Adaptive Implementation of a Community Nutrition and Asset Transfer Program during the COVID-19 Pandemic in Rural Bangladesh

Abstract

ABSTRACTBackgroundReduced health and nutrition services as a result of coronavirus disease 2019 (COVID-19) measures endanger children's well-being. The Bangladesh Rajshahi Division of Maternal and Child Nutrition (BRDMCN; 2018–2020) involving social behavior change communication (SBCC) and an economic development (ED) of asset transfer was implemented.ObjectivesThis study describes how the implementation modality of the BRDMCN was adapted, and changes in the program's short/intermediate-term outcomes during the COVID-19 pandemic compared with pre-pandemic.MethodsThe following evaluation components were assessed: 1) program fidelity, 2) program reach, 3) program acceptance, 4) perceived influence of COVID-19, and 5) short-term outcomes over the 3 y. We compared the first 2 y (“pre–COVID-19,” from April 2018 through December 2019) and the final year (“during COVID-19,” from January to December 2020) for all components except for (3) and (4). Data were collected through multiple sources: reviews of program annual progress reports, monitoring records of SBCC and ED programs, and cohort surveys (n = 1094).ResultsThe percentage dose delivery of activities decreased from 66.7–118% at pre–COVID-19 to 0–90% during COVID-19. The SBCC programs were altered to reduce the frequency of activities as well as the number of participants per session. The ED program involving large group meetings was modified to include within-member meetings, individual visits of community facilitators, or virtual discussions. Production activity using received assets continued during the pandemic, with no significant reduction compared with pre–COVID-19. The percentage of children recovering from underweight after 30 d of a Positive deviance/Hearth (PD/Hearth) session, a component of the SBCC program, remained constant at 16.5–20.3 percentage points before and during the COVID-19 pandemic.ConclusionsProgram activities were scaled back and changed due to the pandemic. The BRDMCN maintained asset management and the degree of short-term outcomes over the course of a 3-y project. Further study is required to determine whether adaptive program management would achieve the long-term expected impact at a population level.