Scaling Up Micronutrient Interventions: Bridging the Gap between Theory and Implementation.

Objectives Introduction: Home-based fortification of complementary food with micronutrient powders (MNPs) has been proven to reduce anemia. In resource constrained contexts - like Madagascar - where child diet is of poor quality and anemia levels high, the challenge lies in finding viable approaches for ensuring sustainable access to MNPs by vulnerable populations. Objective: To assess the effect of social marketing through community-based and private sector channels on access to MNP in rural and urban areas of Madagascar. Methods: Marketing research was conducted to develop product brand and logo. Quantitative and qualitative information was collected to assess infant feeding practices before and after introduction of IYCF [1] activities, awareness of child nutrition, and mothers' aspirations. Willingness-to-pay data helped determine price points and margins for intermediaries. [1] Infant and young child feeding practices. Results: Initial outcomes indicate high trial and acceptability rates among mothers both in urban and rural areas. The revenue from sales from the private channel is used to reinforce activities linked to the community based distribution. Between February and October 2013, 5,615 children received MNP. Of the 5,615 children, 21% (1,200 children) consumed 90 sachets in 6 months. Challenges with poor quality product (taste, odor) – influencing continuation rates -- were partially overcome through CHW counseling on food diversification. Conclusion: Social marketing appears a viable option for ensuring access to MNPs even by vulnerable segments of the population. Findings show this approach can improve communication around IYCF and provide evidence of a solid public-private sector partnership model that can be taken to scale.

The Home Fortification Community of Practice: An Approach to Improve Inter-country Communication and Collaboration to Support the Implementation and Scaling-up of Home Fortification Programs.

Objectives: Home fortification is an innovative way to improve the diet with essential nutrients for targeted vulnerable groups who have higher requirements or do not benefit from other micronutrient interventions. As a relatively new program, there is a tremendous need for technical support. The idea of a community of practice was developed to facilitate inter-country and inter-agency dialogue and learning, with the following objectives: 1. To provide an opportunity and space to exchange information and experiences between program. Implementers. 2. To enhance learning, generate new knowledge and document lessons learned and best practices; and 3. To facilitate coordination, harmonization and support for the scale up of home fortification. Methods: Online survey and informal interviews were conducted to incorporate target users’ opinions on the online community’s organizational, technical and operational features, and the desired benefits and potential barriers to participation. Lessons from existing successful online communities were used to inform stakeholders’ engagement and increase their awareness and involvement. Results: The Home Fortification Network (network.hftag.org) was branded and created as an online discussion forum with organized topics and with document-sharing capabilities. A moderator helps to connect users and facilitate discussion. Different stakeholders around the world are engaged and promote its global awareness and participation. Conclusions: The Home Fortification Network at network.hftag.org is an online community of practice created to facilitate and improve inter-country and inter-agency communication and collaboration to support the implementation and scaling-up of home fortification programs around the world.

Acceptability of and Willingness to Pay for Micronutrient Powder in Somaliland.

Objectives: Under five nutritional deficiencies in Somaliland constitute a major health concern. In response, Population Services International (PSI) undertook a study to examine practices related to acceptability of and willingness to pay for (WTP) MNP. Methods: 72 female caregivers from different socioeconomic groups trialed MNP. Focus group discussions on MNP were conducted with the trialists, a control group of 120 female caregivers, and 30 men. WTP exercises, using both the price sensitivity meter (PSM) and Becker-DeGroot-Marschak (BDM) methods were conducted with women. Results: 95.7% of the MNP trialists used the product; 61.2% would use MNP in the future. 64.2% would prefer to purchase in pharmacies and 28.4% in clinics. Although the PSM exercise indicated a high WTP (4,596 Somaliland Shillings), the BDM exercise resulted in a lower value (2,773 SS). 45.7% bid above the estimated cost (2,958 SS ) and the average bid 93.7% of the estimated cost. Conclusions: MNP would, therefore, be a suitable product for Somaliland; it is relevant to nutrition needs and caregivers show WTP close to the product's cost recovery price, necessitating minimal subsidies.