wash their hands at all five critical times. walk. Hand washing stations near latrines are rare. Schools do not always have hand washing stations at toilets or elsewhere. Adults report they simply don’t have a habit of washing hands at all times. and illness. 2. Promote construction of simple hand washing stations at latrines. 3. Apply Child-to-Child for school parliaments to teach hand washing to younger children and monitor their practices. Have younger children teach younger siblings at home. 4. Mobilize parent committees to construct and maintain simple hand washing stations at schools and kindergartens. eyes, nose and mouth making us sick. 2. Five critical times to wash hands for both adults and children. visits and learning sessions with existing groups Posters, fliers, possible TV spot with AHOP AHOP will teach farmer’s groups Specific practices for IR.3, on improving food storage and preservation for winter will be defined and developed with STTA from SPRING HQ. Note: An improved home storage manual was developed in Year 3 for commonly available fruits, vegetables, and pulses rich in iron, protein, zinc, Vit A, and Vit C. It was disseminated through SPRING and AgroHorizon community networks and implementing partners.
interactive and participatory, respecting the learners as adults who bring their own knowledge and experience to the training focused on skills, allowing time for role plays to practice listening and talking to community members, to practice using job aids to strengthen promotion, and to practice dealing with questions or objections from community members allowing for experience sharing among trainees, so that they can learn from each other and find solutions to challenges together Supportive Supervision and Quality Assurance In addition to training Activists each month, Mentors and Activist Coordinators will plan and implement a rotation system so that they can observe each Activist periodically as they conduct their activities. Supportive Supervision—observing someone at work and providing positive feedback, with constructive suggestions for improvement—is a way of ensuring that the interventions are being implemented with quality, as well as helping workers or volunteers to feel valued and motivated to do well. DIP Supplement E. contains a sample supportive supervision guide which can be adapted and used to help Mentors and Activist Coordinators to provide effective supportive supervision. As the program continues, SPRING should continue working with Activists, Mentors, and Activist Coordinators to find simple and low cost methods for maintaining motivation, and recognizing and rewarding excellent performance and innovative ideas, allowing for input and creativity of Activists within their local areas. These methods can be documented as part of SPRING’s program learning. Monitoring and Reporting SPRING has developed monthly planning and reporting forms for Activists to use, with the support of Activist Coordinators and Mentors. Mentors will collate information from Activists and share it with the M&E team. SPRING should make opportunities to share Activist data back to Activists, families, and communities to build awareness of the investments in nutrition going on by SPRING and the government of Kyrgyzstan. This can help to keep Activists motivated, and build community ownership of their own health and nutrition. List of DIP Supplements Updated Table of Monthly Topics, Channels, and Materials for Activists Updated List of Training and SBCC Materials Sample pre-testing tool for adaptation Sample creative brief for adaptation
October Dietary Diversity including reducing junk food Dietary Diversity including reducing junk food Mother’s brochure (see above) Wall calendar with Seasonal Availability of Iron-rich, Vit A rich, Vit C rich foods, Portions, and IFA reminders Cookbook Mentor module Nutrition month campaign events—VHC’s are doing this program Peace Corps women’s club TOT November IFA for pregnant women Deworming—Link if possible in these materials Nutrition for Adolescent girls (IFA, healthy nutrition, promoting healthy movement) Media spot Wall calendar SMS reminders? Mentor module Nutrition for Adolescent girls module Commitment cards? December Exclusive Breastfeeding See above January 2016 Handwashing and Clean Latrines Handwashing and Clean Latrines (in support of UNICEF school program?) See above February Complementary Feeding, including reducing junk food NA See above March Dietary Diversity, including reducing junk food Dietary Diversity including reducing junk food See above April IFA for pregnant women Deworming—Link if possible in these materials Nutrition for Adolescent girls (IFA, healthy nutrition, promoting healthy movement) See above May Exclusive Breastfeeding NA See above June Handwashing and Clean Latrines NA See above July Dietary Diversity, including reducing junk food NA See above August Food Storage and Preservation including Drying Fruit and Veg NA TBD
DIP Supplement B. Updated List of Training and SBCC Materials Materials to pre-test and share with AgroHorizon In meetings with AgroHorizon, the agreement was that SPRING would develop the following materials: handwashing and latrine posters; cookbook focusing on maternal diet and complementary feeding; food storage, preservation, drying fruit and veg materials. SPRING agreed to give AgroHorizon TA to pre-test materials in at least one of their areas so they can see if any adaptations need to be made based on pre-test results. In this way any adaptations that AgroHorizon would like to make to the materials for their audiences will be Whether AgroHorizon will share costs for production/printing needs to be clarified. List of materials of SPRING project for IR 2 as of June 2015: # Month Topic Materials Format Current status June Exclusive Breastfeeding Nutrition and development of children under two Series of posters on IYCF Booklets for mom, 12 pages Posters – consisting of 4 A2 posters with: EBF, Comp. feeding, Growth of child and dangerous signs – (two of last posters are requirements of MoH to support our messages) Distribution in process Printed. Distribution in process. July Handwashing and clean latrines 2 Posters: 1: handwashing, 5 critical times 2: Use of clean latrines Posters of A2 format Images pending approval. Not printed August Complementary feeding including reducing junk food Judiann’s canning training: Food Storage and Preservation including Drying Fruit and Veg (This will need to be a separate channel and approach if we are doing an actual canning/preservation/storage Booklets for mom, which has a section on complementary feeding. No any materials for junk food Booklets for mom, 12 pages Distribution underway.
Annex F: Social and Behavior Change Communication Strategy Supplement for Urban Intervention Areas: June 2016 Summary The SPRING project has developed this supplementary Social and Behavior Change Communication (SBCC) strategy for urban intervention areas because the SBCC interventions which have been working well in rural areas have not been as effective in city neighborhoods. These interventions include working with Community Activists to engage 1,000 day households and their wider communities, to promote priority nutrition and hygiene behaviors, and to generate demand for nutrition services at health facilities. In urban areas, SPRING has found that the community leaders who are working well as Activists in rural areas are not able to perform as well, for multiple reasons. These people tend to be working more hours in their existing roles, and/or are not as willing to volunteer enough time to participate in Activist trainings, conduct visits for 1,000 households in their assigned areas, and to organize or participate in community meetings. In addition, urban households are not as likely as rural households to perceive Activists as credible sources of information on nutrition and hygiene, and feel too busy to participate in community meetings around health issues generally. The urban SBCC strategy consists of two categories of interventions: Engaging with staff of Health Promotion Units to build their capacity to effectively promote nutrition and hygiene behaviors with clients who come to their facility and in the community generally; and Engaging with and orienting regional TV, radio, and print media personnel to increase the quantity and quality of coverage of issues relating to nutrition during the 1,000 days. These interventions will be carried out, as all of SPRING’s Objective 2 activities, in partnership with the Republican Center for Health Promotion (RCHP) and the Kyrgyz Village Health Committee (KVCH) Association. The strategy focuses on three areas of high priority nutrition behaviors. Kyrgyzstan is not making progress or is actually moving backwards in terms of the prevalence of these behaviors: Exclusive breastfeeding—including family support Women’s care and diet during pregnancy and lactation including increasing dietary diversity and reducing junk food Anemia control—through improved WASH, presumptive deworming, and IFA supplementation SPRING will reach the following primary urban audiences with SBCC activities and materials: newly married couples, which may include older adolescents pregnant women mothers with children under age 2, including some messages tailored to female heads of households Influencing urban audiences to reach with SBCC activities include: older women (including but not limited to grandmothers) health providers (doctors & nurses who currently provide facility-based counseling) HPU staff community activists
Urban Strategy Supplement A. Adapted Strategy Matrix for Urban Audiences Desired Practice Actual Practice from baseline survey Findings from formative research: barriers and facilitating factors Messages Communication Channels All women will take IFA supplements for at least 180 days during pregnancy 16% took iron for at least 90 days Cost of IFA is a major barrier. Prescriptions from medical centers are incomplete and erratically issued. No client follow-up and no counseling on side effects Taste and side effects are lesser barriers than cost Women do not know risks or effects of anemia Key messages from Mentor module plus additional media talking points Re-purpose mass media spot? Tie in IFA reminder card and anemia poster Regional TV Newspapers Social media sites (accessed via computer and mobile phones) Health Facilities Neighborhood events Women will consume 5 or more of nine food groups, including foods and foods to enhance iron absorption Women 42% Jumgal 73% Jalalabad Fruits and vegetables are seldom consumed in winter due to scarcity and price. Some locally available vegetables are under-utilized, including pumpkin and green leaves from beets, radish, and turnips. Families and professionals have little knowledge about nutrient content of different foods Key messages from women’s nutrition and HH dietary diversity modules Tie in the cookbook with media orientation and talking points Tie in food pyramid flyer and anemia poster Regional TV Newspapers Social media sites (accessed via computer and mobile phones) Health Facilities Neighborhood events Infants will receive only breast milk from birth to about six months. 32% practice exclusive breastfeeding from 0-5.9 months Overall, women lack knowledge about exclusive breast feeding or receive false information. General belief that infants need additional liquids and food because breast milk is not sufficient. Some believe that infant formula is Key messages from Mentor module plus additional media talking points Re-purpose mass media spot? Tie in Moms’ brochure and EBF poster (in facilities) Regional TV Newspapers Social media sites (accessed via computer and mobile phones) Health Facilities Neighborhood events
superior. Mothers say they don’t produce enough milk. Families will maintain and use clean latrines. There is no shame associated with having a dirty latrine. No one takes responsibility for cleaning latrines at home or in public places (schools, clinics). People keep indoor flush toilets clean but only prioritize getting these installed for the elderly and disabled. Key messages from module plus additional media talking points Tie in WASH flyer Regional TV Newspapers Social media sites (accessed via computer and mobile phones) Health Facilities Neighborhood events Mothers will dispose of children’s feces by putting them in a toilet or latrine. 40% of mothers in Jumgal and 25% in Jalalabad put the child’s feces in a toilet or latrine. Children’s feces (and feces in general) are not perceived as very harmful. Many mothers have not heard this message before. Almost all households have a latrine or toilet. Key messages from module plus additional media talking points Tie in WASH flyer Mothers will wash hands at 5 critical times 19% of Jumgal women and 28% of Jalalabad mothers wash their hands at all five critical times. Almost all households have access to water within their yard or within a 10 minute walk. Hand washing stations near latrines are rare. Schools do not always have hand washing stations at toilets or elsewhere. Adults report they simply don’t have a habit of washing hands at all times. Key messages from module plus additional media talking points Tie in WASH flyer Regional TV Newspapers Social media sites (accessed via computer and mobile phones) Health Facilities Neighborhood events