In Madagascar, the USAID-funded LINKAGES project, managed by AED, supported activities from 1997-2006. One focus was adoption of the Essential Nutrition Actions (ENA) approach at multiple levels of the health system and in the community. ENA highlights six priority interventions and six specific contacts with the health system for incorporating appropriate nutrition emphases. One of the priority ENA intervetions is women's nutrition
AED's program focused at the national level on building supportive policies, at the provincial level, and at the district and community levels. Activities included promotion of self-learning ENA training modules, mass media (especially radio and television), workplace initiatives, pre-service medical and paramedical training, and an integrated approach focused on small "do-able" actions with easily recognizable health benefits. The focus on "do-able" actions provided a common basis for training, community mobilization, and harmonization of IEC messages.
Improvements in actions regarding women's nutrition, as reflected in changes between the 2000 baseline and the 2005 endline, included:
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Vitamin A supplementation of women within first two weeks after delivery: increased from 17% to 54%
- Iron folic acid supplementation among pregnant women: increased from 28% to 76%.
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Additional meals among breastfeeding women: increased from 62% to 74%.
At the peak of implementation (2001) the program covered 23 districts with a population of about 6 million people. Mass media (primarily radio) reached a significantly larger area.
In India, LINKAGES supported efforts by three PVOs to develop a community model to improve infant and maternal nutrition within their existing programs. AED assisted CARE from 1997 to 2004. CARE's Integrated Health and Nutrition Program (INHP) operates through Anganwadi centers located at the village level, each served by a local woman and a single helper who receive government honoraria for a range of community outreach services. The Anganwadi centers are operated in collaboration with the national Integrated Child Develop Services (CDS) project and the Ministry of Health's Reproductive and Child Health Program.
AED supported CARE's work in Angarah Block, Ranchi District, Bihar (now Jharkand)—a tribal area with particularly high rates of malnutrition among both women and children.
Among its many services, the Anganwadi center provides a Title II food supplement to young children and to pregnant and lactating women. One common challenge of the centers, however, is a perception that it primarily serves children, and the supplement in particular is perceived as being "for children." In addition, formative research showed that in this area of high maternal mortality, pregnant women are fearful of gaining weight and having a large baby, leading to a difficult birth.
The intervention included counseling cards on breastfeeding and maternal diet for use by Anganwadi Workers, cassettes with jingles and songs for women's groups, "danglers" for public display, a Training of Trainers module and manual on Good Health in Pregnancy and Lactation for use in training field staff, revised home visit questionnaires, and scripts for radio spots and folk drama.
Endline results from CARE's pilot project in Angara showed 82 percent of pregnant women receiving and consuming their food ration, compared with 38 percent pre-project.
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