Shaping policies to improve nutrition

The Infant and Young Child Nutrition (IYCN) Project helps countries establish policies and guidelines aimed at preventing malnutrition and increasing children’s chances to flourish and lead productive lives. Working in Africa, Asia, and Latin America and the Caribbean, IYCN supports ministries of health and partners with local organizations to design and implement nutrition interventions that address a community’s specific needs. We help governments incorporate international feeding and nutrition guidelines into their national standards. We then train health workers and community volunteers on nutrition interventions. Our robust approach builds community-level support for new guidelines and ensures that a country’s smallest citizens have access to better nutrition.

IYCN shares lessons learned in influencing national approaches to malnutrition

Below are some lessons IYCN has learned while advocating for policy change and development to improve nutrition among women, infants, and young children. These lessons reflect our work in Côte d’IvoireHaiti, LesothoMadagascar, and Zambia, where nutrition interventions can have a significant impact on countless lives.

Lesson 1: Engage stakeholders early in the process to build support for policy change

Rose Mireille Exumé, IYCN Country Coordinator, speaks to the audience at a stakeholder workshop in Haiti.

IYCN supports ministries of health to formulate new policies and guidelines around maternal, infant, and young child nutrition. We provide them with technical assistance and connect them with partners who have a vested interest in the work. The support of these key partners—such as government officials, local organizations, and health workers—is crucial for the success and longevity of new policy. To encourage buy-in and validation of the proposed policy:

  • Connect with stakeholders before beginning to develop the policy.
  • Listen to stakeholders’ concerns and ideas to understand their experiences.
  • Show stakeholders that their ideas matter by incorporating their feedback into the final document.

Stakeholders’ support will lend valuable legitimacy and will help to build a strong voice for improved nutrition policies.

In Madagascar, IYCN built relationships with the Ministry of Health, government groups, and several local and international nongovernmental organizations to develop a national strategy for improving maternal nutrition and breaking a vicious cycle of malnutrition. The IYCN team coordinated workshops with a wide range of partners to seek their input on the strategy and help them gain ownership of the plan. IYCN is now using these recommendations to incorporate actions and key messages on maternal nutrition into national activities and trainings for health and community workers, bolstered by support from members of these communities.Read more about IYCN’s work on maternal nutrition in Madagascar.

When identifying potential stakeholders, we have learned to think creatively about who these partners might be. In Côte d’Ivoire, for example, IYCN brought together members of the nutrition community and those who support orphans and vulnerable children (OVC)—two groups with a limited history of collaboration—to develop nutrition guidance for OVC populations.

Lesson 2: Identify the need for change

Before embarking on a new policy, we work with ministry staff to establish the objectives for the change. As a first step, it is critical to determine how the policy change will specifically help the government achieve its goals.

In Côte d’Ivoire, the IYCN team researched the landscape of care for OVC and established objectives before convening stakeholders to develop and finalize OVC nutritional guidelines for health providers. IYCN conducted a literature review and analyzed health workers’ field experiences in working with OVC to formulate guidance that best meets the needs of the OVC population. Read more about IYCN’s policy work in Côte d’Ivoire.

New nutritional guidance from the World Health Organization (WHO) prompted change in Lesotho. After WHO released its 2006 guidelines on HIV and infant feeding, IYCN supported the Ministry of Health in revising its National Infant and Young Child Feeding Policy and its national guidelines for preventing mother-to-child transmission of HIV to reflect the new WHO guidelines. Once approved, the guidelines will form the basis for care and treatment nationwide.

After a country adopts a new policy, continue to address why it has changed when introducing it to health workers. When training health staff on the new guidelines, explain explicitly how they differ from earlier policies or practices.

Lesson 3: Consider the health worker’s experience

When a country changes or revises its nutrition policies, the new guidelines impact not just mothers and children but the health workers who disseminate nutritional information. These health workers must be able to explain to mothers why they are now giving them new advice, some of which may conflict with what they previously learned. To improve acceptance of new policies:

  • Provide health workers with tools and information to explain the changes to their patients and the benefits of the new information.
  • Acknowledge what the policy changes will mean programmatically for health workers, clinics, and patients.
  • Use national government trainers, rather than project staff, to roll out the new policy. These trainers can effectively speak to the old policy and provide a powerful endorsement for the new guidelines.

Some health workers may be relieved by a new policy that reinforces the information they have already shared with their patients, while others may be challenged to reconcile the new guidance with their previous training.

Country experiences

The following examples reflect IYCN’s experience supporting countries in addressing improved nutrition through new policies and guidelines.

Haiti: Providing clear guidance on infant feeding

Good infant feeding practices can reduce the likelihood of an HIV-positive mother passing the virus to her infant. But in Haiti, health workers lacked clear guidance and faced conflicting messages on both broad-scale and HIV-specific infant feeding, resulting in potentially harmful information for mothers. To help health workers effectively support their patients, IYCN worked with the Ministry of Health to draft national guidelines to improve nutrition for infants and young children. With the support and input of more than 100 partner organizations, the IYCN team created a 90-page guide that offers consistent messages on infant feeding for both HIV-positive and non-HIV populations. In July 2009, the Ministry of Health began introducing the guide to health workers across the country.

View Haiti’s national norms for safe feeding of HIV-exposed infants and young children (available in French only)

View IYCN’s Haiti Stakeholders’ Workshop Report on HIV and Infant Feeding (available in French only)

Read more about IYCN’s work in Haiti.

Madagascar: Breaking the cycle of maternal malnutrition

Babies born to malnourished mothers are more likely to suffer from malnutrition—a significant problem that, if not addressed, can be passed down through generations. IYCN collaborated with Madagascar’s Ministry of Health and other groups to create a national strategy that establishes priorities and key actions toward improving maternal nutrition. The new policy offers concrete guidance for government officials and nutrition partners. It is one of the first national action plans to address maternal nutrition.

Read more about IYCN’s work in Madagascar.

Côte d’Ivoire: Meeting the needs of OVC

Children orphaned by HIV or left vulnerable to the virus are particularly susceptible to malnutrition and childhood diseases. In 2008, IYCN collaborated with the Côte d’Ivoire government to develop a pocket-sized guide that provides enhanced nutrition guidance for addressing the nutritional needs of OVC. The guide offers specific recommendations for health workers and social workers to integrate support for OVC into larger HIV efforts across the country. To ensure the guide’s use, IYCN and our partners will develop training tools and conduct workshops for health providers about meeting the needs of OVC.

Read more about IYCN’s work in Côte d’Ivoire.