Integrating MIYCN Counseling in Urban Health Services
Condition: Maternal Nutrition
Study type: Interventional

Summary: 
      The study will use a quasi-experimental design to examine the feasibility of standardizing
      MIYCN counseling services in existing health facilities to improve the quality of MIYCN
      services. The impact of standardized and upgraded services on client utilization, knowledge
      and behavior will also be measured. 8 NGO-run urban health facilities in Dhaka will receive
      intensified MIYCN interventions, while another 8 NGO-run urban health facilities will serve
      as a comparison group. No randomization will take place.
    

Detailed description: 
      The primary objectives of the proposed evaluation are to answer the following questions:

        -  Is it feasible to standardize the delivery of MIYCN counseling services in existing
           urban health facilities?

        -  Can quality of MIYCN counseling service be improved by upgrading and standardizing
           existing MIYCN counseling service in urban health facilities?

        -  What are the impacts of standardized and upgraded MIYCN counseling service on
           utilization of MIYCN services and knowledge of clients?

      The secondary objectives are:

        -  What are the impacts of standardized and upgraded MIYCN counseling service on behaviors
           of clients including:

             -  Pregnant women: 1) consumption of diversified foods; 2) intake of IFA and calcium
                supplements during pregnancy

             -  Mothers of children <1 y: age-appropriate infant feeding

      The study will use a quasi-experimental design, with data collection taking place in three
      different stages: 1) Baseline data collection to assess comparability of facilities, service
      quality and client's behaviors, 2) Facility-based endline data collection and 3)
      Community-based endline survey.

      The evaluation was originally intended to be a randomized control trial, covering 20 NGO-run
      urban health facilities under contract with the Urban Primary Health Care Services Delivery
      Project (UPHCSDP). 10 of the 20 health facilities were randomized to receive the
      intervention, while the other 10 facilities would serve as the comparison group. Baseline
      data collection took place in these 20 facilities in October-November 2019. However, the
      project did not receive approval from UPHCSDP, and interventions were not implemented at the
      10 facilities in the treatment group.

      Instead, A&T partnered with 2 other NGOs in Dhaka whose 8 health facilities also provide
      services in urban areas but are not affiliated with UPHCSDP. These 8 facilities will receive
      the intervention. Propensity score matching will be used to select 8 of the original 20
      facilities under contract with UPHCSDP to serve as the control group.

      Baseline data collection in the intervention facilities will take place in February-March
      2020. The facility-based end line will take place in May-June 2022, and the community-based
      endline will take place in June 2022. Data will be collected for the full sample of
      intervention facilities at baseline (i.e. with the same sample size as at endline), given
      uncertainty in obtaining government approval to collect endline data from comparison
      facilities under contract with UPHCSDP. The larger sample from intervention facilities at
      baseline allows for a shift in evaluation design from quasi-experimental to a pre-post
      comparison, if the project does not receive government approval.

      The study will use mixed data collection methods including: 1) facility assessment; 2)
      provider survey; 3) case observations (namely ANC visits, child visits [both sick child and
      immunization], and counseling sessions), 4) client interviews and 5) in-depth interview with
      Program Managers and Field Supervisors.
    

Intervention name(s): MIYCN interventions
Intervention type(s): Behavioral
Intervention description(s): Capacity building for health providers and nutrition counselors (training on MIYCN SBCC from A&T).
Dedicated room for MIYCN counseling at health facilities with standardized layouts, displays of government IYCF logo, and other specifications.
Availability of standardized MIYCN-specific BCC materials and job aids.
Standardized MIYCN counseling services (counseling on diet diversity and quantity, IFA and calcium supplementation, weight gain monitoring, exclusive and early initiation of breastfeeding, complementary feeding, and water, sanitation and health) provided by a dedicated MIYCN counselor hired by A&T.
Dedicated community worker hired by A&T to identify and mobilize beneficiaries needing services in the community (via satellite clinic outreach, distribute MIYCN flyers, and provision of MIYCN education via phone or home visits).
Supportive supervision of MIYCN counselors and community workers by program and facility managers, and field supervisors.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: 8 NGO-run urban health facilities in Dhaka will receive intensified MIYCN interventions, while another 8 NGO-run urban health facilities will serve as a comparison group. No randomization will take place. No randomization will take place. Health workers and clients at these facilities will be participants in the study.
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Urban; Maternal Nutrition; Nutrition Counseling; Behavior change; Infant and young child feeding