Spring Bangladesh Ena Case Study

IMPLEMENTING THE ESSENTIAL
NUTRITION ACTIONS FRAMEWORK

A CASE STUDY FROM BANGLADESH
OCTOBER 2011–2014
BACKGROUND
Since 2011, SPRING’s work in Bangladesh has aligned
with the Government of Bangladesh’s (GOB) National
Nutrition Strategy across different sectors—including
health, hygiene, and agriculture—to implement nutrition-
specific interventions through the Essential Nutrition
Actions (ENA) framework1 and to promote nutrition-
sensitive interventions through essential hygiene
actions (EHA), and by concentrating on homestead food
production (HFP). SPRING uses the 1,000-day approach
to improve the nutritional status of pregnant and
lactating women and children under the age of two, and
is currently working in 40 upazilas in Barisal and Khulna,
two USAID Feed the Future intervention divisions that
cover approximately 5.4 million people.
NUTRITION CONTEXT
Over the past few years, Bangladesh has made important
progress in improving the health of women and children.2
However, the 2011 Bangladesh Demographic and Health
Survey3 and the 2012 National Micronutrients Status
Survey4 confirmed the rampant poor nutrition profile in
the country. Women and children 0–23 months have high
malnutrition rates: under- and over-nutrition for women,
and stunting and wasting for children. Micronutrient deficiencies (vitamin A, iron, zinc, folate, and vitamin B12)
and anemia are high among women and children as well.
1
http://www.jsi.com/JSIInternet/Inc/Common/_display_related_objects.
cfm?thisSection=IntlHealth&thisSectionTitle=International%5EHealth&this- Consumption of calories, proteins, and micronutrients is
Page=techexpertise&ctid=1000&cid=83&tid=2010 below the recommended dietary allowance.
2
http://dhsprogram.com/Who-We-Are/News-Room/Marked-improvements-in-
BUILDING ON EXISTING
maternal-and-child-health-in-Bangladesh.cfm
3
National Institute of Population Research and Training (NIPORT), Mitra and
Associates, and ICF International. 2013. Bangladesh Demographic and Health
Survey 2011. Dhaka, Bangladesh and Calverton, MD: NIPORT, Mitra and Associ-
FOUNDATIONS
ates, and ICF International. http://dhsprogram.com/pubs/pdf/FR265/FR265.pdf
4
icddr,b, UNICEF/Bangladesh , GAIN, and IPHN. 2013. Bangladesh National SPRING builds on international experiences in several
Micronutrients Status Survey. 2011-12 Final Report. icddr, b: Bangladesh. http://
www.suncsa.org/downloads/Bangladesh%20National%20Micronutrient%20Sur-
sectors to design Bangladesh-specific interventions
vey%202013.docx and innovations by targeting health and agricultural
workers within the GOB and among nongovernmental results in a reduction in incidence of diarrheal diseases,
organizations to reach communities and individuals especially in young children.7
(especially pregnant women and new mothers) with
carefully targeted information on breastfeeding,
complementary feeding, and other ENAs. The EHA RESULTS TO DATE
framework and the basics of HFP were included in the
ENA training and support materials. These materials were Using the FNS to support HFP, combined with an
then adapted and tested in the local context. intersectoral promotion of ENA and EHA, SPRING has
introduced an innovative intervention where women can
Government staff from the upazila-level to community- learn in a participatory way. They gain important HFP
level health clinics were trained, and supportive skills and acquire nutrition and hygiene knowledge to
supervision and monitoring systems were put into place. influence positive behavior change, resulting in improved
Delivery of key nutrition services and messages were nutrition outcomes such as increased dietary diversity,
enhanced at all existing contact points in the health improved infant and young child feeding practices,
system, including the community outreach network, improved handwashing practices, and compliance with
where services already provide immunization and family micronutrient supplementations.
planning.
As of March 2014, 5,064 health workers have been
trained, 1,344,482 contacts have been made with women
on nutrition and hygiene information from providers,
155,128 household handwashing stations have been
established, and 77,564 pregnant and lactating women
and mothers of children under two have participated in
3,861 Farmer Nutrition Schools.
SPRING has also established community-based farmer

nutrition schools (FNS) to improve skills and provide
support in HFP5 (vegetable gardening, poultry rearing,
and fish production) targeting pregnant women and
mothers of children under the age of two from the
lowest wealth quintiles. The FNS model6 is a season-long
training activity that takes place in the field and consists
of a group of people with a common interest: they seek
to enhance the production capacity of their households
The USAID centrally-funded SPRING project (Strengthening
by making well-informed crop management decisions. Partnerships, Results, and Innovations in Nutrition Globally) is managed
By incorporating ENA and EHA through small doable by JSI Research & Training Institute, Inc.; Helen Keller International (HKI);
actions, FNS participants learn how to link their HFP with Save the Children (SC); The International Food Policy Research Institute
improved nutrition and hygiene practices. (IFPRI); and The Manoff Group.
To encourage handwashing and hygienic behaviors, For more information, please visit our website at: http://www.spring-
nutrition.org/about-us/field-offices/bangladesh.
SPRING promotes handwashing stations, introducing
“tippy taps” with water and soap. One tippy tap is set up Photos courtesy of Agnes Guyon, JSI
next to the toilet and another next to the kitchen; this
7
Kumar Biswas, Shwapon. 2012. “Uptake of Handwashing with Soap or Soapy
5
http://www.hki.org/working-worldwide/asia-pacific/bangladesh/ Water from a Large-Scale Cluster Randomized Community Trial in Urban Ban-
6
http://en.wikipedia.org/wiki/Farmer_Field_School gladesh.” icddr,b Health & Science Bulletin, 10 (4), pp. 9-15.

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IMPLEMENTING THE ESSENTIAL

NUTRITION ACTIONS FRAMEWORK

SPRING has also established community-based farmer

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