1. 1 Draft Communication for Behavioral Impact Strategy to Promote IYCF/Complementary Feeding in Cambodia Draft Communication for Behavioral Impact Strategy to Promote IYCF /Complementary Feeding in Cambodia

2. 2 Research on IYCF complementary feeding  Infant and young child feeding practices research in Cambodia 2006  Comprehensive review of feeding practices in children from 6 months and also explored some of the barriers for mothers to providing appropriate complementary foods.  Areas highlighted for future BCC interventions included addressing poor quality Borbor introduced at inappropriate times with active feeding and improved variety and quantities.

3. 3 Research location and participants  Research conducted by NNP with SBK Research and Development and partners  5 provinces of Stung Treng, Kratie, Prey Veng, Kampot, and Battambang were selected purposefully to be representative of the main geographic regions of the country.  A total of 110 mothers with children aged 0- 23 months old were interviewed regarding infant and young child feeding practices.

4. 4 Main Findings  For the 6-11 months old  Infants were fed watery bobor, not energy or nutrient dense  Infants were fed only soup liquid with rice  There was inadequate amount, frequency and variety in the diet of the young children  For the 12-23 months old  Delayed introduction of family foods, not enough variety in the diet  Inadequate amount, frequency and variety in the diet of the young children  Child eats by him/herself or with older siblings and does not finish meal

5. 5 Outline of the COMBI process 1.Overall Goal 2.Expected Behavioural Results/ Objective 3.SMACK (Situation Market Analysis for 3.SMACK (Situation Market Analysis for Communication Keys) Communication Keys) 4. Overall Strategy 4. Overall Strategy 5. COMBI Plan of Action 5. COMBI Plan of Action 6. COMBI Programme Management 6. COMBI Programme Management 7. Monitoring and Evaluation 7. Monitoring and Evaluation 8.Implementation Plan 8.Implementation Plan 9.Budget 9.Budget

6. 6 1.Overall Goal  To improve the feeding practices of infants and young children, by increasing knowledge and supporting behaviour changes to encourage appropriate feeding practices (timely, consistency, quantity, quality, frequency, hygiene and active feeding)

7. 7 2.Behavioural Objective 1.Timely : Start complementary feeding when the child is 6 months of age and continue breastfeeding to two years and beyond cab;epþImpþl;GahabEnßmdl;kumarenAGayue Bj 6Ex ehIybnþbMe)AkUn cab;epþImpþl;GahabEnßmdl;kumarenAGayue Bj 6Ex ehIybnþbMe)AkUn edayTwkedaHmþayrhUt ya:gtic[)an2qñaM b¤elIsBIenH. 2Consistency and quality of food: Give Bobor that is thick and has meat, fish, egg, vegetables and oil from complete 6 months. Start each time with 2 spoons and gradually increase quantity to a full bowel 3 times per day to one year of age. pþl;bbrxab;EdlmanlayRtI su‘t sac; bEnø nigEfmxøaj; b¤eRbgpg edaycab;epþIm pþl;bbrxab;EdlmanlayRtI su‘t sac; bEnø nigEfmxøaj; b¤eRbgpg edaycab;epþIm enAGayueBj6Ex pþl;2søabRBakñúg1eBl² ehIybegáInbnþicmþg² rhUtdl;eBj enAGayueBj6Ex pþl;2søabRBakñúg1eBl² ehIybegáInbnþicmþg² rhUtdl;eBj mYycancgÁwH 3dgkñúg1éf¶ enAeBlkumarGayu)an1qñaM. mYycancgÁwH 3dgkñúg1éf¶ enAeBlkumarGayu)an1qñaM.

8. 8 3Hygiene: Wash hands and cooking equipment with soap before preparation of Bobor and before feeding. Wash hands and cooking equipment with soap before preparation of Bobor and before feeding. lagsMGatéd nigsMPar³pÞH)ay CamYysab‘U muneBlcMGinGahar nig muneBlbBa©úkGahardl;kUn. lagsMGatéd nigsMPar³pÞH)ay CamYysab‘U muneBlcMGinGahar nig muneBlbBa©úkGahardl;kUn. 4Active feeding: Feed children with lots of encouragement and patience actively feeding and allowing enough time for feeding. Feed children with lots of encouragement and patience actively feeding and allowing enough time for feeding. pþl;GaharbEnßmedayGt;Fµt; CYyelIkTwkcitþkumar [jaMGahar pþl;GaharbEnßmedayGt;Fµt; CYyelIkTwkcitþkumar [jaMGahar ¬pþl;edayskmµ nigcMNayeBl[)anRKb;rKan;¦. ¬pþl;edayskmµ nigcMNayeBl[)anRKb;rKan;¦. 2.Behavioural Objective

9. 9 Behavioural Objectives that should be part of the strategy?  Sick children  Children over one year   Almost 63% not meeting energy requirements   Still critical age for growth and development  Snacks as part of healthy diet for children less than and over one year.   Helps to meet energy and nutrient deficit

10. 10 Time frame and implementation choices  Use two behavioural objectives per year and build on the following year?  Which ones should be prioritized for the first and second year?  BCC activities should be for one year with messages continued through replacing old practices with new behaviour and reinforcing messages through routine IYCF counseling?  Year one and two introduce new objectives and in year 3 and 4 revise the changes and reinforce the same messages again. -

11. 11 Expected outcomes - what should our targets be?  What will we use as a baseline for many of the behavioural objectives?  CDHS information on breastfeeding and types of foods in complementary feeding from 2005?  What should the yearly targets be? Should they be set? In this way we will have possibly ….. to In this way we will have possibly ….. to X % by 2009 ( Y % by 2010 and Z % by 2011/2012 ) X % by 2009 ( Y % by 2010 and Z % by 2011/2012 ) - By end of 2012....% start complementary feeding from age 6 months, timely, quality, consistency, hygiene, active feeding

12. 12 Cost vs. Value Calculation  Field observations and conversations suggests that individuals will follow-through with the recommended behaviour if in their cost vs. value calculation  it is worth it to invest the effort and bear the “cost” in carrying out the behaviour in relation to the value of what they receive in …  in relation to what other “competition” (is in the environment or “market place.”) 3. SMACK (Situation Market Analysis for communication keys) 3. SMACK (Situation Market Analysis for communication keys)

13. 13 Timely :Start complementary feeding when the child is 6 months of age and continue breastfeeding to two years and beyond  We have no information on the motivators or barriers to starting timely complementary feeding.  The only intervention in the research was attempting to encourage mothers to express breastmilk but this was difficult for mothers to do and not seen as possible the mothers needed a lot of education and counselling

14. 14 Consistency and quality of food: Give Bobor that is thick and has meat, fish, egg, vegetables and oil from complete 6 months. Start each time with 2 spoons and gradually increase quantity to a full bowel 3 times per day to one year of age. Obstacles for Behavioural Change Resources  Buying meats or fish is expensive and mother doesn’t have enough money.  Its common practice in the villages to eat 2 main meals in a day, normally just lunch and dinner  Sometimes family is eating dry food like fried fish with no vegetables,  If mother goes to the field, its not possible to achieve. Child Health  Children are too small and risk of choking on enriched Borbor.  Think some vegetables/foods cause diarrhoea/sickness

15. 15 Hygiene: Wash hands and cooking equipment with soap before preparation of Bobor and before feeding.  Unhygienic feeding behaviours such as not washing the hands before feeding the child or preparing food, using unclean utensils and not washing the vegetables or fruits was observed during the trial. In addition only a minority of homes had latrines.  We have no information on the motivators or barriers to improving hygienic practices from this research.  ? Other research in Cambodia

16. 16 Active feeding: Feed children with lots of encouragement and patience actively feeding and allowing enough time for feeding. General findings on feeding practices  When to feed child: 79% give food when cry or express hunger, only 12% have fixed schedule for feeding.  48% of mothers said full “when the child stops eating or spits out the food” or when they ask for water (10%) and start to play or stop crying (11%).

17. 17 Active feeding: Feed children with lots of encouragement and patience actively feeding and allowing enough time for feeding. Obstacles for Behavioural Change  When child becomes sick they eat very little.  Mothers working in the field.  If child spits out food it was assumed they didn’t like it or was full.  Child vomits after food so mother afraid to force the child as small stomach.  Mothers think that quantities/bowel of food is too much for their children to eat "I was afraid that when he ate more, his stomach would get big and burst because my child is still small"

18. 18 4. Overall Strategy  Behavioural Objectives (after SMACK )  Communication strategy 1 -Administrative mobilization/Public Relations : 2-Community Mobilization 2-Community Mobilization 3.Advertising and promotion 3.Advertising and promotion 4.Personal Selling 4.Personal Selling 5.Point-of-Service promotion 5.Point-of-Service promotion

19. 19 5.COMBI Plan of Action. 1. Administrative mobilization 1. Administrative mobilization /Public Relations /Public Relations 2.Community Mobilization 2.Community Mobilization 3.Advertising 3.Advertising 4.Personal Selling 4.Personal Selling 5.Point-of-Service promotion 5.Point-of-Service promotion

20. 20 Messages  The messages need to address both the Head (logic) and Heart (emotional) dimension of the Cost vs. Value calculation.  On the value side, -……………………

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23. 23 Communication Actions Communication Actions -Design a new logo, Gingle, Slogan and branding them for the recommended behaviour. -To be used on all materials dealing with this plan.

24. 24 1 -Administrative mobilization/Public Relations : -Memos -partnership session -staff meeting,radio /TV,news -staff meeting,radio /TV,news papers, papers, -community meeting/discussion etc -community meeting/discussion etc

25. 25 2-Community Mobilization : -Community meeting and events -Community meeting and events -Mass media -Mass media -traditional media -traditional media - Concert … - with supporting materials

26. 26 3.Advertising and promotion : -Selecting an “advertising agency”, - Confirm agreement on style of advertising - Develop content of the advertisements for radio, television, with reference to the behavioural themes. -News papers -Billboards-Banners -Flipcharts, leaflets, booklets, Flyers, cap, stickers, brochures, banners, T-shirts…

27. 27  Plan IPC and other communication activities at community level with PHD &OD (by NNP and partners)  Develop training materials (by NNP and partners )  conducting training need assessment  develop appropriate training curriculum  for training of trainer to PHD and OD staff  for step down training to health centre staff and MSG.  Conduct training of trainer to PHD and OD staff to targets provinces (by NNP and partners )  Conduct step down training to HC staff & MSG (by PHD and OD with support from NNP and partners) (by PHD and OD with support from NNP and partners) 4.Personal Selling : 4.Personal Selling :

28. 28 - Mother support group, VHSG, and others volunteers. education at village or home to mothers and caretakers education at village or home to mothers and caretakers … with supporting materials e.g.Print materials …,TV/Radio spot.., which covers the behavioural theme to caretakers … with supporting materials e.g.Print materials …,TV/Radio spot.., which covers the behavioural theme to caretakers - Mother is most important decision maker for deciding what foods to give to the child and when both parents work the grandmother often becomes the caretaker.

29. 29 5.Point-of-Service promotion - Display posters in the waiting area, which messages similar to those of TV/radio spots. - Billboards - Banners

30. 30 6. COMBI Programme Management.  NNP and partners

31. 31 A-Monitoring  Random check by NNP and partner for the activities carried out by PHD, OD and MSG.  Random check by PHD and OD for the activities implemented by health centre.  Field observations and KAP SV  Small tracking surveys of mass media activities twice a year (mid year and end year) in the targeted provinces. 7.Monitoring & Evaluation

32. 32  Conduct a final KAP( knowledge,attitude,practice) surveys on CF  by NNP and partners to targeted provinces and other provinces.  Mothers,care givers target group  … B-Evaluation

33. 33 8- Implementation Plan 4 year Duration  From 2009 -2012  Implementers & Partners:  NNP and NGOs, IOs, UNs  PHDs, PHPUs, ODs, HCs, MSG in targeted - Media

34. 34 Operational Plan

35. 35 9.Budget :

36. 36 Next steps for IYCF BCC strategy 1.Finalize messages and field test 2.Develop operational plan and budget requests with all involved partners 3.Share the strategy, operational plan and field tested messages with N TWG 4.Develop materials as identified in the strategy 5.Disseminate/broadcast/use the new materials