SPRING works to improve nutrition outcomes in Barisal and Khulna divisions through a multi-sectoral approach, increasing the capacity of health and agricultural workers to provide nutrition counseling to households in the 1,000 days between pregnancy and a child's second birthday.

In 2015-2016, we—

• worked with approximately 1,400 government health facilities that had 2,285,540 contacts with pregnant or lactating women or mothers of children under the age of two
• trained almost 150 frontline and supervisory health workers on the Government of Bangladesh Basic Nutrition Training curriculum and provided refresher training in nutrition to 937 sub-assistant agriculture officers
• established 1,280 farmer nutrition schools, at which 25,010 women have learned techniques for improved hygiene and production and consumption of nutritious food, bringing the total number of women completing SPRING's farmer nutrition schools to more than 125,000 since the project began

SPRING works in 15 districts in the Northern and Upper East regions in Ghana to bring maternal and child nutrition, WASH, and nutrition-sensitive agriculture programming to 1,000-day households— those with pregnant women, nursing moms, and children under age two. In 2015-2016, this included—

• engaging health facility and community levels, using a variety of communication channels, including radio, video, and interpersonal communication
• working with traditional and natural leaders, community-based water and sanitation management teams, mother-to-mother support groups, and government at all levels to demonstrate and reinforce behavior change
• training facility-based and community-based quality improvement teams to improve the quality of and increase demand for nutrition services.
• supporting women's central role in family nutrition and bringing voluntary savings and loan associations and the Livelihood Empowerment Against Poverty cash transfer program into SPRING-supported mother-to-mother support groups to help empower mothers to make healthy food purchases and choices for their families

While SPRING's mandate is not broad geographic coverage in Guinea, we are building evidence to effectively promote nutrition-specific behaviors and nutrition-sensitive agriculture practices, sharing information and encouraging multi-sectoral collaboration. This includes—

• testing approaches to improve dietary diversity among households with pregnant and lactating women and children under the age of two in Guinea's Faranah prefecture
• strengthening local agriculture institute staff capacity to improve nutrition through nutrition-sensitive agriculture, helping them understand how to analyze agriculture practices promoted by extension services and identify ways to ensure that these practices contribute to good nutrition. Training materials from these trainings will be incorporated into future curricula for agriculture extension staff
• leveraging our social and behavior change approaches to encourage key behaviors in dietary diversity and improved hygiene. SPRING has used 16 community volunteers for 22 screenings of videos promoting hand washing, responsive feeding, exclusive breastfeeding, and maternal nutrition

SPRING's PEPFAR-supported work in Haiti finished in 2016. During the three years we worked there, our focus included—

• enhancing nutrition systems and building capacity to deliver high-quality nutrition assessment, counseling, and support (NACS) services at designated health facilities
• expanding evidence-based learning for the design, planning, and management of effective nutrition programs, focusing on workforce development and new training modalities. We transferred these activities to the Ministry of Health and to other USAID-funded projects that will continue to advance the nutrition agenda

In the Kyrgyz Republic, SPRING improves the nutritional status of women and children within the Feed the Future zone of influence by promoting improved nutrition-related behaviors and high-quality diverse diets. This includes national-level nutrition-centered advocacy and policy recommendations, as well as focused program delivery in Jalalabad and Naryn oblasts. We reinforce nutrition messages through mass media communication platforms including TV, radio, social media, and high-profile community mobilization events.

In 2015-2016, we—

• trained a network of 3,755 community activists to promote improved nutrition practices at the household level
• ensured 119,310 women with children under age two received improved nutrition services through routine medical care
• trained 2,672 health workers on various clinical topics that have become part of the national in-service training curriculum
• provided on-the-job supportive supervision to strengthen the quality of nutrition services and counseling in health facilities

SPRING's work in Mali finished in April 2016. Our work there focused on—

• laying the groundwork for improving nutrition in the Mopti Region through access to diverse and high-quality foods and better water and sanitation
• training 500 community nutrition leaders through farmer nutrition schools who, in turn, conveyed messages about best practices for optimal nutrition and hygiene to 5,500 people
• Teaching 375 local leaders the essential nutrition and hygiene actions needed for good health and optimal growth, which led to community-led total sanitation in 15 villages

In Nigeria, SPRING worked with—and primarily through—local organizations to support better nutrition for orphans and vulnerable children. This work includes—

• continued scale-up through 2016 of training in the government-approved UNICEF infant and young child feeding training package, reaching a total of 127 local government authorities across 16 states. In 2017 we will complete a rigorous evaluation of our efforts to help other programs understand the most effective ways to implement the training package in health facilities and communities
• providing supportive supervision visits to partners, facilities, and communities to reinforce learning and provide training to improve data collection for routine reporting
• developing a training on complementary feeding, materials for a cooking demonstration of nutritious locally available foods, and a curriculum with interactive activities to teach orphans and vulnerable children ages 2–5, 6–11, and 12–17 about nutrition and hygiene

Africa's Sahel region is characterized by a harsh climate that contributes to structural food crises and high rates of severe acute malnutrition among children. SPRING uses community media and peer voices to improve behaviors for dietary diversity, handwashing, exclusive breastfeeding, and complementary feeding. A SPRING pilot study showed that using multiple channels for disseminating messages and engaging with key influencers are promising approaches to empower women, men, and communities to improve their health through improved nutrition and hygiene behaviors.

In 2016, SPRING—

• introduced community video in Burkina Faso's East Region to promote improved maternal, infant, and young child nutrition and hygiene behaviors in 25 villages
• scaled up our ongoing community video approach in Niger from 20 to 115 villages
• held 2,388 video dissemination sessions that reached 35,054 people of reproductive age
• conducted research around the approach to explore how community video can strengthen couples' communication and men's support for maternal, infant, and young child nutrition; and the effectiveness on nutrition outcomes, including dietary diversity, complementary feeding, and breastfeeding, We are also examining how the intervention influences community social networks

SPRING's program in Senegal began in 2016 and is focused on—

• building the capacity of local partners to promote good nutrition practices and integrating nutrition interventions into existing agriculture programs to reduce stunting in three regions across the Feed the Future zones of influence: Kaolack, Fatick, and Kaffrine
• using a multi-sectoral approach to increase demand for good nutrition-related agriculture practices and to improve access to services essential for good nutrition.
• operating with and through existing agricultural value chains and market actors, food security programs, and the health sector
• using capacity building and communication approaches, including community video, radio, and social mobilization campaigns, to direct organizational and social change toward improved nutrition
• promoting diverse and nutrient-rich horticulture and arboriculture crops, as well as sustainable poultry and egg production to improve household nutritional status and livelihoods

SPRING conducted a series of assessments to investigate ways to encourage uptake of nutrition-related behaviors in Sierra Leone, such as exclusive breastfeeding in the first six months, dietary diversity, and improved hygiene. Like our program in Guinea, our mandate is not broad coverage, but rather is focused on testing multi-sectoral approaches to improving nutrition.

Our multi-sectoral approach to social and behavior change considers household and market system factors. For example, SPRING is using the fish and pumpkin value chains to explore how to strengthen the food system to encourage better diets. This includes encouraging market vendors to sell appropriate portions of nutritious foods—at an affordable price—and to minimize spoilage and nutrient loss. The results of the SPRING assessments provide evidence for our behavior change strategy and materials—including a series of visual aids aimed at improving household diets and hygiene—which we share with local stakeholders.

SPRING uses targeted population-based approaches to improve nutrition services and nutritional status of mothers and children in Uganda. These include—

• conducting ground-breaking implementation research on community-based delivery methods for micronutrient powders to fortify complementary foods
• providing technical assistance, leadership, and support for the implementation of policies related to large-scale industrial food fortification
• building the government's capacity to monitor fortification efforts and the quality of fortified foods
• supporting the National Anemia Working Group to develop Uganda's National Multisector Anemia Strategy

In 2016, SPRING helped the Office of the Prime Minister's Scaling Up Nutrition secretariat develop a communications campaign to support the National Nutrition Advocacy and Communication Strategy, which focuses on good nutrition in the first 1,000 days and eating a healthy Ugandan diet throughout the lifecycle. We are also leading the introduction of micronutrient powders to fortify complementary foods for infants 6–23 months in Namutumba District.