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Nigeria

nigeria-photo-credit-is-2012-akintunde-akinleyenurhi-courtesy-of-photoshare

Duration: December 2015 – 2019

Documented results from our first five years of programming (2009-2014) strengthened our understanding of how to improve infant and young child feeding behaviors, and led to additional funding to expand the application of our framework. Today, we’re working to scale up nutrition in Nigeria by applying and adapting tested, proven approaches and tools. Ultimately, A&T’s efforts are expected to result in large-scale social and behavior change that leads to improved infant and young child feeding (IYCF) practices.

In each of its countries, A&T uses a multistakeholder, multicomponent program approach to achieve IYCF impact at scale. This framework serves as the foundation for assessment, planning, and implementation approaches for country program engagement. Because of the size and complexity of Nigeria, A&T is working in two states, Lagos and Kaduna, with national-level advocacy. All four components from A&T’s framework will be applied in the states: (1) Advocacy; (2) Interpersonal communication and community mobilization; (3) Mass communication; (4) strategic use of data.

The overall nutritional status of children in Nigeria has slightly improved over the last decade; nevertheless, the country still has among the world’s highest child mortality rates and some of the lowest rates of recommended IYCF practices. The exclusive breastfeeding rate for 0-6 month olds—a practice that can significantly reduce child deaths— has remained unchanged in Nigeria since 2008 at 17% (Nigeria DHS, 2013). Additionally, only 10% of children age 6-23 months nationwide are fed adequately and appropriately based on recommended IYCF practices (Nigeria DHS, 2013).

Partnerships and alliances make it possible to scale up the strategy
No one organization, actor, or sector can tackle infant and young child nutrition issues alone. A&T sees partnerships in the public, private, and nonprofit realms essential to reach nutrition targets. In Nigeria, A&T is collaborating with a range of partners in design and implementation of the large and complex portfolio of activities.

Advocacy: Because nothing happens in a vacuum
Advocacy for improved infant and young child feeding involves a process of informing and motivating influential audiences—like policymakers and program managers—to create a supportive environment for optimal feeding practices. In Nigeria, A&T’s advocacy efforts are supported by GMMB, with the objectives to:

  • Strengthen implementation of IYCF policies, and advocate for stronger policies, including:
    • Rollout and implementation of National Strategic Plan of Action for Nutrition
    • Maternity entitlements
    • Code of Marketing of Breastmilk Substitutes
    • Infant and Young Child Feeding-Friendly Health Systems strengthening (including a Baby Friendly Hospital Initiative)
  • Improve maternity workplace policies and benefits among the private sector
  • Increase issue salience/raise visibility of infant and young child feeding and support capacity for others to advocate on behalf of nutrition

Interpersonal Communication and Community Mobilization: The heart of behavior change
A&T’s evaluation results from our first phase of programming (2009—2014) confirm the critical role that interpersonal communication plays in achieving behavior change for improved infant and young child feeding practices. For behaviors that are complex and require ongoing adherence, motivation and support from other people—including change agents like frontline health workers, volunteers and family members—are essential.

In Nigeria, A&T’s interpersonal communication and community mobilization component centers on face-to-face conversations and activities between frontline workers and mothers or family members at the household, community, and facility level. Community mobilization activities reinforce interpersonal communication with mothers, shift social norms, and lend credibility to messages given by frontline workers and volunteers. A&T’s program approach addresses these barriers by working through existing community-based child nutrition services that can include home visits, ANC sessions, PNC visits, health fora for mothers, and community mobilization sessions with families and influential members of the community.

As part of its package of interpersonal communication, A&T in Nigeria will be testing out a streamlined approach that uses “rules of thumb”  that are designed to prompt action without necessarily offering rationale, scientific support, or multiple options from which the actor should choose what to do.

Mass Communication: Cost-effective validation, credibility, reinforcement, and much more…
Various channels of mass communication will be used to disseminate key messages throughout Kaduna and Lagos states. Mass communication will inform and remind mothers and family members, community influentials, frontline workers, and health providers of priority and age-appropriate infant and young child feeding behaviors.

Strategic use of data: Assuring effectiveness, efficiency, and sustainability
A&T uses data throughout the entire program cycle to make decisions about program design, shape advocacy messages, and improve program implementation and management. The project design and implementation is informed by a baseline survey and ongoing formative research and data analysis.

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Photo credit: © 2012 Akintunde AkinleyeNURHI, Courtesy of Photoshare