SPRING Quarterly Report Quarter FINAL - pdf.usaid.govpdf.usaid.gov/pdf_docs/PA00MTCG.pdfpositions: Finance and Operations Manager, Knowledge Management and Communications Advisor,

JSI Research & Training Institute, Inc. (JSI) * Helen Keller International (HKI) * International

Food Policy Research Institute (IFPRI) * Save the Children (SC) * The Manoff Group (TMG)

Quarterly Report

Third Quarter

April 1, 2012 – June 30, 2012

Cooperative Agreement Number: AID-OAA-A-11-00031

Submitted August 14, 2012

The Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) Project

is supported by the United States Agency for International Development (USAID) under

Cooperative Agreement No. AID-OAA-A-11-00031. SPRING is managed by JSI Research &

Training Institute, Inc.

SPRING Quarterly Report, April 1 – June 30, 2012

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I. EXECUTIVE SUMMARY

Project Description

Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) is a five-year

cooperative agreement funded by the U.S. Agency for International Development (USAID) to provide

state-of-the-art technical support and facilitate country-led, regional, and global programs to improve

the nutritional status of women and children. At the intersection of the U.S. Government’s two flagship

foreign assistance initiatives, the Global Health Initiative (GHI) and Feed the Future (FTF), SPRING works

across sectors, including health, HIV/AIDS, agriculture, and economic growth. The project is intended to

facilitate the design and implementation of country-led nutrition strategies and provide targeted

technical support to ensure that high quality, multisectoral nutrition programs are taken to scale in a

manner that strengthens country capacity. The SPRING implementation team consists of JSI Research &

Training Institute, Inc. (JSI), Helen Keller International (HKI), the International Food Policy Research

Institute (IFPRI), Save the Children (SC), and the Manoff Group (TMG). SPRING works in close

collaboration with other USAID and non-USAID nutrition and health initiatives.

Third Quarter Activities

SPRING had a productive third quarter—with the work plan approved, staff in place, and operations well

established, SPRING devoted this quarter to implementation and continuing to refine processes and

procedures to ensure efficient and effective operations.

SPRING completed the recruitment and hiring of four important program management and operations

positions: Finance and Operations Manager, Knowledge Management and Communications Advisor,

Web Designer, and Country Program Manager. In addition, SPRING also filled several other technical

positions: SBCC Program Officer and Research and Evaluation Advisor. SPRING also worked closely with

USAID to address the transition in Project Director during this quarter, naming an interim director and

undertaking a widespread recruitment process.

At the country level, SPRING’s portfolio continued to grow:

• In Bangladesh, divisional offices were set up, activities are well under way, and the team has

reached over 25 staff

• Activities in Haiti are being expanded to a greater number of facilities at USAID Mission request

• Uganda became the newest operational focus country for SPRING. After an initial trip, the

remainder of the quarter was dedicated to recruiting a country manager and finalizing the Year

1 work plan

• In Nigeria, an initial scoping trip was made and work plan drafted for first-year activities

The first TAG meeting was held in June to discuss and prioritize the SPRING research agenda. The topics

covered at this TAG were Nutrition & Agriculture and Nutrition Metrics & Monitoring. The meeting was

fruitful thanks to the active engagement by counterparts from USAID, academia, and implementing

partner (IP) organizations.


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SPRING received approval and launched the project website, spring-nutrition.org, in addition to

producing numerous other knowledge management resources for both internal and external

communications.

Planned Activities

In the fourth quarter, SPRING staff will develop the work plan for Year 2, while continuing to implement

the Year 1 work plan

• The KM team will continue to refine the website and add additional content

• Any outstanding partner sub-agreements will be finalized

• SPRING will hold the TAG research prioritization meeting on SBCC, and will host the first

Partners’ Advisory Group meeting since January

• Recruitment of the new project director will proceed; we anticipate that the chosen candidate

will be identified but not yet on board by the end of Q4

• Preparations for the Bureau for Food Security’s global learning exchange events on nutrition (N-

GLEE) will begin. The meetings themselves will be held in late November and early December

2012, i.e., Q1 of PY2


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IR 1: Country-specific approaches to scale up nutrition programs

improved

A. Country-Related Activities

Bangladesh Field Support Program Implementation Preparatory activities:

• Set up SPRING/Bangladesh divisional offices in Barisal and Khulna

• Conducted a staff orientation for Dhaka and Division level SPRING staff

• Recruited a total of 26 staff in Dhaka, Barisal and Khulna offices

• Developed a draft detailed implementation plan (DIP) for FY13

• Developed RFA guidelines for implementing partner non-governmental organizations (IP NGOs)

Core: IR 1.1: Country-specific SBCC programs strengthened and scaled up

• Conducted 3 advocacy events in Barisal, Bhola and Patuakhali districts with divisional, district

and upazila level officials from the Ministry of Health and Family Welfare, Ministry of

Agriculture, Ministry of Education, Ministry of Information, Ministry of Women and Social

Affairs, NGOs and the media, representing all 8 SPRING selected upazilas in Barisal. There was a

total of 80 government and NGO participants excluding staff from SPRING/Bangladesh

• Conducted Training of Trainers for 12 SPRING Dhaka, divisional and upazila level staff on

Essential Nutrition & Hygiene Actions (EHNA) for health workers

• Conducted Peer Community Facilitators training for 20 community facilitators with the Hunger

Project

• Adapted material for Peer Community Facilitators training and handout, ENHA training and

handout for health workers, Household Food Production training and handout, and Farmer Field

School Sessions guides

• Drafted, tested and printed a poster to promote food diversity in women’s diet

IR 1.3: Country-specific scale up of evidence-based nutrition interventions supported

• Participated in a USAID facilitated and SPRING/Bangladesh organized WASH training for SPRING

staff and partners from Alive and Thrive (A&T) and incorporated lessons such as "tippy taps"

into SPRING training manuals

IR 2.1: Policy and advocacy efforts to support food and nutrition policies and programming

strengthened

• Signed a three-way Memorandum of Understanding (MOU) with the Revitalization of

Community Health Care Initiative in Bangladesh, the Community Clinics Project, and the

National Nutrition Service

• Signed a letter of collaboration with the Hunger Project

• Participated as one of three members of the election committee of the executive committee for

the Scaling-Up Nutrition (SUN) Civil Society group in Bangladesh

• Served as notetaker and moderator at the Nutrition Symposium of the Asia Regional Meeting on

Interventions for Impact in Essential Obstetric and Newborn Care held in Bangladesh in May


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• Presented at an IFPRI seminar on IFPRI's role on Nutrition Research in Bangladesh

• Served as a panelist at the Centro Internacional De La Papa (CIP)/The World Vegetable Center

(AVRDC) Nutrition-Agriculture linkage workshop under USAID’s Horticulture Project

• Participated in monthly meetings of USAID partners within the Office of Population, Health,

Nutrition and Education, Bangladesh National Nutrition Working Group and SUN meetings

IR 2.2: Evidence-based learning, monitoring, and evaluation for effective approaches to scale-

up nutrition services expanded

• Revised the Project Monitoring Plan (PMP) and targets, drafted monitoring strategy and tools

with the assistance of the SPRING/DC Strategic Information Team (SI) (Tim Williams and Victoria

Chou)

• Completed sampling frame to add clusters into SPRING targeted upazilas to the Food &

Nutrition Survey Project (FNSP) managed by HKI to regularly collect SPRING related indicators

Next quarter:

1. Preparatory activities

• Receive signed sub-agreements between JSI, HKI, SC and IFPRI

• Finalize selection of SPRING/Bangladesh IPs and recruit their staff

• Conduct orientation for IPs

• Sign LOC with World Fish and USAID Horticulture Project

2. IR 1.1:

• Finalize the following training materials:

• Peer Community Facilitators training guide and handouts

• Training courses for ENHA training guide and handouts for health workers

• Household Food Production training guide and handouts

• Farmer Field School Session guide

• Develop a plan for training Master Trainers within the Ministry of Health & Family Welfare,

Ministry Of Agriculture, and collaborators such as Regional Fisheries and Livestock Development

Component (RFLDC), World Fish, The Hunger Project and USAID Horticulture Project staff. We

will include revisions in their current training as appropriate

• Finalize Year 2 work plan including Year 2 budget and targets

3. IR 1.2:

• Commence Farmer Field Schools with SPRING households

4. IR 1.3:

• Identify Year 2 upazilas5. IR 2.1:

• Present as a USAID FTF/GHI partner at the next bi-annual USAID and Bangladesh Ministry of

Health and Family Welfare Program Steering Committee (PSC)

6. IR 2.2:

• Complete Union level mapping

• Complete FNSP surveys, data collection, and analysis in target upazilas and report

• Finalize monitoring tools and PMP with Year 1 targets

• Attend SPRING Country Managers meeting in Washington D.C.

• Review and assess Year 1 implementation with support from SPRING/DC

• Identify formative research opportunities for nutrition in agriculture


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Haiti Field Support Program Implementation

This quarter, SPRING/Haiti continued to support the Ministry of Health (MOH) and the USAID/Haiti

Assistance Program through its two main activities: 1) Nutrition Assessment, Counseling and Support

(NACS) interventions in the four facilities in the US-assisted corridors in Haiti; and 2) SBCC activities to

strengthen Maternal, Infant and Young Child Nutrition (MIYCN) activities nationally in close

collaboration with the MOH and other partners.

Manisha Tharaney, Policy and Health Systems Advisor, traveled to Haiti from April 1 to 13, 2012 for

SPRING/Haiti’s official launch at the MOH. The objective of the launch was to share the project

objectives with the MOH and ensure that SPRING’s activities were closely aligned with the national

nutrition strategy. The launch meeting was attended by the Chief of Staff representing the MOH, the

Nutrition Directorate staff members, the Director of the MOH Family Health Unit, USAID/Haiti Mission’s

Activity Manager and SPRING. SPRING presented their project’s global agenda as well as their specific

scope of work and guiding principles in Haiti, followed by a question and answer discussion of the work

plan. Feedback from the discussion was included in the PPT presentation and shared with the MOH.

1) NACS interventions in the four facilities in the US-assisted corridors in Haiti

Preparatory work for the NACS Assessment was a key activity this quarter. Ms. Tharaney and

SPRING/Haiti field staff visited two of the four pre-selected health facilities included in the NACS

program. The field visit provided background information on the technical capacity of the health

facilities and the nutrition and HIV services that they provide. SPRING/Haiti and the MOH visited the

remaining three facilities to gather similar information in late April and early May.

A number of existing tools were reviewed including: the NACS assessment from the USAID supported

NuLife Project in Uganda, Organizational Capacity Assessments, Health Facility Assessment tool and

others. In addition, the information gathered from the field visit to the four health facilities provided

good background information and was used to guide the development of the NACS protocol. A draft

protocol and tools were created for the facility and community assessment and were shared with the

MOH and USAID/Haiti office for their feedback.

Upon receiving approval from USAID/Haiti, a request for proposals (RFP) for the assessment data

collection was advertised both nationally and internationally. Based on this competitive process, the

local firm Bureau de Recherche en Informatique et en Développement Économique et Sociale (BRIDES)

was selected and contracted for the anticipated data collection.

Finally, the NACS protocol was submitted for ethical approval to the National Institutional Board in Haiti.

The protocol and tools were translated into Creole and French and consent forms were developed for

the approval process.

2) SBCC activities to strengthen Maternal, Infant and Young Child Nutrition (MIYCN) activities

nationally in close collaboration with the MOH and other partners

SPRING met with key partners, USAID, SC, MSH, FHI360/CHAMPS, and WHO to discuss potential

collaboration in different program areas.


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From May 23-25, the MOH organized the first ever National Nutrition Forum to reposition nutrition in

the country’s national policies and strategies. The Forum was attended by 100 delegates from various

socio-economic and professional backgrounds. It was launched by the First Lady in the presence of five

Ministers and several ambassadors, parliamentarians, heads of UN agencies and NGOs, representatives

of USAID and other agencies. SPRING/Haiti staff attended the meeting and participated actively in all the

nutrition forum discussions.

SPRING also participated in the revision of the national Infant and Young Child Feeding (IYCF) nutrition

norms in Haiti that were organized by the MOH. The IYCF norms were updated to better reflect the 2010

WHO Guidelines on IYCF. The nutrition division of the MOH also made a decision to promote exclusive

breastfeeding for all children under 6 months irrespective of the HIV status of the mother.

Next quarter:

• BRIDES proposition and budget to be approved by USAID/Washington

• BRIDES contract to be signed by SPRING/DC

• BRIDES will carry out the NACS Assessment activities in collaboration with SPRING/Haiti and the

MOH in the four health facilities and their catchment area beginning July 16, 2012

• Preliminary assessment report will be remitted to SPRING around mid-August 2012 for

submission to USAID/Haiti

• SPRING will attend the monthly Technical Committee Meeting held at the MOH

• SPRING will continue to support the National Nutrition Program to strengthen MIYCN activities,

especially in the upcoming Breastfeeding Week preparations.

Uganda Field Support Program Implementation

This quarter focused mainly on start-up activities for SPRING/Uganda. The objective of the tasks

performed and the deliverables achieved was to establish the project while building the necessary

networks and identifying possible partnerships.

Introductory and District Sensitization Meetings

USAID/DC and SPRING/DC traveled to Uganda from March 18–27, 2012. There were several objectives

of the TDY: to finalize the proposed SPRING Year 1 work plan in close consultation with USAID/Uganda

and selected IPs, meet other stakeholders to discuss coordination and obtain more detailed information

on their nutrition activities that will help finalize the work plan, organize field trips to prioritized health

facilities and communities in order to refine proposed approaches and strategies and formulate

implementation plans. SPRING was able to gather and analyze a substantial amount of information on

Uganda’s nutrition landscape and the activities that are being implemented by other partners, projects

and stakeholders. SPRING refined the draft package of proposed activities to be implemented at facility

and community levels to strengthen treatment services and initiate preventive nutrition services. Two

additional districts, Kisoro and Ntungamo, were identified as potential locations to initiate SPRING

activities during Year 1. SPRING also met with potential partners and collaborators and identified

potential staff, management and operations structures. SPRING identified a consultant to represent

SPRING during the start-up phase.


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Technical component

During the first quarter, the technical aspects of the project were to initiate technical planning,

discussions and support to the Government of Uganda (GOU) in SPRING/Uganda nutrition-related

activities. The activities undertaken are outlined below.

SPRING/Uganda participated in several nutrition technical planning and coordination meetings:

• The Office of the Prime Minister (OPM)/National Planning Authority (NPA) and World Food Program(WFP) through REACH Uganda Nutrition Action Plan (UNAP) implementation plan developmentretreat in Jinja on April 17-18, 2012: Draft sector plans for health, agriculture, social development

and coordination were developed. SPRING/Uganda obtained insight on how to coordinate with the

OPM, the MOH, and other sectors in implementing its activities in Uganda.

• National Technical Working Group (TWG) review of the NACS training manual since May: The TWG is

revising the manual to ensure that nutrition is integrated in all the key health service provision

contact points without necessarily focusing on HIV and AIDS alone. Participation in this TWG created

a better understanding of implementing, monitoring and evaluating NACS activities in the Southwest

(SW). SPRING/Uganda is taking the leadership in the development of the NACS assessment tools

that can be used by all partners in the health facility assessment (HFA).

• National Working Group on Food Fortification (NWGFF) meeting convened by the MOH in Kampalaon June 28, 2012: The meeting was convened to plan for the finalization of the priority activities and

to discuss how to sustain the national fortification program at the end of the GAIN funding in July

2012. This meeting allowed SPRING/Uganda to better understand how to work with the GOU

through the MOH and the Uganda Bureau of Standards (UBOS) to continue the implementation of

the mandatory food fortification program.

• Consultative meetings with USAID nutrition and food security IPs were held to understand possible

modalities of partnerships that can be established with SPRING/Uganda in the SW. The partners

included the SCORE Project (AVSI, CARE and TPO), Community Connector, EGPAF, SC, the Initiative

to End Child Malnutrition, FANTA-3, Ankole Private Sector Centre, UNICEF, the Regional Centre for

Quality of Health Care (RCQHC) and Makerere University’s School of Public Health (MaKSPH).

• The technical team discussed the inter-organizational understanding of implementation of

performance improvement projects in the SW involving Community Connector, UNICEF, RCQHC,

MaKSPH and SPRING. The team plans to pool its resources together to strengthen the planning,

implementation, monitoring and evaluation of nutrition-related interventions in the region.

• Participated in the drafting content for the training manual for Subject Matter Specialists supported

by Community Connector through Self Help Africa. SPRING/Uganda will continue its participation to

implement the community aspects of preventive nutrition services in the SW where they plan to

work together with subject matter specialists.

• The technical team supported the development of the social marketing and communication

materials for the national fortification program. GAIN and the MOH contracted Communication for

Development Foundation Uganda to spearhead the development of the materials for increased

public awareness of food fortification in the country.

Mapping of health facilities in Kisoro and Ntungamo districts

• SPRING/Uganda mapped all the health facilities: hospitals, health center IVs, health center IIIs and

health center IIs in the Kisoro and Ntungamo districts. The report was used in the development of

the annual work plan and study protocol for health facility assessment.


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Initiation of the Health Facility Assessment (HFA)

The process for the HFA in the SW began with the development of the study protocol, assessment tools

and SOW for the consultant. The draft protocol and tools have been reviewed by the SPRING/DC team

and are currently being finalized.

NGO and CBO mapping in Kisoro and Ntungamo

• A simple mapping exercise of the NGOs and CBOs operating in Kisoro and Ntungamo districts was

undertaken in May with the aim of identifying potential partners at the grassroots level who could

support in the implementation of SPRING/Uganda activities at the community level.

• The exercise identified a number of good programs and projects at the community level that could

be important in delivering SPRING strategies and interventions for improved nutrition programming.

• However, more detailed study of the NGOs and CBOs is necessary to fully understand how the

synergies between SPRING/Uganda and the existing organizations could be achieved.

Next quarter:

• An official SPRING/Uganda launch to the Office of the Prime Minister (OPM), MOH and National

Planning Authority (NPA), IPs, district health offices (Kisoro, Ntungamo) and district health teams.

• Operationalization of the Mbarara office and finalization of the recruitment of all key staff.

• Complete the necessary formalities to begin the health facility assessment in the selected facilities

(ethical clearance from UNCST, recruitment of consultants and training) to better understand the

current status of preventive nutrition and treatment services.

• Organize an orientation workshop for District Health Teams in Ntungamo and Kisoro, and reproduce

national Integrated Management of Acute Malnutrition (IMAM) and NACS guidelines and protocols.

SPRING/Uganda has already begun reviewing national NACS guidelines, and will begin identifying

vendors for printing the protocols before the end of FY12.

• Identify procurement agents for nutrition supplies based on the outcome of HFA.

• Develop a community-level assessment protocol to identify potential models or delivery systems for

community-based preventive nutrition services. This will involve developing tools and submitting

the protocol for ethical review in Uganda. Planning for the assessment will be completed by the end

of FY12, with an expected start date for the assessment at the beginning of FY13.

• Support coordination meetings with the NWGFF. This will involve setting the agenda, providing

logistics support for meetings, and supporting follow-on activities suggested at meetings that relate

to the IRs listed above.

Nigeria Field Support Program Implementation

SPRING representatives Paige Harrigan, Senior Nutrition Advisor IYCN (team leader) and Peggy Koniz-

Booher, Senior Advisor Nutrition/SBCC, traveled to Nigeria from June 9-22, 2012. The objective of this TDY

was to initiate a work plan based on a set of recommendations previously sent by USAID/Nigeria to

improve recommended IYCF practices to reduce stunting in children under 2 years of age. Meetings were

organized with the Federal MOH, prioritized Nigeria-based IPs, select USG partners, and other

stakeholders. The purpose was to understand federal and state level priorities; discuss coordination; gather

detailed information about ongoing nutrition activities; and review and prioritize strategic, evidence-based

activities that will contribute to the development of a SPRING/Nigeria work plan.

During this visit, SPRING met with members of the USAID PEPFAR team to review the objectives for the


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TDY, USAID’s proposed activities and priorities for SPRING, and priority government groups and IPs to

meet. The SPRING team met in the Federal Capital Territory (FCT) with the FMOH Nutrition Division,

National Aids and STD Control Program (NASCP), National Primary Health Care Development Agency

(NPHCDA), FCT-Primary Health Care Board (FCT-PHCB), UNICEF, GAIN, SC, HKI; JSI (DELIVER, SCMS, and

AIDSTAR-one projects); FHI 360/SIDHAS; International Centre for AIDS Care (ICAP); and former IYCN Project

staff. A field visit to Benue State was organized to observe a Community-IYCF training of trainers and to

meet key State MOH officials. Two follow-up discussions were also held with USAID, including a joint

meeting with the PEPFAR and Health, Population, and Nutrition (HPN) teams.

This mission enabled SPRING to initiate a work plan for FY12 and FY13 that reflects and complements the

priorities, strategies, and ongoing efforts of USAID, the Government of Nigeria, NGOs and other IPs as

discussed in meetings during the mission. A work plan for submission to USAID is currently being finalized.

Proposed activities under initial funding from USAID ($650,000 for FY12 and another $650,000 for FY13)

are detailed below.

Based on meetings with USAID, the MOH, prioritized Nigeria-based IPs, select USG partners, and other

stakeholders in Nigeria, SPRING identified the following as a sub-set proposed of activities for FY12:

• Support World Breastfeeding Week activities in late August

• Finalize community and facility-based IYCF packages, including holding a stakeholders finalization

meeting, fine-tuning graphics, translating materials, and coordinating printing of materials

• Launch and conduct national dissemination of printed IYCF packages

• Identify opportunities to provide TA to the SUN movement

• Meet with and explore opportunities to collaborate with other USAID-supported initiatives

• Meet with the Federal Ministry of Women’s Affairs and Social Development to review the status of

the Nutritional Care and Support for Vulnerable Children: A Resource Manual, developed under

IYCN, and discuss their recommendations for its dissemination

• Review recommendations made under IYCN related to nutrition and agriculture, and discuss

opportunities with USAID to support future work under Feed the Future funding in Nigeria

• Conduct strategic planning for FY13

• Finalize a management plan and proposed budget for the period covering July 2012 through

September 2013

As part of the strategic planning for FY13, SPRING also proposes to organize a strategic planning meeting in

September or early October 2012 with USAID/Nigeria, SPRING AORs, the OHA Nutrition Team, and key

local partners to inform the design of the SPRING FY13 work plan, reflecting a vision for future USAID

investments in nutrition with an emphasis on community-level SBCC, quality improvement, and M&E.

SPRING is concurrently initiating recruitment of SPRING/Nigeria personnel and consultants so that work

can start immediately. Based on the response from USAID after the work plan is submitted for review,

SPRING plans to continue discussions with Nigeria-based organizations on potential partnerships, support

specific World Breastfeeding Week activities (August 2012), organize a strategic planning meeting with

USAID, the Government of Nigeria, and local partners for the FY13 work plan, and have a joint TDY with

SPRING AORs, and OHA to plan future NACS and other nutrition activities (in September or October 2012).


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B. Core-Related Activities

IR 1.1: Country-specific nutrition SBCC programs strengthened and scaled up

Activity 1.1.1 Identify, disseminate and test proven or highly promising nutrition SBCC tools

During this quarter, SPRING began critical work on the research and identification of SBCC tools and the

compilation of the literature review. SPRING began with defining SBCC and its approach to guide SPRING

activities as well as meet the broader need for a communal definition for this widely used term.

Through the literature review, SPRING is identifying the range and effectiveness of SBCC approaches on

key maternal and child care practices. The literature review is in progress after an internal approval of

the search methodology and scope of the review occurred. A draft outline of the final product will be

shared with USAID early next quarter. The literature review is scheduled for completion in FY12 and the

results will be shared on the SPRING website and external networks for dissemination to the broader

health community. Upon identifying gaps in the literature through this review, particularly on highly

promising approaches to social and behavioral change that have yet to be “proven”, SPRING will conduct

research activities to test those approaches to fill those needs. Likewise, upon identifying proven

approaches to social and behavioral change, SPRING will develop and/or disseminate existing guidance

and tools for their implementation planned for FY13.

The first tool SPRING will test is the Digital Green (DG) approach with community-based videos adapted

for the promotion of key maternal and child care practices. This quarter, a concept note, including a

proposed methodology for testing the “proof of concept”, was developed and submitted to USAID/DC

and USAID/India. Next quarter, SPRING will operationalize the plans articulated in the concept note – to

identify a local partner who is on the ground and already implementing nutrition interventions without

video and map out how that partner’s approach might be adapted to the DG approach.

An expert SBCC Technical Advisory Group (TAG) was identified this quarter and will be convened to

provide feedback on SPRING SBCC research priorities, currently scheduled for Q4.

Next quarter:

• Continue to build the pathways of change

• Finalize the SBCC literature review on key maternal and child care practices

• Draft an outline and plan to develop user-friendly products presenting the findings from the

literature review, including the web-based interactive Theory of Change

• Share and discuss these products within SPRING, since this may be a model for sharing evidence

collected by others on SPRING

• Visit DG India to identify local nutrition/health partner(s), select intervention sites, draft scopes

of work for local technical team develop sub-agreements, an implementation plan and

operations research protocol for testing the model

• Conduct an orientation of stakeholders and initial trainings (described in the concept paper)

• Identify additional SBCC tools or models for adaptation/use and testing

• Work with the SI team to develop the operations research project design

• Convene the SBCC TAG and solicit feedback on SBCC research priorities


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Activity 1.1.2 Build capacity of public sector and civil society partners for scale-up of SBCC actions

Discussions with representatives of the CORE Group, TOPS, UNICEF and others to determine potential

collaborations with SPRING regarding SBCC training priorities ensued. Potential regional capacity

building activities include Designing for Behavior Change, Designing by Dialogue, Trials in Improved

Practices (TIPS), Use of mHealth Platforms, Community IYCF counseling, and ENA. Regional trainings will

be conducted in FY13 but country-level trainings will continue for FY12.

SPRING researched existing e-learning modules for SBCC and nutrition as well as reviewed best practices

for e-learning module development. The team continued to collect and review examples of e-learning

curricula, including the USAID Nutrition 101 course, the FAO Food Security Course, the DFID-supported

nutrition programming courses by the London School of Hygiene and Tropical Medicine (LSHTM),

university nutrition courses, the K4Health learning platform, and others. Discussions with K4Health,

Cornell NutritionWorks and LSHTM assessed areas for collaboration for a SBCC for nutrition course.

Next quarter:

• Identify SBCC trainings for execution at country-level

• Develop partnerships and/or circulate expressions of interest for the development of the SBCC

e-learning course in FY13

IR 1.2: Country-specific approaches to improve dietary diversity and quality

advanced

In an effort to design specific approaches to improve dietary diversity and quality, SPRING is assessing

existing approaches and programs being implemented in Uganda and Bangladesh. The information is

expected to widen understanding and identify gaps that will help plan future activities. In Uganda,

national level data on micronutrient interventions are being reviewed to identify implementation issues

to help better inform a planned program assessment workshop. Consultation with the MOH also helped

to identify key areas of involvement to GOU, in collaboration with other IPs. Under this intermediate

result, SPRING provides technical assistance to enhance capacity and improve the quality of services.

During this quarter, SPRING started implementing key sub-activities under activities 1.2.1 and 1.2.2 as

outlined in the Year 1 Core Work Plan.

Activity 1.2.1 - Assess effectiveness of implementation of small-scale agricultural interventions that

lead to nutrition improvements in selected USAID focus countries

Agricultural training modules incorporating nutrition have been adapted for use in farmer field schools

and are currently being translated into Bangla. The agriculture/nutrition training sessions will begin in

September. The success of these modules will be assessed through formative research scheduled to

start in November. This research will elucidate farmer knowledge and interest in nutrition as well as how

the farmers perceive mixed cropping systems.

Sub-activity 1: Build links with GAIN, the Flour Fortification Initiative (FFI) and other partners to

maintain and advance food fortification efforts

SPRING/Uganda participated in the national technical working group for food fortification (NTWGFF)

meeting which helped to prioritize national food fortification program activities and maintain the


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momentum gained through efforts of the GOU, GAIN and other partners. Identified activities include:

building the capacity of industries for the implementation of mandatory food fortification; supporting

the M&E of food fortification; providing financial and technical support for continuity of NTWGFF; and

sensitization of the public and private sector on food fortification.

Sub-activity 2: Strengthen capacity and ability to deliver anemia prevention and control programs in

at least one country: Refer to IR 2.1, activity 2.1.2: sub-activity 2

Sub-activity 3: Facilitate the use and scale-up of innovations, such as MMPs, through strategy

development, capacity strengthening and guide line dissemination

As part of Uganda specific field support, SPRING supports the MOH in the development of the

comprehensive micronutrient policy framework that incorporates multiple micronutrient powders, as an

intervention. The comprehensive micronutrient framework will incorporate different guidelines for

combating micronutrient deficiencies such as the Anemia Policy (2002), guidelines on planning and

implementation of vitamin A capsule supplementation (2001) and facts to know about iodine deficiency

disorders (1998) into a single package.

Next quarter:

• Support the NWGFF in coordinating national fortification efforts through MOH

• Work with the Private Sector Foundation Uganda in mobilizing the private sector for

implementation of mandatory food fortification

• Continue with creation of public awareness on food fortification through supporting social

marketing efforts started by GAIN

• Strengthen food quality control systems for fortified foods in Uganda by working alongside

Uganda Nutrition Bureau of Standards

• Engage in increasing range of micronutrient interventions with the piloting of home food

fortification (e.g. multiple micronutrient powders) in the SW region of Uganda

• Continue to play a role in the national technical working group for micronutrients to develop to

comprehensive micronutrient policy strategy that incorporates multiple micronutrient powders

IR 1.3: Country-specific scale up of evidence-based nutrition interventions

supported This quarter, SPRING attempted to finalize a working definition for scale-up based on the literature

review. Some of the salient features of this definition are:

• Scale refers not just to wider geographic coverage but also to quality, equity and sustainability

• Scale up is not an objective but a multi-sectorial process

• Scaling up pathways should be defined from the onset

• The innovations taken to scale should be simple and evidence-based

SPRING’s definition of scale also emphasizes the importance of functional scale-up (focus on multiple

areas of engagement) as well as on vertical scale up (strengthening institutions from grassroots to

national level), in addition wider geographic coverage to ensure sustainability of the process.

The country database of indicators related to scale-up created in the last quarter was populated with

additional countries and indicators. Currently, there are 57 countries in the database and a total of 116

variables ranging from socio-demographic to health systems, and agriculture. Criteria for case-study


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selection were developed based on the working definition of scale. A nutrition progress score was

developed which classified countries in different “progress levels.” The following criteria were used to

develop country progress levels:

• Status of governance (using the WHO’s classification of high, medium, low)

• Current prevalence of stunting

• Change in stunting trends (in the last 10-15 years based on DHS statistics)

• Equity ratio across stunting levels (calculated using concentration indices)

Countries were further sub-divided into clusters based on a number of socio-economic variables. These

included total fertility rate, population, % of population that is rural, % of population under the age of 2,

%t of population below national poverty line, %t of people with access to improved water and

sanitation, female literacy rates and % of arable land. These clusters will be used to define diversity

among countries for the case study selection. Similar countries within a cluster with different progress

levels will be used to select countries that are most different or diverse. The Most Different method

allows choice among those countries that have had similar progress in scaling up, but are from a wide

array of contexts. The diverse approach will try to capture countries from the range of progress in scale

up. Based on these criteria, Burkina Faso, Nepal, and Uganda have been proposed as potential countries

for the retrospective case studies.

Next quarter:

In the next quarter SPRING will:

• Finalize a research protocol for the retrospective case studies

• Finalize the list of countries for the retrospective case studies in partnership with SUN, USAID,

country governments and other key stakeholders

• Conduct a systematic review of “drivers” and “barriers” to scale-up to decide research domains

• Finalize a SOW for one or two consultants who will assist in the case-study methodology

• Plan the data collection process with SUN, USAID Missions and country governments

• Hold discussions with USAID and SUN to define selection criteria and methodology for

prospective case studies of drivers of scale-up.

II. IR 2: Global evidence base, advocacy platforms, and policies for

nutrition expanded

SPRING made progress this quarter with regards to launching activities that will contribute to the global

evidence base. Of note was progress on several products intended to improve project understanding on

key concepts and foster a unified vision of project goals, objectives, activities, and focus areas going

forward. Such products include an interactive nutrition theory of change (ToC) (under development), a

streamlined conceptual framework diagramming SPRING’s approach to achieving better nutrition

(completed), definitions of “scaling up”, a literature review on SBCC (underway), and production of a

number of knowledge management products. Additionally, a research agenda prioritization meeting was

held, several advocacy efforts towards anemia prevention are underway, several research activities

were begun, initial planning meetings for Nutrition-GLEE were held, and the SPRING website and

Facebook pages were launched. Finally, it is important to highlight that two new full time staff joined

the Strategic Information (SI) team during the April-June quarter, including a Knowledge Management

Advisor (Antonia Wolff) and a Research and Evaluation Advisor (Victoria Chou), and two part-time staff

joined, including an M&E Analyst (Alexis D’Agostino) and a Knowledge Management and


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Communications Manager (John Nicholson). The SI team also benefitted from hosting a Hubert

Humphries Fellow for seven weeks (Nataliya Podolchak), and anticipates welcoming a Health and

Nutrition Economist (Jack Fiedler), beginning in July.

IR 2.1: Policy and advocacy efforts to support food and nutrition policies and programming strengthened

Activity 2.1.1 - Collaborate with and support the SUN Country Reference Group and/or other SUN

stakeholders with substantial involvement of USAID

In June 2012, SPRING AORs participated in a SUN Lead Group Task Team (LGTT) telephone discussion on

Sharing Best Practice across the SUN Movement, including countries, Lead Group members and Network

Facilitators. In a subsequent communication to David Nabarro, SPRING AORs took the opportunity to

express USAID’s commitment to the SUN movement and to offer technical assistance and analytic

support through SPRING and proposed a conference call in July 2012. Next quarter, SPRING and SUN will

discuss potential areas of collaboration specific to technical assistance to SUN and the activity 1.3.1.

Next quarter:

• Carry out meetings with David Nabarro, Coordinator of SUN and other stakeholders, as

appropriate to discuss priorities and potential role for SPRING

• Outline a short list of the kinds of technical assistance that might help shape the discussions as

this work evolves

• Create a list of SPRING staff and consultants who might be called upon to contribute to this work

and draft an illustrative SOW to facilitate it

• Select, in consultation with USAID, SUN and other stakeholders and in response to country

demand, 2-3 countries as prime candidates for targeted short-term technical assistance (STTA)

• Initiate planning of first STTA visit

Activity 2.1.2 - Provide global technical leadership in nutrition through the development, application

and dissemination of evidence based guidelines, tools, position papers and guidelines

Sub-activity 1 - Engage and facilitate current global consultations on anemia

During the last quarter, staff from CORE Group, MCHIP and SPRING met to discuss the need for a USG-

partner anemia task force. The group have worked together to develop the proposal for Multisector

Anemia Prevention and Control (MSAPC) Task Force, which would be USAID-led with CORE Group,

MCHIP, and SPRING acting as the Secretariat. The proposal has been submitted to USAID for feedback.

SPRING participated in the May 2012 MCHIP meeting on iron/folic acid supplementation in Bangladesh.

This exercise helped to initiate discussions and planning with the SPRING/Bangladesh team and other

partners about potential areas of support to strengthen anemia prevention and control work. Staff from

SPRING and global UNICEF, micronutrient and IYCF sections, met to identify areas of collaboration and

engagement in the current efforts that take HF and IYCF interventions to scale. Further discussion is

planned to take place to identify modalities of engagement both at country and global levels in order to

strengthen the global advocacy learning platforms in these priority areas.


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Sub-activity 2: Identify, address and improve supply chain management and distribution of

supplements in selected countries

SPRING developed a SOW for a consultant to facilitate the national workshop using program assessment

guide (PAG) as a tool in Uganda. Also, exploratory data analysis is being done to investigate Uganda’s

national program performance on iron/folic acid supplementation and other related health programs

affecting the burden of anemia (use of impregnated bed net and deworming rates), to assess level of

association with prevalence of anemia in women and children.

Next quarter:

• Follow up with SPRING/Bangladesh to conduct a technical meeting on anemia and identify next

steps using the current DHS data

• Produce a 2-page report on use of prenatal iron/folic acid supplementation for FTF countries

• Analyze DHS data to examine cross country patterns of iron/folic acid supplementation

• Undertake an in-depth analysis using DHS 2011 data to examine performance of health

programs affecting magnitude of anemia in Uganda

• Procure a local consultant to gather and analyze information on anemia program performance

and map out the contribution of partners in the national control and prevention of anemia

control program

• Complete necessary preparatory work and diagnostic analysis to create an agenda for a PAG

workshop on the national anemia prevention and control program in Uganda

• Carry out a national workshop in Uganda (using a PAG as a tool) and identify follow up actions

that strengthen the national anemia control and prevention programs

IR 2.2: Evidence-based learning, monitoring, and evaluation for effective

approaches to scale up nutrition services expanded

Cross-cutting Strategic Information Activities

One of SI’s objectives is to ensure that activities are evidence-based, theory driven, and based on a

common vision of project objectives and strategies to achieve them. SPRING decided that an effective

way to achieve such a unified vision would be to develop an interactive ToC framework and planning

tool. Initially SPRING envisioned the ToC primarily as a way to provide the project with a common vision

of how planned activities lead to desired long term outcomes, as well as showing where proposed

pathways are supported by existing evidence, and where evidence gaps exist.

The initial step was to hold a full project meeting to gain consensus on the ToC and processes to move

forward (held April 18, 2012). At that time it became clear that a priority for the project was a simple

diagram to illustrate in a single “snapshot” of SPRING’s approach to reducing anemia and stunting. This

was developed and a graphics designer was engaged to ensure a professional and polished look since

this figure will be used in SPRING work plans, strategic plans, reports, and SPRING presentations. A final

version, called “SPRING approach to achieving better nutrition during the first 1,000 days”, was

completed and shared with USAID in July 2012. (See Annex 2)

Meanwhile, the vision of the more detailed ToC is to develop an interactive web-based tool for SPRING

staff (country and core) as well as policy makers and program planners globally. The ToC might serve as

a jumping off point for knowledge management and decision-making related to nutrition programs and

policies. On the ToC web page, SPRING could share evidence collected (through the literature review

described earlier in section 1.1.1) on the approaches and interventions for affecting pathways to change


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and provide guidance and tools for implementation of those approaches. This vision has been shared

with SPRING and JSI staff to ensure that it will be useful for the intended audience.

A second cross-cutting SI activity was further progress to define and prioritize the project’s research

agenda, using a three-stage process. For Stage 1, potential research questions were identified internally

based upon a review of the existing evidence and topics were organized into focus areas such as

nutrition-agriculture, nutrition metrics and monitoring, and SBCC for nutrition. For Stage 2, SPRING

convened a TAG meeting comprised of SPRING staff and external experts to refine the list of questions

and select the highest priorities for the research agenda. The first TAG meeting on June 19, 2012

successfully drew together SPRING staff, colleagues from academia, program collaborators, and USAID

representatives for a day of productive and active discussions about two of the focus areas—agriculture

and nutrition integration, and nutrition metrics. A second TAG meeting scheduled for July 31, 2012 will

address potential research related to SBCC. Stage 3 will involve comparison, evaluation, and final

selection of research priorities according to relevant factors such as in-country demand, donor

preferences, funding constraints and logistic limitations.

Next quarter:

• Develop specifications detailing the functionality of the web-based interactive ToC tool

• Continue to build the pathways of change (pre-conditions) and drivers of change (approaches

and interventions) for increasing household access to nutritious and diverse foods, improving

maternal and child care practices, and increasing access to quality services and a healthy

environment, starting with maternal and child care (see also Activity 1.1.1)

• Develop a “beta” version of the web-based interactive tool for a portion of the ToC to guide

further discussions

• Conduct key informant interviews with experts in the field to solicit input on the added value of

such a tool

• Hold a follow-on full project meeting in mid-August to gain consensus on the ToC interactive

tool for knowledge management and decision-making

• Convene second TAG meeting on research priorities in the area of SBCC

• Continue prioritization process and develop concept notes for priority research topics

Activity 2.2.1 - Use a systems approach to analyze scale-up and sustainability of key nutrition

programming

SPRING began work on three important research areas during the past quarter: drivers and inhibitors of

nutrition scale up, relation between under-nutrition in the first 1,000 days and acquiring non-

communicable diseases (NCDs) later in life, and factors affecting consumption of iron folate during

pregnancy. These are described in turn below.

Drivers and inhibitors of nutrition scale-up (see also activity 1.3.1) SPRING has completed an extensive database of 116 variables for 57 countries to assist with country

selection for retrospective case studies on drivers and inhibitors of successful nutrition scale-up. These

data include socio-demographic factors, health and nutrition system factors, in addition to all currently

available nutritional status indicators. The database has contains a wealth of information with a range of

potentially valuable uses beyond the case studies themselves.


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NCD profiles

SPRING has completed preliminary data analysis of the DHS for the 36 high burden (for stunting)

countries, to be used to create country profiles of possible future nutrition-related NCD risk. This

includes prevalence rates for low birth weight, overweight for mother and for children under 5, and

children who are both stunted and overweight. Using an innovative approach, we have also been able to

use the DHS reproductive calendar to split out pre-term babies from the low birth weight sample, which

will give us a rough approximation of those babies who were intra-uterine growth restricted (IUGR), a

more significant predictor of later NCD risks, such as the development of hypertension or insulin

resistance. We expect to have at least one country profile completed to share at the August 8 NCD

expert consultation being led by USAID. Single country profiles will be completed down to the sub-

national level for SPRING’s four field support countries, and for a select set of other countries.

NCD cost-effectiveness model The NCD cost-effectiveness model has been approved by USAID, with the provision that it be reviewed

by an outside technical expert. In preparation, SPRING has conducted a review of the literature and

data. This review identifies what evidence is available to model the relationships for the major pathways

of association between nutritional/growth status in the first 1,000 days and later NCDs. The review has

allowed us to identify the top one or two pathways that have enough evidence to model. Discussions

will be held in July to get more clarity on the interventions that USAID uses to affect nutritional/growth

status. SPRING is also hosting for USAID the NCD technical consultation on August 8, which includes

providing the venue, food, note-takers, and some additional materials for the program. SPRING will

present the results of the review and our pathway model at this meeting.

Iron folate consumption during pregnancy

The SI team used DHS data to develop a rapid assessment tool that provides an understanding of the

performance of IFA distribution programs in 23 countries. The team also developed a template

schematic that can updated as new data become available in order to allow for visual comparisons of

the results across countries. Discussions have been held within SPRING to explore how to broaden the

analysis to include additional factors related to anemia, such as malaria treatment and deworming.

Next quarter:

• Case studies on drivers and inhibitors of nutrition scale-up

o See activity 1.3.1

• NCD profiles

o The test profile will be presented at the NCD technical consultation meeting and

feedback will be used to refine the information included

o The sub-national analysis for the rest of the countries will be completed and those

profiles will be produced

• NCD cost-effectiveness model

o The NCD consultation will occur in the next quarter and the model pathways will be

presented

o SPRING will hold external review meetings prior to the consultation, and based on the

comments received in these meetings, will adjust the model plan as necessary

o If approved, the preliminary model will be complete by September 30, 2012

• IFA during pregnancy

o Use data collected during Q3 to create detailed schematics for each country analyzed,

adding additional factors related to anemia as appropriate


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o Develop country 2-pagers for the four SPRING countries that include the IFA rapid

assessment tool, country-level analysis of the IFA situation, and tables/maps to further

explain the country context

Activity 2.2.2 - Provide technical leadership on measurement, implementation and impact assessment

of nutrition SBCC

SPRING made substantial progress in this area by initiating a comprehensive literature review of

evidence related to the range and effectiveness of SBCC approaches on key maternal and child nutrition

practices (described under activity 1.1.1).

Some of the work related to the development of the detailed ToC (see activity 2.2.1) will also contribute

to better understanding and measurement of SBCC activities and impact. For example, while identifying

pre-conditions or determinants of maternal and child care practices, SPRING is also defining how they

are measured.

Finally, the SI team worked closely with SBCC technical experts to develop a concept note for a “proof of

concept” study to assess feasibility of using the DG communication model to use community-developed

videos to convey nutrition information to community members (described under activity 1.2.1).

Next quarter:

• Refer to above-mentioned sections of the report

Activity 2.2.3 - Provide technical leadership on the contribution of agriculture programs to reducing

childhood stunting and anemia SPRING obtained copies of recent, nationally representative sample-

based household survey databases for Bangladesh (2011), Nigeria (2010) and Uganda (2010). The

databases will be used to analyze the nutrition-agriculture connection at the household level, including

identifying the key food sources of caloric, iron, vitamin A and zinc intakes. Analyses will be done at both

national and subnational levels. In addition, the SI team used DHS data to develop a rapid assessment

tool that provides an understanding of the performance of IFA distribution programs in 23 countries.

The team also developed a template schematic that can updated as new data become available in order

to allow for visual comparisons of the results across countries.

Next quarter:

• Use data collected during Q3 to create detailed schematics for each country analyzed

• Develop country profiles for the four countries that include the IFA rapid assessment tool,

country-level analysis of the IFA situation, and tables/maps to further explain the country

context

Activity 2.2.4 - Provide technical leadership on improved nutrition metrics and monitoring

The Nutrition Metrics Technical Advisory Meeting was held on June 19, 2012. The group was able to

prioritize the following list of questions using a guided set of criteria:


19

Top priority:

1. The three questions under prospective measurement of nutrition scale up were grouped

together, and ranked #1 priority. These should also guide SPRING as the project plans for

prospective case studies of nutrition scale up.

a. What can we assess/measure implementation progress and use metrics that can be

applied across countries?

b. What are the minimum criteria necessary for a country to be able to implement a

successful scaled up nutrition program? [considered to go with measurement of

implementation process]

c. What are the minimum criteria necessary for a country to be able to sustain a successful

scaled up nutrition program?

SPRING should be exploring unique ways to look at nutrition for scale-up. This could be a good

contribution from SPRING, and perhaps looking at metrics is a way to do that.

2. How do outcome and process measures need to differ to accurately capture nutrition in

Nutrition-Specific vs. Nutrition-Sensitive programs?

SPRING should stay engaged in definition process of these two types of programs, which should be

complete by September. Thus, the timing of this question would be at least FY2013, not before.

3. How do you measure integration/successful integration? Is this best approached through

qualitative, quantitative, or mixed methods? What is the minimum criterion for an integrated

approach to be considered successful?

SPRING will engage with bilaterals, nutrition CRSP, and ENGINE to see what work they are doing and if

there is potential to work together.

Lower/Medium priority:

4. How well does low birth weight, specifically IUGR, predict NCD risk? What data are available to

explore this linkage?

5. Can we develop a protocol for using the HCES/HIES data for countries to answer key questions;

how do we leverage HCES/HIES for improving nutrition programming—can we lay out an

example of the different types of issues we could address?

SPRING has already made progress in some of these areas. SPRING attended the International

Conference on Diet and Activity Methods in May at the FAO and presented on the use of HCES/HIES for

monitoring of diet, and met with key leaders on nutrition metrics. SPRING is pushing forward with the

development of 1) measures to identify countries that have made meaningful progress in scaling up

nutrition, and 2) measures to identify countries who are now prepared to undertake such an effort.

Further work has begun on qualitative data collection approaches to assess progress of such efforts for

the case studies. The SBCC team is finalizing the definitions needed to begin metrics work and

continuing to build the pathways around which the metrics will be designed. After the identification by

the TAG of low birth weight (and specifically IUGR) as the most promising proxy predictor of future NCD

risk, SPRING has re-focused efforts on this topic to explore what can be done with secondary data to

better identify those children.


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Next quarter:

• Focus primarily on the development of process measures that will be needed for the country

case studies, as well as adaptation of qualitative inquiry methods to suit that effort

• Pursue improvements in the identification of IUGR babies in secondary data, and begin to

explore what other sources of routine data could provide more regular or more accurate low

birth weight data

Activity 2.2.5 - Encourage use of strategic information at country and global levels through

implementation of a knowledge management (KM) strategy

This quarter officially welcomed the new Knowledge Management (KM) Advisor, Ms. Antonia Wolff. She

started on April 3, and immediately started working to support the project’s KM needs. Shortly

thereafter SPRING welcomed a new member to the KM Team, John Nicholson. Mr. Nicholson began

working with SPRING at 30% time on May 25 and will provide overall leadership and support to KM,

specifically working on developing and expanding the SPRING website.

Activities Completed this quarter:

1. The KM Strategy - An overall strategy to help guide KM over

the course of the project and to support SPRING’s goals by

improving access to and dissemination of best practices and

successful project activities. This was shared in late May with

SPRING Staff and the USAID AORs.

2. The Communications Plan - The Communications Plan is

part of the overall SPRING KM Strategy. It provides an

overview of the established roles, operating norms, available

resources and communication channels for the SPRING team

to ensure consistent, effective and quality messages and

deliverables, reflecting integration and collaboration.

3. Website development - SPRING worked with the AOR Team

and Communication staff to develop a rapid launch plan for

the SPRING website. The beta version of the website officially launched on June 11, 2012, and is initially

intended to establish the project’s digital presence. In its first two weeks, the website received 80

unique visitors from seven countries who viewed an average of 4 pages per visit. The site will be further

developed into the project’s primary internal and external knowledge management portal as the project

scales up and needs or further identified.

4. SPRING Branding/Marking Guidelines –intended to guide staff across partner organizations in

complying with the project’s branding requirements. The audience for this document includes USAID

and SPRING/DC. It provides the rationale for why the project needs additional and slightly nuanced

guidance from what is in the contract. It also defines intellectual property and clarifies WHEN and HOW

we should attribute the intellectual property of our partners and other organizations.

5. Branding FAQ - A 'user-friendly quick reference guide' intended to assist country teams and

organizational partners in correctly using the SPRING and USAID logos, when to use them, if they can be

translated and includes standard language such as our program statement, disclaimer etc. It summarizes

the Branding/Marking Guidelines and can be used by graphic designers, communications staff, and/or

anyone actually designing or producing project materials.

Antonia Wolff has over 15 years

of experience developing KM and

communication strategies for USAID-

funded projects and development

partners. Antonia’s areas of expertise

include designing KM/

communication strategies and

providing technical guidance for a

variety of communication and

advocacy interventions around

nutrition, maternal and child health,

HIV/AIDs, water and sanitation, food

security and gender-based violence.

John Nicholson has served as a

communications and KM specialist

with JSI for over six years. For the past

three years, John has been an integral

member of USAID’s flagship HIV KM

project, AIDSTAR-One, overseeing the

initial development of the project’s

KM strategy and online platform.

Prior to joining AIDSTAR-One, he

supported 11 field offices working to

improve injection safety and health

care waste management practices in

Africa and the Caribbean.


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6. Branding Guidance Document - Also intended for our partnering organizations, country teams, and

home office staff, this document is for a slightly different audience that includes technical counterparts

and authors of SPRING-supported technical documents. It addresses certain questions about what

materials to brand, how to brand, and when to co-brand.

7. SPRING Style Guide - This guide provides clear standards for our documents—printed or electronic—

to ensure consistency and technically accurate information across all project products. This guide is

intended to be used by project staff, partners and country teams.

8. Zotero - New staff was trained in using Zotero, including how to add resources and how to search for

resources. The total number of online resources in the library doubled this quarter, going from over 400

to 816 resources. The library continues to serve a useful reference for all staff and new staff will be

trained systematically to use it.

9. SPRING Facebook page- In May, KM launched the official SPRING Facebook page; by the end of the

quarter, the page has garnered:

• 61 – total likes, the number of unique people who like the SPRING Facebook page

• 29,441 – friends of fans, the number of unique people who are friends with your fans,

including your current fans

• 4 – people talking about this, the number of unique people who have created a story about the

SPRING Facebook page in the last 7 days

• 242 – total reach, the number of unique people who have seen any content associated with the

SPRING Facebook page

10. Other guidance documents and materials- These include guidance for writing an assessment,

document production forms, templates for cover pages, PPT presentations, reports, and SOWs.

11. Re-organization of the project shared network drive – KM re-organized the project-wide G drive

and presented it to the staff.

12. Social Media Working Group– KM participated in the first USAID-sponsored working group on social

media. The purpose of the working group is to learn about how USAID partners are using social media

and begin an ongoing dialogue around social media. The next meeting will be held in September.

13. Secure Nutrition Knowledge Platform– This quarter, KM attended the May 17 official launch of

World Bank’s SecureNutrition Knowledge Platform. SecureNutrition aims to bridge knowledge gaps

between agriculture, food security, and nutrition. This platform offers a space to exchange experiences

and to disseminate and gather information. SPRING is hoping to partner with the World Bank to actively

contribute to the goals and objectives of this platform.

14. ‘Every Child Deserves A Fifth Birthday’ Campaign - KM participated in USAID’s ‘Every Child Deserves

A Fifth Birthday’ Campaign by submitting photos to USAID/KMS and by developing a series of technical

tweets on nutrition, that were tweeted during the nutrition portion of the campaign, May 14–18.

Next quarter:

• Provide on-going support to staff in preparation of reports, presentations and other documents,

as well as implement the KM Strategy


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• Develop the SPRING website, Facebook page, and other KM platforms, including the launch of

an internal SPRING Intranet for project staff and partners as well as a space to capture and share

discussions emanating from the TAGs. The KM Team will also conduct an environmental scan of

existing KM platforms and begin the discovery process for future web development

• Hold discussions with WB on the potential partnership with SecureNutrition

Meetings of Note, April – June 2012 Date and Venue SPRING Participants Description

April 9

International conference

call

Tim Williams

Amanda Pomeroy

Peggy Koniz-Booher

Discussion with Mercy Corps in Indonesia regarding possible future

collaboration with the Hati Kami Project

April 18

Arlington, VA

All Staff Internal SPRING meeting (full technical team and senior partner

technical representatives) to introduce concepts around a “Theory

of Change” for SPRING and agree on a process for developing the

framework/tool

Mid May Paige Harrigan Meeting with David Nabarro, Coordinator of the SUN Movement

and Special Representative of the UN Secretary General for Food

Security and Nutrition, on collaboration with SUN: This discussion is

now scheduled to take place in July 2012.

May 14-17

Rome, Italy

Amanda Pomeroy

Jack Fiedler

International Conference on Diet and Activity Methods – this venue

provided a venue to discuss and collect information on what is

currently being done on measures to assess NCD risk

Various dates in April and

May

Marisha Tharaney

Tim Williams

SPRING served as of one of the “Evidence Review Teams” that

helped plan and prepare for the “USG Evidence Summit on

Community and Formal Health System Support for Enhanced CHW

Performance.” SPRING also reviewed multiple articles on formal

health systems support to CHWs, Tharaney helped prepare

conference presentations, and Williams participated in four

meetings on a ToC for CHW performance.

May 31 – June 1

Washington, DC

Manisha Tharaney

and Paige Harrigan

SPRING participated in the two-day Evidence Summit on

Community and Formal Health System Support for Enhanced CHW

Performance, organized by USAID. The lack of skilled and motived

CHWs to deliver nutrition services is one constraint to scaling up

nutrition. To help alleviate the shortage of skilled, motivated and

supported health workers globally, many countries are

implementing large- scale CHW programs to extend the reach of

services to underserved populations. The nutrition community is

not always represented well in the CHW discussions and this was a

good opportunity to share nutrition specific examples in the small

group and plenary sessions. June 18

Washington, DC

Tim Williams MCHIP partners meeting to discuss newly developed compendium

of indicators for monitoring and evaluating community case

management programs.

June 19

Arlington, VA

All technical staff TAG research prioritization meeting focused on Nutrition &

Agriculture and Nutrition Metrics & Monitoring.


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III. SPRING Programmatic and Administrative Management

SPRING had a productive third quarter—with the work plan approved, staff recruited and operations

well established, SPRING devoted this quarter to implementing the approved work plan, while

continuing to refine and assess processes and procedures to ensure efficient and effective operations.

SPRING completed the recruitment and hiring of four key program management and operations

positions including the Finance and Operations Manager, the Knowledge Management and

Communications Advisor, the Web Designer and the Country Program Manager. In addition, SPRING

also filled several other key technical positions including the SBCC Program Officer and the Research and

Evaluation Advisor. SPRING also initiated and worked closely with USAID on the recruitment of a new

Project Director during this quarter.

During the third quarter, with USAID approval, core work plan activities moved forward at a rapid pace.

From the country perspective, Uganda became a new focus country for SPRING, and after an initial trip

in March, the remainder of the quarter was dedicated to recruiting a country manager and finalizing the

first year work plan. In addition, the first TAG meeting was held to discuss the SPRING research agenda

in June.

SPRING also received approval and was able to launch the SPRING website. While we continue to

develop and add content to the website, SPRING regularly explores innovative and alternative means to

share and transfer knowledge.

Next quarter:

• Continue to implement the approved work plan, but will also strategically discuss activities for

Year 2

• Continue to refine the website and add additional content

• Hold an additional TAG meeting this quarter on SBCC and will host the first PAG meeting


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ANNEX 2: SPRING APPROACH to achieving better nutrition during the

first 1,000 days


27

ANNEX 3: QUARTER THREE TRIP REPORTS

STRENGTHENING PARTNERSHIPS, RESULTS AND INNOVATIONS IN NUTRITION GLOBALLY (SPRING)

TRIP REPORT

Country Visited Bangladesh

Technical Assistance Provider(s):

Marcia Griffiths, President of the Manoff Group Paige Harrigan, SPRING Senior Advisor Nutrition/IYCN

Dates of Visit: May 2‐7, 2012

Date Submitted: June 6, 2012

Trip Purpose:

The purpose of this to trip was to provide technical support to the MCHIP/USAID Asia regional meeting, “Guidance on Implementing Effective Programs to Prevent Preeclampsia and Eclampsia and Anemia to Improve Maternal and Newborn Outcomes” and to provide technical assistance to the SPRING Project related to the potential to include anemia control actions in year two and to strengthen communication support to the behavior change agenda.

Specific Objectives:

1. Organize and execute meeting on “Guidance on Implementing Effective Programs to Prevent Preeclampsia/ Eclampsia and Anemia to Improve Maternal and Newborn Outcomes” through pre‐meeting consultations, and note taking and facilitation during the meeting.

2. Present a powerpoint on the demand‐side of iron‐folic acid (IFA) supplementation and its relevance to calcium supplementation programs.

3. Provide technical assistance to the SPRING/Bangladesh Country Manager on the potential for including actions related to anemia control within SPRING programming for Year Two.

4. Provide technical assistance to the SPRING/Bangladesh Country Manager on behavior change and communication programming.

Trip Report MCHIP/USAID Asia regional meeting and SPRING/B visit, May 2‐7, 2012 Cooperative Agreement No: AID‐OAA‐A‐111‐00031

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5. Discuss the status of SPRING partner, Save the Children (SC), and provide support for their work with SPRING/Bangladesh.

Trip Findings and Accomplishments: All five objectives of the trip were accomplished, and it was a useful opportunity to get to know SPRING/Bangladesh Country Manager, Elizabeth Isimhen Williams, and provide her with support although Ms. William’s time was limited due to a holiday that was called on May 6th. The consultant team was unable to meet with USAID/Bangladesh, due to limited time as well. Following is a summary of activities.

1. Prior to traveling to Bangladesh, Ms. Harrigan and Ms. Griffiths supported the development of the meeting agenda and gave technical comments on the Iron Supplementation Decision Tree. On May 3rd, Ms. Griffiths and Ms. Harrigan actively participated in the meeting on high impact nutrition actions (IFA and calcium supplementation) to reduce maternal and newborn mortality and took notes that will be included in the final report of the meeting. Ms. Harrigan and Ms. Griffiths facilitated exercises in which small groups of participants developed “scale‐up maps” for how to improve IFA or initiate calcium supplementation programs. This type of scale up mapping has been used successfully by MCHIP and there may be applications for SPRING. SPRING was recognized as a technical collaborator and co‐sponsor of the MCHIP meeting, which was a good opportunity to introduce the SPRING Project.

MCHIP will distribute minutes and the presentations from the meeting once they are finalized. Here are a few key points:

The maternal health community at the meeting endorsed IFA supplementation programs. However, there is a continual need to reinforce the experience and evidence on the successful implementation of IFA programs and offer clear steps for how to fit IFA within antenatal care programming.

The evidence is available to support calcium supplementation among pregnant women who have diets deficient in calcium to reduce the risk of pre‐eclampsia/eclampsia during pregnancy. The WHO guidelines call for supplementation of between 1,500 and 2,000 mg/ day. However, more research is needed on the dose requirements since they could be as low as 500 mg (1 pill/ day) which would make calcium supplementation more feasible in light of cost, logistics and adherence.

A few countries are piloting programs to provide calcium supplements, most notably Nepal, Bangladesh (ICCDR‐B) and likely Indonesia. One of the critical problems at this time is identifying an inexpensive source of calcium supplements.

The emphasis at this meeting was on IFA supplementation. A successful program in Nepal, the Iron Intensification Program (IIP), was profiled. The meeting emphasized that iron supplementation needs better integration within a package of broader anemia prevention and control (which would include deworming, malaria interventions and dietary recommendations).

The list of essential drugs for maternal and newborn programs does not include IFA or calcium supplements. This is a situation that needs to be addressed immediately and is an opportunity for SPRING to demonstrate leadership in the area of maternal anemia control.

2. Ms. Griffiths gave a presentation titled “Improving the Chances that Nutrient Supplements Will

Make a Difference.” It focused on the demand creation lessons from IFA supplementation


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programs and their relevance to calcium supplementation programs. Ms. Griffiths’ presentation defined demand creation as the interplay between a product and/or service and its use. In the case of supplementation programs, the activities that comprise proper adherence should be viewed as three: trial and continuation for an initial period (in the case of IFA supplements, 30 days), continued use for the recommended period, and correct use. In each period, three aspects must be considered and tailored to facilitate consumer adherence: the product and its packaging; distribution/resupply and service provision surrounding distribution; and individual and cultural context. Issues that may exist for calcium supplementation, especially when provided alongside IFA supplements, were outlined. Among critical considerations were: the number of pills required, supplement formulation, the absence of visible signs of a problem, and the interaction of calcium with the iron and the description of benefits. The presentation was requested by many participants who found the discussion useful for their programs.

3. The team explored the potential for adding maternal and/or child anemia control activities to

Year Two. Ms. Griffiths met with Alive & Thrive (Tina Sanghvi), CARE (Shahed Rahman) and the Micronutrient Initiative (MI) (Zeba Mahmud). Other key agencies, apart from the government, that should be included in future information gathering are UNICEF, BRAC and ICDDR‐B (research). Below is brief summary of what the contacted agencies are doing and the potential for learning and collaboration, followed by ideas for partnerships and activities for Year Two.

Agency Activity Learning/Collaboration

Alive & Thrive Selling and promoting Sprinkles (15 micronutrients [MN]) for use with young children in connection with BRAC community agent (Shasta Sevika) who sell packets to families.

SPRING could support procurement and use of Sprinkles where SPRING overlaps with BRAC – data should be available soon on the uptake of Sprinkles through this distribution system.

CARE Providing free Sprinkles (5 MN supported by the government of Bangladesh) through the CARE Window of Opportunity program. They have modified the instructions for use of Sprinkles to ensure they promote improved complementary feeding.

CARE will have preliminary information by late 2012 on feeding practices and use of Sprinkles that can inform SPRING activities. The Sprinkles are the same ones distributed by UNICEF and supported by GAIN and the Social Marketing Company.

Micronutrient Initiative (MI)

Working on IFA supplementation for pregnant and lactating women. Zeba of MI reports the government is supportive and has asked MI to conduct a pilot in 2 districts—one is a district next to a SPRING district in the SW. The pilot is just beginning.

MI improved the IFA tablets, working with EDCL (govt. pharma), and have packaged them as 10 pills to a blister pack, with women getting three cards at a time. Pilot work may be spread through SPRING, particularly if SPRING can strengthen the adherence.

Ms. Griffiths and Ms. Harrigan discussed the results of meetings with Ms. Williams and suggested that SPRING add anemia control to Year Two. Initially, consideration should be given to both promotion of Sprinkles (depending on the overlap with BRAC’s distribution program) and the inclusion of IFA supplements for women. MI is highly interested in collaboration, and given their close association with the government and the opening for SPRING to improve adherence, this opportunity seems appealing for SPRING. If SPRING chooses to work on reducing


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maternal anemia, SPRING could contract local NGOs, many of whom are using the cadre of Community Nutrition Workers (CNWs) from the earlier National Nutrition Program. These CNWs would have had experience with IFA supplementation for women.

4. The work plan narrative and the detailed implementation plan for Year One were shared and discussed through SPRING/HQ and SPRING/Bangladesh. There was a request from SPRING/Bangladesh to review the plans through the lens of social and behavior change communication and the ability of the proposed activities to effect changes in behavior. The discussion with Ms. Williams centered on the reason for the reliance on orientations and dissemination of information to improve knowledge, particularly related to dietary diversity. Based on these discussions, SPRING could move away from knowledge‐based information provision to behavior change‐focused communications. Ms. Williams has requested examples of the more strategic use of communication for behavior change. She is also keen to have SPRING/Bangladesh engage more with SPRING/HQ to ensure that a more complete range of technical expertise can be drawn upon.

5. The tremendous potential and eagerness of the Agriculture Information Service (AIS) to work with SPRING was mentioned and Ms. Williams is eager to have suggestions for activities to develop with them. There was not time to work on this, but getting to know them and beginning to lay the ground work for Year Two actions should begin immediately.

6. Ms. Harrigan met with SC representatives, Dr. Golam Mothabbir and John Meyer, who have been active in SPRING project implementation. Unfortunately, Mr. Mike Foley, the Team leader for Health and Nutrition in Dhaka, was ill and unable to meet. SPRING/HQ can remain in frequent contact via email and Skype. SC has recruited a very well regarded new staff member who will be joining as the Bangladesh Country Deputy Director for SPRING in June 2012. The team is very excited about this new hire. A number of observations were shared in the discussions; SC in Bangladesh would welcome increased technical participation from a greater number SPRING partners including SC. We realize that resources are limited but there was interest to engage with and benefit from the range of technical resources SPRING has to offer.

Next Steps:

Next Step Due Date

1. Disseminate the presentation “Improving the Chances that Nutrient Supplements Will Make a Difference” among SPRING, especially the Bangladesh team and MI/Bangladesh. Conduct SPRING/HQ brown bag on the topic.

May 14th to SPRING/Bangladesh May 15th to SPRING/DC (Ms. Griffiths)

2. Send SPRING/Bangladesh the project organogram and list of staff biographies to give the SPRING/Bangladesh team a better sense of the staff expertise that can be made available to the Bangladesh program among the partners.

Week of May 14th (Ms. Harrigan)

3. Outline for how to develop a communications strategy to support specific, priority behavior change objectives of SPRING/Bangladesh.

Week of May 21st (Ms. Griffiths)

4. Hold SPRING debrief with SPRING/W that outlines key recommendations from the SC and SPRING discussions held the week of May 6th 2012 in Dhaka.

Week of May 14th (Ms. Harrigan and Ms. Griffiths)


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Appendices A: Agenda: “Guidance on Implementing Effective Programs to Prevent Preeclampsia and Eclampsia and Anemia to Improve Maternal and Newborn Outcomes” B: Power Point: Ms. Griffiths—“Improving the Chances that Nutrient Supplements will Make a Difference”

TRIP REPORT

Country Visited Italy


Amanda Pomeroy, Research and Evaluation Advisor

Dates of Visit: 5/14/2012 – 5/17/2012

Date Submitted: July 3, 2012

Trip Purpose:

To attend International Conference on Diet and Activity Methods (ICDAM) meeting at Food and Agriculture Organization (FAO)


1. Participate in conference on behalf of SPRING. 2. Discuss and collect information on what is currently being done on measures to assess non-

communicable disease (NCD) risk.

Trip Findings and Accomplishments:

1. Participated in fruitful discussions with several participants on topics related to SPRING’s core strategic information (SI) work, including nutrition metrics on early warning for NCD risk, data availability for the NCD simulation model, and uses of the Household Consumption and Expenditure Surveys (HCES) for programming.

2. Reviewed presentation documents and materials relevant to NCD work related to the topics listed above.

3. Produced a summary document of notes on the presentations and outcomes of the consultation (see Appendix 1).

4. ICDAM represented the state-of-the-art in dietary measurement, yet there are still many issues that need to be resolved on a measure of NCD risk. In particular, there has been little to no work on such a measure in a developing country setting for infants and young children. Several panel discussions centered on the usefulness of such a tool, but none mentioned any in the works.

SPRING Trip Report: Italy (May 14-17) Cooperative Agreement No: AID-OAA-A-11-00031

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5. Follow up meetings with Drs. Newby, Caulfield, Ogden and Arimond are all in process and will be completed by the end of June.

Next Steps:

1. Complete follow up meetings. 2. Add new contacts made at this meeting to the list of invited attendees for the Metrics Technical

Avisory Group meeting in June. 3. Define new measure of NCD risk in 1,000 days period.

Appendices:

1. Meeting notes


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Appendix 1: Notes from the International Conference on Diet and Activity Methods, Hosted by the FAO, Rome, Italy, May 14 – 17th, 2012

Monday

Key note speakers: P-1 Keynote address: Measuring upstream: indicators of action and impacts on food environments Boyd Swinburn, Professor of Population Nutrition and Global Health, University of Auckland - New Zealand Dr. Swinburn is attempting to start a new consortium, IMFORMAA, in conjunction with the International Obesity Task Force (IOTF) to help develop guidelines and measures around the process and impacts of food environments, since only outcomes are being dealt with in the current WHO framework. The monitoring framework focuses almost exclusively at the health system level. He is interested in measures of behavior change, particularly to capture the small incremental changes that may lead to bigger changes in outcomes. He also spoke about a community readiness to change measure. P-2 Keynote: Research and action to improve diets Barrie Margetts, Professor of Public Health Nutrition, Faculty of Medicine, University of Southampton - United Kingdom Dr. Margetts spoke about the need for research, and on the policy implications of diet and physical activity research. The next speaker, Billie Giles Corti, also discussed this in more detail, giving examples of papers devoted to this topic and identifying the need for knowledge brokers to help bridge gaps between policy makers, practitioners, and researchers. P-3 Keynote lecture: Social policies to encourage physical activity Billie Giles-Corti, Director of the McCaughey VicHealth Centre for Mental Health and Community Wellbeing, Melbourne School of Population Health, The University of Melbourne Dr. Giles Corti spoke of some specific actions that can help bridge the divide between policy makers, practitioners, and researchers:

1. Increase contact between groups. 2. Jointly define a research agenda that is relevant to policy and programs. 3. Adopt their language. 4. Use a knowledge management broker.

Panel Sessions: B-1 Nutrition and food security analyses using household surveys Chair/co-chair: John L. Fiedler, Carlo Cafiero Invited speakers: Keith Lividini, Jennifer Coates, Dirce Marchioni Oral presentations: Pereira et al. - The challenging inclusion of the first Brazilian individual dietary survey in the 2008-2009 HCES Moursi et al. - How do household consumption and expenditure surveys compare to 24-hour recalls in terms of nutrient intakes? Evidence from Uganda and Mozambique Loopstra-Masters & Tarasuk - Assessing change in household food insecurity Jack Fiedler led this panel, giving examples of how IFPRI has used HCES. The main examples came from Zambia, Uganda, and Mozambique. In these countries, the work looked at micronutrient portfolios and dietary patterns. In Bangladesh, Rogers, Coates and Blau tested how well the household level


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consumption data compare to individual 24- hour recall data. The findings suggest that for smaller households that are static, the two compare well, but as the household grows and changes composition, the household measure performs worse. Similarly, during the Wednesday panel related to measuring dietary diversity, Dr. Kathryn Ogden of WFP presented their analysis of the HCES in Nepal. It was extremely relevant as they did this to inform their programming, going beyond creating scores or defining consumption to using the individual food groups across different socio-demographic populations to help them target and plan their distribution and supplementation programming. Jack is now connected with her and will be discussing extensions of this work.

Tuesday

A-2 Dietary surveys and indicators for formulating policies Chair/co-chair: Aida Turrini, Barrie Margetts Invited speaker: Barrie Margetts Oral presentations: Judd et al. - Dietary patterns associated with demographic and socioeconomic groups Pot et al. - Development of UK eating choices index Morris et al. - Is a healthy diet the most expensive type of diet? Using dietary data from the UK women’s cohort study Burley et al. - Comparability of dietary patterns derived from food frequency questionnaire and food diary approaches in the UK women’s cohort study (UKWCS) Dr. Pot discussed the construction of the UK Eating choices index, which is meant to capture choice, not diversity. She gave these key criteria for construction of such an index, beyond validity and reliability:

1. Comparable

2. Sensitive

3. Collected at the right level of the population at the right time

4. Affordable

5. Practical

She noted the Nutrition Indicators for Development guide by Delpelch (FAO 2005, WHO 2008). Dr. Burley mentioned the key importance of cost in accessibility of healthy food. They found 45% of the variation in their measure was explained by the cost. A-4 Dietary patterns: Methodological advances and new research directions Chair: P.K. Newby Oral presentations: Reedy et al. - A comparison of four diet quality indexes with all-cause and cause-specific mortality Lassale et al. - Association between dietary scores and 13-y weight change and obesity risk in a French prospective cohort: Comparison of their predictive value Tognon et al. - Applications and modifications of the Mediterranean diet index for a more precise estimate of the association with longevity and morbidity Krebs-Smith et al. - Development and evaluation of the Healthy Eating Index-2010 Miller et al. - Dietary patterns and colorectal cancer incidence: a classification tree analysis

Dr. Reedy presented a comparison of U.S.-based diet quality indices, focusing on “investigator-led”, meaning theory driven, approaches rather than data driven approaches: Alternate Healthy Eating Index (AHEI), Mediterranean Diet Score (MDS), the DASH diet index, and the Health


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Eating Index (HEI-2005). They all use balance, avoidance, and adequacy to choose individual components. However, they use various ways to categorize “bad foods” like alcohol, sugar, solid fat, etc. so that while they have fundamental similarities, with these categories they may vary quite a bit. Sodium was another area of difference. How would one modify these for Asian populations, or other sub-populations like Africans or African Americans with known differences in NCD risk to certain dietary components like salt or sugar? She showed several versions of risk ratios to show the relationships to all cause and cancer mortality risk for each of the indices, and for cardiovascular disease.

Ms. Lassale presented on a discrimination analysis to define the changing out of one score for another. The method was called integrated discrimination improvement, and could possibly be of use later for testing of our new score.

Dr. Krebs-Smith discussed their process for developing their new score for healthy eating, which started with decoupling quality from diversity. This started with the dietary guidelines, which were derived from evidence on healthy food patterns. They have a new focus on reduction and adequacy, rather than specific amounts. The aim was to limit the number of components and complexity of the algorithm. They had to give special consideration to whether and how to weigh components. They used cutoffs to create binary values.

Wednesday B-6 Measuring dietary diversity Chair/co-chair: Marie Claude Dop, Joyce Luma Invited speakers: Nelia Steyn, Mary Arimond Oral presentations: Moursi et al. - Association between dietary diversity and child growth in rural Uganda and Mozambique Mathiassen et al. - Household Food Consumption: looking beyond the score Büchner et al. - Comparison of Diet Diversity Scores for fruit and vegetables and plasma carotenoids levels in the cross-sectional study of the European Prospective Investigation into Nutrition and Cancer (EPIC) Burke et al. - U.S. trends in dietary variety and its association with BMI and micronutrient intakes among younger and older age groups

Dr. Arimond presented on where the use of dietary diversity scores stand in resource poor countries, including the remaining challenges in use and effective interpretation. She noted particularly the use of scores for vulnerable groups such as infants, young children, and mothers.

Dr. Steyn presented on dietary diversity scoring for 1-9yr olds in South Africa. She mentioned that this scoring would be useful for clinicians so they can do this when seeing children to assess risk of micronutrient deficiency.

Dr. Moursi presented on HarvestPlus data and looked at changes over time in a dietary diversity score and how it performed when used to assess child growth. (I had some misgivings around specification of his model for the type of data they had). He used baseline and end line data for Uganda from 2006 and 2009.

See note above on first day about Dr. Ogden’s WFP presentation. A-8 Challenges in assessing diets of children and adolescents Chair/co-chair: Lauren Lissner, Gianni Barba Invited speaker: Christel Larsson Oral presentations: Caulfield et al. - The use of a harmonized protocol to capture dietary intakes of children from birth to 2 years in 8 countries: the Malnutrition-Enteric Disease MAL-E


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Lanfer et al. – Food frequency questionaire-based indices to reflect children’s propensities towards fat and sugar Burrows et al. - Who is the most accurate reporter of child energy intake -mothers, fathers or the child? - a doubly labeled water validation study of an FFQ Ambrosini - Tracking an obesogenic dietary pattern from 7 to 13 years of age: the Avon longitudinal study of parents and children (ALSPAC)

Dr. Caulfield of Johns Hopkins University (JHU) presented on the MAL-ED study which is an eight country study on the effect of enteric disease on malnutrition. It is funded by the Gates Foundation, out of the Fogarty Center at National Institutes of Health, headed by Dr. Mark Miller. They enrolled babies starting at 0-15 days, and kept track of them through 24 months.

One site is in Dhaka, the JHU site is in Peru. All sites but Brazil showed growth faltering at just after 4 months, indicating some issues when food other than breast milk was introduced. They have collected extensive data to inform this study on breastfeeding (BF), complementary feeding (CF), micronutrients, and gut function, on a regular basis, from every 2-3 days for BF to monthly for the rest. Data on diet for CF was collected using the same methods as DHS until 8 months, then 24-hour recall after that. I spoke with her after and will follow up with her to get more information on the study, and set up a call with them, if possible.

Notes for going forward Many presentations were done on Dietary Diversity Scores and their relationship to each other, and to outcomes such as mortality. However, few went into how useful they are as a diagnostic tool for clinicians or as a programmatic tool for implementers. It seems to be a very stagnant approach, which is in general a problem with indices. Dr. Steyn showed that theirs was correlated highly to z-score, but it is no cheaper than anthropometry to collect. While it can indicate a risk of micronutrient deficiency, it gives no disaggregated information in order to know which foods they are missing. It seems like a more sensitive indicator should be called for that avoids a simple binary or indexed grouping of binary measures. In terms of methods, several presentations at this meeting seemed to ignore or mis-specify their regression models with regard to the effect of time in longitudinal (cohort) and in repeated cross section such as pre- and post-intervention data. This should be a consideration when we are interpreting their results. Some ideas on how to go forward with our measure:

1. Improve the BF measures to ensure we are effectively capturing exclusive breastfeeding, as this is a leading risk factor for later NCD risk (see Monica Neuberger poster attached).

2. How can we better utilize the CF measure in DHS? Can it be reformed for NCD risk? 3. How does household risk correlate to child risk? Set up a discussion with Mary Arimond. 4. How to incorporate food insecurity in to any developed world measure is going to be an issue. 5. Reconsider length or other growth monitoring modification.

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TRIP REPORT

Country Visited Bangladesh


Tim Williams (TW), Senior Strategic Information Specialist Victoria B. Chou (VBC), Research and Evaluation Advisor

Dates of Visit: Tim Williams: May 24 – June 9, 2012 (including travel) Victoria B. Chou: May 18 – June 1, 2012 (including travel)

Date Submitted: August 10, 2012

Trip Purpose:

TDY to Bangladesh to develop strategic information (SI) activities


1. Develop SI strategy and related monitoring tools/activities with the SPRING/Bangladesh team to contribute to achieving program objectives

2. Strengthen linkages with current SPRING/Bangladesh partners and explore potential opportunities for building future collaborations

3. Provide capacity building and other technical assistance related to the initiation of SI activities Trip Findings and Accomplishments: 1. Develop SI strategy and related monitoring tools/activities with the SPRING/Bangladesh team to

contribute to achieving program objectives Meetings and interactive discussions with the SPRING/Bangladesh Strategic Information Officer and other Bangladesh staff were held to discuss the current status of program implementation and to draft a suite of SI materials, including a revised performance monitoring plan (PMP), monitoring tools and guidelines, work plan and timeline. SPRING objectives, work plans, progress to date, and anticipated obstacles or barriers were discussed in addition to future opportunities for relevant research, monitoring and evaluation (M&E), and professional development.

One of the main meetings attended (TW) was a two-day SPRING orientation (June 3-4) for new SPRING/Bangladesh staff. During this meeting, the PMP was revised in an interactive process with all staff’s participation, and timelines, reporting schedules and other SI topics were discussed. Valuable insights on nutrition indicators and potential monitoring tools were also gained through meetings with M&E and research staff at Nobo Jibon, a multi-year assistance program funded by USAID, and Alive & Thrive (A&T), a six-year program sponsored by the Bill & Melinda Gates Foundation. Also of great value was a one-day field visit to Babuganj Upazila in Barisal Division (TW with the SPRING SI Officer) to observe health services related to nutrition at various levels and a farmer field school in action. Based on all these meetings and experiences, PMP indicators and targets were revised. A finalized PMP with targets was developed following the trip and shared with USAID/Bangladesh in early July 2012 (note: the PMP is available upon request). Drafts of simple, user-friendly monitoring tools and guidelines were developed during the trip and revised following the trip. These tools and guidelines are expected to enable SPRING to routinely track PMP monitoring indicators and use the information for informative reporting and program improvement. Meetings, including an out-briefing, were held with USAID Mission staff to provide updates on progress and to seek guidance about appropriately designing certain M&E indicators for greatest accuracy and alignment with other USG-sponsored programs, particularly to ensure that indicators would be collected and reported in line with Feed the Future (FtF) requirements (TW, VBC). 2. Strengthen linkages with current SPRING/Bangladesh partners and explore potential opportunities

for future collaborations A SPRING representative (VBC) attended the all-day conference sponsored jointly by local colleagues at the International Food Policy Research Institute (IFPRI) and BRAC. The seminar presented a broad overview of the current nutrition research portfolio that IFPRI and key partners manage in Bangladesh. Comprised of key nutrition stakeholders in Bangladesh, the informative meeting promoted collaboration, fostered discussion about complementarities and overlap, and highlighted potential research gaps that future programs or projects will hopefully address. Meetings were held with critical research staff from IFPRI who are directly involved with the design and data analysis of the Bangladesh Policy Research and Strategy Support Program (PRSSP) which may serve as a proxy baseline for SPRING/Bangladesh (VBC). With a core set of indicators already incorporated for the FtF program, sampling and survey administration for PRSSP encompasses the Barisal and Khulna divisions (see Appendix 2), the two divisions where SPRING/Bangladesh activities are being implemented. The surveillance surveys carried out three times a year under FSNSP also provide useful planning information and can also potentially serve as a proxy baseline for SPRING. Meetings were held with the lead researcher for the Food Security Nutritional Surveillance Program (FSNSP) about expanding the sample in the current survey round to improve the potential for meaningful baseline/follow-up comparisons (TW). Eight SPRING-supported upazilas were added to the three (SPRING-supported) upazilas already in the FSNSP sample. The FSNSP core questionnaire was adapted for this special sample by adding a series of questions directly related to SPRING indicators, while eliminating a small number of questions not relevant to SPRING.

Valued feedback was collected from open discussions with colleagues in the shared Helen Keller International (HKI) office (TW, VBC). Senior staff working on two local programs, the European Union (EU)-sponsored FSNSP and USAID-funded Nobo Jibon, offered knowledgeable input about country-context-specific details that may impact baseline analysis and targeting. Important lessons learned were also shared about implementation challenges that SPRING/Bangladesh may similarly encounter in-country. 3. Provide capacity building and other technical assistance related to the initiation of SI activities At the SPRING orientation meeting mentioned previously (June 3-4), TW provided a generic M&E orientation to all SPRING staff. At the end of the meeting, more targeted M&E training was carried out to benefit the Dhaka-based SI Officer and the Divisional M&E Specialists. Topics included basic M&E concepts and SI principles, indicators, target setting, data sources, roles and responsibilities, use of information, and how SI processes could be implemented to successfully monitor and evaluate SPRING/Bangladesh activities. Targeted training continued with the SI Officer and one Divisional M&E Specialist on the final day of the TDY. Useful links and websites on SI and M&E, such as MEASURE Evaluation and the USAID Global Health eLearning Center, were provided to the SI Officer for ongoing capacity building. The field visit to a farmer field school supported by DANIDA, and various health facilities in Barisal, was highly beneficial to understanding practical conditions for program interventions, existing routine information, and the potential for routine data collection of information to measure SPRING indicators (TW). During the visit, TW and the SPRING/Bangladesh SI Officer were able to assess potential data collection constraints and work together to develop appropriate tools for data collection to monitor SPRING/Bangladesh’s multisectoral activities. Next Steps:

Proposed Activity Due Date 1. Finalize SI Strategy including monitoring tools,

guidelines, and timelines for SPRING-Bangladesh (TW, VBC and SI Officer).

August 2012

2. Carry out descriptive analysis of PRSSP survey data and share findings with SPRING/Bangladesh to contribute to program planning and measurement of select baseline indicators (VBC).

August 2012

3. Implement and adjust M&E framework and tools as needed to optimize efficiency and information usefulness (TW).

Ongoing

4. Provide ongoing SI support and capacity building to the SPRING/Bangladesh SI Officer and the Division M&E Specialists (TW and VBC)

Ongoing

5. Continue to seek opportunities for meaningful cooperation between existing SPRING/Bangladesh partners (e.g. IFPRI) and cultivate relationships with new organizations that may be valuable for future research collaborations (TW and VBC).

Ongoing

Appendix 1. List of Main Contacts

Name of Person Contacted Organization or Affiliation Williams, Elizabeth, [email protected]

SPRING/Bangladesh Country Manager

Hassan, Shareful, [email protected]

SPRING/Bangladesh SI Officer

Abdulla, Mohammad, [email protected]

SPRING/Bangladesh (Divisional) M&E Specialist

Mia, Mohammed Monirul Islam, [email protected]

SPRING/Bangladesh (Divisional) M&E Specialist

Young, Shannon, [email protected] USAID/Dhaka/PHNE, Health Officer Ahmed, Akhter, [email protected] IFPRI-Dhaka Chief of Party – PRSSP Menon, Purnima, [email protected] IFPRI-New Delhi Senior Research Fellow Naher, Firdousi, [email protected] IFPRI-Dhaka Postdoctoral Fellow Ruel, Marie, [email protected] IFPRI Division Director Saha, Kuntal, [email protected] IFPRI-Dhaka Postdoctoral Fellow

(Alive & Thrive) Erica Khetran, [email protected] HKI Country Director Sinharoy, Sheela, [email protected] HKI (Nobo Jibon) Waid, Jillian, [email protected] HKI (FSNSP) Meyer, John, [email protected]

Save the Children, Chief of Party-Nobo Jibon

Towfique Aziz,

Save the Children, M&E Manager, Nobo Jibon

Foley, Mike, [email protected]

Save the Children, Director – Health and Nutrition

Mothabbir, Dr. Golam, [email protected]

Save the Children, Advisor – Health and Nutrition

Arifeen, Shams El ICDDR,B Haque, Raisul BRAC Roy, Sumitro FHI360 (Alive & Thrive) Siraj, Saiqa BRAC Multiple staff at Babuganj Upazila Health Complex, and one Community Clinic

Ministry of Health and Family Welfare sites in Barisal Division

Hoegh, Dr. Kenneth H.O. Danida Barisal Office, Senior Advisor

mailto:[email protected]
















Appendix 2. Map of All Upazilas in Barisal and Khulna Divisions (SPRING - highlighted)

Upazilas of the Barisal Division (Eight (8) SPRING)

Capital: Barisal

Barguna District

Amtali ·Bamna ·Barguna ·Betagi ·Patharghata

Barisal District

Agailjhara ·Babuganj ·Bakerganj ·Banaripara ·Gaurnadi ·Hizla ·Barisal ·Mehendiganj ·Muladi ·Wazirpur

Bhola District

Bhola ·Burhanuddin ·Charfasson ·Daulatkhan ·Lalmohan ·Manpura ·Tazmuddin

Jhalokati District Jhalokati ·Kathalia ·Nalchity ·Rajapur

Patuakhali District

Bauphal ·Dasmina ·Galachipa ·Kalapara ·Mirzaganj ·Patukhali ·Dumki

Pirojpur District

Bhandaria ·Kawkhali ·Mathbaria ·Nazirpur ·Pirojpur ·Nesarabad ·Ziangar

Upazilas of the Khulna Division (Seven (7) SPRING)

Capital: Khulna

Bagerhat District

Bagerhat ·Chitalmari ·Fakirhat ·Kachua ·Mollahat ·Mongla ·Morrelganj ·Rampal ·Sarankhola

Chuadanga District

Alamdanga ·Chuadanga ·Damurhada ·Jibannagar

Jessore District

Abhaynagar ·Bagherpara ·Chaugachha ·Jhikargachha ·Keshabpur ·Jessore ·Manirampur ·Sharsha

Jhenaidah District

Harinakunda ·Jhenaidah ·Kaliganj ·Kotchandpur ·Maheshpur ·Shailkupa

Khulna District

Batiaghata ·Dacope ·Dumaria ·Dighalia ·Koyra ·Paikgachha ·Phultala ·Rupsa ·Terokhada

Kushtia District

Bheramara ·Daulatpur ·Khoksa ·Kumarkhali ·Kushtia ·Mirpur

Magura District

Magura ·Mohammadpur ·Shalikha ·Sreepur

Meherpur District Gangni ·Meherpur ·Mujibnagar

Narail District Kalia ·Lohagara ·Narail

Satkhira District Assasuni ·Debhata ·Kalaroa ·Kaliganj

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TRIP REPORT

Country Visited Zambia


Hana Nekatebeb

Dates of Visit: May 21 -25, 2012


Trip Purpose:

The purpose of this visit was to attend the second Workshop on Improving the Nutritional Quality of Complementary Foods for Young Children 6-23 months through Home Fortification in sub-Saharan Africa.


1. To understand the research and programmatic evidence on home fortification (HF) and determine a way forward for SPRING’s engagement; and

2. To understand the proposed decision tree from the Home Fortification Technical Advisory Group (HF-TAG) as a strategy to improve complementary feeding for children ages 6-23 months.

Trip Findings and Accomplishments: This workshop provided an opportunity to better understand the latest research and programmatic evidence on HF to help inform SPRING Project activities, especially in Uganda, where HF activities are listed under Intermediate Result 4 in the country workplan. Knowledge gained from presentations and discussions during the workshop will be used to shape a more detailed action plan on HF for SPRING/Uganda. This workshop also facilitated some networking opportunities for SPRING and the HF-TAG, and established links for further collaboration at the global level. Next Steps:

1. Ensure that the detailed implementation plan for SPRING/Uganda includes key milestone activities that support the country’s initial plan to roll out HF in nine model districts.

2. Organize a follow up meeting with Mr. Arnold Timmer, Senior Advisor for Micronutrients at UNICEF, to discuss future areas of collaboration.

Appendices: 1. Meeting Notes 2. List of Participant Countries in 2nd Workshop 3. List of Participant Countries in 1st Workshop

Appendix 1: Meeting Notes 1. The workshop 1.1 Highlights The workshop was organized by the UNICEF Headquarter and Regional Offices and co-sponsored by the U.S. Centers for Disease Control and Prevention and its partners, including the Global Alliance for Improved Nutrition, Helen Keller International, the Micronutrient Initiative, Populations Services International, Sight & Life, the United Nations High Commissioner for Refugees, the University of British Columbia, the University of California-Davis, the World Food Program and the Sprinkles Global Health Initiative. Appendix 2 contains a list of the nine countries that participated in the workshop. The first workshop, held in Dakar, Senegal in June 2011, brought together delegations from 14 countries (see Appendix 3). It was designed to disseminate state-of-the art knowledge and share experiences from pilot HF initiatives. The second workshop was organized for additional countries in sub-Saharan Africa that are in the planning stages of incorporating HF into their existing complementary feeding strategies. Uganda, one of the SPRING Project focus countries, attended both workshops. 1.2. Components of the workshop Highlights from key presentations are summarized below. 1.2.1. Justification for use of home fortification Deficiencies of vitamins and minerals, particularly of iron, vitamin A and zinc, affect approximately half of the infants and young children under two years of age worldwide. Exclusive breastfeeding until six months of age, and continued breastfeeding for at least two years, are recommended to maintain children’s adequate health and nutrition. After six months of age, infants start receiving semi-solid foods, but the amount of vitamins and minerals in their diet is not always sufficient to fulfill all the requirements of the growing infant. Micronutrient powders (MNPs) containing iron, vitamin A, zinc and other vitamins and minerals that can be sprinkled on to any semi-solid food at home or at any other point-of-use, increase the content of essential nutrients in the infant’s diet during this period. Research has shown that the use of MNP containing at least iron, zinc and vitamin A for HF of foods was associated with a reduced risk of anemia and iron deficiency in children under two. The use of MNP was beneficial for infants and young children ages six to 23 months, independent of whether they lived in settings with different anemia and malaria backgrounds, or whether the intervention was provided for two, six or 12 months. However, the most appropriate arrangements for use (daily or intermittently), the appropriate vitamin and mineral composition of the mix of powders, and the way to deliver this intervention effectively in public health programs to address multiple micronutrient deficiencies remain unclear. 1.2.2. Country Experiences in HF Experiences of implementing HF in Kyrgyzstan (national), Rwanda (six districts) and Kenya were shared. The experiences show the need to systematically address multiple implementation factors that are needed for step-by-step implementation of the HF programs. In these countries, strengths in assessing ways of procuring MNPs at the national and local levels, determining possibilities for local production of MNPs, ensuring quality of MNPs being distributed and use of functional delivery systems, were identified as key components of their programs. Emphasis was also given for the need to register MNPs as food supplements or drugs, according to the local context and the comparative advantage to be gained in choosing either of these two labels. The importance of referring to existing national laws, standards, and guidelines when designing HF programs, was also mentioned.

1.2.3. Social behavior change communication (SBCC) in HF programs The workshop highlighted the development of a SBCC plan as a very important component in implementing HF programs. The role of social marketing, as an important SBCC strategy, was also discussed. In this regard, the experience in Mexico was presented as a successful case study in planning and implementing a strong SBCC component into the HF program. The program used four-step approach (planning, strategy development, implementation and plans for impact evaluation) for provision of MNPs. The model put a strong focus on ongoing monitoring and evaluation to document the process. 1.2.4. Monitoring and evaluation The need to design context-specific monitoring and evaluation systems for HF was emphasized. The importance of local ownership was also brought up to encourage use of data for timely decision. Suggested key areas to be considered for monitoring include delivery systems, coverage, and adherence. Participants were also encouraged to plan for impact evaluations at the beginning of the MNP/IYCF (infant and young child feeding) interventions in collaboration with external agencies (e.g. universities), in order to improve the quality of data collection and analysis. 2. Uganda’s Draft Country plan Delegates from Uganda developed a draft outline to implement HF in nine model districts of South West and Northern Regions as an initial phase of implementation. The group presented the draft plan for critique and inputs, and revisions were made accordingly. The final draft country plan outline for Uganda is presented below. 2.1 Draft Uganda Outline for Country Plan Goal

Improve the quality of complementary foods to reduce undernutrition

Objective:

30% reduction in anemia prevalence in children 6-23 months old within two years in regions with highest rates of anemia (South Western, Northern regions)

Four districts in the South Western based on Demographic Health Survey data showing high levels of stunting and anemia

Five districts in Northern region

Positioning:

Immediate entry point: Integrated Micronutrient guidelines- integrate into existing zero draft

Eventually: Integrate into the Food and Nutrition Policy and the Food and Nutrition Strategy

Target group:

6-23 months (about 500,000 children in nine districts - 1st pilot)

Frequency of Dosage:

180 sachets/year (1 sachet every 2 days) providing 50% of the RNI for 6-23 months old

Frequency of Distribution:

Quarterly: Community Connector is working with BRAC who sell health products at a subsidized price. They are paid by visiting a minimum number of households. BRAC agents will be trained to distribute MNPs.

Duration of Model:

2 years. Scale-up afterwards

Potential partners for pilot:

UNICEF, USAID/SPRING and World Bank (through the Japan Social Development Fund program)

Monitoring and Evaluation:

Design an integrated plan for MNP within IYCF

Next Steps:

First, meet as a nutrition technical group (MOH, IYCF partners, and donors) to report on this meeting and get buy in, then, engage other sectors.

Second, organize a broader meeting with the Multisectoral Technical Working Group to get more buy-in (government ministries, UN agencies, stakeholders, academia)

Decide on components of formative research before roll-out. Identify how long the assessment would take and who can provide support. Network with other countries to get generic tools for adaptation.

o Communications strategy. Identify generic materials for modification. Develop a nutrition communications/SBCC strategy (under EU regional project).

Appendix 2: List of Participant Countries in 2nd Workshop

Madagascar

Mozambique

Malawi

Rwanda

Tanzania

Uganda

Zambia

Zimbabwe

Appendix 3: List of Participant Countries in 1st Workshop

Ethiopia

Ghana

Kenya

Liberia

Mali

Mauritania

Mozambique

Niger

Nigeria

Rwanda

Senegal

Sierra Leone

South Africa

Uganda

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TRIP REPORT

Country Visited Nigeria


Paige Harrigan, Senior Advisor for IYCF Peggy Koniz-Booher, Senior Advisor for Nutrition/SBCC

Dates of Visit: June 10 – 22, 2012


Trip Purpose:

To initiate a work plan based on a set of recommendations previously sent by USAID/Nigeria aimed to improve recommended infant and young child feeding (IYCF) practices to reduce stunting in children under two years of age.


1. Meet with USAID/Nigeria to discuss and clarify expectations. 2. In coordination with USAID/Nigeria (when appropriate), meet with SPRING partners currently

working in Nigeria, specifically JSI Research & Training Institute Inc., Helen Keller International (HKI), and Save the Children (SC), to discuss and prioritize strategic evidence-based activities.

3. Coordinate with critical technical resource partners in the Federal Ministry of Health (FMOH), UNICEF, USAID, Department for International Development (DFID), and potential key implementing partners (IPs) to identify and refine opportunities for collaboration and to leverage resources.

4. Develop an operational plan, including initiating the staffing and recruitment plans for SPRING/Nigeria personnel.

5. Obtain necessary inputs for the development of an initial annual budget. 6. Identify options for SPRING/Nigeria office space(s). 7. Debrief with USAID/Nigeria.

Trip Findings and Accomplishments: The objective of this initial SPRING TDY was to initiate a work plan based on a set of recommendations previously sent by USAID/Nigeria aimed to improve recommended IYCF practices to reduce stunting in children under two years of age. Meetings were organized with the FMOH, prioritized Nigeria-based IPs,

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select United States Government (USG) partners, and other stakeholders. The purpose of the meetings was to understand federal and state level priorities; discuss coordination; gather detailed information about ongoing nutrition activities; and review and prioritize strategic, evidence-based activities that will contribute to the development of a SPRING/Nigeria work plan. A list of contacts from the TDY can be found in Appendix 1. During this two week visit, Ms. Harrigan and Ms. Koniz-Booher met initially with members of the USAID PEPFAR team to review the objectives for the TDY, USAID’s proposed activities and priorities for SPRING, and priority government groups and IPs to meet with during the TDY. During the first week, SPRING travelers met in the Federal Capital Territory (FCT) with the FMOH Nutrition Division, National Aids and STD Control Program (NASCP), National Primary Health Care Development Agency (NPHCDA), FCT-Primary Health Care Board (FCT-PHCB), UNICEF, GAIN, SC, HKI; JSI (DELIVER, SCMS, and AIDSTAR-one projects); FHI 360 SIDHAS; International Centre for AIDS Care (ICAP) (by phone); and former Infant & Young Child Nutrition (IYCN) Project staff. During the second week, a field visit to Benue State was organized to observe a Community-IYCF training of trainers supported by HKI and to meet key State MOH officials. Two follow-up discussions were also held with USAID, including a joint meeting with the PEFPAR and Health, Population, and Nutrition (HPN) teams. This mission enabled SPRING to initiate a work plan for Fiscal Year (FY) 2012-2013 that reflects and complements the priorities, needs, strategies, and ongoing efforts of USAID, the Government of Nigeria, NGOs and other IPs. A detailed implementation plan for FY12/13 will be developed based on planning meetings to be conducted in August and/or September, and confirmed funding level. A long-term staffing and management plan will be completed based on the work plan and available resources.

Proposed Activities under Initial Funding ($650,000) and FY12 Work Plan (3+ months); and FY13 (October 1, 2012 – September 30, 2013; anticipated $650,000):

Based on meetings with USAID, the FMOH, prioritized Nigeria-based IPs, select USG partners, and other stakeholders, SPRING identified the following proposed activities for the FY12 work plan:

Support World Breastfeeding Week activities in August

Finalize Community- and Facility-IYCF Packages, including holding a stakeholders finalization meeting, fine-tuning graphics, translating materials, and coordinating printing of materials

Coordinate training of local graphic artists (related to IYCF Packages)

Launch and conduct national dissemination of printed IYCF Packages

Organize step-down trainings in FCT and Benue State (for facility health workers, community health volunteers and community health workers)

Initiate coordination with UNICEF/SC in the North, including Memorandum of Understanding (MOUs) as appropriate

Meet with and explore opportunities to collaborate with other USAID-supported activities

Develop MOUs with IPs such as FHI 360, TSHIP, and other USAID implementing partners/projects, if appropriate

Meet with the FCT QI/NACS team that was formed under IYCN, review accomplishments and develop recommendations related to continuing work under SPRING

Meet with the Federal Ministry of Women’s Affairs and Social Development to review the status of the Nutritional Care and Support for Vulnerable Children: A Resource Manual, developed under IYCN, and discuss their recommendations for its dissemination

Review recommendations made under IYCN related to nutrition and agriculture, and discuss opportunities with USAID to support future work under Feed the Future funding in Nigeria

Conduct strategic planning for FY13

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While finalization of the FY12 work plan and rapid initiation of activities was stressed during the TDY, a number of robust and appropriate illustrative activities and strategies were raised for the development of the detailed FY13 work plan. SPRING proposes that these illustrative strategies and activities be vetted and ground-truthed over the next several months in Nigeria through a highly consultative process that that will include USAID, the FMOH, prioritized Nigeria-based IPs, select USG partners, UNICEF, and other stakeholders. The proposed strategies and activities include:

Support roll out of training strategy for Community and Facility IYCF Packages

Develop and support routine monitoring and evaluation (M&E) of the training strategy

Coordinate with UNICEF on the design of a research protocol and submit an application for financing a study looking at the impact of the Community and Facility IYCF Packages in differing contexts

Carry out a one-day event around the launch of the Nutritional Care and Support for Vulnerable Children: A Resource Manual, if the need is confirmed in FY12

Support SUN in Nigeria in consultation with FMOH

Support/coordinate with UNICEF a Communication for Development strategy

Analyze current Health Management Information Systems for nutrition information; and make recommendations

Several strong ideas were raised during the TDY that that may fall outside the scope of the current program being proposed. These ideas are worth capturing if additional resources and partners can be identified in the future:

Write a concept note for operational research on micronutrient powders in collaboration with GAIN

Follow up on interest stated by multiple stakeholders in maternal nutrition, summarize recommendations, and outline a possible set of applicable activities1

Explore USAID and FMOH interest in focusing on Non Communicable Diseases (NCD)-related issues in Nigeria

Assess opportunities to support strategic planning around nutrition and agriculture Proposed Strategic Planning Process with OHA and SPRING AORs:

SPRING will organize a strategic planning meeting in September or early October with USAID Nigeria, SPRING AORs, OHA Nutrition Team, and key local partners to inform the design of the SPRING FY13 work plan. This plan will reflect a vision for future USAID investments in nutrition (IYCF, NACS, PMTCT/infant feeding, micronutrients, agriculture/nutrition, and orphans and vulnerable children, with an emphasis on community-level SBCC, quality improvement, M&E).

Proposed Initial Management Plan:

We propose the following for the SPRING/Nigeria team:

Housed by HKI, with key technical and operational support from SC

Country Manager: Babajide Adebisi

Senior Technical Advisor: Beatrice Eluaka

JSI may support M&E and/or quality improvement (QI) (TBD)

1 Current rates of anemia among preschool aged children and pregnant women are 76% and 67%, respectively. WHO.

2008. Worldwide Prevalence of Anemia 1993-2005: WHO Global Database on Anemia.

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SPRING/HQ will support scale up, SBCC, Strategic Information (SI), operational research, and SUN activities as appropriate

Next Steps:

Finalize and submit SPRING/Nigeria work plan to USAID/Nigeria

Initiate recruitment of SPRING/Nigeria personnel/consultants

Continue discussions with Nigeria-based organizations on potential partnerships

Support specific World Breastfeeding Week activities (August 2012)

Organize strategic planning meeting with USAID, government, and local partners for FY13 work plan (August); and joint TDY with SPRING AORs, and OHA to plan future NACS and other nutrition activities (September-October)

Appendices: Appendix 1: Contact List-Nigeria Appendix 2: Debrief PowerPoint Presentation

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APPENDIX 2: Debrief Power Point Presentation

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Documents

SPRING Quarterly Report Quarter FINAL - pdf.usaid.govpdf.usaid.gov/pdf_docs/PA00MTCG.pdfpositions: Finance and Operations Manager, Knowledge Management and Communications Advisor,