From Ethiopia to Liberia: a nutrition experience

 

 

Using behavior change communication materials to practice negotiation skills in the community.
Using behavior change communication materials to practice negotiation skills in the community.

In Liberia, 39% of children are chronically malnourished, largely due to sub-optimal breastfeeding practices, poor diversity of complementary foods for children, and micronutrient deficiencies. As the basis to scale-up high impact nutrition interventions, the Liberia Ministry of Health and Social Welfare (MOHSW) Nutrition Division adopted the Essential Nutrition Actions (ENA) framework. JSI has been an advocate of the ENA framework in Liberia since 2009 through two USAID funded projects: Rebuilding Basic Health Services (RBHS) in collaboration with UNICEF, and the Liberia Agricultural Upgrading Nutrition and Child Health (LAUNCH) project[1].

Simulation exercise (role play) by training participants.
Simulation exercise (role play) by training participants.

In August, JSI and UNICEF hosted three weeks of training on ENA. Abdulselam Jirga, from the USAID funded Integrated Family Health Program (IFHP) in Ethiopia[2], traveled from Ethiopia to conduct trainings for MOHSW district health officers, county nutrition supervisors, and program staff from several partner organizations. Abdulselam has traveled to Liberia three times since 2010. He has become a mentor to Liberians in bringing behavior change at the community level.

Demonstrating proper breastfeeding positioning.
Demonstrating proper breastfeeding positioning.

Even though Abdulselam comes from a country with a different language, culture, and health system, in the training hall in Liberia, everyone came to understand the same language: The language of the ENA framework. This is the language of negotiation and counseling of caretakers to improve maternal, infant, and young child feeding practices and micronutrient intakes in order to prevent malnutrition. Training activities included brainstorming, demonstrations, case studies, group work, and role-play. Participants gained practical experience through sessions conducted in nearby communities were participants worked with breastfeeding mothers, pregnant women, and caregivers of young children. Abdulselam coached each of the participants to become trainers themselves so that they could train health workers and community health volunteers at the county level.

Discussing care/feeding practices with Care Group members (Lead Mothers).
Discussing care/feeding practices with Care Group members (Lead Mothers).

With the completion of these trainings, the MOHSW is taking ownership and planning to scale-up ENA implementation in each of the 15 counties in Liberia. All County Health Departments now have a nutrition supervisor who is trained in ENA. Furthermore, all district health officers in Bong, Nimba, and Lofa counties (three counties supported by RBHS) have been trained. Following Abdulselam’s departure, the MOHSW started training county-level general Community Health Volunteer (gCHV) supervisors. These newly trained health workers will facilitate the cascade of training to all key health facility staff and gCHVs, enabling the spread of ENA to all communities in Liberia. The exchange of lessons and experiences across Africa should continue to ensure the prevention and reduction of chronic malnutrition among women and children.


[1] JSI is implementing the RBHS, a bilateral project funded by USAID, and providing technical assistance to the LAUNCH project. LAUNCH is a Food for Peace Multi-Year Assistance Program (FFP-MYAP) that is managed by ACDI/VOCA in collaboration with Project Concern International (PCI), John Snow, Inc. (JSI) and Making Cents International (MCI).

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