>>WELCOME TO THE THIRD AND
FINAL WEBINAR IN THE LESSONS
LEARNED FROM GLOBAL FOOD AND
NUTRITION INSECURITY WEBINAR
SERIES.
MY NAME IS SUSAN VORKOPER, AND
I'M WITH THE NIH FOGARTY
INTERNATIONAL CENTER.
>>AND I'M BRAMARAMBA WOWTHA.
THIS IS BUILT ON THE INVESTMENTS
THAT U.S. GOVERNMENT IS MAKING
IN FOOD NUTRITION INSECURITY
BOTH AT HOME AS WE SAW DURING
THE WHITE HOUSE CONFERENCE ON
FOOD NUTRITION AND HUNGER AND
ABROAD WITH THE RECENT PASSAGE
OF GLOBAL MALNUTRITION ACT.
THIS HIGHLIGHTS INNOVATIVE
RESEARCH PROJECTS ON NUTRITION
AND FOOD INSECURITY AND HEALTH
OUTCOMES IN GLOBAL SETTINGS AND
IDENTIFIES LESSONS LEARNED AND
OPPORTUNITIES FOR ADAPTATION IN
U.S. AND OTHER CONTEXTS.
OUR FIRST WEBINAR PROVIDED AN
OVERVIEW OF THE IMPACTS OF FOOD
AND NUTRITION INSECURITY ACROSS
THE WORLD IN VARIOUS AGE GROUPS
AND SETTINGS, INCLUDING THE
CONNECTION TO CHRONIC AND
INFECTIOUS DISEASES, AS WELL AS
SPECIFIC EXAMPLES OF
INTERVENTION RESEARCH THAT
PRESENT OPPORTUNITIES FOR
TRANSLATIONS AND ADAPTATIONS.
DURING OUR SECOND WEBINAR, WE
LOOKED AT THE ROLE THAT THE HOME
NEIGHBORHOOD AND COMMUNITY FOOD
ENVIRONMENTS PLAY IN FOOD
INSECURITY AND PROVIDES EXAMPLES
OF EFFECTIVE FOOD ENVIRONMENT
AND FOOD SYSTEM EXHIBIT VENGSESS
ACROSS MULTIPLE REGIONS.
THIS THIRD AND FINAL WEBINAR
TODAY FOCUSES ON IMPLEMENTATION
SCIENCE TO ADDRESS FOOD AND
NUTRITION INSECURITY.
AS YOU KNOW, IT IS A FIELD OF
RESEARCH THAT ADDRESSES
CHALLENGES AT THE INTERSECTION
OF RESEARCH AND PRACTICE AND
AIMS TO UNDERSTAND FACTORS THAT
INFLUENCE IMPLEMENTATION OF
PROVEN INTERVENTIONS IN REAL
WORLD SETTINGS.
IN TODAY'S WEBINAR, WE WILL
EXPLORE THE IMPLEMENTATION
SCIENCE METHODS AND APPROACHES
USED IN FOOD AND NUTRITION
INSECURITY RESEARCH AND PROVIDE
EXAMPLES OF GLOBAL FOOD
INSECURITY INNOVATION THAT HAS
BEEN ADAPTED ACROSS SETTINGS.
AND WE WILL END WITH A DYNAMIC
DISCUSSION ON HOW IMPLEMENTATION
SCIENCE CAN CONTRIBUTE TO
LONG-TERM SUSTAINABILITY OF FOOD
AND NUTRITION SECURITY
INNOVATIONS.
SUSAN?
>>SO THIS WEBINAR SERIES IS
MADE POSSIBLE THROUGH
PARTNERSHIPS WITH NIH'S OFFICE
OF DISEASE PREVENTION, OFFICE OF
NUTRITION RESEARCH, THE NATIONAL
CANCER INSTITUTE, THE NATIONAL
HEART, LUNG, BLOOD AND SLEEP
INSTITUTE AND THE NATIONAL
INSTITUTE FOR CHILD HEALTH AND
HUMAN DEVELOPMENT, AS WELL AS
USAAD AND CDC, TO DEVELOP THIS
THREE-PART SERIES.
WE WELCOME QUESTIONS FROM THE
AUDIENCE TO ASK QUESTIONS, CLICK
ON THE "SEND LIVE FEEDBACK"
BUTTON DIRECTLY BELOW THIS
VIDEO.
I'LL INTRODUCE YOU TO OUR FIRST
SPEAKER AND THE LEAD FOR THIS
WEBINAR, PROFESSOR AND DIRECTOR
OF GLOBAL HEALTH INITIATIVES AT
THE UNIVERSITY OF SOUTH CAROLINA
AND PRESENT OF THE SOCIETY FOR
IMPLEMENTATION SCIENCE AND
NUTRITION.
ED?
>>THANK YOU, SUSAN.
SO I'M PLEASED TO BE WITH YOU
THIS AFTERNOON TO DISCUSS
IMPLEMENTATION SCIENCE IN
NUTRITION.
SO I'M GOING TO START WITH THE
IDEA THAT IN ORDER TO TAKE
STRATEGIC ACTIONS FOR IMPROVING
NUTRITION AND HEALTH, IT'S
USEFUL TO THINK ABOUT TOLEDO
MAINS, ABOUT A BIOLOGICAL AND
EPIDEMIOLOGICAL DOMAIN, A
SOCIAL, POLITICAL AND POLICY
DOMAIN AND IMPLEMENTATION.
SO WE HAVE, IN NUTRITION, WELL
OVER 100 YEARS NOW OF DEVELOPING
THE SCIENCE, THE BIOLOGICAL
SCIENCE OF NUTRITION, THE SOCIAL
AND POLITICAL AND POLICY DOMAIN
REALLY HAS STARTED BEING APPLIED
AS A SCIENCE AND NUTRITION MUCH
LATER, MAYBE OVER THE LAST 20 TO
25 YEARS, AND IMPLEMENTATION
SCIENCE AND NUTRITION IS NASCENT
IN COMPARISON TO THESE.
SO WHY IMPLEMENTATION SCIENCE?
SPECIFIC INTERVENTIONS WE KNOW
CAN BE EFFECTIVE AT LOW COST AND
RELATIVELY CONTROLLED
ENVIRONMENTS AND SHORT TERM
STUDIES OR ON SMALL SCALES, BUT
WHAT ABOUT AT LARGE SCALES, SO
WE CAN REALLY IMPACT THE
PUBLIC'S HEALTH, WE NEED TO HAVE
STRONG AND RESPONSIVE SYSTEMS
THAT IMPLEMENT THESE
INTERVENTIONS THAT PROMOTE
HEALTH AND WELL-BEING THROUGH
SUSTAINABLE STRATEGIES THAT WORK
ON A LARGE SCALE IN THE REAL
WORLD, IN ORDER TO ADDRESS
ISSUES LIKE MALNUTRITION AND
POOR HEALTH IN ALL ITS FORMS,
AND THE NEED TO WORK THROUGH
MULTIPLE SYSTEMS SUCH AS
AGRICULTURE, FOOD, EDUCATION,
AND HEALTH.
WE HAVE SOME PROVEN
INTERVENTIONS, BUT THEIR
EFFECTIVE IMPLEMENTATION IS
REQUIRED IN ORDER TO REACH THE
SUSTAINABLE DEVELOPMENT GOALS
AND TO MEET NATIONAL COMMITMENTS
FOR UNIVERSAL HEALTH COVERAGE
AND OTHER NATIONAL GOALS IN ALL
COUNTRIES INCLUDING THE U.S.
SO WHAT'S THE NEED?
ONE WAY TO THINK ABOUT THE NEED
IS THAT WE HAVE TO FOCUS ON,
REFOCUS ON IMPLEMENTATION
INTERVENTIONS AND NOT JUST THE
INTERVENTION IMPACTS OF
IMPLEMENTATION, NOT JUST ON
EVALUATION, BUT ON STUDY
IMPLEMENTATION ITSELF.
MORE STUDY OF IMPLEMENTATION
WHERE IT'S THE MAIN OUTCOME OF
THE STUDY IN TERMS OF
FEASIBILITY, ADOPTION,
ACCEPTANCE, QUALITY, EQUITY,
EFFICIENCY, SCALE,
SUSTAINABILITY, ET CETERA.
, THAT WE CONSIDER DIFFERENT
PHASES OF IMPLEMENTATION AND NOT
JUST IMPLEMENTATION EXAMINATION
THAT OCCURS NESTED WITHIN
PROCESS OR LONG TIRM IMPACT
EVALUATIONS, AND THAT WE
DETERMINE WHAT EFFECTS
IMPLEMENTATION QUALITY ACROSS
MULTIPLE DOMAINS AND HOW TO
IMPROVE THAT.
SO SOME EXAMPLE QUESTIONS FOR
IMPLEMENTATION SCIENCE, THESE
WERE GENERATED BY A DISCUSSION
COMING OUT OF THE -- AT THE END
OF THE 12 YEARS OF THE ALIVE AND
THRIE PROGRAM, AND THINKING
ABOUT GOING ACROSS THE ENTIRE
PORTFOLIO IN MANY COUNTRIES
DURING THAT TIME THAT THE
EVALUATION TEAM WAS THINKING
ABOUT, OKAY, WHAT ARE THE BIG
QUESTIONS THAT WE NEED TO
ANSWER?
SO WE CAME UP WITH QUESTIONS
SUCH AS, HOW CAN PROGRAMMING BE
INTEGRATED INTO AND STRENGTHEN
EXISTING SYSTEMS AND PLATFORMS,
HOW CAN DATA AND IMPLEMENTATION
LEARNING BE USED TO IMPROVE
IMPLEMENTATION QUALITY,
COVERAGE, EQUITY OF SERVICES,
AND WHO'S ACCOUNTABLE WHEN IT
DOESN'T GO RIGHT?
WHAT CONDITIONS AND STRATEGIES
AND METHODS ARE NEEDED TO ENABLE
COUNTRY-LEVEL SCALE-UP, HOW DOES
ONE MOTIVATE INDIVIDUALS TO
ADOPT AND SUSTAIN BEHAVIOR
CHANGE, BEING PROMOTED BY
INTERVENTIONS THAT WE BELIEVED
WILL WORK?
HOW CAN CAPACITIES,
CAPABILITIES, MOTIVATION AND
PERFORMANCE OF FRONTLINE WORKERS
BE IMPROVED?
AND HOW CAN PROGRAMS BE
SUSTAINED AT MULTIPLE LEVELS,
COMMUNITY, PROGRAM AND
INSTITUTION?
WE ORGANIZED TWO WORKSHOPS IN
2019, ONE AT THE AMERICAN
SOCIETY FOR NUTRITION MEETING
AND ONE AT THE A & H ACADEMY
WEEK, AND IT WAS STRIKING THAT
THE WORKSHOP PARTICIPANTS IN
BOTH WORKSHOPS IDENTIFIED SOME
CHALLENGES THEY SAW WITH
IMPLEMENTATION SCIENCE AS
APPLIED TO NUTRITION.
LITTLE AGREEMENT REGARDING
DEFINITIONS, METHODS AND
CURRICULA, THE GOVERNMENTS AND
DONORS TYPICALLY FOCUS ON
END-LINE RESULTS AND DON'T VALUE
ACHIEVING IMPLEMENTATIONS AND
OUT COME, THUS LIMITING FUNDING
OPPORTUNITIES.
OBVIOUSLY THAT'S CHANGING, WHICH
IS WHY WE'RE HAVING THIS
WEBINAR, AND WE'RE GRATEFUL FOR
THAT.
INFREQUENTLY BUILT INTO PROGRAMS
AND STUDIES, BEING UNDERVALUED
IN ACADEMIA, NOT WIDELY SHARED
AND DISSEMINATED AT CONFERENCES.
THAT'S ALSO CHANGING.
THAT IT WAS CHALLENGING TO REACH
AND ENGAGE WITH NUTRITION
PRACTITIONERS, A LACK OF
CONCEPTUAL COHESION AROUND
IMPLEMENTATION AS AN OBJECT OF
STUDY, AND THE TENDENCY TO
DESCRIBE IMPLEMENTATION SCIENCE
IN TERMS OF METHODS RATHER THAN
STARTING WITH THE QUESTIONS
ASKED, THE ISSUES RAISED AND THE
CONTRIBUTIONS TO MAKE.
AND SO ANDREA WARREN, WHO'S HERE
ON THE CALL, IS A PANELIST, HOOE
TOOK WHAT WE LEARNED FROM THESE
WORKSHOPS AND TRIED TO FIND A
PATH FORWARD.
ONE OF THE THINGS THAT -- ONE OF
THE WAYS IN WHICH WE THOUGHT IT
WAS IMPORTANT TO GO FORWARD WAS
TO RECOGNIZE THE IMPORTANCE OF
BOTH DISCOVERY AND MISSION
ORIENTATIONS, THAT
IMPLEMENTATION SCIENCE HAS TO
CREATE QUESTIONS, WHERE WE SEEK
TO CREATE A RESERVOIR OF
JEBIZEED KNOWLEDGENERALIZED -- E
SEEKING TO CREATE KNOWLEDGE TO
HELP ACCOMPLISH A VERY SPECIFIC
OBJECTIVE IN FRONT OF US.
SO THAT MEANS THAT
IMPLEMENTATION SCIENCE QUESTION
SHOULD BE INSPIRED BY THEIR
USEFULNESS BUT NOT NECESSARILY
LIMITED TO ONES THAT HAVE
IMMEDIATE USE.
WE ALSO FOUND THAT A LOT OF THE
CONFUSION CAME ABOUT BECAUSE
THERE WERE THREE DISTINCT
PERSPECTIVES BEING DISCUSSED
ABOUT IMPLEMENTATION SCIENCE AND
NUTRITION AND OFTEN HAD PEOPLE
TALKING PAST EACH OTHER.
SO ONE OF THOSE PERSPECTIVE WAS
A BIOMEDICAL ONE WHERE THE
STARTING POINT IS THE NEED TO
TRANSLATE BASIC BIOMEDICAL
SCIENCE INTO PRACTICE, SOMETHING
THAT'S VERY IMPORTANT TO DO, AND
ITS PURPOSE IS TO IDENTIFY,
UNDERSTAND AND DEVELOP
STRATEGIES FOR OVERCOMING
BARRIERS TO THE ADOPTION,
ADAPTATION, INTEGRATION,
SCALE-UP AND SUSTAINABILITY OF
INTERVENTIONS, TOOLS, POLICIES
AND GUIDELINES THAT WE BELIEVE
WORK FROM THE INVESTIGATION
THAT'S BEEN DONE, AND TO ALSO
UNDERSTAND WHEN DO WE STOP
IMPLEMENTING INTERVENTIONS THAT
ARE INEFFECTIVE, UNPROVEN, LOW
VALUE OR HARMFUL?
DISTINCT FROM THAT WAS A PROGRAM
OR POLICY PERSPECTIVE WHERE THE
STARTING POINT WAS TO IMPROVE
IMPLEMENTATION OF A PROGRAM OR
POLICY WHICH WE FOUND
DE-EMPHASIZES DISCOVERY-ORIENTED
SCIENCE SINCE IT'S PRIMARILY
MISSION-ORIENTED, SO HERE THE
PURPOSE IS TO IDENTIFY AND
ADDRESS IMPLEMENTATION
BOTTLENECKS, IDENTIFY, EVALUATE
AND SCALE UP IMPLEMENTATION
INNOVATIONS AND ENHANCE THE
UTILIZATION OF EXISTING
KNOWLEDGE AND TOOLS AND
FRAMEWORKS BASED ON THE EVOLVING
SCIENCE.
AND THEN FINALLY, HEALTH SYSTEMS
PERSPECTIVE AS AT THE STARTING
POINT UNDERSTANDING SYSTEM
FUNCTIONING AND ALIGNMENT AND
ARTICULATION WITHIN AND BETWEEN
THE DIFFERENT SEMI SYSTEMS THAE
INVOLVED.
SO HERE THE PURPOSE IS TO
UNDERSTAND HOW HEALTH
INTERVENTIONS WORK OUT THERE IN
THE REAL WORLD IN REAL SYSTEMS,
TO CAPTURE AND ANALYZE
INFORMATION AND TO HELP
ORGANIZATIONS DEVELOP CAPACITY
TO LEARN FROM IMPLEMENTATION SO
THERE'S AN ITERATIVE PROCESS OF
KNOWLEDGE GENERATION AND USE.
SO BASED ON ALL OF THIS, WE
DEFINED IMPLEMENTATION SCIENCE
AS A BODY OF SYSTEMATIZED
KNOWLEDGE, THAT'S WHAT A SCIENCE
IS, ABOUT HOW TO IMPROVE
IMPLEMENTATION, AND THAT
IMPLEMENTATION SCIENCE RESTS ON
THREE PRINCIPLES.
ONE IS THAT IT'S DISTINGUISHED
BY ITS AIM TO LEARN ABOUT THE
PROCESS OF IMPLEMENTATION, NOT
NECESSARILY TO JUDGE WHETHER
THERE'S BEEN IMPACT, THAT'S A
VALUATION, BUT HERE TO FOCUS ON
THE PROCESS OF IMPLEMENTATION,
TO ADOPT METHODS THAT DERIVE
FROM AND FIT WITH THE AIMS THAT
HAVE BEEN ARTICULATED, AND TO
RECOGNIZE THAT IMPLEMENTATION
SCIENCE IS BUILT WITH TACIT AS
WELL AS EXPERT KNOWLEDGE AND
EXPERIENTIAL LEARNING FROM
STAKEHOLDERS, SYSTEMS, PROVIDERS
AND RECIPIENTS AS WELL AS
SCIENTISTS.
SO I WANTED TO GIVE AN EXAMPLE.
TATIANA MARTINEZ LED THE
DEVELOPMENT OF AN INTERVENTION
IN COSTA RICA THAT HAD THE AIM
TO BOTH REDUCE DISCOURAGEMENT IN
FOOD INSECURITY BUT ALSO PREVENT
EXCESS WEIGHT GAIN.
SO THIS IS A CLUSTER RA RANDOMID
DESIGN WHERE THERE WAS AN
INTERVENTION ARM COMPARED TO --
THAT WAS INTENSIVE COMPARED TO A
NON-INTENSIVE ARM AND THEN A
FOLLOW-UP WAS DONE SIX MONTHS
LATER.
THE EVALUATION SHOWED CLEARLY
THAT THERE WAS A REDUCTION IN
OVERWEIGHT MORE IN THE
INTENTATIVE ARM, HOWEVER IT WAS
MEASURED, THAT FOOD INSECURITY
WAS REDUCED, THAT THERE WAS AN
INCREASE IN PSYCHOLOGICAL
EMPOWERMENT, AN INCREASE IN
CONTRIBUTION TO HOUSEHOLD
SUPPORT FROM WOMEN, THAT MORE
WOMEN FOUND A JOB, MORE WOMEN
USED THE EMPLOYABILITY AND
WOMEN'S OFFICES IN THE CITY OF
ALOALA, WHERE THE STUDY WAS
DONE, AND THE WOMEN HAD GREATER
FAVORABLE CHANGES IN FOOD
CONSUMPTION IN THE INTENSIVE
ARM.
SO THE QUESTION IS, HOW DID THIS
HAPPEN?
TWO PREVIOUS STUDIES THAT WERE
RANDOMIZED, ONE IN MEXICO AND
ONE NA GUATEMALA, IN TRYING TO
IMPROVE FOOD SECURITY, HAD
ACTUALLY RESULTED IN AN INCREASE
IN WEIGHT IN WOMEN SO THIS STUDY
ACHIEVED THE OPPOSITE.
SO IMPLEMENTATION SCIENCE WAS
CRUCIAL HERE.
THERE WAS PREVIOUS QUALITATIVE
WORK THAT MARTINEZ LED WHICH
SHOW THAT DISCOURAGEMENT IS WHAT
LINKED FOOD INSECURITY AND
EXCESS BODY WA WEIGHT AMONG COSA
RICAN WOMEN, THAT FAMILY AND
EXISTING GENDER NORMS
CONTRIBUTED TO AND COMPOUND IN
COEXISTENCE, THAT HOUSEHOLD
RESPONSIBILITIES PREVENT WOMEN
FOR ASSUMING OTHER OPPORTUNITIES
IN SOCIETY AND OPPORTUNITIES FOR
SELF-CARE, AND THESE TOGETHER
AFFECTED WOMEN'S PHYSICAL AND
MENTAL HEALTH THROUGH
PSYCHOLOGICAL DISEMPOWERMENT AND
DISCOURAGEMENT.
SO SHE LED A GROUP, A
PARTNERSHIP OF HER SCHOOL OF
NUTRITION AT THE UNIVERSITY OF
COSTA RICA, THE WOMEN'S OFFICE
AND ALOWELA, WHICH IS THE SECOND
CITY IN COSTA RICA, AN NGO
FOCUSING ON WOMEN'S WELL-BEING,
THE EMPLOYABILITY OFFICE AND THE
UNIVERSITY OF SOUTH CAROLINA,
AND CONDUCTED -- SHE AND HER
COLLEAGUES CONDUCTED
IMPLEMENTATION RESEARCH AT
MULTIPLE LEVELS.
SO THIS WAS AT THE WOMEN'S EAFL,
THE HOUSEHOLD OR FAMILY LEVEL,
THE HEALTH CENTER LEVEL, AND THE
COMMUNITY LEVEL, USING A NUMBER
OF DIFFERENT METHODS, DID
EXTENSIVE TESTING OF
IMPLEMENTATION COMPONENTS, AND
GATHERED INFORMATION ABOUT THE
IMPLEMENTATION THROUGHOUT THE
INTERVENTION THAT COULD BE FED
BACK TO IMPROVE THE
IMPLEMENTATION AS IT WENT.
I WAS IN COSTA RICA AT THE END
OF SEPTEMBER AND ATTENDED ONE OF
THE WOMEN'S GROUPS.
THE PROGRAM IS NOW SUSTAINED
OVER TIME BY THE WOMEN'S OFFICE,
OVER THE LAST FOUR YEARS, AND
THE WOMEN'S GROUP WAS JUST
WONDERFUL.
IT WAS JUST VERY INSPIRING TO
HEAR WOMEN TALKING ABOUT HOW
WHAT THEY WERE LEARNING THERE
AND THE WAY IN WHICH THEY WERE
ABLE TO SUPPORT EACH OTHER WAS
ABLE TO OVERCOME THE ISSUES THAT
HAD BEENLYING THEM TO
DISSCOURGEMENT AND PREVENTING
THEM FROM ACHIEVING FOOD
SECURITY AND CONTROLLING WEIGHT.
SO FINALLY, WE KNOW THAT THE
BIOMEDICAL TRANSLATIONAL MODEL
OF GETTING INFORMATION FROM THE
LABORATORY, FROM BENCH SCIENCE
OUT INTO COMMUNITIES TAKES 15 TO
20 YEARS, AND THAT RESEARCH
EFFORT IS CRUCIAL.
BUT WE ALSO KNOW IF WE'RE GOING
TO AFFECT PUBLIC HEALTH AND
PUBLIC NUTRITION IN A SHORTER
AMOUNT OF TIME, WE HAVE TO HAVE
OTHER MODELS TO GO FORWARD.
SO TODAY WE'RE GOING TO HEAR
ABOUT TWO EXAMPLES.
ONE FROM ESIAN IN MEXICO AND ONE
FROM ALIVE & THRIVE, INITIATIVES
THAT DEMONSTRATE AN ALTERNATIVE
MODEL FOR BEHAVIORAL
INTERVENTIONS WHERE THEY BROUGHT
TOGETHER BRIGHT, COMMITTED AND
TALENTED PEOPLE OUTSIDE AND
WITHIN THE COUNTRIES TO TRY TO
MAKE A DIFFERENCE AT LARGE SCALE
IN A RELATIVELY SHORT PERIOD OF
TIME, WHERE THE INTENTION,
COMMITMENT AND PLANNING TO DO
THAT WAS THERE FROM THE OUTSIDE,
AND IN BOTH OF THESE EXAMPLES,
REQUIRED IMPLEMENTATION SCIENCE
AND WE LOOK FORWARD TO HEARING
MORE DETAILS ABOUT THAT FROM OUR
NEXT TWO SPEAKERS.
SO OUR NEXT PRESENTER IS
ANNABELLE, DIRECTOR OF RESEARCH
IN NUTRITION POLICIES AND
PROGRAMS IN THE CENTER FOR
RESEARCH AND NUTRITION AND
HEALTH AT THE NATIONAL INSTITUTE
OF PUBLIC HEALTH IN MEXICO.
SO THANK YOU, ANNABELLE, FOR
JOINING US TODAY.
>>THANK YOU, ED.
GOOD AFTERNOON, AND THANKS TO
THE ORGANIZERS FOR INVITING ME
TO SHARE OUR EXPERIENCE.
TODAY I WILL PRESENT AN EXAMPLE
AS ED SAID OF USING A
COMPREHENSIVE RESEARCH APPROACH
THAT WE APPLIED TO SUPPORT A
LARGE SCALE PROGRAM IN MEXICO.
CALLED ESIAN.
SO THE ESIAN STRATEGY WAS ONE OF
THE INNOVATIONS OF SEVERAL
INNOVATION RESEARCH APPLIED TO
THE HEALTH AND NUTRITIONAL
COMPONENT OF A LARGE SCALE
PROGRAM TO IMPROVE PUBLIC
SERVICE UTILIZATION ACROSS THE
HEALTH AND -- SECTORS IN
NUTRITION.
INITIALLY THE PROGRAM WAS CALLED
PROGRESA, IN A LIMITED NUMBER OF
AREAS IN 2002.
THEN IT WAS EXPANDED, AND AT THE
END, AFTER 20 YEARS OF
IMPLEMENTATION, IT WAS SCALED UP
TO MORE THAN 6.1 MILLION
FAMILIES.
WL PROSPERA, THE FAMILIES WERE
PROVIDED WITH AN ECONOMIC
INCENTIVE, TO BE USED FOR THE
PREVENTION OF HEALTH SERVICES.
AS FOR INSTANCE, WOMEN WERE
REQUIRED TO REGULARLY ATTEND AND
TAKE THEIR CHILD TOLL A REGULAR
WELL CHILD CLINIC AS WELL AND
OBTAIN HEALTH WORKSHOP.
THE PROGRAM ALSO PROVIDED
MULTIPLE MICRO NUTRIENT
SUPPLEMENTS DURING THE PREGNANCY
AND UP TO ONE YEAR OF POSTPARTUM
AS WELL AS TWO CHILDREN FROM
6 MONTHS TO 5 YEARS OF AGE.
DURING THE 20 YEARS THAT WE HAD
THE PROGRAM, SEVERAL DIFFERENT
SUPPLEMENTS WERE PROVIDED.
SO RIGOROUS EVALUATION SHOWED A
POSITIVE IMPACT ON PATIENT
OUTCOMES BUT ALSO SUBSTANTIAL
GAPS IN ADDRESSING NUTRITION.
NUTRITION PROGRAMS.
FIRST WE HAVE A RESULT FROM
URBAN AND RURAL AREAS FROM
MEXICO.
THEN WE'LL DEMONSTRATE THIS
PROGRAM HAS POSITIVE IMPACT ON
LINEAR GROWTH.
CHILDREN FROM THE POOREST
BENEFICIARIES GREW 1 CENTIMETER
MORE THAN CHILDREN IN PAIR SON
FAMILIES, ESPECIALLY IN THE
FIRST MONTH OF LIFE, HOWEVER,
WHETHER THIS IMPACT WAS ENOUGH
OR SUFFICIENT GIVEN THE PROGRAM
DESIGN AND INVESTMENT.
AND ALSO IF THE IMPACT WAS LARGE
ENOUGH TO ACCOMPLISH OR TO
CONTRIBUTE TO THE ACHIEVEMENT OF
THE PROGRAM'S FINAL GOALS THAT
WAS IMPROVE THE HUMAN CAPITAL.
SOs THERE WAS ALSO A 10%
DECREASE IN THE PREVALENCE OF
ANEMIA IN RURAL AREAS AND SOME
EVIDENCE OF IMPACT IN A SMALL
YOSUBSAMPLE OF CHILDREN IN RURAL
AREAS, ESPECIALLY IN THOSE 6 TO
36 MONTHS OF AGE.
BUT DESPITE THIS POSITIVE
IMPACT, A HIGH PREVALENCE OF
MALNUTRITION PERSISTS IN THE
POPULATION.
THE SERVICE IMPROVED BUT THE
QUALITY OF CARE WAS LUCKY.
THE CONCEPTION OF THE --
LACTATING WOMEN WAS IRREGULAR,
BUT THE PATTERN OF THE YOUTH
WOULD LIMIT IN FREQUENCY AND
QUANTITY CONSUMED.
THEN SUBSTANTIAL DIVERSITY OF
THE PREVALENCE OF MALNUTRITION
WAS DOCUMENTED OR MALNUTRITION
IN THIS CASE UNDER NUTRITION
SPECIFICALLY, AND WAS
INCREASED -- THERE WAS AN
INCREASE OF THE RISK OF
OVERWEIGHT AND OBESITY AMONG
WOMEN.
SO THIS LEADS TO A SERIES OF
ANALYSIS, THE EVALUATION OF THE
DATA AND SEVERAL COMPLEMENTARY
STUDIES TO EXPLORE IN DEPTH THE
QUALITY OF IMPLEMENTATION AND
THE ADEQUACY OF THE DESIGN FOR
THE CONTEXT IN VARIOUS SUBGROUP
OF THE IMPLEMENTATION, AND ALSO
MEASURE OF THE INTERMEDIATE
RESULTS.
SO HERE WE HAVE THE STUDIES
CONDUCTED.
SO THE REVIEW OF THE PROGRAM
IMPACT PATHWAY, WE HIGHLIGHT
SEVERAL GAPS IN THE DESIGN OF
THE PROGRAM FOR SOME GROUP OF
POPULATION AND THE QUALITY OF
THE IMPLEMENTATION.
DESPITE THAT SUPPLEMENTS WERE
HIGH IN QUALITY, THERE WERE VERY
HIGH QUALITY -- AND WERE
ACCEPTED BY THE POPULATION.
THEIR USE, HOWEVER, WAS NOT
ALIGNED WITH THEIR
RECOMMENDATION.
LIKELY BECAUSE OF SEVERAL
FACTORS INCLUDING INADEQUATE
PROMOTION, WHICH RELATES TO THE
SECOND GAP THAT WAS IDENTIFIED
THAT WAS POOR QUALITY OF THE
DESIGN AND IMPLEMENTATION OF THE
COMMUNICATION STRATEGY.
AND ALSO WE HAD A COMMON DESIGN
ACROSS REGIONS THAT THIS WAS NOT
WELL TREATED TO THE SPECIFIC
NEEDS OF SOME OF THE POPULATION
AS WE WERE COMMENTING.
SO THIS TRIGGERED ADDITIONAL
STUDIES, ALSO TO IMPROVE THE
COMMUNICATION COMPONENT THAT
SEVERAL BARRIER LIMITATION WERE
IDENTIFIED BEFORE AND TO EXPLORE
THOSE FACTORS THAT MAY HAVE
INFLUENCED THE PROGRAM
ACCEPTANCE AND USE.
ONE OF THESE STUDIED WAS AN
EFFICACY STUDY THAT WE CONDUCTED
IN CHILDREN, WOMEN AS WELL BUT
PRESENTED RESULTS FROM CHILDREN
AND WE USED THREE TYPES OF
SUPPLEMENT WITH IDENTICAL --
THAT WAS PROVIDED BY THE
PROGRAM.
THE RESULTS INDICATE THE MICRO
NUTRIENT SUPPLEMENT WAS --
COMPLEMENTARY FOOD WITH LOWER
COST AND HIGHER POTENTIAL TO
REACH THE TARGET POPULATION.
AND ALSO THAT WE NEED AN
INTEGRATED APPROACH AND A
STRATEGY JUST FOCUSED ON A MICRO
NUTRIENT SUPPLEMENTS.
THOSE CONCRETE RECOMMENDATIONS
WERE MADE TO THE PROGRAM'S
IMPLEMENTERS TO FORMULATE A
NUTRITION COMPONENT THROUGH THE
STRATEGY WE ALREADY COMMENT AND
NOW THE STRATEGY WAS FOCUSED ON
THE 1,000 DAYS TO ADDRESS THE
TREATMENT BURDEN OF
MALNUTRITION, UNDERNUTRITION,
MICRO DEFICIENCIES AND OBESITY
TO INCORPORATE DOUBLE DUTY
ACTIONS OF PROVEN EFFICACIES AND
TO CHANGE IN A DIFFERENT FORMAT
FOR RURAL AND URBAN GROUPS.
FOR RURAL, WE CONTINUE TO
PROVIDE THE FORTIFIED FOOD, AND
THEN WE ADD MICRO NUTRIENT
POWDERS, AND FOR CHILDREN IN --
WE JUST PROVIDE POWDERS.
FOR LACTATING WOMEN WE CHANGE
TO -- WITH A SPECIFIC
FORMULATION FOR MEXICO.
SO AFTER THE ASSESSMENT OF ALL
THE -- HERE WE HAVE THE PROGRAM
THEORY OF A STRATEGY, BUT I WILL
FOCUS MORE ON THE PROCESS.
AFTER THE ASSESSMENT OF THE
INFORMATION THAT WAS AVAILABLE
FOR PREVIOUS STUDIES AND
EVALUATION WE PRESENT BEFORE, WE
CONDUCT FORMATIVE RESEARCH TO
GUIDE THE DESIGN OF THE
STRATEGY.
TYPICAL INFORMATION FOR MATERNAL
INFANT FEEDING AND SERVICES
DELIVERED WAS COLLECTED, AND
SOME KEY DECISIONS WERE TAKEN
BASED ON THESE RESULTS.
FIRST IT WAS NECESSARY TO
INTEGRATE THE EVIDENCE-BASED
NUTRITION INTERVENTION INTO THE
PRIMARY HEALTHCARE SERVICES,
INCLUDING FOR INSTANCE GROWTH
MONITORING AND COUNSELING.
WE NEED TO HAVE ACHIEVED FROM
A -- APPROACH TO A PREVENTIVE
APPROACH, WE NEED TO START
UPDATING AND STANDARDIZING
INFORMATION THAT HEALTH WORKERS
PROVIDE, IMPROVE THEIR PRACTICE
AND THE QUALITY OF THE
INTERACTION THEY HAVE WITH THE
MOTHERS.
AND THEN IT WAS EVIDENT THAT WE
NEED TO DEVELOP A BUSINESS
STRATEGY TO APPROACH ALL THE
BARRIERS WE IDENTIFIED, AND WE
DID SO ASSIGNING DIFFERENT ROLES
FOR DIFFERENT HEALTH WORKERS AND
COMMUNITIES HEALTH VOLUNTEERS,
AND DEVELOPING MATERIALS TO
IMPROVE THEIR ACTIVITIES.
ISO THE DEVELOPING STRATEGY IN
FOUR STATES OF THE COUNTRY AND
WAS EVALUATING WITH EXPERIMENTAL
DESIGN USING MIXED METHOD
APPROACH.
IT SHOWED POSITIVE RESULTS IN
DIFFERENT OUTCOMES, INCLUDING
SIGNIFICANT DIFFERENCE IN
COUNSELING OF BREASTFEEDING AND
COMPLEMENTARY FEEDING, AND ALSO
IN ANEMIA REDUCTION, ESPECIALLY
IN RURAL AREAS AS WE SEE IN THE
GRAPH.
SO IN ADDITION, THIS PILOT STUDY
WAS QUITE IMPORTANT TO HIGHLIGHT
SEVERAL CHALLENGES THAT COULD
AFFECT IMPLEMENTATION AT LARGE
SCALE.
AND SOME OF THE MOST RELEVANT
WERE THE HIGH TURNOVER OF THE
HEALTH PERNE PERSONNEL, ESPECIAY
PHYSICIANS, THE -- OF TRAINING
AND THE LACK OF ACCOUNTABILITY,
THERE WAS NOT A MONITORING AND
SUPERVISION SYSTEM, AND LACK OF
VALIDATION OF THE COMMUNICATION
MATERIAL.
SO WE DID SEVERAL ADJUSTMENTS TO
OVERCOME THIS PROBLEM, INCLUDING
THE DEVELOPMENT OF A
COMPUTER-BASED TRAINING SYSTEM
ONLINE AND OFFLINE, AND
MONITORING AND SUPERVISION
SYSTEM.
AND OF COURSE THE COMMUNICATION
MATERIAL WERE VALIDATED AND WERE
FORMULATED BEFORE THEY WERE
SCALING UP.
SO THE STRATEGY WAS SCALE UP AND
THE TRAINING REACHED ALMOST
200,000 PHYSICIAN AND NURSES
THAT PROVIDE SERVICES TO THE
POPULATION.
THIS WAS INTEGRATED IN THE
PRIMARY HEALTHCARE SERVICES, IT
WAS ADOPTED INTO THREE OF THE
CRITICAL HEALTH -- WORKFORCE AND
FINANCING.
AND THE KEY ASPECT THAT WE
IDENTIFY FOR SCALE-UP AND AT A
NATIONAL LEVEL AND TO ENSURE
FUNDS FOR IMPLEMENTATION, AS
MENTIONED, A SCALE-UP MINDSET
FROM THE BEGINNING OF THE
PROGRAM, AND WE WERE -- SCALING
UP.
THE IMPLEMENTATION RESEARCH WITH
A MIXED METHOD APPROACH THROUGH
THE LIFE OF THE PROGRAM YEN RATE
EVIDENCE FOR THE SCALING UP AND
FOR MAINTAINING THE PROGRAM
THROUGH THE 20 YEARS.
THE POLITICAL WILL MOMENTUM AND
A SYSTEMATIC COORDINATION
THROUGH A NATIONAL COORDINATION
OF THE PROGRAM WAS ALSO A KEY
ASPECT FOR SCALING UP.
AND MOST IMPORTANT, THE ENABLING
ENVIRONMENT FOR USE OF THE
EVIDENCE FROM THE IMPLEMENTATION
SCIENCE TO IMPROVE DESIGN AND
IMPLEMENTATION THROUGH THE LIFE
OF THE PROGRAM, TO ENSURE THE
COMMITMENT FOR MOVING FROM THE
PILOT STUDY AND FOR SCALING UP
TO NATIONAL LEVEL, AND TO ENSURE
THE FUND FOR DESIGNING
IMPLEMENTATION AND EVALUATION,
AND ALSO THE LOCAL
MANUFACTURE -- AND DISTRIBUTION
SYSTEM FOR THE MICRO NUTRIENT
COMPONENT, SUPPLEMENTATION
COMPONENT OF THE STRATEGY.
THE MAIN STRENGTH THAT WE
IDENTIFIED WAS FOR ONE SIDE THE
LOCAL PRODUCTION OF THE
SUPPLEMENT DUE TO THE HIGH
DEMAND BECAUSE IT WAS
INCORPORATED IN THE SOCIAL
PROTECTION PROGRAM THROUGH THE
HEALTH SYSTEM, SO IT WAS
PROVIDING SUPPLEMENT TO MORE
THAN 5 MILLION FAMILIES, AND
THESE CONTRIBUTE TO THE
APPROPRIATION BY THE GOVERNMENT
AND ITS SUSTAINABILITY.
SO THE LOCAL MANUFACTURING.
THE GOVERNANCE SYSTEM WITH A
CONSTANT INTERRELATION BETWEEN
IMPLEMENTERS, EVALUATORS,
FACILITATED CONTINUITY IN
FUNDING, COMMITMENT TO
EVALUATION AND CONTINUOUS
EVIDENCE-BASED IMPROVEMENT OF
THE PROGRAM.
AND THE CONDITIONALITY WHICH
INCREASED THE ACCESS TO
HEALTH -- AND THIS LEADS TO THE
LARGE IMPACT OF THE -- THE LARGE
SCALE IMPACT OF THE PROGRAM.
AMONG THE CHALLENGES, WELL, WE
HAVE THAT FROM 2012 TO 2019, WE
START TO SEE AN ACCEPTANCE OF
THE IMPROVEMENT.
WE DO NOT KNOW QUITE SURE WHY
THIS WAS BECAUSE THE PROGRAM WAS
DISCONTINUED, BUT THE EXPERTS
AGREE THAT IT COULD BE TO THE
SCALING UP PROCESS, IT WAS SUCH
A BIGGING SCALE TO WHOLE FAMILY,
THE COMPLEXITY OF -- FOUR KIND
OF SUPPLEMENTS AND THE
MONITORING OF SUPERVISION OF THE
STRATEGY THAT MADE OPERATION
MORE DIFFICULT.
ALSO, WE CANNOT FORGET THAT
CHANGES IN DIET PATTERNS WITH
MARKED INSCREES IN THE
CONSUMPTION OF OLDER PROCESSED
FOOD IN THE COUNTRY OF LOW
NUTRITIONAL QUALITY, AND MEXICO
IS ONE OF THE COUNTRIES THAT
HAVE THE BIGGEST ULTRA PR PROCED
FOOD CONSUMPTION IN THE WORLD.
SO TO FINISH, SOME OF THE
LESSONS LEARNED WAS THAT, WELL,
AS YOU KNOW INTEGRATIVE MATERNAL
AND CHILD NUTRITION INTO PRIMARY
HEALTHCARE SERVICES IS A COMPLEX
TASK, BUT WHERE IMPLEMENTATION
RESEARCH FACILITATE THE PROCESS
AND ALLOW PROGRAMS INNOVATION
AND THE SUSTAINABILITY OF THE
PROGRAM.
OH, THE ME SON WAS THAT WAS
ALWAYS TRANSLATED AS YEN RATED
INTO POLICY AND PROGRAM.
FOR INSTANCE, THE EVIDENCE THAT
WE GENERATE, WE PROPOSE TO TYPE
OF SUPPLEMENTS BUT THE PROGRAM
WANTS TO KEEP DIFFERENT
FORMULATION OF SUPPLEMENTS, SO
THIS COMPLICATES THE MANAGEMENT
OF THE SUPPLEMENTS, AND THAT IN
THE END, I'M MONITORING A
SUPERVISION SYSTEM, BUT THIS WAS
NOT IMPLEMENTED AS DESIGNED AND
AS I SAID BEFORE, THIS MIGHT
AFFECT THE RESULT OF THE
PROGRAM.
SO THANK YOU VERY MUCH FOR YOUR
ATTENTION, AND NOW I WILL
INTRODUCE OUR NEXT SPEAKER.
SONI IS A RESEARCH FELLOW IN THE
FOGARTY DIVISION OF THE
INTERNATIONAL FOOD POLICY
RESEARCH INSTITUTE.
>>THANKS, ANNABELLE.
>>HOLD ON ONE SECOND.
>>GOOD AFTERNOON, EVERYONE.
I'LL BE PRESENTING ON A CASE
STUDY OF IMPLEMENTATION SCIENCE
APPLIED WITHIN A NUTRITION
INTERVENTION STUDY IN ETHIOPIA.
THE CASE I'LL BE PRESENTING ON
IS BASED ON A LONG-TERM
COLLABORATION THAT OUR TEAM HAS
HAD WITH THE ALIVE & THRIVE AS A
RESEARCH PARTNER FOR OVER A
DECADE.
ALIVE & THRIVE IS A GLOBAL
INITIATIVE TO SAVE LIVES,
PREVENT ILLNESS AND ENSURE
HEALTHY GROWTH OF MOTHERS,
CHILDREN IN MULTIPLE COUNTRIES,
WORKING TO STRENGTHEN DIVERSE
SYSTEMS, PARTICULARLY APPLYING
THE SOCIAL AND BEHAVIOR CHANGE
FRAMEWORK AND POLICY ADVOCACY
STRATEGIES.
ALIVE & THRIVE HAS GONE THROUGH
SEVERAL PHASES AND GENERATIONS
OF PROJECTS IN THE PAST 12
YEARS, BUT AT THE FIRST PHASE OF
THE WORK, WE CONDUCTED RESEARCH
STUDIES TO EVALUATE LARGE SCALE
INVENTIONS TO IMPROVE INFANT AND
YOUNG CHILD FEEDING PRACTICES IN
THREE COUNTRIES, INCLUDING EET
ETHIOPIA, WHICH I'LL BE TALKING
MOSTLY ABOUT TODAY.
A RATIONALE FOR WORKING ON IYCF
IN ETHIOPIA, IN 2011, ONLY HALF
OF MOTHERS WITH INFANTS
PRACTICED EARLY INITIATION OF
BREASTFEEDING AND EXCLUSIVE
BREASTFEEDING WHICH HAS NOW
IMPROVED SIGNIFICANTLY TO 72%.
LESS THAN HALF OF THE CHILDREN
CONSUMED COMPLEMENTARY FOODS AT
6 TO 8 MONTHS, AND ONLY 4% OF
CHILDREN CONSUMED AT LEAST FOUR
FOOD GROUPS, WHICH HAVE IMPROVED
SINCE THEN BUT STILL REMAIN
VERY, VERY LOW IN THE COUNTRY.
IN 2011, 44% OF CHILDREN UNDER H
RECENT DATA SHOW IS STILL ABOUT
37% OR ABOUT ONE-THIRD OF
CHILDREN OR MORE THAN ONE-THIRD
OF CHILDREN.
OUR OVERALL RESEARCH DESIGN IN
EET COPE YA WAS A PRE/POST
EVALUATION IN TWO PROGRAM AREAS.
ONE IN THE SOUTH AND ONE IN THE
NORTH.
WITH TWO CROSS-SECTION SIGNAL
SUSURVEYS, A BASELINE SURVEY IN
2010 AND 2014.
IN ETHIOPIA HE TIME OF OUR STUDY
THE GOVERNMENT WAS OPPOSED TO
RANDOMIZATION BUT SINCE THEN
THEY'VE ALL BEEN CLUSTER
RANDOMIZED CONTROL TRIALS.
THE CORE INTERVENTIONS INCLUDED
COUNSELING BY TWO ALL-FEMALE
CADRES, HEALTH EXTENSION WORKERS
WHO WORKED PRIMARILY AT THE
LOCAL HEALTH POSTS, AND
COMMUNITY VOLUNTEERS CALLED THE
WOMEN'S DEVELOPMENT ARMY.
THEY VEST ITED HOMES OF FAMILIES
IN THEIR COMMUNITIES FOR HEALTH
AND SANITATION SERVICES, AS WELL
AS OTHER FUNCTIONS AND
ACTIVITIES.
COMMUNITY MEETINGS WERE HELD
WITH MOTHERS AND FATHERS OF
YOUNG CHILDREN AND TV AND RADIO
SPOTS BLASTS IYCF MESSAGES.
OUR PRIMARY STUDY OUTCOMES
INCLUDED EIGHT WHO RECOMMENDED
IYCF INDICATORS AMONG CHILDREN
UNDER TWO YEARS AND STUNTING
AMONG OLDER CHILDREN AGED 24 TO
59 MONTHS, WHOSE NUTRITIONAL
STATUS WAS EXPECTED TO HAVE
BENEFITED FROM THE INTERVENTIONS
TARGETED AT UNDER 2 YEARS OF
AGE.
FROM THE INCEPTION WE DEVELOPED
A LEARNING AGENDA WITH ALIVE &
THRIVE THAT INCLUDED IMPACT
EVALUATIONS AND STUDIES ON THE
IMPLEMENTATION PROCESS.
FORMATIVE RESEARCH AND
STAKEHOLDER ENGAGEMENTS WERE
DONE WITH THE ALIVE AND THRIVE
TEAMS TO INFORM INTERVENTION
DESIGN AT SCALE-UP, WHICH WAS A
MAJOR PARTY FOR ALIVE & THRIVE
IN THE START.
WE EMBEDDED IMPLEMENTATION
SCIENCE PRINCIPLES AND METHODS
IN RESEARCH WORK WHICH IS
DEMONSTRATED IN THE BOX,
INCLUDING DEVELOPING IMPACT
PATHWAYS OF HOW WE EXPECTED THE
INTERVENTIONS TO ACHIEVE IMPACT
IN EACH STUDY, WE COLLECTED DATA
MAPPED TO THESE PROGRAM IMPACT
PATHWAYS, WE LINKED PROCESS AND
IMPLEMENTATION STUDIES WITH
IMPLEMENTATION TIME LINES WHICH
INVOLVED EXAMINING MONITORING
DATA IN ROLLOUT, REACH AND
UPTAKE OF INTERVENTIONS AND WE
HAD CLOSE ENGAGEMENTS BETWEEN
OUR RESEARCH TEAM AND THE
PROGRAM IMPLEMENTATION AND
MANAGEMENT TEAMS.
ALSO IMPORTANTLY, THE PARTNERS
WERE COMMITTED TO DOCUMENTING
ALL OUR WORK IN VARIOUS FORMS,
PUBLISHING IN PEER REVIEWED
JOURNALS TO SHARE WITH THE
RESEARCH COMMUNITY AND A WIDER
AUDIENCE, AND TO DISSEMINATING
OUR FINDINGS WITH STAKEHOLDERS.
THIS APPROACH TO A LEARNING
AGENDA WAS PUBLISHED EARLY ON IN
THE PROGRAM.
THE ALIVE & THRIVE HAD A STREA
TEE JIK FRAMEWORK, WHICH IS
APPLIED IN ALL OF ITS COUNTRY
PROGRAMS.
ITS CORE STRATEGIES ARE SHOWN
HERE IN THE DARK GREEN, WHICH
INCLUDED ADVOCACY, INTERPERSONAL
COMMUNICATION, AND COMMUNITY
MOBILIZATION, MASS COMMUNICATION
THROUGH TV, RADIO AND/OR
INTERNET IN CASE OF VIETNAM, AND
STRATEGIC USE OF DATA ALL TO
REINFORCE EXISTING DELIVERY
SYSTEMS.
THESE STRATEGIES WERE TARGETED
TO VARIOUS DECISION-MAKERS,
SERVICE PROVIDERS AND
BENEFICIARIES, AND THEY AIM TO
IMPROVE KNOWLEDGE AND SKILLS AND
THE ENABLING ENVIRONMENT IN
SUPPORT OF IMPROVED IYCF
PRACTICES.
AND IN EACH COUNTRY CONTEXT,
FORMATIVE RESEARCH WAS CONDUCTED
TO DESIGN SPECIFIC INTERVENTIONS
AND TO CONTEXTUALIZE TOOLS AND
MESSAGES.
IN THE CASE OF ETHIOPIA,
INTERVENTIONS FOCUSED ON SMALL,
DOABLE ACTIONS AND THEY CAME UP
WITH SEVEN EXCELLENT ACTIONS ON
IYCF PROMOTED BY THE HEALTH
EXTENSION WORKERS AND THE
COMMUNITY VOLUNTEERS, AS WELL AS
THROUGH THE TV AND RADIO SPOTS
REINFORCING THESE DIFFERENT
MESSAGES.
THIS STRATEGIC FRAMEWORK AND
APPROACH TO AN INTERVENTION
DESIGN WAS ALSO PUBLISHED BY OUR
ALIVE AND THRIVE PROGRAM TEAM.
AS MENTIONED EARLIER, WE'VE THEN
DEVELOPED PROGRAM PATHWAYS
TOGETHER WITH THE COUNTRY TEAM,
DURING IMPLEMENTATION, WE
COLLECTED DATA ALONG THESE
PATHWAYS TO BETTER UNDERSTAND
THE EXTENT OF IMPLEMENTATION AND
ANY GAPS IN THESE COMPONENTS.
WE USED PROGRAM MATERIALS AS A
WAY TO UNIQUELY TRACE PROGRAM
EXPOSURE AND REACH SINCE THE
INFORMATION ABOUT BREASTFEEDING
OR COMPLEMENTARY FEEDING IN
ITSELF WERE NOT NECESSARILY NEW
AND MAYBE RECEIVED FROM OTHER
SOURCES.
WE OBSERVED EXPOSURE AND RECEIPT
OF THE TOOLS WERE HIGH AMONG
HEALTH WORKERS AND SUPERVISORS,
BUT LESS AT THE COMMUNITY LEVEL
AMONG VOLUNTEERS AND THE
MOTHERS.
THEN WE ACTUALLY SHOWED THE
SEVEN EXCELLENT ACTIONS TOOL
WITH MESSAGES COVERED AND THE
IDENTIFIED GAPS WHERE THE
MESSAGES WERE NOT RECOGNIZED OR
NOT CORRECTLY UNDERSTOOD, SUCH
AS ON EBF OR EXCLUSIVE
BREASTFEEDING AND ABOUT FEEDING
DURING ILLNESS.
WE ALSO PUBLISHED THESE FINDINGS
AND FIDELITY.
AT END LINE OUR EVALUATION
RESULTS SHOW SIGNIFICANT
IMPROVEMENTS ACROSS ALL OF THE
IYCF PRACTICES IN THE
INTERVENTION AREAS, HOWEVER, WE
OBSERVED NO SIGNIFICANT
IMPROVEMENTS IN CHILD GROWTH.
SO ALONGSIDE THESE RESULTS, WE
ALSO CONDUCTED PLAUSIBILITY
ANALYSIS TO UNPACK OUR FINDINGS,
WHICH WE DETAILED IN AN ANALYSIS
PLAN.
WE TRACED THE CHANGES ALONG THE
PROGRAM PATHWAY AND USED
DOSE-RESPONSE ANALYSIS TO
FURTHER EXAMINE THE RELATIONSHIP
BETWEEN PROGRAM EXPOSURE AND
OUTCOMES.
TO YOUR RIGHT IS A TABLE ON THE
ASSOCIATION BETWEEN EXPOSURE
INTENSITY IN TERMS OF CONTACTS
AND RECALL OF KEY MESSAGES AND
OUTCOMES.
THERE WAS LOW EXPOSURE TO A
SINGLE INTERVENTION BUT EXPOSURE
TO MULTIPLE CHANNELS AT HEALTH
POSTS, IN THE COMMUNITY, THROUGH
MASS MEDIA, WITH ODDS OF
ACHIEVING HIGHER OUTCOMES.
THEN AFTER END LINE WE HELD
DISSEMINATION MEETINGS
PARTICULARLY WITH THE GOVERNMENT
OFFICIALS, PROGRAM IMPLEMENTERS
AND OTHER COUNTRY STAKEHOLDERS,
AND THE ALIVE AND THRIVE TEAM
CONTINUED TO DISSEMINATE AND
ADAPT THROUGH IYCF TOOLS AND
MATERIALS IN OTHER REGIONS.
FINDINGS FROM THIS STUDY LED TO
ANOTHER STUDY SPECIFICALLY
FOCUSED ON TACKLING KIELD CHILD
FEEDING DURING FASTING.
ALSO THE AGRICULTURAL SECTOR WAS
ENGAGED.
THEN WE EXPANDED TO OTHER TARGET
GROUPS.
WE RECENTLY CONDUCTED A
FEASIBILITY STUDY TO STRENGTHEN
MATERNAL NUTRITION INTERVENTIONS
DURING ANTENATAL CARE IN TWO
REGIONS IN THE COUNTRY.
AS WELL AS A FEEDABILITY STUDY
ON ADOLESCENT NUTRITION
INTERVENTIONS IN TWO REGIONS.
THE CYCLE HAS BEEN ON LEARNING
FROM IMPLEMENTATION RESEARCH ON
HOW TO STRENGTHEN NUTRITION
INTERVENTIONS THROUGH EXISTING
SYSTEMS, DOCUMENTING AND
DISSEMINATING ADAPTING AND
SCALING UP.
HERE I'VE TAKEN THIS NICE SLIDE
FROM OUR ALIVE AND THRIVE
COLLEAGUES TO SHARE THE GLOBAL
LEARNING AGENDA AS THIS WORK
GOES BEYOND JUST ETHIOPIA.
WE'VE PARTNERED ON
IMPLEMENTATION AND EVALUATION
RESEARCH, AS VIETNAM, BANGLADESH
AND ETHIOPIA, BROADER LEARNING
AGENDA TO BUILD A PROOF OF
CONCEPT OF LARGE SCALE SPCC
PROGRAM, ADAPTING TO NEW
CONTEXTS, DIFFERENT DELIVERY
PLATFORMS, VARIOUS SECTORS ON
NUTRITION TOPICS, THEN
REPLICATING A SCALING UP WITH
MORE PARTNERS AND COLLABORATORS.
FINALLY I'LL CLOSE WITH A FEW
TAKEAWAYS.
WE NEED TO GENERATE DATA FOR
DECISION-MAKING ALONG EVERY STEP
OF OUR INTERVENTION WORK.
FOCUS SHOULD BE ON COLLECTING
INFORMATION ABOUT WHAT WORKS BUT
ALSO WHAT DOES NOT WORK.
AND I THINK ANNABELLE ALSO
ILLUSTRATED ALL OF THIS.
ALONG THE WAY, THERE NEEDS TO BE
TOUCH POINTS FOR COMMUNICATING
FINDINGS WITH DIFFERENT
STAKEHOLDERS, AND LASTLY,
IMPLEMENTATION RESEARCH REQUIRES
DEDICATED FUNDING AND TRUE PARTS
NER SHIPS.
TTRUEPARTNERSHIPS.
THANKS FOR YOUR ATTENTION.
I CAN'T ACKNOWLEDGE ALL OF THEM
BY NAME BUT SOME KEY GROUPS
INCLUDE OUR TEAM, UNIVERSITY OF
SOUTH CAROLINA, ALIVE & THRIVE
IN WASHINGTON, D.C. AND
ETHIOPIA, ALL OUR STUDY
PARTICIPANTS AND OF COURSE
FUNDING FOR OUR RESEARCH WORK
FROM THE BILL AND MELINDA GATES.
BACK TO YOU FOR THE PANEL
DISCUSSION.
>>THANK YOU SO MUCH, SUNNY, ED
AND ANNABELLE.
I'M GOING TO ASK ALL OF YOU TO
KIND OF COME BACK AND GET OUR
DISCUSSION STARTED.
I ALSO WANT TO VERY MUCH WELCOME
ANDREA WARREN, THE NUTRITION
RESEARCH ADVISOR AT THE BUREAU
OF HUMAN YAIR TAN ASSISTANCE AT
USAID AND APRIL LOWE AT THE
NATIONAL CANCER INSTITUTE, WHO
WILL ALSO BE JOINING US.
SO I THINK BUILDING ON THE
PRESENTATIONS THAT WE JUST HEARD
AND I THINK ECHOING SOME OF THE
QUESTIONS THAT WE'RE HEARING
FROM BOTH THE AUDIENCE AND THAT
I THINK WE HEAR GENERALLY AROUND
IMPLEMENTATION SCIENCE, I'M
GOING TO OPEN US WITH A QUESTION
ABOUT HOW DO WE ACTUALLY
FACILITATE THE USE AND
APPLICATION OF IMPLEMENTATION
SCIENCE AND HOW CAN WE ENSURE
THAT IMPLEMENTATION SCIENCE
CONTRIBUTES TO LONGER-TERM
SUSTAINABILITY?
ANDREA, I'LL START WITH YOU.
>>THANKS, SUSAN.
GREAT.
SO YEAH, SO HOW CAN WE
FACILITATE THE USE AND
APPLICATION OF IMPLEMENTATION
SCIENCE?
IT'S A GREAT QUESTION.
SO US -- AID FUNDS BOTH RESEARCH
AND PROGRAMMING SO FOR THIS
QUESTION, I'LL SPEAK TO THE
PROGRAMMING SIDE.
AND I THINK AS ED NOTED, IT'S
REALLY IMPORTANT TO BE
INTENTIONAL ABOUT WEAVING
IMPLEMENTATION SCIENCE INTO
PROGRAM DESIGN FROM THE VERY
BEGINNING.
SO AS AN EXAMPLE OF THIS, MY
BUREAU, BUREAU FOR HUMANITARIAN
ASSISTANCE, FUNDS FIVE-YEAR
MULTI-SECTORAL RESILIENCE
PROGRAMMING.
THESE ARE CALLED RESILIENCE FOOD
SECURITY ACTIVITIES OR RIFSAs,
AND WITHIN THAT FIVE-YEAR
PROGRAM CYCLE, THE FIRST YEAR IS
USUALLY DEDICATED TO LEARNING,
SO IMPLEMENTING PARTNERS CAN USE
THIS TIME TO PILOT SPECIFIC
APPROACHES OR DO FORMATIVE
RESEARCH OR COMMUNITY
CONSULTATIONS TO BETTER
CONTEXTUALIZE THEIR INTERVENTION
MATERIALS OR APPROACHES OR THEIR
TARGETING.
WE CALL THIS THE REFINE AND
IMPLEMENT APPROACH, AND THE
INTENTION IS REALLY JUST TO HELP
IMPLEMENTING PARTNERS DESIGN
MORE SUSTAINABILITY AND RELEVANT
INTERVENTIONS.
SO FROM THE DONOR PERSPECTIVE,
THAT'S ONE WAY WE CAN AND DO
FACILITATE THE USE AND
APPLICATION OF IMPLEMENTATION
SCIENCE.
TO THE SECOND QUESTION ABOUT
SUSTAINABILITY, SO THAT'S A BIG
CONCEPT, SO I'LL JUST REFER HERE
TO SUSTAINABILITY IN TERMS OF
PROGRAM LONGEVITY.
I THINK AS ANNABELLE ILLUSTRATED
SO WELL, IT REALLY BENEFITS A
PROGRAM AND IT BENEFITS
DECISION-MAKERS TO HAVE A MORE
NUANCED UNDERSTANDING OF HOW AND
WHY A PROGRAM DOES AND DOESN'T
WORK.
SUNNY ALSO POINTED THAT OUT IN
HER EXAMPLE.
BUT IMPLEMENTATION SCIENCE, IT
REALLY JUST ALLOWS FOR SMARTER
ADAPTIVE MANAGEMENT AND COURSE
CORRECTION WHERE NEEDED AND,
WHEN DONE WELL, IT ALSO IMPROVES
BUY-IN AND UPTAKE BY
STAKEHOLDERS AT ALL LEVELS.
DONORS, IMPLEMENTERS AND
PARTICIPANTS, AT KEY POINTS IN
TIME.
SO I THINK I'LL LEAVE IT THERE,
AND MAYBE PASS IT OVER TO APRIL.
>>GREAT.
THANK YOU SO MUCH.
YOU KNOW, I AM JUST SO STRUCK BY
THESE EXAMPLES SHARED BY OUR
PANELISTS.
YOU KNOW, FOR ME, THERE ARE A
COUPLE OF KEY PIECES THAT I TOOK
AWAY IN TERMS OF IMPACT OF
IMPLEMENTATION SCIENCE AND ITS
POTENTIAL.
SO ONE IS WITH ANNABELLE'S
PRESENTATION, A REACH GOING FROM
A LIMITED NUMBER OF RURAL AREAS
TO 6.1 MILLION FAMILIES,
ULTIMATELY 26 MILLION PEOPLE,
THAT'S THE KIND OF PUBLIC HEALTH
IMPACT THAT WE WANT TO HAVE,
PARTICULARLY FOR SOMETHING SO
IMPORTANT AND SO IMPACTFUL
ACROSS THE LIFE COURSE OF CHIRP
AND FAMILIES WITH FOOD SECURITY.
SO THAT REACH IS IMPRESSIVE.
AND SOME OF THE KEY PIECES THAT
SHE MENTIONED AROUND POLITICAL
WILL, SOME OF THE CHALLENGES
AROUND THE EVIDENCE-BASE THAT
WAS DISCOVERED AND THAT
TRANSLATION PROCESS INTO POLICY,
THIS SEEMS TO ME A KEY
OPPORTUNITY FOR US AS A FIELD IN
FOOD SECURITY, NUTRITION,
BEHAVIOR CHANGE POLICY AND
IMPLEMENTATION SCIENCE, TO LOOK
AT EXAMPLES LIKE THIS, AND
REALLY LEARN ABOUT HOW OUR
EVIDENCE BASE CAN REALLY MOVE TO
BIGGER REACH AND BROADER IMPACT.
AND IT REMINDS ME TOO OF
THINKING NOT JUST ABOUT
IMPLEMENTATION PROCESSES BUT
ALSO HOW DO WE COMMUNICATE BACK
THE BENEFIT OF THESE EVIDENCE
BASE PROGRAMS OF THE PROCESSES
AND WORK TO CHANGE POLICY AND TO
HAVE THIS REACH.
SO SUNNY'S KEY EXAMPLE, I REALLY
THOUGHT WAS SUCH A FABULOUS ONE
IN REALLY SE DINING FOR YOUR
INTERVENTION -- DESIGNING WITH
IMPLEMENTATION IN MIND, AND
THINKING ABOUT THOSE KEY
MULTIPLE STAKEHOLDER PARTNER,
COMMUNITY PARTNERS AT EACH LEVEL
OF AN INTERVENTION, AND THE KEY
PIECE FOR ME THAT SEEMED TO COME
OUT OF THAT FOR LONG TERM
SUSTAINABILITY WAS AROUND
EMPOWERMENT OF COMMUNITY.
AND ONE OF THE WAYS IT SEEMED TO
ME THAT SUNNY WAS DOING THAT WAS
BY SHARING DATA BACK, AND GIVING
THE DATA BACK TO DECISION-MAKERS
SO THAT THEY'RE A PART OF THAT
PROCESS IN TERMS OF LEARNING
ABOUT WHAT WORKS AND HOW TO
PIVOT AND HOW TO MOVE FORWARD
FROM THERE.
SO WOULD LOVE TO HEAR MORE AT
ANOTHER POINT, TOO, ABOUT HOW
THAT DATA WAS COMMUNICATED BACK,
AND WHAT METRICS MIGHT BE USED
IN TERMS OF IDENTIFYING HOW THAT
REALLY CHANGES EMPOWERMENT,
TRUST, TO BUILD TOWARDS THOSE
LONG-TERM SUSTAINABILITY GOALS.
SO REALLY JUST SO EXCITED FOR
THOSE EXAMPLES AND I HOPE THAT
IN THE CHAT, I THINK WE WERE
GOING TO TRY TO SHARE SOMERMAN
SOMEMANUSCRIPTS OR PAPERS SO YOD
THE AUDIENCE CAN LOOK DEEPER
INTO EXAMPLES.
>>YES, WE'LL BE SHARING STUFF
ON OUR WEBSITE THAT WE'RE
DEVELOPING.
WE'RE UNFORTUNATELY UNABLE TO
SHARE ON THE VIDEOCAST
CURRENTLY.
BUT I THINK YOUR POINT, APRIL,
IS REALLY GOOD, SO I ALSO REALLY
ECHO YOUR EXCITEMENT ABOUT THESE
EXAMPLES.
I'M GOING TO TURN IT OVER TO
SUNNY.
I THOUGHT YOUR POINT ABOUT --
EVEN AT THE VERY END ABOUT THE
TOUCH POINTS ABOUT WHEN IT IS
THAT YOU'RE GOING THROUGH AND
YOU'RE KIND OF CONNECTING WAS A
REALLY IMPORTANT POINT.
I MEAN, I THINK IT BUILDS ON
WHAT ANNABELLE ALSO HAD TO SAY
AND I'D LOVE TO HEAR FROM THEM
NEXT, BUT SUNNY, I'D LOVE TO GET
YOUR TAKE ON THIS.
>>ONE OF THE STRATEGIES FOR
SURE THAT HAS BEEN BUILT INTO
THE ALIVE AND THRIVE WORK WAS
BECAUSE IT'S ABOUT SOCIAL AND
BEHAVIOR CHANGE, IS TO REALLY
ENGAGE FROM THE DESIGN WITH
ACTIVE PARTICIPATION FROM THE
STAKEHOLDERS TO UNDERSTAND
WHAT'S FEASIBLE TO INTEGRATE
INTO THEIR WORK SCHEDULE, FOR
INSTANCE, FOR HEALTH WORKERS TO
ADAPT MORE COUNSELING
INFORMATION, FOR INSTANCE, TO
DELIVER DURING THEIR HEALTH
CONTACTS, OR FOR COMMUNITY
WORKERS WHO ARE VOLUNTEERS
ACTUALLY DOING OTHER POLITICAL
ACTIVIST WORK IN VOTE,
PROMOTIONS AND OTHER THINGS THEY
CAN INTEGRATE INTO THEIR WORK TO
DELIVERING NUTRITION MESSAGING.
SO THERE'S A LOT OF ACTIVE
PARTICIPATION IN THE DESIGN, AND
THEN ALONG THE DIFFERENT
IMPLEMENTATION MOMENTS TO REALLY
SPEAK BACK TO THE DIFFERENT
LOCAL DECISION MAKERS ABOUT THE
PROGRESS OF THE PROGRAMMING AND
IMPACTS, I THINK IT'S REALLY
CRITICAL TO BUILD THAT IN, WHICH
I REFER TO AS THESE TOUCH POINTS
TO DIFFERENT STAKEHOLDERS, HAS
BEEN REALLY CRITICAL.
ON THE POINT OF SUSTAINABILITY,
I THINK SOME OF THE COMPONENTS
ARE, YOU NEED TO HAVE SOMEBODY
LIKE LASTING LEADERSHIP ADVOCACY
OR CHAMPIONING REALLY FOR THIS
WORK CAPACITY IN PARTICIPATION,
BUT THE OTHER COMPONENT, I ALSO
WAS THINKING ABOUT WAS WE DIDN'T
REPORT BACK A LOT ABOUT
FINANCING, AND I THINK ANNABELLE
AND I BOTH MENTIONED FUNDING,
FUNDING, FUNDING IN THESE POINTS
AT THE END, AND THIS HAS BEEN
RAISED BUT SOMETIMES EVEN AS
OPPORTUNITIES DO OPEN UP, IT'S
STILL A CHALLENGE TO GET SUPPORT
FOR IMPLEMENTATION RESEARCH AND
STUDIES ON PROGRAM MAINTENANCE
AND SUSTAINABILITY.
SO I THINK JUST DELIVERING BACK
THESE MESSAGES AND HOW TO APPLY
THIS INFORMATION TO ADVOCATE FOR
THESE RESOURCES AND SUPPORT IS
CRITICAL.
>>THANKS.
ANNABELLE OBVIOUSLY
SUSTAINABILITY IS SOMETHING THAT
YOU WERE THINKING OF AND HAVE
BEEN WORKING TOWARDS THROUGHOUT
YOUR RESEARCH.
>>YES.
AND I ACTUALLY WANT TO COMMENT
ON APRIL'S QUESTION OF HOW WE
COMMUNICATE IN OUR CASE, BECAUSE
IT WAS A FEDERAL PROGRAM, WE
HAVE A NATIONAL COORDINATION
WHERE DIFFERENT SECTORS SIT A
MONTHLY OR I THINK IT WAS
BI-MONTHLY TO DISCUSS ALL THE
ASPECT OF THE PROGRAM.
AND WE HAVE THESE CONTINUAL
INTERRELATION WITHIN THE
RESEARCHER WITH THE IMPL IMPLEMS
AND EXPLAIN IN ALL THESE
MEETINGS LIKE THE RESULTS OF THE
RESEARCH AND ALL THIS
INFORMATION THAT WAS KEY TO
DEVELOPING THE NEXT STUDIES AND
IMPROVING THE -- AND APPLYING
THE INNOVATION THAT WE WERE I'D
FAYINGIDENTIFYING FOR THE PROGR.
IT WAS THIS NATIONAL
COORDINATION THAT FACILITATE THE
PROCESS AND ALSO TWO IMPORTANT
POINTS.
ONE WAS THE MOMENTUM, LIKE WHEN
GOVERNMENT CHANGED, BECAUSE THE
PROGRAM WAS THROUGH FOUR
DIFFERENT GOVERNMENT PERIODS.
AND IN THE LAST -- WELL, IN TWO
PERIODS BEFORE, THE RESULT FOR
THE IMPLEMENTATION RESEARCH WERE
READY.
AND IN THIS TIME, ONE OF THE
GOVERNMENT CAME AND SAW THE
RESULT AND SAID OKAY, YES, WE
NEED TO APPLY IT AND WE NEED TO
GO TO A SCALE-UP.
SO THIS CHANGE WAS VERY FAVOR
FOR US FOR THE SCALING UP
PROCESS, AND OF COURSE WE HAVE A
WELL-KNOWN VOICE IN OUR RESEARCH
TEAM THAT THIS ALSO FACILITATE
THE PROCESS OF THE SCALING UP.
>>THAT'S A REALLY GOOD POINT.
YOU KNOW, ED, I KNOW THAT THIS
IS SOMETHING THAT SUSAN HAS BEEN
REALLY THINKING ABOUT AT KIND OF
LIKE EVEN A SORT OF BROADER
SCALE.
PERHAPS YOU COULD SAY A LITTLE
MORE ABOUT THAT.
>>WELL, I THINK THAT REALLY THE
CHALLENGE IS HELPING SORT OF
SPREAD THE WORD, I GUESS YOU
COULD SAY, TO DISSEMINATE THE
UNDERSTANDING OF THE IMPORTANCE
OF THIS.
I WAS STRUCK QUITE A NUMBER OF
YEARS AGO NOW, YOU MAY KNOW THAT
ABOUT 10 OR -- 10 OR 11 YEARS
AGO, IT WAS DISCOVERED THAT ZINC
SUPPLEMENTATION, WHEN
ADMINISTERED IN A TIMELY WAY TO
YOUNG CHI CHILDREN WHO HAD DIARA
WOULD SUBSTANTIALLY REDUCE THE
MORTALITY OR MORBIDITY.
I REMEMBER TALKING TO SOMEONE IN
ONE OF THE COUNTRIES I WAS
WORKING IN WHO WAS VERY
FRUSTRATED WHO SAID WELL, THIS
SHOULDING STRAIGHTFORWARD, YOU
MANUFACTURE THE PILLS, YOU GIVE
THEM TO THE CLINICS, THE NURSES
OR THE PRIMARY HEALTHCARE WORKER
GIVES TO THE CAREGIVER, THEY
GIVE TO THE CHILD, AND WE REDUCE
MORBIDITY AND IT'S NOT HAPPENING
AND WHY IS THAT?
THAT'S A PROBLEM OF
IMPLEMENTATION SCIENCE, IS
UNDERSTANDING WHAT ARE THOSE
PROCESSES THAT ARE INVOLVED AND
WHAT GETS IN THE WAY OF EVEN
SOMETHING THAT SEEMS ON THE FACE
OF IT AS SIMPLE AS THAT.
AND I THINK THAT JUST -- AGAIN,
JUST CONVEYING THE IMPORTANCE OF
THE KINDS OF PROCESSES THAT
SUNNY AND ANNABELLE WERE TALKING
ABOUT, AND WHY THOSE MATTER IN
TERMS OF WHETHER OR NOT THE
INTENDED BENEFICIARIES ACTUALLY
HAVE A BENEFIT GENERATED FOR
THEM.
>>YEAH.
I'M GOING TO FOCUS TO ANOTHER
QUESTION ONE THAT UNDERLIES THIS
ENTIRE WEBINAR SERIES WHICH IS
HOW WE KIND OF TRANSLATE OR
ADAPT DIFFERENT INTERVENTIONS
ACROSS SETTINGS?
YOU KNOW, I THINK THAT THAT'S
REALLY THE GOAL OF WHAT WE'RE
TRYING TO LEARN HERE FOR THIS
WHOLE WEBINAR SERIES, SO I THINK
EVEN WITH THIS LAST MOMENT, I
THINK IT WOULD BE WORTH
ADDRESSING.
ANNABELLE, DO YOU WANT TO TRY TO
ANSWER THAT ONE?
>>YES, I THINK THAT FOR THESE
FORMATIVE RESEARCH IS KEY, AND
USING A MIXED METHOD APPROACH TO
IDENTIFY BARRIERS AND THEN TO
IDENTIFY ALSO THE WAY TO DEVELOP
OR TO ADAPT THE STRATEGIES TO
OVERCOME THESE BARRIERS AND
CONSIDERING THE NEIGHBORS IN
THESE DIFFERENT CONTEXT.
I THINK IN OUR EXPERIENCE, NOW
THAT THE IMPLEMENTATION RESEARCH
SCIENCE FIELD IS DEVELOPING, WE
HAVE BEEN -- I MEAN, WE HAVE
MORE THAN 20 YEARS IMPLEMENTING
FOFORMATIVE RESEARCH, INCLUDING
NOW ALL THESE -- THAT HAVE BEEN
DEVELOPING IN THE FIELD OF
IMPLEMENTATION AND FOR INSTANCE
IN THE LAST FORMATIVE RESEARCH
IN A SIMILAR STRATEGY WE ARE
DEVELOPING, WE APPLIED LIKE THE
FRAMEWORK FROM -- WHERE THEY --
IT'S AN ADAPTATION OF FRAMEWORK
FOR IMPLEMENTATION RESEARCH, BUT
NOW WE GO PREVIOUS TO THE
COMMUNITY WITH THE DIFFERENT
STAKEHOLDERS AND EXPLORE THESE
DOMAINS THAT WE KNOW THAT ARE
RELATED WITH THE SUCCESSFUL
IMPLEMENTATION, OR FOR INSTANCE,
ALSO INCLUDING THE
IMPLEMENTATION RESEARCH OUTCOMES
SUCH AS THE ONE THAT HAS BEEN
PUBLISHED BY PROCTOR, WHERE WE
IN ADVANCE GO WITH THE
STAKEHOLDERS AND SEE HOW IS THE
ADOPTION, THE APPROPRIATION, THE
FLEXIBILITY OF IMPLEMENTING
THESE NEW INNOVATION OR CHANGES
OR NEW STRATEGIES, SO I THINK
THAT THESE NOW MORE THAN EVER IS
REALLY IMPORTANT TO GO WITH A
VERY WELL FORMATIVE RESEARCH,
INFORMED BY THE IMPLEMENTATION
RESEARCH FRAMEWORK THAT WE HAVE
NOW THAT WE DIDN'T HAVE BEFORE,
AND TAKE ADVANTAGE OF THIS TO
DEVELOP BETTER INTERVENTION AND
TO ADAPT INTERVENTIONS THAT ARE
ALREADY IN PLACE TO THE
DIFFERENT CONTEXTS.
>>THANK YOU SO MUCH, ANNABELLE,
AND REALLY TO ALL OF OUR
PANELISTS.
REALLY APPRECIATE YOU JOINING US
TODAY.
I NOW WANT TO PASS IT OVER TO
DR. RAFAEL PEREZ, SCIENTIFIC
CHAIR FOR THIS PROJECT, TO WRAP
UP THIS WEBINAR AND THIS SERIES
AS A WHOLE.
>>THANK YOU VERY MUCH, SUSAN,
AND CONGRATULATIONS TO ALL THE
PRESENTERS AND ALL THE
DISCUSSANTS ON TODAY'S
OUTSTANDING WEBINAR FOCUSING ON
IMPLEMENTATION SCIENCE.
I WANT TO START BY THANKING
SUSAN ENORMOUSLY, NOT ONLY FOR
BEING THE DRIVING FORCE BEHIND
THESE WEBINARS, BUT ALSO FOR
SUGGESTING THE TOPIC TO BEGIN
WITH.
I THINK SHE PUT TOGETHER AN
INCREDIBLE GROUP OF FEDERAL
AGENCIES THAT, TOGETHER, COULD
HAVE A HUGE IMPACT ON ADVANCING
FOOD SECURITY POLICIES,
PROGRAMS, AS WELL AS
IMPLEMENTATION SCIENCE EFFORTS
GLOBALLY.
THERE IS NO DOUBT THAT THROUGH
THIS SERIES OF THREE WEBINARS,
WE HAVE LEARNED THAT STRENGTH,
THAT POWERFULNESS OF CROSS
BORDER COLLABORATIONS AND
SHARING OF LESSONS LEARNED TO
ADVANCE FOOD SECURITY.
IN THE FIRST WEBINAR, WE LEARNED
THAT THROUGH THIS EXTENSIVE
SHARING, THE WORLD HAS BEEN ABLE
TO REACH GLOBAL CONSENSUS ON THE
DEFINITION OF FOOD SECURITY, HOW
BOTH DIETARY QUALITY AND SAFETY
ARE VERY MUCH A PART OF THE
DEFINITION OF FOOD SECURITY, NOT
ONLY QUANTITY OF FOOD OR
CALORIES, AND IN ADDITION, THE
IMPORTANCE OF BOTH FOOD SECURITY
AND HEALTH SECURITY ON
DETERMINING NUTRITION SECURITY.
WITHOUT THIS CROSS BORDERS
SHARING OF KNOWLEDGE AND
FRAMEWORK, THESE WILL HAVE NEVER
HAPPENED.
SECONDLY, WE HAVE LEARNED
THROUGH THIS SERIES THAT REGIONS
LIKE LATIN AMERICA HAVE ACTUALLY
GENERATED AN ENORMOUS AMOUNT OF
KNOWLEDGE AS SHARED,
ILLUSTRATING HOW PROGRAM DESIGN,
HOW POLICIES AND ALSO HOW
REGULATIONS COMBINED WITH
NUTRITION EDUCATION AND
COUNSELING CAN INDEED HELP
PROMOTE HEALTHIER EATING
PATTERNS AND ACHIEVE BETTER
NUTRITION OUTCOMES.
BUT WE ALSO HAVE SHOWN THROUGH
THESE WEBINARS THAT THE LESSONS
LEARNED ACROSS THE GLOBE IS THAT
THESE WILL JUST NOT HAPPEN
WITHOUT MAJOR TRANSFORMATIONS OF
THE GLOBAL FOOD SYSTEMS THAT
SURROUND HUMAN BEINGS SINCE THE
DAY THEY ARE CONCEIVED.
THIS MAJOR TRANSFORMATIONS ARE
REALLY GOING TO REQUIRE MAJOR
IMPLEMENTATION SCIENCE THINKING
AND APPLICATIONS IN THE CONTEXT
OF COMPLEX ADAPTIVE SYSTEMS.
THERE IS VERY LITTLE DOUBT THAT
WITHOUT WITHOUT APPLYING THE
PRINCIPLES OF IMPLEMENTATION
SCIENCE THROUGH AN EQUITY LENS,
THAT THESE WILL JUST NOT HAPPEN.
AND LAST BUT NOT LEAST, I WANT
TO LEAVE YOU WITH PERHAPS WHAT
IS ONE OF THE MOST IMPORTANT
LESSONS THAT WE'RE STARTING TO
LEARN FROM COUNTRIES LIKE
BRAZIL, FROM COUNTRIES LIKE THE
U.S., THAT FOR INSECURITY,
MONITORING, EVALUATION IS NOT
JUST IMPORTANT FOR INDIVIDUAL
PROGRAMS OR ASSESSING INDIVIDUAL
POLICIES, BUT AT THE END OF THE
DAY, IT'S CRUCIAL FOR ADVANCING
FOOD SECURITY COHORT LENS.
SO THANK YOU VERY MUCH, AGAIN,
SUSAN FOR GIVING ME THE
PRIVILEGE, THE HONOR OF CHAIRING
THIS WEBINAR SERIES, AND MOVING
FORWARD, WE HOPE THAT THE
SPECIAL ISSUE THAT WILL BE
PUBLISHED NEXT YEAR VERY MUCH
INSPIRED BY THIS WEBINAR WILL
HELP MANY OF YOU TO CONTINUE
BUILDING COLLABORATIONS OR
STARTING NEW COLLABORATIONS
ACROSS BORDERS IN THE AREA OF
FOOD INSECURITY AND NUTRITION.
THANK YOU VERY, VERY MUCH,
AGAIN, TO ALL OUR WONDERFUL
AUDIENCE.