areas

Moderate & severe Mild NormalIntegrated monitoring

Baseline (July-Oct 2014) Mid Term (Jan-Mar 2016) done by ICDDR,B

Underweight and Wasting Comparison between Baseline and Mid Term Survey

Things We are Learning for Multi-Dimensional Approach to Health

• COMPLEXITY • TIME • COMPETENCE • PARTNERSHIP • COORDINATION • SCOPE

Untying the knot - together

Creative and innovative examples of multi-dimensional programs are changing the lives of women, children and communities around the world.

We can no longer say that we don’t know what to do, or we don’t know how.

We need to learn, share and act TODAY.