1. Case Studies Scale:
The ENA Framework
Understanding the ENA Framework
Pre-session GHPC - May 5th, 2014
Jennifer Nielsen, PhD - HKI
Agnes Guyon, MD, MPH - JSI

2. Health sector
The ENA Framework

3. Mali & Niger – CSHGP
• Supported development of national
ENA policy statements & training
• Collaborated with MOH at regional, district, and health
facility levels to improve quality of nutrition content in
health services
• Community volunteers at village level were linked as
extension of health system
• Project supervisors reinforced capacity & ownership of
local partners
• HKI had strong political and technical support from both
countries

4. Mali & Niger – CSHGP
• Formative research simple:
Mali used Barrier Analysis;
Niger used long-time expert
• Cascade training with one refresher mid-term:
– MTOT 10 days (HKI & MOH at national, region, district)
who then trained
– Health workers (5 days), who then, with support of MT
trained
– Community volunteer groups (3 days)
• Multichannel SBC emphasized IPC (TIPS)
reinforced by group discussions at health centers
and community level and radio messages.

5. USAID bilateral (RBHS) &
UNICEF
Liberia
• Messages developed from formative research & harmonized
• Training materials developed based on generic ENA materials
• Master trainers carried out cascade training of selected health
providers and community volunteers
• SBCC strategy finalized
• Update IMCI with ENA and CMAM
• Integrate ENA into community strategy
• Assist the MOHSW in advocacy, the promotion
and the roll-out of high impact nutrition
interventions through the Essential Nutrition
Actions (ENA) framework

6. LAUNCH project
Liberia
USAID/Food For Peace Multi-Year
Assistance Project – FFP/MYAP
by ACDI/VOCA with PCI, JSI & Making Cents
• Use MOHSW materials and assist in TOT and roll-out
training (HW, CHW, Care Groups)
• Carry-out survey post-training on HW practices
• Initiate TTM to promote ENA at community level
• Draft and use a supportive supervision checklist to
mentor HW and organize review meetings with
volunteers (GCHV and TTM)
• Monitor programs and nutrition practices using mobile
phone

7. Across sectors
The ENA Framework

8. SPRING/Bangladesh
2 sectors :Agriculture & Health
2 Divisions - around 5.7 million
 Work with GoB structure, NGOs, Feed the Future
partners
Essential Nutrition Actions and Essential Hygiene Actions
Homestead Food production using the Farmer Field
School model and 1000 days
 Messages developed from formative research from
A&T
 Training materials based on ENA generic and HKI-HFP
Draft

9. SPRING/Bangladesh
Cascade training
 GoB front line health providers trained
 GoB Agriculture Extension and community partners
 HFP-FFS Facilitators
Multi-platformand multi- contact
Monitoring & Supervision at all levels
Communications
Draft

10. Peace Corps
West Africa Food
security
Partnership
Draft
4 sectors :Agriculture/Environment, Education, Health,
Small Business
 TOT PC staff in March 2013
Benin, Senegal, Guinea, The Gambia & Sierra Leone
 French & English
 Development & testing of training materials based on
ENA generic materials, EHA and HFP
 Training roll-out with Peace Corps Volunteers
 Monitoring & Supervision

11. Reference Booklet on key ENA, EHA
HFP practices
For all PCV regardless of their sectors
Community Training guide
Orientation guide
Health Volunteers Training
guide

12. Nepal and Burkina
E-HFP Platform
• ENA promoted within in ag-nut strategy (Enhanced
Homestead Food Production)
• Behavior change through
community volunteers (FCHV-
Nepal; Grandmothers & Village
Health Committees-Burkina) with
support of local NGO partners
• Village model farms/community
gardens were meeting venue for
ENA discussions and provided
ingredients for enriching
complementary foods

13. Nepal and Burkina
HFP Platform
• Formative research in Nepal used in-depth interviews, focus
group discussions and the DBC framework; in Burkina a
community participatory rural appraisal approach
• MOH district staff supported training & supervision; MOA &
livestock, local development received ENA orientation
• BCC also emphasized IPC
reinforced by radio &
community events
• Nepal governance component
strengthened multi-sectoral
planning and financing at
national, regional and VDC
levels.

14. Monitoring
The ENA Framework

15. QUARTERLY MONITORING :
• Breastfeeding practices
• Mother and child feeding
practices/nutrition
• Hygiene practices
• Food preparation and
storage
• Time travelled to FDP
• Participation in Care Groups
& Farmer Groups
Liberia-quarterly monitoring surveys are
conducted at distribution sites

16. Use of mobile phone improves transfer of
beneficiary information
By Paper By Mobile Phone
10.6
13.9
21.4
20.5
10.7
5.9
5.1
3.6 4.1
0
5
10
15
20
25
Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12
WEEKS

17. Burkina & Nepal
• In Burkina, a round of operations research
was conducted with mixed methods:
survey, in-depth interviews and
observations; weaknesses identified for
correction (anemia, home visits)
• In Nepal bi-annual surveys and observations
were conducted using LQAS
to identify areas for
strengthening (poultry
management)

18. Thank you!