Abstract

The Alive & Thrive programme scaled up infant and young child feeding interventions in Bangladesh from 2010 to 2014. In all, 8.5 million mothers benefited. Approaches – including improved counselling by frontline health workers during home visits; community mobilization; mass media campaigns reaching mothers, fathers and opinion leaders; and policy advocacy – led to rapid and significant improvements in key practices related to breastfeeding and complementary feeding. (Evaluation results are forthcoming.) Intervention design was based on extensive formative research and behaviour change theory and principles and was tailored to the local context. The programme focused on small, achievable actions for key audience segments identified through rigorous testing. Promotion strategies took into account underlying behavioural determinants and reached a high per cent of the priority groups through repeated contacts. Community volunteers received monetary incentives for mothers in their areas who practised recommended behaviours. Programme monitoring, midterm surveys and additional small studies to answer questions led to ongoing adjustments. Scale‐up was achieved through streamlining of tools and strategies, government branding, phased expansion through BRAC – a local non‐governmental implementing partner with an extensive community‐based platform – and nationwide mainstreaming through multiple non‐governmental organization and government programmes. Key messages Well‐designed and well‐implemented large‐scale interventions that combine interpersonal counselling, community mobilization, advocacy, mass communication and strategic use of data have great potential to improve IYCF practices rapidly.Formative research and ongoing studies are essential to tailor strategies to the local context and to the perspectives of mothers, family members, influential community members and policymakers. Continued use of data to adjust programme elements is also central to the process.Scale‐up can be facilitated through strategic selection of partners with existing community‐based platforms and through mass media, where a high proportion of the target audience can be reached through communication channels such as broadcast media.Sustaining the impacts will involve commitments from government and capacity building. The next step for capacity building would involve understanding barriers and constraints and then coming up with appropriate strategies to address them. One of the limitations we experienced was rapid transition of staff in key positions of implementing agencies, in government leadership, donors and other stakeholders. There was a need for continued advocacy, orientation and teaching related to strategic programme design, behaviour change, effective implementation and use of data.

Highlights

  • Direct nutrition interventions such as improving infant and young child feeding (IYCF) practices are considered a high priority for programmes aimed at improving health and nutritional status and child survival (Dewey & Brown 2003; Lutter et al 2011; Onyango 2013)

  • The existence of supportive national policies on child nutrition in Bangladesh meant that investments were not needed in this area and advocacy should focus on stimulating and supporting implementation of existing policies and guidelines

  • Alive & Thrive (A&T) saw an urgent need for harmonizing efforts of multiple implementing non-governmental organization (NGO) and donors working in different geographic areas of the country

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Summary

Introduction

Direct nutrition interventions such as improving infant and young child feeding (IYCF) practices are considered a high priority for programmes aimed at improving health and nutritional status and child survival (Dewey & Brown 2003; Lutter et al 2011; Onyango 2013). Breastfeeding is one of the most cost-effective life-saving interventions known (Bhutta et al 2008). Bhutta et al (2013) estimated that more than 220 000 lives would be saved each year with delivery of an infant and young child nutrition package that includes breastfeeding and complementary feeding. In Bangladesh, scaling up these interventions would benefit, in terms of child health and mortality, the two poorest wealth quintiles more than twice as much as upper quintiles, suggesting an important effect on reducing health and economic disparities (Bhutta et al 2013).

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