2023 Kick-Off CROWN Convening
Dates: March 14-16, 2023
Location: Addis Ababa, Ethiopia
Download the full Post-Convening Report
Event Objectives
- Establish a community of practice to foster collaboration among project implementing partners and stakeholders
- Identify methods for developing an effective partnership across projects
- Share information, knowledge, and tools
- Establish a knowledge-sharing network
- Discuss and disseminate innovative approaches and best practices
- Prepare a symposium submission to the Micronutrient Forum, the 2023 Nutrition for Resilience Global Conference.
Conference Proceedings Summary
March 14, 2023
The first day of the CROWN Convening kicked off with a welcome from Rajiv Rimal, lead investigator for the CROWN project, followed by opening remarks by Zeina Sifri and Fred Grant of the Bill and Melinda Gates Foundation. Zeina and Fred provided insights into some of the Foundation’s’ goals for the CROWN projects and convening, including:
- Prioritizing data generation and access to data on nutrition to affect policy change
- Supporting faster uptake of nutritional supplements and service delivery innovation
- Seeking to scale and sustain these interventions at the global level
Tewabech Sheno of JHU CCP and Olajumoke (Ola) Olarewaju from CROWN led the introductions and ice breakers session to allow participants from the different projects and stakeholder groups to get to know one another and their respective roles. Tewabech and Ola then facilitated the learning expectations and helped facilitate a discussion on ground rules, which were recorded and then categorized into themes by the CROWN internal team.
Session 1: Ethiopia Adherence Project (Habtamu Temesgen)
Habtamu Temesgen opened the session with an overview of the Ethiopia Adherence project, followed by breakout groups for discussion. Habtamu noted that the Ethiopia project has three main goals: to contribute to the reduction of anemia prevalence in Ethiopia, to develop effective and scalable solutions to optimize IFA uptake and adherence among pregnant women, and find effective solutions to reach and access adolescent girls. Discussions in the groups focused on the implications for other CROWN interventions, questions and comments on the Ethiopia project, and areas of technical strength that projects could leverage.
Session 2: Nigeria MMS Project (Nkechinyere Adinoyi)
Nkechinyere Adinoyi of Nutrition International led a review of the Nigeria project, followed by breakout groups and a larger group discussion and sharing session. The NI project is unique in that it is focusing on optimizing adherence for maternal MMS in Nigeria, using evidence from a cost-benefit analysis conducted in 2020 that showed MMS as a greater value for money than IFA in Nigeria. Their research goals are to understand how to optimize adherence to maternal MMS in Nigeria, utilizing a gender- and HCD-informed lens across urban, peri-urban, and rural settings.
Session 3: Uttar Pradesh IFA Project (Thomas Forissier)
Thomas Forissier of FHI360 virtually presented a project overview of the Uttar Pradesh project in India, followed by breakout groups. Though the UP study has yet to kick off, Thomas provided the results of a preliminary assessment that focused on pregnant women, lactating women, and school-going adolescents, noting that the main issues were IFA initiation and daily access to IFA (or weekly for adolescents).
Session 4: Compilation of CROWN Expertise (Daryl Stephens)
Daryl Stephens led the technical expertise and collaborations session, which was intended to build a CROWN-wide database for project staff to access contacts who can provide technical expertise and assistance as needed throughout the lifecycles of the project. This database will be shared with all conference participants and will allow for cross-country collaboration and outreach for questions, study design and implementation ideas, and technical assistance in specific areas (e.g., gender, HCD).
March 15, 2023
Session 1: Audience Segmentation Methods (Tracy Johnson, Melanie Wendland)
The first presentation of the day was on “Learnings from Audience Segmentation” by Tracy Johnson from BMGF and Melanie Wendland from Sonders Design. This highly interactive session covered the Foundation-supported “Pathways” data and insights platform to improve women’s health and well-being through operationalizing social determinants of health. Tracy showed how segmenting households on vulnerabilities makes the link between needs and health outcomes visible, and she provided examples from the Pathways pilot study. Melanie explained how design contributes to operationalizing the vulnerability segmentation by looking at desirability, feasibility, and viability. A key takeaway of this session was that design can come in various “dosages” – it can be a spark, an ingredient, or an end-to-end process based on what is appropriate for the project.
Session 2: Adherence Measurement Literature Review (Julia Burleson)
Julia Burleson from CROWN presented findings from the CROWN literature review on measurement of adherence across a range of topics. The review included studies on adherence to HIV, nutrition, and diabetes medication to understand reliability and validity measures for medication adherence. The literature review highlighted that there is no single “gold standard” that exists in adherence measurement, and therefore triangulation (measuring multiple modalities and, within each modality, various methods) allows for a diverse set of assessments that are flexible in practice and adaptable in low-income settings.
Session 3: Background on Nutrition (Jennifer Busch-Hallen)
Jennifer Busch-Hallen from Nutrition International provided everyone with a virtual “crash course” on nutritional supplements. Jennifer offered a background on the history of WHO recommendations surrounding micronutrient supplementation during pregnancy, including the 2016 comprehensive report on ANC Nutritional Outcomes for Positive Pregnancy Outcomes which promoted daily IFA supplementation, and the 2020 nutritional recommendation update which proposed MMS use in tandem with intensive implementation research. Jennifer provided evidence of effectiveness of MMS and IFAs in reducing anemia during pregnancy, and discussed the need for marrying knowledge with optimum practice.
Session 4: Background on Social and Behavior Change (Rajiv Rimal)
The next “crash course” was on Social and Behavior Change by Rajiv Rimal. Rajiv’s presentation highlighted the ways in which the COVID-19 pandemic showed the world that when we neglect differences in society, we exacerbate inequality. The importance of SBC for global health programming was codified in the 2023 WHO Recommendations “Behavioral Sciences for Better Health,” which requests member states to invest in behavioral sciences and to create SBC capacity in regional WHO offices. Rajiv walked conference members through what SBC is (about behaviors!) and what it is not (just about communication!), and offered some data-driven questions to consider when creating and implementing an SBC intervention.
Session 5: GenderTech Guidance (Erica Sedlander, Nandita Kapadia-Kundu)
Erica Sedlander from GenderTech and Nandita Kapadia-Kundu from JHU CCP led a gender workshop, in which they provided an overview of evidence and research methods for identifying gender barriers to nutritional supplementation adherence. Erica’s portion of the workshop focused on the different ways in which programs can utilize gender analyses and gender-intentional lenses to uncover gender barriers. Through a case study on the RANI project, Erica highlighted how using gender measures in the project provided key qualitative data around gender-based barriers to IFA uptake and adherence in Odisha, India. Nandita then shared a case-study example of using a gender lens prevention approach on pre-term birth in Ethiopia, emphasizing how discovering vulnerability factors for pregnant women will allow the Ethiopia CCP team to address pre-term birth issues.
Session 6: Adherence Systematic Literature Review (Bee-Ah Kang)
Bee-Ah Kang from CROWN presented a systematic literature review on maternal micronutrient supplementation, focusing on how adherence has been measured across MMS studies for women of reproductive age, what interventions and strategies have been used to improve adherence, and what lessons can be learned from these interventions. For practice, Bee-Ah recommended use of behavior change strategies, participant-centered strategies, and context- specific strategies, and for research she highlighted the need for data triangulation and implementation research to better understand adherence of nutritional supplements.
March 16, 2023
The third day of the convening was focused almost exclusively on human centered design. Danielle Piccinini Black, the Design Innovation Lead at JHU CCP, provided an introduction to the concept of human-centered design. She discussed the importance of putting the user’s needs at the forefront of the design process and how it can lead to better outcomes in public health and business. Danielle walked participants through the five distinct steps of the Hopkins-adapted HCD framework: empathize, define, ideate, prototype, and test. She provided participants with the basic tools needed to utilize HCD in their individual projects in an iterative, collaborative fashion.
Session 1: HCD Literature Review (Bee-Ah Kang, Manvi Poddar)
Bee-Ah Kang and Manvi Poddar from CROWN presented a literature review on HCD, reviewing case studies which showed how HCD has been applied across diverse health areas and in the realm of research. Manvi explored five case studies that exemplified each of the five steps of the HCD process outlined above (empathize, define, ideate, prototype, and test), noting that HCD is especially effective if the study team has access to key stakeholders and end-users throughout the program lifecycle. This review highlighted how LMICs can use HCD in health interventions.
Session 2: HCD in the Ethiopia Project (Biruk Melaku)
Biruk Melaku, the Senior Director for SBC Design and Innovations at JHU CCP in Ethiopia, shared case studies on the application of HCD in Ethiopia. The Ethiopia case study used HCD to enhance uptake and adherence of IFA among pregnant women and adolescent girls in Ethiopia. Though this project is in early stages, the “empathy” phase of the process has uncovered key insights for pregnant women, adolescent girls, and those working in service delivery, which will then be used in future phases of the study.
Session 3: Nigeria Case Study (Jennifer Amadi, Leeor Levy)
Jennifer Amadi and Leeor Levy presented case studies from Sonders Design. This study utilized the Northern Nigeria Pathways segmentation (as discussed in Tracy and Melanie’s talk from Day 2) to understand behavioral, social, cultural, and environmental enablers and barriers to understand the context of women taking antenatal supplements in Northern Nigeria. By utilizing their unique “adherence journey” approach, which illustrates the steps required for women to receive and adhere to supplementation during pregnancy, they are able to work toward the development of effective, feasible, and women-centered programs and strategies.
Concluding Session
Rajiv Rimal facilitated the final session of the conference, providing reflection on the insights shared throughout the proceedings of the conference and highlighting next action steps for the Collaborative.