Exploring barriers and enablers for scaling up a community-based grain bank intervention for improved infant and young child feeding in Ethiopia

A qualitative process evaluation

Binta Sako, Joanne N. Leerlooijer, Azeb Lelisa, Abebe Hailemariam, Inge D. Brouwer, Amal Tucker Brown, Saskia J.M. Osendarp*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Child malnutrition remains high in Ethiopia, and inadequate complementary feeding is a contributing factor. In this context, a community-based intervention was designed to provide locally made complementary food for children 6–23 months, using a bartering system, in four Ethiopian regions. After a pilot phase, the intervention was scaled up from 8 to 180 localities. We conducted a process evaluation to determine enablers and barriers for the scaling up of this intervention. Eight study sites were selected to perform 52 key informant interviews and 31 focus group discussions with purposely selected informants. For analysis, we used a framework describing six elements of successful scaling up: socio-political context, attributes of the intervention, attributes of the implementers, appropriate delivery strategy, the adopting community, and use of research to inform the scale-up process. A strong political will, alignment of the intervention with national priorities, and integration with the health care system were instrumental in the scaling up. The participatory approach in decision-making reinforced ownership at community level, and training about complementary feeding motivated mothers and women's groups to participate. However, the management of the complex intervention, limited human resources, and lack of incentives for female volunteers proved challenging. In the bartering model, the barter rate was accepted, but the bartering was hindered by unavailability of cereals and limited financial and material resources to contribute, threatening the project's sustainability. Scaling up strategies for nutrition interventions require sufficient time, thorough planning, and assessment of the community's capacity to contribute human, financial, and material resources.
Original languageEnglish
Article numbere12551
JournalMaternal and Child Nutrition
Volume14
Issue number2
DOIs
Publication statusPublished - 1 Apr 2018

Fingerprint

Ethiopia
Infant Nutritional Physiological Phenomena
Child Nutrition Disorders
Ownership
Focus Groups
Motivation
Volunteers
Decision Making
Mothers
Interviews
Delivery of Health Care
Food
Research

Keywords

  • complementary feeding
  • Ethiopia
  • infant and child
  • nutrition
  • nutritional interventions
  • process evaluation
  • scaling-up

Cite this

@article{29213c36da684797aba32931fad5af35,
title = "Exploring barriers and enablers for scaling up a community-based grain bank intervention for improved infant and young child feeding in Ethiopia: A qualitative process evaluation",
abstract = "Child malnutrition remains high in Ethiopia, and inadequate complementary feeding is a contributing factor. In this context, a community-based intervention was designed to provide locally made complementary food for children 6–23 months, using a bartering system, in four Ethiopian regions. After a pilot phase, the intervention was scaled up from 8 to 180 localities. We conducted a process evaluation to determine enablers and barriers for the scaling up of this intervention. Eight study sites were selected to perform 52 key informant interviews and 31 focus group discussions with purposely selected informants. For analysis, we used a framework describing six elements of successful scaling up: socio-political context, attributes of the intervention, attributes of the implementers, appropriate delivery strategy, the adopting community, and use of research to inform the scale-up process. A strong political will, alignment of the intervention with national priorities, and integration with the health care system were instrumental in the scaling up. The participatory approach in decision-making reinforced ownership at community level, and training about complementary feeding motivated mothers and women's groups to participate. However, the management of the complex intervention, limited human resources, and lack of incentives for female volunteers proved challenging. In the bartering model, the barter rate was accepted, but the bartering was hindered by unavailability of cereals and limited financial and material resources to contribute, threatening the project's sustainability. Scaling up strategies for nutrition interventions require sufficient time, thorough planning, and assessment of the community's capacity to contribute human, financial, and material resources.",
keywords = "complementary feeding, Ethiopia, infant and child, nutrition, nutritional interventions, process evaluation, scaling-up",
author = "Binta Sako and Leerlooijer, {Joanne N.} and Azeb Lelisa and Abebe Hailemariam and Brouwer, {Inge D.} and {Tucker Brown}, Amal and Osendarp, {Saskia J.M.}",
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Exploring barriers and enablers for scaling up a community-based grain bank intervention for improved infant and young child feeding in Ethiopia : A qualitative process evaluation. / Sako, Binta; Leerlooijer, Joanne N.; Lelisa, Azeb; Hailemariam, Abebe; Brouwer, Inge D.; Tucker Brown, Amal; Osendarp, Saskia J.M.

In: Maternal and Child Nutrition, Vol. 14, No. 2, e12551, 01.04.2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

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T2 - A qualitative process evaluation

AU - Sako, Binta

AU - Leerlooijer, Joanne N.

AU - Lelisa, Azeb

AU - Hailemariam, Abebe

AU - Brouwer, Inge D.

AU - Tucker Brown, Amal

AU - Osendarp, Saskia J.M.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Child malnutrition remains high in Ethiopia, and inadequate complementary feeding is a contributing factor. In this context, a community-based intervention was designed to provide locally made complementary food for children 6–23 months, using a bartering system, in four Ethiopian regions. After a pilot phase, the intervention was scaled up from 8 to 180 localities. We conducted a process evaluation to determine enablers and barriers for the scaling up of this intervention. Eight study sites were selected to perform 52 key informant interviews and 31 focus group discussions with purposely selected informants. For analysis, we used a framework describing six elements of successful scaling up: socio-political context, attributes of the intervention, attributes of the implementers, appropriate delivery strategy, the adopting community, and use of research to inform the scale-up process. A strong political will, alignment of the intervention with national priorities, and integration with the health care system were instrumental in the scaling up. The participatory approach in decision-making reinforced ownership at community level, and training about complementary feeding motivated mothers and women's groups to participate. However, the management of the complex intervention, limited human resources, and lack of incentives for female volunteers proved challenging. In the bartering model, the barter rate was accepted, but the bartering was hindered by unavailability of cereals and limited financial and material resources to contribute, threatening the project's sustainability. Scaling up strategies for nutrition interventions require sufficient time, thorough planning, and assessment of the community's capacity to contribute human, financial, and material resources.

AB - Child malnutrition remains high in Ethiopia, and inadequate complementary feeding is a contributing factor. In this context, a community-based intervention was designed to provide locally made complementary food for children 6–23 months, using a bartering system, in four Ethiopian regions. After a pilot phase, the intervention was scaled up from 8 to 180 localities. We conducted a process evaluation to determine enablers and barriers for the scaling up of this intervention. Eight study sites were selected to perform 52 key informant interviews and 31 focus group discussions with purposely selected informants. For analysis, we used a framework describing six elements of successful scaling up: socio-political context, attributes of the intervention, attributes of the implementers, appropriate delivery strategy, the adopting community, and use of research to inform the scale-up process. A strong political will, alignment of the intervention with national priorities, and integration with the health care system were instrumental in the scaling up. The participatory approach in decision-making reinforced ownership at community level, and training about complementary feeding motivated mothers and women's groups to participate. However, the management of the complex intervention, limited human resources, and lack of incentives for female volunteers proved challenging. In the bartering model, the barter rate was accepted, but the bartering was hindered by unavailability of cereals and limited financial and material resources to contribute, threatening the project's sustainability. Scaling up strategies for nutrition interventions require sufficient time, thorough planning, and assessment of the community's capacity to contribute human, financial, and material resources.

KW - complementary feeding

KW - Ethiopia

KW - infant and child

KW - nutrition

KW - nutritional interventions

KW - process evaluation

KW - scaling-up

U2 - 10.1111/mcn.12551

DO - 10.1111/mcn.12551

M3 - Article

VL - 14

JO - Maternal and Child Nutrition

JF - Maternal and Child Nutrition

SN - 1740-8695

IS - 2

M1 - e12551

ER -