global health and wash working in maternal and child health, nutrition, hiv and aids, and water,...

Global Health and WASH

Working in maternal and child health, nutrition, HIV and AIDS, and water, sanitation and hygiene

World Vision’s “Timed and Targeted Counseling” Approach for Health and

Nutrition

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World Vision’s 7-11 strategy is based in part on a behavior

change communication approach recognizing that the practice of

key health and nutrition behaviors at the individual -

household level is fundamental to achieving improved maternal

and child outcomes.

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Targets

Pregnant Women: -9 months

Children: 0-24 months

Core interventions

1. Adequate Diet2. Iron/Folate Supplements3. Tetanus Toxoid

Immunization4. Malaria Prevention and

Intermittent Preventive Treatment

5. Healthy Timing and Spacing of Pregnancy and Birth Preparedness

6. De-worming7. Facilitate access to

Maternal Health Service: ANC PNC, Skilled Birth Attendance, PMTCT, HIV/STI/TB Screening

1. Appropriate Breastfeeding

2. Essential Newborn Care3. Hand Washing with soap4. Appropriate

Complementary Feeding (6-24 months)

5. Adequate Iron 6. Vitamin A

Supplementation 7. Oral Re-Hydration

Therapy/Zinc 8. Prevention & Care

Seeking for Malaria9. Full Immunization for Age10.Prevention & Care

Seeking for ARI11.De-worming (+12

months)

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Individual:TTC

Community

EnvironmentWhere does TTC fit in the overall 7-11 strategy?

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Timed and Targeted Counseling refers to a CHW/Volunteer approach to extending

primary health care counseling to the household level.

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What does this approach entail?

• Cadres of volunteers who can deliver TTC include CHWs, care group / women’s group volunteers or other existing health voluntary cadre.

• TTC home visitors make a series of visits to households where there are pregnant women, and through infancy, organizing all of the 7-11 messages to be communicated at the most appropriate times, using a counseling and dialogue-based approach.

• Caregivers are provided with information, counseling and support to promote practice of a host of critical health and nutrition-related behaviors.

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What does “Timed and Targeted” mean?

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PMTCT

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The TTC Package includes:Introductory Packageo TTC Programming

Guidelines (TTC Toolkit)

o CHW AIM Assessment Tool

Training TTC HVs & Job Aids

o Facilitators Manual for TTC

o TTC Workbook (for literate CHW / home visitors)

Visual AidsoTTC Job Aids: Flip-Book Stories (11 flip-book stories)•Household Handbooks (appx. 15 pages)Training of TrainersoTraining of Facilitator Guidelines/MaterialsoTraining of Trainers Guidelines/MaterialsOtheroData Collection and Monitoring SystemoSupervision Guide (in development)

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Standardized Counseling StepsStep 1: Review previous meeting and actions that the household agreed to try

Step 2: Problem Story and Guiding Questions (Guiding Qs lead users from analyzing as outsiders, to personalizing the issues)

Step 3: Positive Story and Guiding Questions (Guiding Qs lead users from understanding the benefits of the actions, to personalizing)

Step 4: Dialogue and “Negotiation”, using Household Handbook

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Stories at heart of counseling/dialogue• Stories written to cover all messages for each

household counseling visit

• Stories told through use of visuals

• Normally 1or 2 problem stories, and 1or 2 positive stories per visit

• A structured process for telling stories, asking Guiding Qs, praising existing behaviors, negotiating new behaviors

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Example Guiding Questions1. At the end of the story, Biba’s baby died. What

happened in the story that might have caused that?

2. Can you tell me about pregnant women in this area, about the work that they do and how much they push their bodies when they are pregnant? Is it similar to Biba’s situation, or different? How?

3. Is it common for people to sell nutritious crops because they need the money, instead of eating them? Explain.

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Thank You

• ttC/CHW evolved from USAID-funded Pragati Child Survival Project implemented in India (1998 and 2007)

• Drew on external resources: • WHO/UNICEF CHW Curricula (Caring

for the Newborn at Home and Counsel the Family on Feeding),

• American College of Nurse Midwives Home Based Life Saving Skills (counseling methodology),

• USAID/Health Care Improvement Project CHW-AIM (functionality assessment), and UNICEF Facts for Life

• Key contributors: Michele Gaudrault, Danielle Chekarou, Dan Irvine, and Fe Garcia

• M&E package and database – above authors and Beulah Jayakumar, Annette Ghee, and Polly Walker

• For more information: www.wvi.org/health