Maximising the nutritional impact of FSL interventions
TRAINING KIT
Facilitator Guidance Introduction & Session notes
Version 1.0 – February 2012
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 1 Table of content
This training kit was developed by Géraldine Le Cuziat, with the support of Julien Morel and Sabrina Silvain from October to December 2011. It benefited from precious contributions and feedbacks from a number of ACF Food Security and Livelihoods Coordinators and Advisors during the ACF FSL Workshop held in Kenya in October 2011.
The format used for this Facilitator Guidance and some other tools of the training package are largely inspired by materials developed by the CaLP – Cash Learning Partnership.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 2 1. Course overview
Aim of the training
The training has two broad complementary goals:
1. To increase participant’s knowledge, skills and aptitudes in maximising the nutritional impact of food security and livelihood interventions. 2. To share and disseminate lessons learnt, experiences and best practices of ‘nutrition-sensitive’ interventions.
Module Session N° Specific learning Objectives Title n° 1. Define undernutrition and explain its consequences & determinants 2. Define nutrition security and explain the linkages between food Session 1 security, livelihoods, agriculture, nutrition and health Acknowledging 3. List the resources and key sources of information related to & undernutrition understanding 1 food security 4. Design and conduct a ‘nutrition-sensitive’ assessments through the lens of nutrition Session 2 5. Explain how the findings from nutrition-sensitive assessment can be used to plan and adapt FSL programmes 6. Define the concept of ‘window of opportunity’ and explain its Session 3 operational implications 7. Define the ‘programme theory pathway’ and explain its purpose in Session 4 the programme’s design Aiming for 8. Identify nutrition-related indicators to measure outcomes & impact’s 2 Nutrition intervention impact Session 5 9. Explain the purpose and process of collecting individual dietary information using IDDS and IYCF. 10. Define the ‘do no harm approach’ and list key steps of ‘a do no harm approach’ strategy Do no harm Session 6 3 11. Explain the purpose and process of using the IYCN Nutritional Impact tool assessment Including 12. Explain the purpose of nutrition promotion and how this should be Nutrition used promotion 4 and/or Session 7 13. Explain the purpose of Behaviour Change Strategy (BCS) and how Behaviour this should be used Change Strategy (BCS)
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 3 To whom this guidance is designed This guidance is designed for ACF technical advisors, coordinators and programme managers already experienced in food security and livelihoods with some knowledge in nutrition. The training course is based on the ACF International manual published in July 2011: Maximising the Nutritional Impact of Food Security and Livelihoods Interventions, A manual for field workers. It is not intended as a training of trainer guide; users are expected to already be fluent in course content and delivery from prior experience with similar initiatives.
Time Frame The course is currently designed to last 2 days; however they can be adapted for shorter time frames by removing modules. In addition of the two-day course, one optional day is being developed as an introduction to nutrition for FSL coordinators and/or programme managers who have limited knowledge and understanding of nutrition. The nutrition coordinator/programme manager (if any in the country) may conduct the session of this optional day.
Prior consideration Is the Training Before organising the training check that it is the right training for your intended needed? target audience.
Who will be in charge Two essential roles to sort out from the start are the role of course administrator of organising the in charge of the overall management of the course and the training team (which training? should preferably be two trainers).
The overall budget needs to be agreed and allocated from the start. Typical Budget costs are the venue, meals and refreshments, per diem, accommodation, training and organising fees, printing, stationery and equipment such as a projector.
Learner Profile The training targets ACF national and international staff, coordinators and programme managers who need to plan, design, implement and monitor FSL interventions whether in emergency or in protracted relief and rehabilitation operation. It is expected that participants will have limited or no experience in maximising the nutritional impact of FSL. The training can also be conducted with partner and stakeholder staff with similar roles, skills, and experience as ACF participants. It is highly recommended that the nutrition staff (programme manager and coordinator) also attend the training in order to increase collaboration, understanding, synergy and expertise within both teams.
This course however, is not about integration between the different technical sectors per se but aims to mainstream nutrition into the standard FSL activities and practices, by increasing collaboration between sectors. It aims to raise awareness of ACF staff and other humanitarian practitioners on the impact they can have on nutrition by implementing nutrition-sensitive interventions and by promoting adequate nutrition practices.
Prerequisites 1. Nomination and acceptance based on role and experience. 2. Reading the ACF manual Maximising the nutritional impact of FSL interventions in addition to other compulsory readings listed below. (Section Readings)
Course Norms 1. 7 hours (4 sessions of 1.45 minutes) of active participation and homework per day. 2. Participants agree to capitalise on the opportunity to enhance their skills and experience. Successful course completion will be required for a certificate. A final evaluation will be completed by each participant at the end of the course to assess the relevancy of the training and contribute to the improvement of the material. Course agenda (2 days) The sequence of sessions is recommended, but can be adapted if time or process make this appropriate. The course is based on adult learning principles and is intended to provide a balance of theory and practice, of passive and active learning. Most of the PowerPoint presentations are structured around a series of open- ended questions to encourage on-going participants’ contribution and discussion throughout the session.
The materials are intended as a framework. They were designed for use in contexts where FSL interventions are required but it is up to the trainer to make them realistic for the specific context in which they are training, by providing illustrations and examples from the context. As a trainer you may also decide that certain exercises/case-studies are not suitable for your audience and adjust accordingly.
The course is divided in 4 modules. The module one lasts one full day meanwhile module 2, 3 and 4 are done during the second day. The latter can be further expanded if need be. Given the limited knowledge and understating in nutrition, one optional day is being developed as an introduction to nutrition, which should be conducted prior to the course.
It is a tight agenda with many sessions, notes, and exercises. Training facilitation should therefore be shared between two people. One of the main challenges for facilitators will be to keep the sessions as active as possible. Regular review sessions are conducted for continuous reinforcement of course content. All outputs, field tool formats, and session slides should be given to participants on a CD or flash drive at the end of the training .
TIME OPTIONAL DAY DAY 1 8.30 - Opening Recap of the previous day -15’ 10.15 Basics of Nutrition Welcome & game Ball game Macronutrients & Micronutrients Participants & Facilitators presentation Module 2: Aiming for nutrition impact Healthy diet Training objectives Session 1 Participants expectations & specific Programme theory pathway learning objectives ‘Porridge Mum’ in Guinea Agenda & training rules Case study 3 - Exercise and group Individual pre-test on Nutrition presentation Module 1: Acknowledging & understanding through the lens of nutrition Session 1 Overview of undernutrition BREAK 10.45- Group exercise 1 & group presentation Session 2 12.30 Nutritional needs of specific Scale, trends and variations Nutrition-oriented indicators & tools groups (e.g. PLW, children under Nutrition security Group exercise 2 & group two, PLWHIV) presentation NutVal exercise Case-study 1 - Exercise END MODULE 2 Ccl and operational recommendations LUNCH 1.30 – Session 2 Module 3: Do no harm 3.15 Nutritional Assessment & ‘Nutrition-sensitive’ assessment Do no harm interpretation (i.e. GAM, SAM, Case-study 2 - Exercise IYCN presentation (Nutritional Impact MAM) Assessment Tool) Case-study END MODULE 3
Module 4: Including nutrition promotion and Behaviour Change Strategy Overview of nutrition promotion and BCS ‘Health gardens in Mali & group discussion END MODULE 4 BREAK 3.45 – Case-study group presentation Conclusion 5.30 Direct nutrition interventions Ccl and operational recommendations Film video (J.Hoddinott) – 15’ Case-study Action plan – 60’ Session 3 Oral & written feedbacks from Story telling participants – 30’ Window of opportunity Group brainstorming & discussion about operational implications END MODULE 1 – Main Recommendations -10’ Readings Hereafter is the list of compulsory and optional readings to accompany the training. Participants should get familiar with the readings and read the compulsory ones before attending the session. Most of the readings are also mentioned in the ACF manual. These documents are all available in the folder 5.Readings of the Training Kit.
Compulsory 1. ACF, 2012, Glossary of terminology commonly used to prevent, diagnose and treat undernutrition 2. Scaling Up Nutrition (SUN), 2010, Scaling Up Nutrition: A Framework for Action; Available at: http://www.unscn.org/files/Annual_Sessions/2009_Brussels/SUNframework_sept2010.pdf 3. WFP, 2006, NutVal 2006 – V2.2 4. IFPRI, 2008, Investing in early childhood nutrition. Policy Brief ; Available at: http://www.ifpri.org/publication/investing-early-childhood-nutrition 5. IFPRI, 2011, Leveraging Agriculture for Improving Nutrition and Health: Highlights from an International Conference, Washington, DC 6. ACF Mali, 2011, Health Gardens – A nutrition centred Approach. Impact and capitalisation study
Optional 1. ACF, 2007, Basics of nutrition, 2007 2. UNSCN, 2010, 6th report on the World nutrition situation, Geneva. 3. WFP, 2010, Revolution: From Food Aid to Food Assistance, Innovations in overcoming Hunger, Edited by Omano, Gentilini and Sandström, WFP, Rome 4. FAO, 2010, Combating Micronutrient Deficiencies: Food-based Approaches, edited by Brian Thompson and Leslie Amoroso, FAO, Rome. 5. UNSCN, 2010, Policy Brief on Climate change and Nutrition Security 6. LINKAGES Factsheets, Breastfeeding, Maternal nutrition, Infant Feeding, 2003-2004 (3 documents) 7. European Commission, 2011, Addressing Undernutrition in External Assistance, An integrated approach through sectors and aid modalities, Reference Document, Tools and Methods Series 8. DFID, 2010, The neglected crisis of undernutrition: Evidence for action 9. DFID, 2011. Scaling Up Nutrition. The UK's Position on Undernutrition 10. AED & LINKAGES, 2003, Formative Research, Skills and Practice for Infant and Young Child Feeding and Maternal Nutrition, AED/LINKAGES India 11. IYCN, 2011, Behavior change interventions and child nutritional status, Evidence from the promotion of improved complementary feeding practices, Literature review, USAID/IYCN, Washington 12. IYCN, 2011, Nutritional Impact Assessment Tool. Electronic Worksheet & Guidance (2 documents) 13. Save the Children, 2009, Hungry for Change, an eight-step, costed plan of action to tackle global child hunger, Save the Children, London 2. Course Preparation
Pre-course Logistics
Choosing A wide range of considerations need to be taken into account when location and deciding where to run the course (country and city) and in which dates: dates accessibility of the place, visas, season, cultural/religious festivities, etc.
Before advertising the course, make sure you have identified and booked Selecting the the appropriate venue to run the course. venue Things to check are space for the amount of participants you have in mind, including for exercises, space to hang flip charts on the wall, natural daylight and basic facilities for photocopying, email etc.
Retro-planning
a. 2 month before the course
Send invitation including all relevant information regarding the aims, objectives and rationale of the course, expectations and methodology and conditions to participate. The pre-communication also contains a preliminary questionnaire to tailor the training to the needs and experience of interested/potential participants.
b. 1 month before the course
Collect info on country context and strategy, projects on-going related to the topic, potential contributions/presentation from participants, assessment data Update training content if need be (e.g. undernutrition trends per region/country – see Slide 2 session 1.1) and update slide accordingly. Once participants have been confirmed, they should be sent: - A revised agenda (according to needs and expectations -> make sure to change accordingly Handout 1 – Agenda before printing) - Logistics information relating to the venue, transport arrangements etc. - A participant list - An invitation to make a presentation if need be - Documents to read before the course Order training material and resources. All necessary stationary, technical equipment and training materials (See Training Material Check List below) need to be ordered as soon as possible before the training. Order printing of needed resources (See Training Material Check List – a. Printing below)
c. 1-week before the course
Divide participants in working groups (e.g. minimum 3 groups and maximum 6; groups should be composed of 4 to 6 people). Make sure participants’ background and level are mixed within the groups. Select who will write minutes during the course (if need be) Ensure that material, equipment and stationary will be available in a timely manner Read the training material and content and make changes/updates accordingly
d. 1-2 days before the course starts
Prepare the room Check all equipment, materials and printing Test video and speakers Print all remaining documents Prepare material for exercises (Key words exercise 1 – plan for 1 hour of preparation) e. During the course
Burn and distribute the CD/USB key with material and additional reference documents to be distributed to participants at the end of the course Print and fill up the Attendance List Take a picture of the group Take notes and debrief daily amongst facilitators in anticipation of the training report writing Keep record of any remarks/ideas to change/improve the training materials Update participants list with contact details and add to participants CD/USB Key
f. After the course
Analyse participants evaluation form Prepare and share a short report with relevant stakeholder (e.g. ACF-F Food Assistance & Policy Senior Advisor, HR department) Send a follow-up e-mail 1 month after the course to participants
Training Material Checklist *: Non-compulsory
a. Printing ACF Manual ‘Maximising the nutritional impact of FSL interventions’: 8 copies (B&W printing). Note: ideally participants should come with their own copy. (▶ 4.Ressources\Manuals) FAO and EC, 2011, Guidelines for measuring household and individual dietary diversity: 4 copies (B&W printing) (▶ 4.Ressources\Manuals) WHO et al, 2008, IYCF Definitions: 4 copies (B&W printing) (▶ 4.Ressources\Manuals) WHO et al, 2010, IYCF Measurement: 4 copies (B&W printing) (▶ 4.Ressources\Manuals) Copies of Handouts : 1/participant) (▶3.Handouts) Tool - Exercice 1- Key Words: 7 copies (▶4.Ressources\Tool) Tool - Team Numbers: 2 copies (▶4.Ressources\Tool) Tool – Timing: 2 copies (▶4.Ressources\Tool) Participant list (name, org, role, sector, phone and e-mail contacts) : 1 copy for facilitator Participant Attendance List (2 copies) and Evaluation Forms : 1/Participant (▶4.Ressources\Template) Participants Evaluation Form : 1/Participant (▶4.Ressources\Template) Participants Certificate: 1/participant (▶4.Ressources\Template)
b. Stationary
Name tags/stickers (1/participant) Notebooks/pads (1/participant) Pens (1/participant) 3 Packs of A4 paper Marker pens: 3 boxes, mixed colours (black, blue, red, green); Post-it medium size (12,7 x 7,6 cm): 2 to 3 colours, 4 packets of each 3 blue tacks 2 tapes Blank CDs or USB Key (1/participant + office, training centre, and headquarter copies) c. Equipment (to be lended by the mission, the venue or if need be rented)
Laptop computer Projector, screen, remote control* with laser pointer*, spare batteries 2 multi-plug extension cables (with universal plug holes), 5m metres Attachable microphones for facilitators and hand held for participants* 1 Printer with installation software and extra toner cartridge 2 flipchart stands (+ 5 additional recommended for group work) 3 rolls of Flip chart papers 1 scissors (large) 1 stapler 1 ball 5 MUAC tapes
d. Other
Video 1: Linkages between Agriculture, Nutrition and Health available at Available at http://www.youtube.com/watch?v=VKciI1RexvA or in tool folder. Memory stick/CD with all reference materials and course content (Training Kit)
Content of the Resources Folder Manuals - ACF, 2011, ‘Maximising the nutritional impact of FSL interventions, a manual for field workers’ - FAO & EC, 2011, Guidelines for measuring household and individual dietary diversity - WHO, UNICEF, FANTA, 2008, IYCF Definitions - WHO, UNICEF, FANTA, 2010, IYCF Measurement
Templates - 1.Participants Attendance List_EN.doc - 2.ACF PowerPoint Template_EN.ppt - 3.Participants Evaluation Form_EN.doc - 4.Participants Evaluation Database_EN - 5.Training Report_EN.docx - 6.Participants Certificate_EN.doc
Tools - Tool - Exercice 1 - Key Words.docx - Tool - Team Numbers.docx - Tool - Time_keeper.ppt - Tool - Timing.docx
Other - VIDEO - 2020 conference - Day 2 - 1B Plenary - Part I.flv
Content of the CD/USB key to distributed to participants All the following folders and their content should be provided to participants on a CD or USB Key by the end of the course:
2.Presentations folder 3.Handouts folder 4.Ressources\Manuals folder 4.Ressources\VIDEO - 2020 conference - Day 2 - 1B Plenary - Part I.flv 5.Readings folder 3. Session Guidance Notes
Each session is supported with a set of Facilitator Notes in this same format. While the overall direction, content, and flow of each session is included, facilitators are nonetheless encouraged to modify these as much as possible or relevant so that the course they deliver is in fact their own. The first section provides an overview of key information, including the equipment or materials required for the session. The second section proceeds through each PowerPoint slide independently, with supporting commentary to assist session facilitation. Some sessions also include an exercise, in which case it is discussed in the third part of the Guidance Notes. 0.0 Opening and Objectives
Objectives 1. Open the training & welcome participants 2. Introduce & present participants 3. Clarify training objectives 4. Compare participants’ expectations to learning objectives 5. Present the agenda and training rules 6. Assess the pre-training knowledge level of participants Duration 85’ (reminder - Aan introduction should last 10% of the total duration of the training). Timekeepers are available in the folder ‘Resource’. Seating Plan Chairs in a circle, with tables 5/6 persons per group Keep in mind that groups should not be the same all along the training session. Mix the groups! Put some music when the participants are coming into the meeting room to get a nice atmosphere. The room should be comfortable and prepared before the training starts. An extra table should be dedicated to ‘resources/readings”, that are of interest for the training (see further readings and websites in the manual). Exercise(s) Warm up ‘Optical illusions’ Reading(s) Optional Reading 1: Basics of Nutrition Handout(s) Handout 0: Training & specific learning objectives Handout 1a: Agenda Handout 1b: Readings List Handout 2a: Individual pre-test ‘Basics on nutrition’ Equipment(s) Projector Remote control Material(s) Flip chart for writing expectations Flip chart with learning objectives – already written. Name tags Markers Training schedule Recording sheet to note questions that caused confusion or should be revised. Output(s)
Session Plan
Slide # Guidance Notes 1. Welcome participants and thank them for their participation. Welcome 5 ‘ As a facilitator, it is crucial to be ready, on time, positive, welcoming, energetic to capture the audience attention. Keep in mind that the first 15 minutes will set the tone of your course. Suggested intro: - Burning topic with increasing evidence-based and research towards maximising the nutritional impact of FSL interventions. The guidance/training draws on the outcomes of the conference that took place in New Delhi in February 2011 “Leveraging agriculture for improving nutrition and health” to sustainably prevent and reduce undernutrition. This forum brought over 1,000 policy makers, practitioners, politicians, NGOs, international organisations, academics, researchers, representatives from ministries of health and agriculture to look for synergies among initiatives to improve nutrition and health through agriculture. A number of publications, brief policies, discussions were issued and are available at http://2020conference.ifpri.info/ and http://2020conference.ifpri.info/publications/ - Dispel the myth that increased agricultural production or income necessarily translates into improved nutrition. Not true as other factors affect the nutritional status. - Manual needs to be field-tested and opportunity to develop new and more nutrition-sensitive interventions all along the project cycle. Remains country specific and requires adaptation to local and cultural context. - The intention of the training is not to make FSL staff nutritionist but raise the awareness about optimal nutrition knowledge and practices. 2. ‘ Warm up game’ to create a working and enabling environment. This will allow GAME 5 ‘ participants to ‘get into the course’ and leave some extra time to the late birds. Note that it does exist many other ice-breaker/games to start a training session and encourage participation. Well-selected icebreakers and openers can help members feel “associated with” group members and the facilitator and could be created or adapted to the context. 6. Pick of the following options or create new ones to introduce participants & Participants & facilitators. facilitators “Name Game” presentation 20’ Ask each person to compare herself or himself to an animal or thing that exemplifies some trait of his/her personality and explain the choice. Examples: “I am like an ant because I am always on the move,” “I am like a horse because I swiftly do my tasks,” “I am like a bird because I like to dream.” “Commonalities” Divide participants into pairs. Ask participants to share their names and positions and to try to find three things they have in common. Allow 10 minutes for this exercise. In plenary, have each pair introduce each other to the group and share one commonality they discovered. 7 1. To increase participant’s knowledge, skills and aptitudes in maximising the Training Objectives nutritional impact of food security and livelihood interventions. 5 ‘ 2. To share and disseminate lessons learnt, experiences and best practices of ‘nutrition-sensitive’ interventions. 8. Whenever possible, ask participants in plenary session to name their expectations Participant for this training. Alternatively, ask every group to define 3/4 expectations & specific objectives/expectations. Every group leader will present the group’s findings to the learning objectives 10’ others. Write participants’ responses on the flipchart. Present learning objectives for writing specific and tell participants whether their expectations will be addressed in the design of objectives & 20’ for the training. Compare participants’ expectations to learning objectives and allow presentation participants to ask questions. If realistic, add any additional objectives recommended based on participants’ expectations. Distribute Handout 0 9. Agenda & training Distribute Handout 1a and Handout 1b. rules 5’ Facilitator will walk participants through the workshop structure and content. It is essential to agree upon norms and ground rules that respect individual rights and responsibilities, build trust among participants and between participants and facilitator. Both participant & facilitator will contribute to a successful learning experience and this should be decided on as a group in the beginning. List the agreed rules on a paper board (if not mentioned, add punctuality, mobile phones silent, respect of each other and listening to others etc.). In addition, participants will receive the list of compulsory and optional readings; this aims at increasing participation and experience sharing during the training. 10. Distribute Handout 2a Individual pre-test This is to briefly assess the pre-training knowledge level of participants as well as 15’ an opportunity for participants to assess their own level. Distribute pre-test sheets and ask them to complete the pre-test. Tell participants they have 15 minutes to complete the test. Give them a 5-minute and 2-minute warning. No restitution is planned, as the answers will come up during the two-day sessions. It is very important to IDENTIFY topics that caused disagreement or confusion that need to be addressed: ask after completion of the test which questions were particularly difficult to answer. Remind them to go back to the handout during the course to correct or precise their answers (in the right column).
Encourage participants to have a look at optional Reading 1: ‘Basics of nutrition’ to get familiar with macronutrients, micronutrients and recommended nutrient intakes. Module 1: Acknowledging & understanding food security through the lens of nutrition
No Module Session Specific learning Objectives Title no 1. Define undernutrition and explain its consequences & determinants (knowledge) Session 1 2. Define nutrition security and explain the linkages between food security, Acknowledging livelihoods, agriculture, nutrition and health (knowledge) & 3. List the resources and key sources of information related to undernutrition understanding (knowledge) 1 food security 4. Design and conduct a ‘nutrition-sensitive’ assessment (skills & through the aptitudes) lens of nutrition Session 2 5. Explain how the findings from nutrition-sensitive assessment can be used to plan and adapt to FSL programmes (skills & aptitudes) Session 3 6. Define the concept of ‘window of opportunity’ and explain its operational implications (knowledge & aptitudes) Session 4 7. Define the ‘programme theory pathway’ and explain its purpose in the programme’s design Aiming for 8. Identify nutrition-related indicators to measure outcomes & impact’s Nutrition 2 intervention impact Session 5 9. Explain the purpose and process of collecting individual dietary information using IDDS and IYCF 10. Define the ‘do no harm approach’ and list key steps of ‘a do no harm approach’ strategy Do no harm Session 6 3 11. Explain the purpose and process of using the IYCN Nutritional Impact tool assessment Including 12. Explain the purpose of nutrition promotion and how this should be used Nutrition 13. Explain the purpose of Behaviour Change Strategy (BCS) and how this 4 promotion Session 7 should be used and/or BCS
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 16 1.1 Overview of undernutrition
Objectives Define undernutrition and explain its consequences & determinants. Define nutrition security and explain the linkages between food security, livelihoods, agriculture, nutrition and health. List the resources and key sources of information related to undernutrition. Duration 125’ Facilitator Minutes Writer Seating Plan Chairs in a circle, with tables 5/6 persons per group Exercise(s) Group exercise 1 (40’) Case-study 1 (35’) Reading(s) Manual – See Section 1 & Annex 2 Compulsory Reading 1: Glossary of terminology commonly used to prevent, diagnose and treat undernutrition Compulsory Reading 2: Scaling Up Nutrition (SUN): A Framework for Action. Compulsory Reading 5: IFPRI, Leveraging Agriculture for Improving Nutrition and Health: Highlights from an International Conference. Optional Reading 2: UNSCN ‘6th report on the World nutrition situation’. Handout(s) Handout 3: Life cycle of nutrition challenges Handout 4: Where to get information on undernutrition? Handout 5: Size of the nutrition problem in South Africa Equipment(s) Projector Remote control Material(s) Flip charts and cards with key-words (already filled in – see exercise notes below) Markers Blue tack or glue/tape Output(s)
Session Plan
Slide Guidance Notes 0. Opening Benefits for participants: 1’ Increase collaboration and interaction with technical departments and colleagues (especially with nutrition) by leveraging knowledge in nutrition. Save time and resources especially when comes the time of identifying needs, conducting an assessment or writing proposals/reports. 1. Session Define undernutrition and explain its consequences & determinants. objectives Define nutrition security and explain the linkages between food security, 1’ livelihoods, agriculture, nutrition and health. List the resources and key sources of information related to undernutrition 2. What is What is it? undernutrition Ask in plenary session some key words related to UNDERNUTRITION and how do 5’ they relate to each other? Facilitator will write them on a paperboard and will be able to gauge the existing level of knowledge and understanding among participants. Note: the level of understanding will depend on participant’s exposure to nutrition programmes and individual sensitivity. FYI, participants should be familiar with the word ‘undernutrition‘ as they were asked to read the manual before coming to the training and this is thoroughly detailed in section 1 of the manual.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 17 3. Picture 1 Human face of food insecurity, hunger and undernutrition 30 seconds 4. Picture 2 Human face of food insecurity, hunger and undernutrition 30 seconds 5. Estimates Facilitator should look for updated estimates (worldwide/regional/country) prior 1’ starting the training. There is no need to provide a bunch of estimates, but participants should bear in mind that undernutrition is widespread and remains one of the world’s most serious but least addressed socioeconomic and health problems. 6. Definition At that stage, the facilitator provides a brief definition and will put not only focus on 2’ acute malnutrition but on others as undernutrition encompasses a broad range of conditions: Acute malnutrition Chronic malnutrition Micronutrient deficiencies or hidden malnutrition Maternal undernutrition Low birth weight Underweight Make sure that participants are able to distinguish malnutrition/undernutrition. There is no need to broadly detail every component, as this will be done later during the exercise. (Facilitator support: refer to solution to question 1 pre-test – handout 2b for short definition of each condition).
Mention to participants compulsory Reading 1 to get familiar with technical terms related to undernutrition. 7. Graph Graph on undernutrition 2’ 8. Determinants Participants are usually very familiar with the conceptual framework of malnutrition 3’ and less familiar with the revised one from Black (2008) or World Bank (Draft 2011- not yet released). Immediate determinants: inadequate dietary intake and disease. Underlying determinants: food insecurity, inappropriate care practices and an unsafe environment including access to water and hygiene, and inadequate health services. Basic determinants: rooted in poverty and involve interactions between social, political, demographic, and societal conditions All these factors result in increased vulnerability to shocks and long-term stresses. Add a focus on seasonality, as this is one of the major contributing factors of undernutrition.
Example: Facilitator can recall ACF publication ‘Seasons of Hunger: Fighting Cycles of Quiet Starvation Among the World’s Rural Poor’. In many places, the lean season is associated with low food stocks, reduced job opportunities and increased risk of morbidity (rainy season will increase risk of malaria/diarrhoea).
9. Consequence Distribute Handout 3 s SHORT and LONG TERM consequences. 4’ Facilitator needs to emphasise on the vicious circle of undernutrition and poverty.
Example: Nutritional needs of girls/women during the life cycle are rarely met and they are vulnerable to malnutrition throughout the life cycle for both biological and social reasons. Facilitator presents the maternal undernutrition through the different stages: infancy/early childhood/ adolescence/ pregnancy and lactation.
Conversely, there is strong evidence that good nutrition can lead to an impressive range of benefits (e.g. improved health, cognitive development, and work capacity, greater economic and agricultural productivity, better education, and better workforce development, as well as greater resilience to shocks induced by social,
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 18 economic and natural causes.) Powerful tool in poverty reduction and livelihood improvement (World Bank 2007).
Refer to compulsory Reading 2 (Scaling Up Nutrition) and briefly outline the aim and objective of the SUN. 10. Exercise See exercise notes below. 15’ 11. Exercise Each group will present and explain the results to other participants. This is the correction opportunity for the facilitator to recall the definition for each condition. 25’ Refer to manual p.2 for additional information. 12. Nutrition Nutrition security goes beyond the traditional concept of food security (access, security availability, stability and utilisation of food). Dependent on a wide and multi-sectoral 4’ array of factors. + This is again the opportunity to dispel the myth that improved agriculture production or income improves the nutritional status.
Example: Agriculture as a main source of food can influence health positively through enhanced nutritional status, but also negatively by increasing human exposure to toxicants, food-borne and zoonotic diseases related to agriculture and food chains. Conversely, good nutrition improves agricultural productivity. Keep in mind that participants may only see one way (positively through enhanced nutritional status) and tend to overlook the other way around.
Refer to compulsory Reading 5 ‘Highlight from an international conference ‘Leveraging Agriculture for improving Nutrition and Health’. 13. Nutrition Figure on Nutrition Security security 1’ 14. Nutrition Definition security definition ‘ A household has achieved nutrition security when it has secure access to food 2’ coupled with a sanitary environment, adequate health services, and knowledgeable care to ensure a healthy life for all household members’ (Benson, 2004).
Nutrition security is not a new concept but has gained significance over the past years. (e.g. used to receive far less attention in the literature than has food security). However, there is no international consensus on what is nutrition insecurity.
According to Benson, a household is food secure if it can reliably gain access to food in sufficient quantity and quality for all household members to enjoy a healthy and active life. It is possible, however, for individuals in food-secure households to have deficient or unbalanced diets. A person may have reliable access to the components of a healthy diet, but because of poor health or care, ignorance, or personal preferences with negative nutritional implications, he or she may not be able to or choose not to use the food in a nutritionally sound manner. Just as food production and availability are necessary but not sufficient conditions for food security, food security itself is a necessary but not sufficient condition for nutrition security and a healthy and active life. Moreover, the availability of nutrition resources and the degree to which an individual has access to such resources are a function of how society is organized in terms of economic structure, political and ideological expectations, and its institutions. The determinants of nutrition security extend far beyond the control of the household itself. Unlike food security, nutrition security is the concern of many more institutions, sectors, and other actors than those typically found in the food sector. Nutrition security must be a subject for political debate and an issue of immediate concern to any national development strategies.
15. Scale and Facilitator will review the types of primary and secondary data to be collected to determinants gain understanding of undernutrition, its magnitude and determinants. This is the 5’ first step in designing relevant interventions and encouraging synergies among initiatives to improve nutrition. This is done in collaboration with the whole
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 19 technical team under the supervision of the Country Director.
16. Public health It is important to remind the audience that there is no official agreement on what is threshold of a ‘nutrition emergency’ (i.e. commonly we use the 10% cut-off threshold for acute significance malnutrition). It does exist thresholds of public health significance for 3’ undernutrition. Refer to p. 12 of the manual + Annex 2. 17. Trends & Important to understand undernutrition trends and how changes over time can variation reveal a deteriorating/improving the nutritional situation. This will also show 5’ nutrition in its seasonal cycle. Facilitator adds on the need to desegregate data whenever possible per age, sex, region.
Example: Figures/estimates can mask disparities between men/women, boys and girls. In some countries, boys will get access to more nutritious food because they are perceived as ‘future’ breadwinner of the family. Refer to handout 4 for sources of information related to undernutrition.
This is the opportunity to discuss about unknown/unfamiliar sources of information such as the WHO database on vitamins and minerals or the Demographic Health Survey (DHS), provides relevant websites (e.g. UNSCN, SUN etc) and operational tool with the distribution of handout. Distribute Handout 4 18. Working Make sure again participants are not worried about their ‘new tasks’. together The objective of the training is not to have nutritionist per se’but nutrition-sensitive 5’ FSL staff. Cooperation and collaboration between sectors is a requirement. There is need to speak the same language. Nutrition outcomes may be intuitive/obvious for nutritionist but not for agriculturalist. FSL field workers cannot do it ALONE!
19. Case study 1 See notes below 35’ Distribute Handout 5 20. Summary of Why maximising the nutritional impact of FSL interventions? key points & Increasing the nutritional benefits and minimising the potential harm Operational What does it mean? implications Acknowledging, understanding and acting through the length of nutrition and at 5’ the intersection of Agriculture, FS Nutrition and health sectors, all along the project cycle. FSL can bring about short and long term benefit by providing the right intervention as the right time. Looking at UNDERNUTRITION at a whole and not only ACUTE malnutrition. Working in close collaboration with all departments – especially NUTRITION to identify data, sources of information, and gain understanding of causality and trends. Identifying specific secondary data of relevance. MAPPING nutrition and non-nutrition interventions in the area of intervention. Keep in mind: no need of being an expert in nutrition but still need background and basics to ensure relevant FSL interventions to fight undernutrition.
Exercise 1:
What is the learning objective? Be familiar with technical terms and key words that describe undernutrition How long this exercise be done? 15 minutes group work and 25 minutes for group presentation (5’ per group) What materials are needed? One flip chart per technical term: acute malnutrition, chronic malnutrition, micronutrient deficiencies, maternal undernutrition, low birthweight and underweight. The following 25 terms are written separately on pieces of paper for each group. Blue tack or tape to stick pieces of paper on flip chart. Where to find the materials and preparation needed
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 20 The material is available in the folder ‘Resources’. Print the whole word document in 6 copies, cut the different 25 terms of each, and put them in a box/envelope (Each of the 6 groups should receive an envelope with the 25 terms). In the meantime, stick the key technical term on a separate flip chart. (e.g. one set per group) Instructions: The participants are asked to match technical terms that describe undernutrition to keywords. Each group will work on one specific condition (i.e. group 1/acute malnutrition, group 2/chronic malnutrition, group 3/ micronutrient deficiencies etc.). Cards with key words are already filled up, are picked one by one and stuck under the condition they have been assigned on a flip chart. Note: some key words may be associated to more than one condition.
Acute Chronic Micronutrien Maternal Low Malnutritio Underweight Malnutrition t deficiencies undernutrition birthweight n
1. Wasting 2. “Too thin for the height” 3. Bilateral oedema 4. MUAC < 115 mm 5. Rapid weight loss 6. Food shortage 7. Inappropriate childcare and feeding practices 8. Stunting 9. “ Too small for the age” 10. Growth failure 11. Long-term consequence 12. Prolonged/repeated episodes of nutritional deficiencies/illnesses 13. Mineral 14. Vitamin 15. Iron Deficiency Anaemia 16. Goitre 17. Vitamin A 18. Hidden malnutrition 19. Poor diet diversity 20. Low body mass Index 21. Pre-conception, pregnancy, postnatal 22. Intrauterine growth retardation 23. Small baby 24. Inadequate pregnancy gain weight 25. Low weight-for-age
MODEL ANSWER
Acute Malnutrition Chronic Malnutrition Micronutrient deficiencies Wasting Stunting Mineral “Too thin for the height” “Too small for the age” Vitamin Bilateral oedema Inappropriate childcare and Iron Deficiency Anaemia MUAC < 115 mm feeding practices Goitre Rapid weight loss Growth Failure Vitamin A Food shortage Long-term consequences Hidden malnutrition Inappropriate childcare and Prolonged/repeated episodes of Inappropriate childcare and feeding practices nutritional deficiencies/illnesses feeding practices Poor diet diversity
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 21 Maternal undernutrition Low birthweight Underweight
Low body mass Index Intrauterine growth retardation Low weight-for-age Pre- conception, pregnancy, Small baby postnatal Inadequate pregnancy gain Mineral weight Vitamin Iron Deficiency Anaemia Goitre Vitamin A Hidden malnutrition Poor diet diversity
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 22 Case study 1: Size of the nutrition problem in South Africa (adapted from the nutrition cluster harmonized training package)
Case study is presented from South Africa. Case studies are useful for getting participants to think through real-life scenarios. They also provide an opportunity for participants to work in a group and develop their analytical and decision-making skills. Trainers are encourages developing their own case studies, which are contextually appropriate to the particular participant group.
What is the learning objective? To give participants an overview of the size and distribution of the problem of undernutrition in their country How long should the exercise take? 35 minutes Give the groups 20 minutes to answer the questions and prepare a 3-minute presentation of their answers. What materials are needed? Handout 5: Size of the nutrition problem in South Africa (questions)
Instructions: Each group is requested to answer the two following questions and prepare a brief presentation of the discussion.
1. What do these graphs tell us about the distribution of undernutrition in South Africa?
Table 1: Underweight (weight-for-age) and Stunting (height-for-age) rates in % by Province Province Underweight Stunting Eastern Cape 7.1 20.5 Free State 14.3 29.6 Gauteng 8.8 20.4 KwaZulu-Natal 6.0 18.5 Mpumalanga 4.2 26.4 Northern Cape 23.7 29.6 Northern Province 15.0 23.1 North West 15.3 24.9 Western Cape 8.3 14.5 Source: Labadarios, D (ed). The National Food Consumption Survey (NFCS): Children aged 1-9 years, South Africa, 1999.
2. What do you notice about the distribution of micronutrient deficiencies?
Table 2: Mean Intake of Vitamin A by Province and Age Group Nutrient Age Group Vitamin A1 1-3 years 4-6 years 7-9 years Highest levels Western Cape Western Cape Mpumalanga Gauteng Gauteng Northern Cape Northern Province Northern Cape North West
Lowest levels Mpumalanga Mpumalanga KwaZulu-Natal Northern Province Free State Gauteng Western Cape North West North West Source: Labadarios, D (ed). The National Food Consumption Survey (NFCS): Children aged 1-9 years, South Africa, 1999.
1 RDAs: Vitamin A = 1-3 yrs (400 RE); 4-6 yrs (500 RE); 7-9 yrs (700 RE) respectively.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 23 Table 3: Mean Intake of Iron by Province and Age Group Nutrient Age Group Iron2 1-3 years 4-6 years 7-9 years Highest levels Northern Province Northern Province Northern Province Western Cape Western Cape Western Cape KwaZulu-Natal KwaZulu-Natal KwaZulu-Natal
Lowest levels Northern Cape Northern Cape Northern Cape Free State Free State Free State Eastern Cape Eastern Cape North West
MODEL ANSWER: Size of the nutrition problem in South Africa
1. What do these graphs tell us about the distribution of under-nutrition in South Africa?
Northern Cape, North West and Northern Provinces have high rates of underweight and also high rates of stunting. Remind participants that stunting is related to long-term undernutrition when children fail to grow taller due to chronic (or long-term) undernutrition as a result of the poor quality of their diet and/or frequent or chronic illness.
2. What do you notice about the distribution of micronutrient deficiency?
The distribution is rather similar to underweight and stunting. Undernutrition is common in low-income groups in developing countries and is strongly associated with poverty. Discuss the situation of undernutrition and its causes in South Africa (and in the provinces/regions, in particular, where the training and/or programme is being conducted/implemented). Poverty results in not having enough to eat or limiting dietary variety. Thus the manifestations are indicative of a problem further “up the line”, food insecurity in this case.
Note: in many developing countries, under and overnutrition occur simultaneously reflecting the consequences of a poor diet. This phenomenon is referred to as the double burden of malnutrition.
2 RDAs: Iron = 10 mg for all age groups considered.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 24 1.2 ‘Nutrition-sensitive’ assessment
Objectives Design and conduct a ‘nutrition-sensitive’ assessment Explain how the findings from nutrition-sensitive assessment can be used to plan and adapt to FSL programmes. Duration 105’ Seating Plan Chairs in a circle, with tables 5/6 persons per group Exercise(s) Case-study 2 (60’) Reading(s) Manual – See Section 2 – Guidance 2 Annexes 5a and 5b: IYCF protocols (Definition and Measurements) Annex 6: Helen Keller dietary assessment tool to measure vitamin A intake Annex 7: HarvestPlus dietary assessment tool to measure iron and zinc intake Annex 10: Overview of the cost of a healthy diet by Save the Children UK Compulsory Reading 3: NutVal 2006 (V3) Compulsory Reading 5: IFPRI, Leveraging Agriculture for Improving Nutrition and Health: Highlights from an International Conference (p.5-8) Optional Reading 3: WFP, Revolution: From Food Aid to Food Assistance, Innovations in overcoming Hunger. Optional Reading 4: FAO, Combating Micronutrient Deficiencies: Food-based Approaches. Optional Reading 5: UNSCN, Policy Brief on Climate change and Nutrition Security. Handout(s) Handout 6: Linking food security and nutrition data Equipment(s) Projector Remote control Material(s) Flip chart Markers Output(s)
Session Plan
Slide Guidance Notes 1. Opening Benefits for participants: 1’ Save time and resources especially when comes the time of conducting an assessment. It increases collaboration among technical departments and reduces risk of programme’s failure. 2. Session objectives Design and conduct a ‘nutrition-sensitive’ assessment 1’ Explain how the findings from nutrition-sensitive assessment can be used to plan and adapt to FSL programmes. 3. ‘Nutrition-sensitive’ The facilitator re-introduces the concept of NUTRITION SECURITY if not assessment mentioned by the participants. ‘Nutrition-sensitive’ assessment looks not only at Definition ‘standard FSL indicators’ (household economy, livelihoods, coping mechanisms 3’ etc.) but also at OTHER VARIABLES that affect the nutritional status. ACF is capable to conduct technical joint assessment that includes all immediate and underlying factors of undernutrition and this is a chance!
Examples: Nutritional Causal Analysis, Joint assessment. Note: NCA guidelines are not ready yet at the time of writing.
Field workers can overcome the operational/timing/donor constraints of joint assessment by conducting food security assessment in the same communities where nutrition, Mental Health & Care Practices and WASH teams did their assessments or incorporating more detailed questions into a stand-alone standard
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 25 SMART nutrition survey. FOCUS on strong technical and geographical collaboration towards a same objective. This requires expertise in some field (care practices – not always implemented in every mission) but this should not prevent the team from conducting joint & comprehensive assessment. 4. Why is it 4 main reasons to be highlighted: important? - Comprehensive overview and undernutrition pathways 4’ Example: care and feeding knowledge and practices have been for a long time overlooked but are key-contributing factors in children malnutrition. Example: low birth spacing in Bangladesh or mothers do not take adequate weight gain during pregnancy because they believed a small baby will facilitate the deliver and avoid birth complications.
- Encourage synergies and integration between sectors. Example: need to work at the intersection of agriculture, food security health and nutrition to achieve tangible progress in nutrition and MDG-1.
- Reduce the risks of programme’s failure & conversely increase chance of programme’s impact. Example: distribution of livestock as physical capital/asset and not for consumption; or, the livestock production is not ‘fairly’ allocated within the household and women tend to eat the less nutritious parts. Need to gain understanding of food intra-household allocation patterns.
- Milestone for the ‘do no harm approach” – will be further explained later. Example: gender considerations should be addressed during the assessment as women may not be the decision maker within the households about food purchase/preparation, income allocation etc. Mother-in-law usually plays a key role within the household. 5. Variables The facilitator mentions the main variables to collect. Once again, participants 4’ should be reminded that only variables related to nutrition are included and not the other ‘core’ FSL variables/indicators. Need to consult ACF guideline on food security and livelihoods assessment + Refer to Manual Section 2, guidance 2 for additional information. Nutritional status Food consumption patterns & dietary intake Care practices Nutritional needs of specific groups Gender considerations Health and sanitary environment The following will only provide details on the nutritional status, food consumptions patterns and care practices. Refer to the manual for the others 6. Nutritional status The nutrition team is in charge of collecting key-nutritional data such as 2’ anthropometry, MUAC, micronutrient deficiencies. FSL assessment does not include anthropometric measurement per se. However, there may be some exceptions (MUAC when FSL team is the first to arrive). Taking anthropometric measurements requires TRAINING and SKILLS. It does exist field-friendly and cheap method to detect IDA with Hemocue. 7. Food consumption Broad concept and very country-specific! & dietary intake This includes: 5’ Local perception of a “healthy diet’ might be very different from a nutritionist perception Cultural beliefs around food (e.g. food restrictions during pregnancy/lactation time) Meals frequency (very much affected by seasonality effects) Dietary diversity (number of different food groups consumed by an individual/household over a given time). Household level = proxy for food security and food access Individual level= proxy for nutrient adequacy
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 26 Dietary intake (caloric and nutrient intake against the Recommended Dietary Allowances) Food utilisation (storage, processing and preparation)
8. Tools Ask participants to raise their hands if already using the following tools: 5’ Seasonal calendar Household Dietary Diversity Score/Individual Dietary Diversity Score FFQ to measure micronutrient adequacy/dietary intake. See Annex 6 and 7 for dietary assessment models. New tools i.e. Cost of the Diet developed by Save the Children. See Annex 10 – Overview of the cost of a healthy diet by Save the Children. Note: On-going efforts to develop field-friendly tools to measure adequate dietary intake and micronutrient adequacy. Problems of measuring micronutrient adequacy with FFQ is partly due to nutrient’s interaction (e.g. iron utilisation is enhanced with the vitamin C intake) Have a look at NutVal – useful tool to calculate a balanced food ration. 9. Care practices Care refers to the behaviours and practices of caregivers (mothers, siblings, Definition fathers and childcare providers) to provide the food, health care, stimulation, and 3’ emotional support necessary for children’s healthy survival, growth, and development (Engle, 1995). Practice + Environment + Resources It does exist measurable indicators for infant and children feeding practices. Ask participants to raise their hands if they already used IYCF in their programme.
10. IYCF What are IYCF? 3’ IYCF stands for Infant and Young Children Feeding.
IYCF practices directly affect the nutritional status of children under two years of age and, ultimately, impact child survival. Improving infant and young child feeding practices in children 0–23 months of age is therefore critical to improved nutrition, health and development of children. During a long period of time, the only indicator to measure IYCF mainly focused on breastfeeding practices. Following new evidence about what constitutes optimal breastfeeding and complementary feeding practices a new set of indicators was recommended. 2 key-documents were recently published on IYCF resulting from a 5-year collaboration from a range of agencies including WHO, UNICEF & FANTA.
1. IYCF Definition. It presents a set of simple, valid and reliable indicators to assess infant and young child feeding practices that should be considered together (because of the multi-dimensional aspects of appropriate feeding at this age). The document provides a list of 8 core and 7 optional indicators (Refer to slide 10 below).
This set of indicators looks at breastfeeding practices BUT not only and look at other feeding practices (e.g. complementary feeding, and feeding of non-breastfed infants and young children less than 2 years of age) at population level. They are food-related (no about other optimal feeding aspects and do not investigate ‘responsive feeding’ or adequate food texture. They can be used during (i) assessment to describe trends, but also for (ii) targeting to identify populations at risk, target interventions, and make policy decisions about resource allocation and lastly (iii) M&E to monitor progress in achieving goals and to evaluate the impact of interventions They should not be translated into messages for improved feeding practices. Field practitioners should refer to WHO guidance for feeding recommendations.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 27 2. IYCF Measurement. This guide on measurement provides tools for data collection and calculation of the indicators. IYCF are usually part of larger surveys, are collected through 24h recall (to reduce recall bias) and administer to mothers/caregivers. See a model of questionnaire in the guide. Questions should be also adapted to the local context. 11. IYCF Core indicators. IN BOLD are the most important ONES. Core indicators 1. Early initiation of breastfeeding 3’ 2. Exclusive breastfeeding under 6 months 3. Continued breastfeeding at 1 year 4. Introduction of solid, semi-solid or soft foods 5. Minimum dietary diversity 6. Minimum meal frequency 7. Minimum acceptable diet 8. Consumption of iron-rich or iron-fortified foods
Optional indicators – not mentioned in the slide 9. Children ever breastfed 10. Continued breastfeeding at 2 years 11. Age-appropriate breastfeeding 12. Predominant breastfeeding under 6 months 13. Duration of breastfeeding 14. Bottle feeding 15. Milk feeding frequency for non-breastfed children
Refer to Manual Annex 5a and 5b for detailed explanations. 12. Differences with a. More comprehensive (look at individual > household) standard FSL b. Increased focus on food utilisation assessment c. IYCF 3’ d. Women (maternal cares, gender considerations etc). 13. Integration of Number of ways. findings into Provides concrete examples from case studies or participants experiences. programme’s - Types and modalities of intervention (e.g. short-term fresh food vouchers in design Haiti including access to proteins) 5’ - Timing (e.g. cash for work intervention as safety nets during the lean period) - Targeting (e.g. blanket distribution for PLW) - Do no harm approach (i.e. seasonal calendar to include women’s workload) - Complementary interventions (e.g. linking to health/de-worming interventions) Refer to compulsory reading 5 and optional readings 3, 4 and 5 for examples of ‘nutrition-sensitive’ interventions. 14. Case study 2 See notes below and ▶ distribute the Handout 6. 60’ 15. Summary of key - Linking with other sectors when designing and conducting assessment points & - Requesting technical support if need be Operational - Spending more time on understanding food consumption patterns Implications - Using IDDS and IYCF as tools for assessment. 3’ - Including other core FS variables
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 28 Case study 2: Linking Food security and nutrition data: Zimbabwe 2001 (adapted from the nutrition cluster harmonized training package)
What is the learning objective? Appreciate the importance of linking food security and nutrition data. How long should the exercise take? 60 minutes Give the groups 40 minutes to answer the questions and prepare a 3-minute presentation of their answers. What materials are needed? Handout 6: Linking food security and nutrition data: Zimbabwe 2001
Instructions: Each group should answer the following questions and prepare a brief presentation of the discussion.
The situation in Zimbabwe spiralled into crisis as a result of complex underlying factors. Firstly, the political environment was unstable and the government was accused of poor governance. Secondly, the economic situation was deteriorating with high inflation, high unemployment, and closure of factories and businesses. Thirdly, the impact of HIV/ AIDS was affecting over 30 per cent of the population. These factors had a major impact on food security. In response, the Vulnerability Assessment Committee (VAC) – a conglomeration of government and humanitarian agencies carried out an assessment in August 2002. The aims of the assessment were to determine whether households were able to meet their immediate food needs (i.e. any food deficit), and to identify vulnerable households and their coping capacities. A survey approach was adopted that integrated analysis of the household economy, coping strategies, dietary intake, agricultural inputs, and nutritional anthropometry. A complementary Household Economy Analysis (HEA) was also conducted in four Food Economy Zones (FEZs).
Part 1 The VAC assessment found a prevalence of wasting (global acute malnutrition or GAM) of 7.3% in children under five using standard cut-off points for weight-for-height Z-scores. This was similar to national surveys using random sampling methods as table 1 illustrates. The United Nations classifies a prevalence of GAM between 5-8% as a worrying nutritional situation, and prevalence greater than 10% as a serious nutritional situation.
Table 1: Prevalence of malnutrition in children in Zimbabwe Survey Sample size GAM % Date Demographic Health Survey 3,566 6 1999 Ministry of Health/UNICEF 23,400 6.4 May 2002 VAC 695 7.3 Aug 2002
Address the following questions: 1. What can you conclude from this information? 2. What interventions would you recommend to international agencies and donors to address the situation?
Part 2 Crop production The 2001/02 crop-growing season was among the worst three since 1990 and cereal crop production was seriously reduced due to: The dry spell experienced during the second half of the season The resettlement programme that disrupted commercial farming The Government agricultural input programme that delivered inputs late Draft power shortages The high cost of inputs, which farmers could not afford.
The VAC assessment concluded that Zimbabwe was facing a severe food crisis, which would become a humanitarian crisis in the next seven months unless urgent action was taken. Cereal availability was a critical factor with an initial cereal deficit of 1.65 million MT. The Grain Marketing Board had imported only 335,000 MT, and humanitarian food relief 70,600 MT. Private sector commercial imports were negligible. The
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 29 assessment found that 75% of households had less than ½ bag (50kg) of maize in stock. Furthermore 94% of farmers did not have enough seed for the following agricultural year.
Cash crop production The major cash crops grown in Zimbabwe include tobacco, flowers, vegetables, fruits, cotton, soya beans, groundnuts, sunflower, sugarcane, coffee, tea and paprika. Most of the cash crop production had decreased in the past three years.
Market prices The annual inflation rate at the beginning of 2001 was 57%. By January 2002, it had doubled to 116% and further increased to 124% in July. The increase in inflation rate was compounded by the shortage of basic consumer goods, agricultural inputs, fuel and foreign currency.
The assessment found that 70% of households were dependent on purchasing their cereals, and yet 64% of the communities stated that cereal was not, or seldom, available.
Livelihoods and coping strategies The assessment confirmed the impact of the crisis on peoples’ lives and livelihoods. Most rural income strategies are dynamic throughout the year. The community analysis indicated that 83% of the communities expected casual labour availability to decrease this year—severely limiting income opportunities especially for the poor. The casual labour averaged $200 per day. Half the households interviewed reported incomes of less than $5,000 per year. Even if all of the $5,000 were spent on cereal alone, this could only purchase enough cereal for a typical family size to meet their needs for 7 ½ months.
Households were asked if they had engaged in any of seventeen distress coping strategies within the past two months. These include: borrowing food, purchase food on credit, get food from relatives or friends from outside the household, regularly limit size of portions at mealtimes, regularly reduce the number of meals eaten during the day, skip whole days without eating, reduce expenditure on health care, reduce expenditure on education, reduce expenditure on beer and tobacco, sell all poultry to get food, sell all goats to get food, sell breeding and draft power cattle to get food, sell land or gave up rights to land, sell other assets to get food, take children out of school, send children away to friends or relatives, forced to migrate to find work or food.
The most commonly cited strategies involved reduction in consumption, with 86% of the households limiting portions of meals, and another 86% reducing the number of meals eaten in a day. A total of 18% of the households had removed one or more children from school. A majority (68%) of households were employing multiple distress coping strategies.
Other commonly mentioned coping strategies included illegal gold panning (often involving removing children from school to assist, and also leads to environmental damage), prostitution, and eating wild foods that were new to the households and can sometimes lead to health complications.
Public health The assessment found that the incidence of diarrhoea and acute respiratory infection (ARI) had increased dramatically. This increase could be attributed to deteriorating health conditions due to lack of water and proper sanitation and possibly complications of HIV/AIDS. Vitamin A deficiency (VAD) was 35.8% among children aged 12-71 months and anaemia was 19.3% in the same age group. In a crisis situation VAD is exacerbated and other vitamin deficiencies such as pellagra can surface.
Address the following question: 3. How do these findings alter your conclusions and recommendations? 4. Which non-nutritional data did you find most compelling with regard to determining the severity of the situation and why? 5. What lessons can be learnt from doing this case study?
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 30 Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 31 Case study 2 MODEL ANSWER
Part 1:
What can you conclude from this information?
These levels of wasting on there own do not indicate a deteriorating situation although the fact that the three surveys presented are undertaken at different times of the year makes rigorous comparison difficult
What interventions would you recommend to international agencies and donors to address the situation?
A follow up nutrition survey in three months would be valuable to determine whether the situation is deteriorating and also some sentinel site monitoring of MCH programmes and paediatric wards in order to determine whether number of cases of children presenting with malnutrition is increasing. No other interventions are indicated by these data alone.
Part 2:
How do these findings alter your conclusions and recommendations?
It is clear that the population is under considerably more stress than indicated by the anthropometric survey alone. Food availability (crop production) and access (through markets) is considerably compromised while diverse coping strategies are being employed some of which are damaging to long-term livelihoods, e.g. selling draft animals and land or land rights. It also appears that coping strategies are limited and are being exhausted.
A number of interventions are needed to address the situation. However, detailed analysis is needed to assess the feasibility and appropriateness of each option. A SWOT analysis is useful (strengths, weaknesses, opportunities and threats). Possible response options include;
Implementation of general rations Gearing up to selective feeding programme implementation Market support initiatives, e.g. subsidised sale of cereals, in order to improve access to cereals Livestock de-stocking and restocking programmes Seed fairs Water and sanitation programmes
Which non-nutritional data did you find most compelling with regard to determining the severity of the situation and why?
Although there is a subjective element to the question the most compelling non-nutritional data must in some way relate to extreme non-reversible coping strategies as well as predictions of how long population groups can hold out using available coping strategies. Other compelling evidence includes data which shows a change from the normal, e.g. market prices, less casual labour available.
What lessons can be learnt from doing this case study?
The importance of linking anthropometric data with food security and livelihoods data.
The importance of data that may indicate the need for interventions, which go beyond feeding and address recovery, e.g. sale of seeds and livestock.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 32 1.3 ‘Window of Opportunity’
Objectives Define the concept of ‘window of opportunity’ and explain its operational implications. Duration 45’ + 10’ (end of module 1) Seating Plan Chairs in a circle, with tables 5/6 persons per group Exercise(s) None Reading(s) Manual – See Section 2 – Guidance 3 Compulsory Reading 4: IFPRI, Investing in early childhood nutrition. Optional Reading 6: LINKAGES Factsheet about breastfeeding, complementary feeding and maternal nutrition. Handout(s) None Equipment(s) Projector Remote control Material(s) Flip chart Markers Record sheet to note scores and questions to be revised. Output(s)
Session Plan
Slide Guidance Notes 1. Opening Benefits for participants: 1’ Raise awareness about the nutritional needs of pregnant and lactating women and children under two. This could be very useful for them and their own families. Increase programme’s accuracy (delivery of inputs, targeting, messages) 2. Session objectives Define the concept of ‘window of opportunity’ and explain its operational 1’ implications. 3. Story telling Ask the participants to relax and close their eyes. 3’ The facilitator tells a story of Farida available at http://www.thousanddays.org/success-story/maternal-undernutrition-a-mothers- story/ Farida, a 23-year-old Bangladeshi woman, lives with her husband and in-laws in a sub district near Dhaka. Like many women in rural Bangladesh, Farida is a housewife. Married at the age of 17, Farida became pregnant within a year. During her pregnancy, Farida had no access to skilled prenatal care or education. Instead, she took tabij (amulet) and pani pora (chanted water) for minor problems. She went into labor prematurely at home, and lost her baby. Two year after, she got pregnant again but sadly, Farida’s baby was stillborn. Several months later, Farida met Nurunnahar, a Community Nutrition Worker of an NGO in Bangladesh. Nurunnahar encouraged her to attend nutritional information sessions. At these sessions, Farida learned about the importance of prenatal care, a nutritious diet and proper rest during pregnancy. The lessons learned in the nutrition sessions were complemented by regular household visits with Nurunnahar, during which Farida could consult with her on questions or concerns. When Farida became pregnant, she went to medical centers near her home for regular prenatal visits. At the time of delivery, Farida went to a hospital, where she gave birth to a healthy baby boy. She breastfed after delivery, and continued exclusive breastfeeding until her son was six months old. Now 17 months old, Farida’s son is happy, healthy and keeps her very busy!
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 33 4. Definition Before giving the definition of the window of opportunity, try asking participants to 4’ give their own definitions, which will help facilitators understand existing capacity in the workshop.
Evidence shows that the “window of opportunity” for addressing child nutrition needs is short and lasts from conception to the age of two. After the consequences of undernutrition are irreversible - this is also the window of opportunity for combat undernutrition; Make sure that participants are familiar with the different terminologies: ‘1,000 days’, pre-conception to the age of two. Example: iron deficiency between 6 to 24 months impairs child cognitive development.
Refer to compulsory reading 4: Investing in early childhood nutrition Policy Brief’
5. Operational Ask participants to brainstorm about the operational implications for FSL implications – interventions with 4 guiding questions and make a 3-minute presentation of their small group discussions. discussion What does this mean in terms of need’s assessment? 20’ What does this mean in terms of targeting? What does this imply for programme’s design? What are the potential challenges?
6. Operational Needs assessment: This requires getting specific data for PLW and children under implications - two (anthropometric, food consumption) and to a broader extent for women of presentation reproductive age. 15’ Targeting: combination of criteria (vulnerability + window of opportunity) or exclusive/unique criteria. This will depend on the type of the programme (e.g. blanket feeding or agricultural programming) Programme’s design: pay specific attention to the nutritional needs of PLW and children under two (e.g. encourage home food fortification, cash transfers depend on women attending ante natal care consultation) Potential challenges: not always feasible and desirable. Create tensions within the communities and ultimately depends upon objectives and need’s assessment.
7. Summary of key- The ‘window of opportunity’ period starts with a mother’s pregnancy points & until a child is two years old and also refers to the window of Operational opportunity to take action to combat undernutrition as consequences Implications after this period are irreversible. 1’ Including this target group in your next intervention. End of MODULE Ask participants to recall the main recommendations and key points of the module 1 10’ 1. This could be done in small groups or in plenary session.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 34 Module 2: Aiming for nutrition impact
No Module Session Specific learning Objectives Title no 1. Define undernutrition and explain its consequences & determinants Session 1 2. Define nutrition security and explain the linkages between food security, Acknowledging livelihoods, agriculture, nutrition and health & 3. List the resources and key sources of information related to undernutrition understanding 4. Design and conduct a ‘nutrition-sensitive’ assessment 1 food security 5. Explain how the findings from nutrition-sensitive assessment can be used through the Session 2 to plan and adapt to FSL programmes lens of nutrition 6. Define the concept of ‘window of opportunity’ and explain its operational Session 3 implications Session 4 7. Define the ‘programme theory pathway’ and explain its purpose in the programme’s design (knowledge & skills) Aiming for 8. Identify nutrition-related indicators to measure outcomes & impact’s Nutrition 2 intervention (knowledge & skills) impact Session 5 9. Explain the purpose and process of collecting individual dietary information using IDDS and IYCF (skills) 10. Define the ‘do no harm approach’ and list key steps of ‘a do no harm approach’ strategy Do no harm Session 6 3 11. Explain the purpose and process of using the IYCN Nutritional Impact tool assessment Including 12. Explain the purpose of nutrition promotion and how this should be used Nutrition 13. Explain the purpose of Behaviour Change Strategy (BCS) and how this 4 promotion Session 7 should be used and/or BCS
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 35 2.1 Programme Theory Pathway (PTP)
Objectives Define the ‘programme theory pathway’ and explain its purpose in the programme’s design. Duration 95’ Seating Plan Chairs in a circle, with tables 5/6 persons per group Exercise(s) Group exercise (’) Case-study 3 (’) Reading(s) Manual – See Section 2 – Guidance 4 Handout(s) Handout 7: Programme Theory Pathway in Myanmar Equipment(s) Projector Remote control Materials(s) Flip chart Markers Tape Post-it Presentation - Module 2.1 Field Experience Guinea - Porridge mums.ppt Output(s)
Session Plan
Slide Guidance Notes 1. Opening Benefits for participants: 1’ Reduce the risk of programme’s failure with the identification of the PTP. No more struggle when comes the time to design the log-frame. Save time, resources and headache! 2. Session objectives Define the ‘programme theory pathway’ and explain its purpose in the 1’ programme’s design 3. Programme Before introducing the concept of programme’s pathway, ask participants to list the Theory Pathway main steps of the PROJECT CYCLE. What SHOULD they do at designing and definition formulation stages? 8’ Problem tree, solution tree, logic chain, log-frame with definition of general and specific objective.
Participants should bear in mind that the project’s outcomes will not be achieved automatically.
Example: the potential of egg, meat, fish or dairy products to alleviate micronutrient deficiencies as part of a food-based strategy is well recognised especially in countries where the main staple food is cereal. However, the promotion of animal rearing will not automatically lead to improved consumption. Experience shows for instance that the livestock will sometimes be kept as an asset (e.g. cattle or small ruminant such as goats), or sold in the market to cover other expenses (e.g. school fees, health care) and not be used to improve the diet diversity. Give a concrete example of programme that failed to reach the expected specific objective/improve the nutrition status because enhancers/inhibitors factors were not well taken into account.
Example: livestock is distributed to increase the consumption of micronutrient-rich food but the goat is kept as an asset/capital and used for other expenses (school or medical fees). The project would rather have given guinea fowls for consumption rather than goat.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 36 The Programme Theory is the pathway from an intervention input through programmatic delivery, household and individual utilisation to its desired impact. It puts a stronger FOCUS on the intermediary outcomes and problems that may arise alongside the intervention to bridge the gap between the concept of an intervention and the reality of its impacts.
The introduction of livestock in the household may also negatively impact the family if adequate hygiene promotion is not undertaken or mitigation measures are not taken.
Example: livestock potentially increases the nutritional benefits in the long run but at the same time may increase wasting among children because of a contaminated environment (e.g. children are in contact with animal’s faeces). Livestock activities can also impact the social dynamics within the household if significant income is generated by the project and women are not able to take decisions in relation to the management of household finances. Vulnerable households may benefit in a short term from a livestock intervention but not be able to afford the related costs induced by the intervention in the longer run (e.g. veterinary costs); this can be offset by providing vouchers or taking part in a IGA programme. 4. Example 1 Make sure that participants understand the difference with a ‘standard solution’ 3’ tree. In a PTP, it is needed to highlight the intermediary outcomes and potential bottlenecks that may arise at each stage of the project. Note: this figure is missing the bottlenecks, as it is the subject of the next exercise.
Keep in mind that it is very difficult to assess the contribution of each pathway to the specific objective (e.g. improved production or additional purchase). Up to now little evidence is available due to a combination of factors (poor study design, up to now low interest).
5. Example 2 Long pathway from food preparation to food intake. 3’ Getting the programme theory ‘RIGHT’ is particularly important for nutrition- sensitive interventions because they involve complex biological, psychosocial, individual and social factors (i.e. food taboos or restriction, norms etc.)
Facilitator should recall the nutrition security concept. There are many other determinants that affect the relationship between diet diversity/food intake and nutritional status. For instance, when the absorption of nutrients is impaired by parasites. These considerations may lead to complementary interventions, such as de- worming. 6. Key-questions Discuss with participants the main questions to highlight 2’ How is the intervention going to bring about a change of the nutrition status? What is happening as the intervention moves along the pathway from initial input to impact? What are the primary impact pathways? What are the intermediary outcomes? What are the bottlenecks? How to solve them? How will seasonality affect the programme impact pathways? What are the barriers and enhancers to achieve impact on nutrition? 7. Project Project presentation ‘Porridge Mum’ in Guinea. Refer to PowerPoint presentation. presentation This presentation aims at providing an example of PTP analysis and identifies 10’ + 5’ group barriers to impact on nutrition. This exercise was conducted as a mid-term project discussion revision highlighting new recommendations and guidance.
8. Exercise Distribute Handout 7. 40’ See exercise notes below.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 37 9. Exercise Each group will present the results to other participants. correction In addition to the group’s presentation, the facilitator comes back to slide 4 with the 20’ potential bottlenecks.
10. Summary of key Crucial step for ‘nutrition-sensitive’ intervention. points and Easier if you have conducted a ‘nutrition-sensitive’ assessment. operational implications Other factors that may affect the nutritional status – make sure that 2’ you have a broad understanding of the determinants of undernutrition. The PTP should also be used during the programme implementation as M&E tool.
Case study 3: Programme Theory Pathway in Myanmar What is the learning objective? Be familiar with the PTP by designing one. How long should the exercise take? 60 minutes Give the groups 40 minutes to answer the questions and prepare a 3-minute presentation of their answers. What materials are needed? Handout 7: PTP in Myanmar Instructions: Each group should answer the following questions and prepare a brief presentation of the discussion.
Although Myanmar is considered as a food-surplus country with agriculture potential and natural resources, it is one of the poorest countries in Asia and ranks 132 on the 2010 HDI. Chronic food and nutrition insecurity is the consequence of unfavourable economic policies, rural underdevelopment coupled with vagaries of weather, seasonality and the marginalisation of some sectors of the population. This situation is affecting the ability of many households to access sufficient levels of nutritious food as well as basic services such as clean water, health and education and is particularly pronounced in the border areas and among ethnic minorities. The official data related to chronic and acute malnutrition are largely outdated and indicates that 41% of children under five years are chronically malnourished while 11% suffer from acute malnutrition in 2003. The percentage of population suffering from inadequate micronutrient intake (especially vitamin A, iodine, iron, zinc, and thiamine/vitamin B1) is expected to be high, as the dietary diversity and the basic knowledge of what constitutes a healthy diet are low.
Against this background, you decide to support households in implementing homestead and community gardens with the production of micronutrient-rich foods. The crop selection will not only be based on agronomic and environmental factors, but will also take into account the nutritional content of the crop and the prevalence of micronutrient deficiencies in the area (e.g. plant rich in vitamins A, iron, B-vitamins, poly- unsaturated fatty acids and phytochemicals).
Address the following questions: 1.List the different mechanisms/pathways by which the nutritional status of the targeted households is expected to improve. 2.List the intermediary and final outcomes. 3.List the potential problems that may arise. 4.Draw on a flip chart the whole programme pathway.
MODEL ANSWER
Agriculture and nutrition are intrinsically linked through five different pathways that should be considered when designing agricultural interventions: 1. Household production for own consumption is the most fundamental and direct pathway by which increased production leads to greater food availability and food security. 2. Income generated by the sale of (surplus) production that is used to buy more food and/or nutritious foods. 3. Empowerment of women who are the gatekeepers for household nutrition, food security, health and care. 4. The decrease of food prices for consumers through increased food production and availability.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 38 5. Increased national revenue, used to support provision of improved state services and reduce poverty.
Potential problems may raise and prevent the programme to achieve a nutrition impact.
At outcome level: Taxation by the government Women workload Priority given to income > diet diversity /decision maker within the household Intra-food allocation patterns (in quantity and quality) Cultural food beliefs Knowledge of optimal nutrition and feeding practices Lack of caregiver or female headed household
At impact level: Food selection, preparation and hygiene Feeding practices Closure of health facilities run by other NGOs Parasite infestation Health-seeking behaviour
Remind participants that some constraints are common and others may be country and project specific.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 39 2.2 Nutrition-oriented indicators
Objectives Identify nutrition-related indicators to measure outcomes & impact’s intervention. Explain the purpose and process of collecting individual dietary information using IDDS and IYCF. Duration 95’ + 10’ (end of module 2) Seating Plan Chairs in a circle, with tables 5/6 persons per group Exercise(s) Group exercise 2 (60’) Reading(s) Manual – See Section 2 – Guidance 4 Compulsory Reading 5: IFPRI, Leveraging Agriculture for Improving Nutrition and Health: Highlights from an International Conference (p.11-12) Compulsory Reading 6: ACF, Impact and capitalisation study, Health Gardens – nutrition centred Approach. Optional Reading 8: DFID, the neglected crisis of undernutrition. Optional Reading 7: EC, Addressing Undernutrition in external assistance, an integrated approach through sectors and aid modalities. Optional Reading 13: Save the Children, Hungry for Change, an eight-step, costed plan of action to tackle global child hunger. Handout(s) Handout 8 – IDDS/IYCF Equipment(s) Projector Remote control Material(s) Flip charts Markers FAO & EC, 2011, Guidelines for measuring household and individual dietary diversity 4 copies (B&W printing) WHO, UNICEF, FANTA, 2008, IYCF Definitions: 4 copies (B&W printing) WHO, UNICEF, FANTA, 2010, IYCF Measurement: 4 copies (B&W printing) Output(s)
Session Plan
Slide Guidance Notes 1. Opening Benefits for participants: 1’ No more struggle when comes the time to design the log-frame and the M&E system. Save time, resources and headache! 2. Session objectives Identify nutrition-related indicators to measure outcomes & impact’s 5’ intervention. Explain the purpose and process of collecting individual dietary information using IDDS and IYCF.
In plenary session, ask participants about the difference between an outcome and an impact. • Outcome refers to the short/medium term change induced by the project. • Impact is the long-term benefit for targeted groups and the wider society. 3. Guiding principles FSL interventions have great potential to improve the nutritional status of an 10’ individual BUT other factors will intervene before these positive effects are translated into an improved nutritional status. 1. Type 2. Duration 3. Feasibility 4. Expertise Ask the participants to think about their project in their countries and brainstorm in
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 40 plenary session about nutrition-indicators. Ask participants to raise their hands if already using nutrition objectives and indicators in the log-frame.
Refer to compulsory reading 5: Leveraging Agriculture for Improving Nutrition and health. 4. Log-frame with a The nutrition objective in the log frame refers to the direct or indirect improvement nutrition objective of nutritional status by the project beneficiaries as a result of utilising the services 3’ provided by the programme. This objective explicitly demonstrates how the project contributes to improve the nutritional status of the population. Make sure, however, that the objective is attainable within the framework of the project.
Different scenarios are possible depending on if the intervention includes only FSL activities or is integrated with other sectors. FSL interventions have great potential to improve the nutritional status of an individual (e.g. by increasing access to nutritious food, by improving the diversity of diet and/or by improving household incomes), but other factors will intervene before these positive effects are translated into an improved nutritional status (e.g. access to health care and child care patterns). Integrated programming is hence more likely to show impacts on the nutritional status as the intervention seeks to tackle a variety of the underlying determinants.
Example 1: Improve the intake of micronutrient-rich foods of vulnerable households by X % points in rural areas of Shan State through the consumption of Animal Source Food. Example 2: Reduce the prevalence of Global Acute Malnutrition (GAM) by X % points in Maungdaw by 2013. Refer to DFID (optional reading 8) and Save the Children plan of action (optional reading 13) for detailed guidance on nutrition-sensitive interventions.
5. Nutrition-oriented The chosen nutrition outcome or impact indicators will vary according to the nature indicators and the duration of the intervention. The measurable effects of stand-alone FSL 5’ interventions on the nutritional status are likely to be less significant (with the potential exception of food aid interventions) than multi-sectoral interventions, thus most changes will be detected at outcome level. The duration of the intervention will also play a significant role (short vs. long term).
Participants should use dietary diversity to measure the outcome of a short- term (<1 year) standalone FSL intervention. Dietary diversity is one of the determinants of nutritional status but is not an indicator per se of the nutritional status.
Participants should use anthropometric measurements to measure the impact of long-term FSL programming or multi-sectoral interventions. Refer to EC strategy (optional reading 7) for detailed guidance on nutrition- oriented indicators.
This is difficult and requires time and skills and a number of conditions should be met (e.g. context stability, at least 3-year intervention, SMART surveys at start and conclusion of the intervention, statistic treatment of confounding factors and determinants etc.). Refer to manual p. 30 for detailed guidance.
Important to account for nutrition promotion and changes in knowledge and practices. Changes may be accounted for through pre-post KAP surveys. It is however relatively easy to measure change in knowledge, but it is difficult to measure sustainable change in practices and behaviours. 6. Example 1 Concrete examples of short and medium term indicators 2’
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 41 7. Example 2 Concrete examples of long-term indicators 2’
8. Methodologies & The facilitator will mention some relevant and helpful tools: tools Put a strong focus on DDS and anthropometric measurements. 5’ Make sure that participants are aware of limitations and constraints of both. Refer to manual for additional information on limitations p.29 (Quantity and caloric intake, substitution effects, data disaggregation, food use and absorption by the body). Refer as well to ACF FSL Assessment (2009) and FSL M&E (2011) manuals for guidance on core indicators and methodology of measure. 9. Group exercise Distribute Handout 8 40’ and exercise See notes below. correction Each group will present the results to other participants. 20’ 10. Summary of key- No ready-to-use solutions but guiding principles to keep in mind points The effects FS standalone interventions on the nutritional status are likely to be 2’ less significant Most changes will be detected at outcome level. FSL teams are trained on HDDS/IDDS/IYCF as well as KAP and should request technical support for anthropometric measurements. END of MODULE Ask participants to recall the main recommendations and key points of the module 2 2. This could be done in small groups or in plenary session. 10’
Exercise 2:
What is the learning objective? Be familiar with dietary diversity tools: IDDS/IYCF. How long should the exercise take? 60 minutes Give the groups 40 minutes to answer the questions and prepare a 3-minute presentation of their answers. What materials are needed? Handout 8: IDDS/IYCF 1 guideline (per group) for measuring household and individual dietary diversity 1 guideline (per group) for measuring IYCF Instructions: Split the participants in small groups. Half of the groups will work on IDDS meanwhile the other one will work on IYCF. Each group should answer the following questions and prepare a brief presentation of the discussion.
TEAM 1- Individual Dietary Diversity Score You plan to conduct a FSL assessment in a rural and remote area. One of the main determinants of undernutrition is the poor diet diversity resulting in high rates of maternal undernutrition and micronutrient deficiencies. You will therefore investigate the dietary quality and variety at individual level, especially women of reproductive age. Use the FAO/EC guidelines on HDDS/IDDS to address the following questions:
1. Design an Individual Dietary Diversity questionnaire – including food groups reflecting locally available foods. Refer to the FAO manual for further guidance (p 7-8 and 15-19).
2. Select one member of the team that will play the role of the respondent (for example, a woman of reproductive age) and administer the questionnaire in ‘real conditions’. Refer to the FAO manual for further guidance (p 21-22).
3. Collect the answer, compute and analyse the data. Final score should be between 0-9.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 42 Refer to the FAO manual for further guidance (p 23-26).
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 43 MODEL ANSWER
Individual Dietary Diversity Questionnaire (adapted from FAO guidelines) Please describe the foods (meals and snacks) that you ate yesterday during the day and night whether at home or outside the home. Start with the first food eaten in the morning. Question Food group Examples YES= 1 number NO= 0
CEREALS Bread, noodles, biscuits, cookies or any other foods 1 1 made from millet, sorghum, maize, rice, wheat + insert local foods or other locally available grains. 2 WHITE TUBERS white potatoes, white yams, cassava or foods made 0 AND ROOTS from roots. 3 VITAMIN A RICH pumpkin, carrots, squash, or sweet potatoes that are 0 VEGETABLES yellow or orange inside + other locally available AND TUBERS vitamin-A rich vegetables 4 DARK GREEN sweet pepper, dark green/leafy vegetables, including 1 LEAFY wild ones + locally available vitamin-A rich leaves such VEGETABLES as cassava leaves etc. 5 OTHER other vegetables including wild vegetables 1 VEGETABLES 6 VITAMIN A RICH ripe mangoes, papayas + other locally available 0 FRUITS vitamin- A rich fruits 7 OTHER FRUITS other fruits, including wild fruits 1 8 ORGAN MEAT liver, kidney, heat or other organ meats or blood-based 0 (IRON-RICH) foods 9 FLESH MEATS beef, pork, lamb, goat, rabbit, wild game, duck or other 1 birds 10 EGGS 0 11 FISH fresh or dried fish or shellfish 0 12 LEGUMES, NUTS beans, peas, lentils, nuts, seeds or foods made from 0 AND SEEDS these 13 MILK and MILK milk, cheese, yogurt or other milk products 1 PRODUCTS 14 OILS and FAT oil, fats or butter added to food or used for cooking 1 15 SWEETS sugar, honey, sweetened soda or sugary foods such as 0 chocolates ,sweets or candies 16 SPICES, tea (black, green, herbal) or coffee 1 CONDIMENTS, BEVERAGES YES=1 No=0 B Did you eat anything (meal or snack) OUTSIDE the home yesterday ? 0
Aggregation of food groups from the questionnaire to create IDDS
Question number(s) Food group Yes = 1 No= 0 1,2 Starchy staples 1 4 Dark green leafy vegetables 1 3,6 Other vitamin A rich fruits and 0 vegetables 5,7 Other fruits and vegetables 1 8 Organ meat 0 9,11 Meat and fish 1 10 Eggs 0 12 Legumes, nuts and seeds 0 13 Milk and milk products 1
IDDS= 5/9
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 44 TEAM 2- Infant and Young Children Feeding (IYCF)
One of the main determinants of undernutrition is due to lack of knowledge on nutrition and appropriate practices related to Infant and Young Children Feeding (IYCF). Children are most vulnerable to malnutrition and growth faltering during the period when complementary foods are initiated, as it often coincides with decreased breast milk consumption, increased micronutrient deficiencies, diarrheal illness and suboptimal IYCF practices. Common inappropriate complementary feeding practices include introducing foods too early or too late, limiting the diversity of foods, and providing an inadequate quantity of food. You decide to gain a better understanding of the IYCF in the area you work by including some questions related to IYCF in your assessment. Use the two IYCF guidelines (Definition & Measurements) to address the following questions:
1. Start by reading the definition of indicators in the Definition guideline (p.5-9) 2. Select three members of the team that will play the role of the respondents.
Respondents are free to answer the question as they like but they have to make sure that answers are coherent. The respondent is the primary caregiver of the child and is the person that knows the most about how and what the child is fed. First respondent is a 25-year-old mother who has a 5-month baby and a 22-month child. The second respondent is a 19-year-old woman. Sadly, her baby was stillborn when she delivered two months ago. The third one is 34-year-old and has 4 children. One is 4-month; the others are respectively 19 months, 3 and 6 years.
3. Administer the questionnaire in ‘real conditions’ to the 3 respondents. Refer to the questionnaire p 5-10 in the Measurement guideline.
4. Collect the answers, compute and calculate the indicator of early initiation of breastfeeding. Refer to the Measurement guideline for further guidance (p. 32-33)
MODEL ANSWER
Early initiation of breastfeeding Definition Proportion of children born in the last 24 months who were put to the breast within one hour of birth 2 infants are less than 6 months (<730 days). 1 was put to the breast within one hour of birth; the other was put to the breast after 4 hours. Calculation (1/2) * 100 = 50%
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 45 Module 3: Do no harm
No Module Session Specific learning Objectives Title no 1. Define undernutrition and explain its consequences & determinants Session 1 2. Define nutrition security and explain the linkages between food security, Acknowledging livelihoods, agriculture, nutrition and health & 3. List the resources and key sources of information related to undernutrition understanding 4. Design and conduct a ‘nutrition-sensitive’ assessment 1 food security 5. Explain how the findings from nutrition-sensitive assessment can be used through the Session 2 to plan and adapt to FSL programmes lens of nutrition 6. Define the concept of ‘window of opportunity’ and explain its operational Session 3 implications Session 4 7. Define the ‘programme theory pathway’ and explain its purpose in the programme’s design Aiming for 8. Identify nutrition-related indicators to measure outcomes & impact’s Nutrition 2 intervention impact Session 5 9. Explain the purpose and process of collecting individual dietary information using IDDS and IYCF 10. Define the ‘do no harm approach’ and list key steps of ‘a do no harm approach’ strategy (skills & aptitudes) Do no harm Session 6 3 11. Explain the purpose and process of using the IYCN Nutritional Impact tool assessment (skills & aptitudes) Including 12. Explain the purpose of nutrition promotion and how this should be used Nutrition 13. Explain the purpose of Behaviour Change Strategy (BCS) and how this 4 promotion Session 7 should be used and/or BCS
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 46 3.’Do no harm’
Objectives Define the ‘do no harm approach’ and list key steps of ‘a do no harm approach’ strategy. Explain the purpose and process of using the IYCN Nutritional Impact Assessment tool. Duration 45’ + 10’ (end of module 3) Seating Plan Chairs in a circle, with tables 5/6 persons per group Exercise(s) None Reading(s) See Manual – Section 2, Guidance 6 and 7 Handout(s) Handout 9: Relationship between infection and undernutrition Handout 10: IYCN Nutritional Impact Assessment Tool Equipment(s) Projector Remote control Material(s) Flip charts with FSL intervention (overall, agriculture, livestock, food assistance, CBI, IGA) Markers Presentation - Module 3. Presentation IYCN Nutritional Impact Assessment Tool.ppt Output(s)
Session Plan
Slide Guidance Notes 1. Opening Benefits for participants: 30 seconds Ethic & Humanitarian values Reduce risk of programme’s failure 2. Session objectives Define the ‘do no harm approach’ and list key steps of ‘a do no harm 1’ approach’ strategy. Explain the purpose and process of using the IYCN Nutritional Impact tool assessment. Growing interest on the subject and a lot of research is currently on going. 3. Why a “do no harm”? Ask participants to brainstorm and discussion about the potential adverse 10’ Brainstorm and 10’ effects of FSL interventions on the NUTRITIONAL STATUS. One group will Feedback work on adverse effects that are common to all FSL interventions meanwhile the other groups will work on a specific type of FSL intervention (i.e. overall, agriculture, livestock, food aid, CBI, IGA) Each group will write down the adverse effects on flip charts.
Remind the participants that some will be obvious/intuitive/direct; others are more difficult to detect and very country specific. Some are common to all FSL interventions and some are intervention-specific. Give a 5 and 2 minutes warning. Each group has 2 minutes to present their main findings to the rest of the assembly.
Main findings that should come up from the discussion: - Women workload - Child labour - Project’s timing compromising other livelihoods or not addressing seasonality - Agricultural and/or zoonotic diseases - Breastfeeding’s displacement - Food safety - Inadequate conditionality etc.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 47 4. Why a “do no harm”? FSL interventions have the potential to negatively impact on food 3’ security, human health and the nutritional status of the beneficiaries, care practices, women’s and men’s status to name a few. ETHIC + ACCOUNTABILITY 5. Picture Women working in gardens. Put a strong focus on ‘WOMEN workload. 30 seconds Women should directly benefit from the intervention as much as possible because i) they already have less access to resources and opportunities than men, and ii) they play a key role as the gatekeeper of household food security, health and nutrition. It is CRUCIAL to avoid increasing the already heavy work burden of women. Manual work in agro-sylvo-pastoral or in for-work activities is usually time consuming and physically demanding, which may put strain on their nutritional status and the time dedicated to childcare.
The project should not hamper women from doing their essential normal tasks or lead to any major additional workload for women or conflict within the family. Planning of the intervention should be carefully designed taking into account the normal workloads (e.g. duration of the programme; number of hours/time of beneficiaries involvement, distance between the place of intervention and women’s home should be addressed through open dialogue with mothers of the project. 6. Infection/Undernutrition Distribute Handout 9 2’ Recall links between the vicious circle of infection/undernutrition. Undernutrition and infection often occur at the same time because one can lead to another, and creates a vicious circle. A malnourished child, whose resistance to illness is poor, falls ill and becomes more malnourished which reduces his capacity to fight against illness and so on. 7 IYCN Tool Distribute Handout 10 8’ “Nutrition Impact Assessment Tool” to detect any harm to the nutritional status of beneficiaries. Refer to ICYN presentation. The presentation is lengthy (22 slides) but can be reduced to include the key steps of a ‘do no harm approach’. 8 Mitigation Measures Examples of concrete preventive/corrective mitigation measures per FSL 8’ interventions Example: Agriculture Provide protective clothes and/or equipment (e.g. impregnated bed net) if the intervention involves irrigation schemes in areas with a high prevalence of malaria or exposure to microbial and pollutants from wastewater irrigation. Livestock Systematically investigate the risk of zoonotic infections and facilitate access to drugs and vaccines for the animals along with information about prevention of zoonotic diseases. CBI Use conditionality with precaution, as there are some significant disadvantages. For instance, the most vulnerable households may not be able to participate if compliance is too costly (e.g. transportation costs too high, clinics too far away, or opportunity costs of labour are too great). FA Do not put groups at risk of ingesting too many micronutrients (e.g. vitamin A which is toxic in very high doses, especially for pregnant women). 9…..Summary of key- Vital to dedicate enough time/resources to the topic during the designing points & Operational and planning stages. Implications Using the IYCN tool whenever feasible/do no harm approach at designing 2’ stage but also include it into the M&E system to detect any adverse effect of the intervention.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 48 END of MODULE 3 Ask participants to recall the main recommendations and key points of the 10’ module 3. This could be done in small groups or in plenary session.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 49 Module 4: Nutrition promotion and Behaviour Change Strategy
No Module Session Specific learning Objectives Title no 1. Define undernutrition and explain its consequences & determinants Session 1 2. Define nutrition security and explain the linkages between food security, Acknowledging livelihoods, agriculture, nutrition and health & 3. List the resources and key sources of information related to undernutrition understanding 4. Design and conduct a ‘nutrition-sensitive’ assessment 1 food security 5. Explain how the findings from nutrition-sensitive assessment can be used through the Session 2 to plan and adapt to FSL programmes lens of nutrition 6. Define the concept of ‘window of opportunity’ and explain its operational Session 3 implications Session 4 7. Define the ‘programme theory pathway’ and explain its purpose in the programme’s design Aiming for 8. Identify nutrition-related indicators to measure outcomes & impact’s Nutrition 2 intervention impact Session 5 9. Explain the purpose and process of collecting individual dietary information using IDDS and IYCF@ 10. Define the ‘do no harm approach’ and list key steps of ‘a do no harm approach’ strategy Do no harm Session 6 3 11. Explain the purpose and process of using the IYCN Nutritional Impact tool assessment Including 12. Explain the purpose of nutrition promotion and how this should be used Nutrition (knowledge & aptitudes) 4 promotion Session 7 13. Explain the purpose of Behaviour Change Strategy (BCS) and how this and/or BCS should be used (knowledge & aptitudes)
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 50 4. Nutrition promotion & Behaviour Change Strategy
Objectives Explain the purpose of nutrition promotion and how this should be used. Explain the purpose of Behaviour Change Strategy (BCS) and how this should be used Duration 45’+ 10’ (end of Module 4) Seating Plan Chairs in a circle, with tables 5/6 persons per group Exercise(s) None Readings(s) See Manual – Section 2 Guidance 8 Compulsory Reading 6: ACF, Gardens of Health impact and capitalization study Optional Reading 10: AED & Linkages, Formative Research, Skills and Practices for IYCF and Maternal nutrition. Optional Reading 11: IYCN, Behaviour Change Interventions and child nutritional status. Handout(s) None Equipment(s) Projector Remote control Material(s) Flip charts Markers Presentation - Module 4. Field Experience Mali - Health Gardens.ppt Output(s)
Session Plan
Slide Guidance Notes 1. Opening Benefits for participants: 30 seconds Learn/promote optimal practices for your health, and well-being and family. Increase the impact of the intervention. 2. Session objectives Explain the purpose of nutrition promotion and how this should be used. 30 seconds Explain the purpose of Behaviour Change Strategy and how this should be used 3. Why Increasing evidence suggest that agricultural interventions are more likely to 1’ contribute to positive nutritional outcomes if they address gender/women empowerment, nutrition education and the five livelihood capitals (World Bank, 2007). 4. Gender/Women This is the opportunity to highlight again why and how women should be empowerment empowered. 2’ Less access to resources and opportunities than men (e.g. access to land, livestock, education, childcare, financial services, extension services, technology, markets and employment) Gatekeeper of household food security, health and nutrition. WARNING: Fathers/men/boys should not be forgotten. It is necessary to educate them to become more supportive of women as they often are the decision makers in the communities and within the households. 5. Nutrition promotion Be careful about the terminology that can be confusing! vs. BCS Nutrition promotion aims at increasing knowledge & potentially practices of 2’ participants about optimal nutrition. Example: participants during cooking demonstrations can learn some cooking and food handling tips that are useful to preserve the quality of the nutrients. Vegetable and fruits are eaten raw to increase vitamin and mineral intake. Vegetables are not overcooked and preferably steamed until just
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 51 tender. Other cooking methods for vegetables that preserve nutrients are stir frying (e.g. frying very quickly over high heat), or sautéing (e.g. cooking in fat or oil in a pan or on a griddle) Food is eaten soon after cooking. However, giving someone information is not usually enough to change behaviour. Example: Smoking 6. Nutrition promotion BCS fosters positive behaviour change at the individual, household, and vs. BCS community levels, with the goal of improving the nutritional status/health through. 2’ It encourages sustainable changes and maintains optimal behaviours. BCS mainly relies on: Behaviour Change Communication (BCC) which is a multi-level tool for promoting and sustaining risk-reducing behaviour change in individuals and communities by distributing tailored specific nutrition/health messages in a variety of communication channels: mass-media campaigns, print materials, interpersonal communication, group talks, health fairs, drama, or story telling. Formative research: consists of assessing the behaviours, attitudes and practices of a community, and understand the target group’s perspective, which influence their behaviours, and determines the best ways to reach them. Several formative research methods may be used to develop BCS including barrier analysis, trials of improved practices, positive deviance, focus groups, in-depth interviews, supporting groups for accompanying the change, reinforcing the positive practices, and finding coping strategies. Formative research occurs before a program is designed and implemented, or while a program is being implemented. Various theoretical models are appropriate for considering the forces that affect change at the individual level (e.g. Health belief model, Theory of reasoned action, Transtheoretical, social learning theory). Irrespective of the label given, the aim should be to understand the key constraints that operate at the individual level within the target population, so that the optimal intervention can be developed to address these constraints. Dietary and care practices are embedded in people’s beliefs, norms, habits and traditions, and convincing people to change behaviour requires time and expertise! Need to see a benefit to change! This is a very innovative feature for ACF interventions that requires time, expertise and may be controversial. Changing long-rooted behaviours requires time. Does it fall within ACF mandate? This could be discussed among participants during the discussion after the case studies. WARNING: the objective is not to go in detail of BCS but explains the purpose and provides main recommendations/readings. 7. Nutrition promotion Vital to improve nutrition and care of children, women and household. and BCS Targets women of reproductive age and decision makers related to food and 1’ children decision. Who is responsible for designing and conducting nutrition promotion and BCS? This will differ from one mission to another. The care practices and nutrition team (if any) will help in conducting formative research and design adequate messages for care and IYCF. The FS team will be in charge of conducting the nutrition promotion session. This can also be done in collaboration with the nutrition team. Ask for external expertise if need be. 8. Key-steps 1. Understand context, norms and levers related to dietary and care 2’ practices 2. Design actionable and well-tailored messages 3. Use existing channels of dissemination & cooking demonstrations 4. Measure the changes with KAP surveys 9. Limitations 1. Feasibility: context, duration and objective of the intervention 2’ 2. Expertise and skills (e.g. nutritionist, care practices, formative research etc.) 3. M&E system (e.g. KAP as means of verification for change in practice is
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 52 not the best methodology. This can be coupled with field observation). Request support from the Wash team, as they are very familiar with KAP surveys.
10. Project presentation Project presentation ‘Health gardens in Mali. Refer to ppt presentation. 15’ + 15’ group Mention here the impact study and capitalisation report (compulsory Reading 6). discussion This project is an innovative and sustainable approach that seeks at improving knowledge and practices of optimal nutrition. It is based on vegetables gardens coupled with education nutrition sessions and cooking demonstration. The project targets in priority mothers and caregivers.
11. Summary of key - Nutrition-sensitive assessments are helpful to identify norms, beliefs related to points & operational food, nutrition and decision-making. implications - Modalities will differ whether it is long or short-term strategy but focus on a set of 2’ messages using the existing/new channels of dissemination and communication. - KAP on nutrition and practices as a baseline/endline to monitor some changes. - Be aware of limitations. END of MODULE 4 Ask participants to recall the main recommendations and key points of the 10’ module 4. This could be done in small groups or in plenary session.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 53 Conclusion & Closing
Objectives 1. Close the training 2. Review the course 3. Draw Action plan 4. Collect participant’s feedbacks Duration 105’ Seating Plan Chairs in a circle, with tables / 5/6 persons per group Reading(s) None Exercise(s) None Handout(s) Handout 11: Conceptualizing the linkages between agriculture, health and nutrition Participants Evaluation Form Note: no PowerPoint presentation for conclusion. Equipment(s) Projector Remote control Speakers (for movie) Material(s) Flip chart Markers Participant’s pre test Participant’s evaluation form VIDEO FILM - 2020 conference - Day 2 - 1B Plenary - Part I.flv Output(s)
Session Plan Slide Guidance Notes 1. Film video Distribute Handout 11 14‘ Film video – AGRICULTURE, HEALTH AND NUTRITION Conceptualizing the Linkages Available at http://www.youtube.com/watch?v=VKciI1RexvA J. Hoddinnot – Feb 2011 John Hoddinott is deputy division director and a senior research fellow in the Poverty, Health, and Nutrition Division of the International Food Policy Research Institute (IFPRI), Washington, DC. Although a bit tough, this 12-minute video is a very good summary of the training. Make sure that the quality of the video is all right before broadcasting it! 2. Action plan Participants are requested to draw an action plan to incorporate the lessons learnt 60’ and recommendations from the training in their interventions. Action plans should be SMART. This exercise can be done individually or in groups. The action plan should consider the following aspects: What steps or actions need to be taken? Necessary resources Necessary support Timelines Constraints/foreseen challenges Others Participants are encouraged to use the manual. Facilitator will send an email to participants in 1-month time to assess the implementation of the action plan by the participants. 3. Feedbacks The feedback session is done in plenary session (10’) and through an individual 30’ written evaluation form (20’). ▶Distribute Participants Evaluation Form. Encourage participants to give positive and negative feedbacks to improve the content and design of the training tool kit. Ask participant to get back to their pre-tests to assess any progress.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 54 4. Closing Thanks the participants for their participation and collaboration. 1’ Encourage participants to get in touch with the facilitator or key-person in the mission if there is a need for support in the coming months while maximising the nutritional impact of FSL interventions.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0 55