Operationalizing Key Family Practices for Child Health and Nutrition at Scale

Published by the Basic Support for Institutionalizing Child Survival Project (BASICS II) for the United States Agency for International Development, this 33-page paper offers a behaviour change communication (BCC) model and planning tool for child health, with a focus on immunisation.

Executive Summary

The child health agenda is unfinished. After important declines in child mortality over the second half of the 20th century, the rate of decline since the 1990s has leveled off or even reversed in some countries. The majority of children in the Third World still continue to die at home, often with no contact with a health care facility. Significant impact on child survival could be achieved by ensuring that key preventive, case management, and care-seeking behaviors are adopted by large numbers of caregivers of children less than five years of age.

Experiences from the Democratic Republic of Congo, Senegal, Benin, El Salvador, and Honduras show that key caretaker behaviors in child health and nutrition can be promoted at scale using the Steps Towards Expanding Partnership at Scale (STEPS) framework presented here. This five-step framework has been instrumental in operationalizing key practices in maternal and child health at scale by focusing implementation on a core set of high-impact, easy-to-change behaviors.

Experience from the Basic Support for Institutionalizing Child Support Project (BASICS and BASICS II), in collaboration with ministries of health and other national partners, shows that five steps are critical for implementing large-scale communication and behavior change (CBC) packages in collaboration with national partners:

• Step #1: Developing a shared vision among partners
• Step #2: Developing a behavior-centered strategy [*]
• Step #3: Designing an integrated package of CBC materials
• Step #4: Scaling up implementation of the CBC package from early implementation sites
• Step #5: Monitoring and reprogramming interventions based on results

The STEPS framework is complemented by a set of tools for identifying and prioritizing a key set of high-impact, easy-to-change behaviors. This report and the tools referred to in it can be found on the accompanying CD-ROM. Both the framework and tools are intended to assist child health program managers, communication professionals, and behavior change technical advisors from cooperating agencies to design and implement integrated CBC packages at scale.

Excerpts from the Introduction: Key Family Practices for Improving Child Health and Nutrition

For physical growth and mental development

1. Breastfeed infants exclusively for at least four months and, if possible, for up to six months. (Mothers found to be HIV-positive require counseling about possible alternatives to breastfeeding.)
2. Starting at about six months of age, feed children freshly prepared energy and nutrient-rich complementary foods, while continuing to breastfeed up to two years or longer.
3. Ensure that children receive adequate amounts of micronutrients (vitamin A and iron, in particular), either in their diet or through supplementation.
4. Promote mental and social development by responding to a child's needs for care, through talking, playing, and providing a stimulating environment.





For disease prevention


5. Take children as scheduled to complete a full course of immunizations (BCG, DPT, OPV, and measles) before their first birthday.
6. Dispose of feces, including children's feces, safely; and wash hands after defecation, before preparing meals, and before feeding children.
7. Protect children in malaria-endemic areas by ensuring that they sleep under insecticide-treated bednets.
8. Adopt and sustain appropriate behavior regarding prevention and care for HIV/AIDS-affected people, including orphans.





For appropriate home care


9. Continue to feed and offer more fluids, including breastmilk, to children when they are sick.
10. Give sick children appropriate home treatment for infections.
11. Take appropriate actions to prevent and manage child injuries and accidents.
12. Prevent child abuse and neglect, and take appropriate action when it has occurred.
13. Ensure that men actively participate in providing childcare, and are involved in the reproductive health of the family.





For seeking care


14. Recognize when sick children need treatment outside the home and seek care from appropriate providers.
15. Follow the health worker's advice about treatment, follow-up, and referral.
16. Ensure that every pregnant woman has adequate antenatal care. This includes having at least four antenatal visits with an appropriate health care provider, and receiving the recommended doses of the tetanus toxoid vaccination. The mother also needs support from her family and community in seeking care at the time of delivery and during the postpartum and lactation period.

[*] Behavior-centered programming is a service mark provided by the Manoff Group, Inc. (2003).

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