implemented by a large number of managers and staff. EHC provided a ready-made platform for scale and sustainability with its own workforce, infrastructure, operational modalities, monitoring mechanisms, and potential for long-term financing from BRAC’s institutional resources. Although the wide geographical distribution of the 50 upazilas
was challenging to manage, with one manager per seven, each upazila acted as a learning site for further geographic expansion in a region. Tools, processes, and lessons learned from the 50 sites are being incorporated into other stakeholder programs, and the IYCF interventions have already reached well beyond the 50 upazilas—for example, through BRAC’s MNCH program. Lessons on how to maintain quality and achieve sustainability
came not only from the pilot but from the first and second phases of scale up, when the number and diversity of local contexts, managers, and workers increased. During the first phase, regional managers with decentralized responsibility and authority were deployed, and performance incentives were introduced. In the second phase, program organizers were hired specifically to carry out the social mobilization strategy. In some areas, many health volunteers had dropped out because they had joined without a clear understanding of their workload and remuneration. As a result, a large number of households were not receiving regular visits by the volunteers, and performance checklists for the health volunteers indicated gaps in knowledge. To address these challenges, BRAC increased the performance-based incentives, revised the criteria for selection of volunteers and their tasks, and introduced quarterly IYCF refresher training for the frontline workers. The enabling environment or spaces for scale were created
in several ways. Adequate funding from the Gates Foundation removed financial constraints. To remove policy constraints, A&T, in collaboration with UNICEF and government agencies, developed a national behavior-change communication plan for IYCF with specific goals, targets, responsibilities, and measurement and evaluation (M&E) indicators. BRAC assigned the necessary staff with operational skills to push the scaling-up process forward. A&T’s engagement strategy with governmental agencies and the media created political space. Formative research and frequent reviews of field experiences helped ensure that the program reflected cultural
sensitivities. Practical yet comprehensive M&E and knowledge- sharing processes were established to foster ongoing adjustments. The drivers of scale for A&T in Bangladesh included ideas and
models from former successes in breastfeeding and complementary feeding programs and endorsement of proven, high-impact IYCF programs. Visionary leaders at BRAC, A&T, and the Gates Foundation, with the encouragement of the government’s nutrition leadership, drove the scaling-up process forward. In the aftermath of the dismantling of Bangladesh’s National Nutrition Program, in part due to its limited scale, the search for a better option worked as an external catalyst. The Gates Foundation’s “learning grant” program acted as an incentive, as it required a high level of accountability for results at scale. Overall, the framework for scaling up developed for this series
was broadly validated, with some caveats. A phased scaling up with key learning objectives at each phase is critical given the nature and challenges of sustaining IYCF behavior change. Reviewing experiences when operating at scale helped identify core processes for ensuring quality at scale. A strong technical team to adapt innovations was key, as was BRAC’s ability to address variable needs such as staffing up volunteers and adding support for social mobilization. Different monitoring modalities, reporting to different units, also contributed to assessing and addressing program quality. Finally, a conducive, preexisting national policy environment for IYCF, created by an existing national IYCF Strategy (2007), and a more detailed and comprehensive national communication plan that was endorsed and adopted by the government (2010) helped ensure that all core processes and players were approved, and no additional clearances were required once scale up started. These various factors came together to form an ideal
environment for replicating and expanding IYCF interventions. Monitoring data indicate that IYCF practices have continued to improve in program areas during scale up, and early process evaluation data suggest services provided are of good quality. It is anticipated that the A&T approach will help achieve and maintain the impact of good IYCF practices at a large scale in Bangladesh for years to come.
For further reading: Alive & Thrive,
www.aliveandthrive.org.
Raisul Haque (
raisul.h@brac.net) is a senior program manager. Kaosar Afsana (
afsana.k@brac.net) is a director. Saiqa Sira (
saiqa.s@brac.net) is a senior program specialist with BRAC in Bangladesh. Tina Sanghvi (
tsanghvi@fhi360.org) is a senior country director with Alive & Thrive, Bangladesh. Purnima Menon (
p.menon@
cgiar.org) is a senior research fellow with IFPRI in New Delhi.
www.ifpri.org
Copyright © 2012 International Food Policy Research Institute. All rights reserved. Contact
ifpri-copyright@cgiar.org for permission to republish.
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