Project Summary
The project seeks the following objectives:
- To generate evidence on which set of strategies drives adherence to maternal nutrition products and provides high return on investment in Ethiopia.
- To demonstrate that high adherence to maternal nutrition products and impact at scale is achievable in Ethiopia, which could be a model for replication in other parts of the world with similar settings.
- To make sustainable impact through strategies adopted and owned by local organizations and governments; digitized tools for dissemination and use by others; and a body of published literature, technical briefs and policy materials that are publicly accessible.
Approach
Working alongside the Ethiopian Federal Ministry of Health (FMOH), CCP is applying an implementation science framework to test a set of strategies, initially at a pilot level and then a scalable level. These strategies will aim to increase consumption of IFA/MMS supplements among two main groups in rural areas: adolescent girls aged 10 to 19 years who are not pregnant and pregnant women aged 15 to 49 years. A mixed method approach, including Human Centered Design (HCD) and a randomized control trial (RCT) will be used to design and test a set of strategies. CCP will address key implementation research questions to inform feasible and cost-effective strategies to support adherence to and delivery of recommended maternal nutrition interventions.
Process
Desk Review: CCP will conduct a desk review of appropriate peer reviewed journals, program reports, frameworks, policies and guidelines to understand IFA/MMS delivery processes, supply chain and delivery mechanisms, increasing adherence and uptake through demand generation across the socio-ecological spectrum in Ethiopia. A mapping exercise will be conducted to determine key groups to be included in HCD and implementation. Likewise, for best practices for adaptation, Ethiopia-specific and global lessons will be reviewed.
Stakeholder Consultative Meetings: CCP will lead national and regional level consultations and crowdsourcing to determine key IFA/MMS adherence barriers and facilitators and identify and prioritize strategic areas for the HCD design challenge. Representatives from all relevant directorates of the FMOH and Regional Health Bureaus (RHB), the Seqota Declaration Coordination Office and implementing partners will be invited to participate.
Human Centered Design Process: CCP will utilize a five stage HCD process (Empathy, Define, Ideate, Design and Test). The process includes an intensive Empathy phase to assess and respond to context specific barriers and facilitators to adherence, including those related to gender. The process will be designed based on findings from the desk review, stakeholder consultative workshops, and structured interviews with users and non-users.
Gender Transformative Approach: Gender is a centerpiece of this intervention and research, and CCP will assess, measure, and address gender-related barriers for adherence to IFA/MMS—including attitudes, gender norms, couple communication, and decision-making—throughout all stages of the project (desk review, stakeholder consultations, formative assessments, design, and evaluation).
Adaptive Implementation: CCP will work with the FMOH and two implementing partners to roll out the HCD-designed strategies in close coordination with woreda health officials and different cadres of community health workers, school personnel, and other groups. Strategies will be rolled out in all kebeles in the intervention woredas. Activities will include developing staffing plans, implementation plans, skills-based training, supportive supervision, and performance reviews.
Implementation Research: CCP will conduct two cross sectional surveys using a cluster Randomized Controlled Trial (cRCT) design to assess the impact of the delivery mechanism and the SBC package on IFA/MMS reach as well as consumption. The Project will also measure cost effectiveness against outcomes such as coverage and adherence.