This Side-by-Side Summary of Two Packages that Support Community-Based Infant and Young Child Feeding (IYCF) Programs was designed as a quick reference document outlining two internationally-recognized sets of IYCF-related training and counseling materials – the CORE Group’s Essential Nutrition Actions (ENA) Framework, originally produced under the LINKAGES Project, and the UNICEF Community Infant and Young Child Feeding (C-IYCF) Counseling Package. Both packages reflect the latest evidence on high-impact nutrition practices most recently presented in The Lancet Maternal and Child Nutrition Series 2013 and the WHO Essential Nutrition Actions. Although many other frameworks and materials on IYCF exist, these two packages were selected because variations of one or both are prominent in the countries where nutrition is a priority for the USAID Global Health Bureau, USAID missions, and Feed the Future. The document is intended to assist practitioners, particularly those at country level, in understanding the similarities and differences between the two packages, and in making informed decisions about the right materials for their context.
Both packages contain state of the art, technically sound, evidence-based information that follows the latest advances in IYCF, and both have been used with success globally. Skilled and trained staff are needed to support the training and roll out of both packages, which is often a challenge at country level. Each is intended to be adapted to the local context through formative research and a consultative process involving stakeholders. The materials and techniques are not designed to compete with one another and can in fact coexist in the same country.
SPRING is positioned and willing to support the adaptation and implementation of both packages, but will take the lead from the national governments and local partners on the ground to determine which is best suited in a particular context. Much of the content of each package is similar, although differences in focus, organization, and priority topics do exist. Similarities and differences are outlined below. This summary, focused on the main elements of each package, was carefully constructed by technical experts familiar with both packages.
Generic versions of both the ENA Framework and the UNICEF Community IYCF Counselling Package are available in both French and English. The ENA Framework includes four primary components that can be accessed in English and French using the following link: Essential Nutrition Actions (ENA) Trilogy. The complete UNICEF Community IYCF Counseling Package can be accessed in English and French using the following link: UNICEF C-IYCF Counseling Package.
The Side-by-Side Summary
The side-by-side summary is organized around two tables.
Table 1 provides a general overview of each package. It is divided into seven sections:
- Job Aids
- Training Guides for Community-based Volunteers/Workers
- Training Assessments
- Field Practica
- Implementation Guidance
Table 2 provides an overview of key content areas and interventions covered by each package. It is divided into nine sections. An “X” indicates that the materials address a given content area or intervention.
- Women’s Nutrition
- Complementary Feeding
- Nutrition in Special Circumstances
- HIV and Nutrition
- Micronutrient Deficiencies
- Water, Sanitation, and Hygiene
- Nutrition Counseling Skills
- Other Skills
In selecting the most appropriate package, stakeholders should consider existing programming, the national policy environment, and the objectives of the work. Whichever package is selected, ensuring high quality local adaptation and consistent messages across programs and sectors is critical.
Table 1: Side-by-Side Summary of the CORE Group’s ENA Framework Trilogy and UNICEF’s Community IYCF Counseling Package
|ENA Framework||UNICEF Community IYCF Counseling Package||Key Similarities or Differences|
|In 2010, the CORE Group adapted the Essential Nutrition Actions (ENA) Framework Trilogy training and communication materials to focus on a child’s first 1,000 days of life—from the start of a mother’s pregnancy to the child’s second birthday.
The current ENA package has evolved from earlier USAID funded frameworks and materials developed under the BASICS Project (the Minimum Package for Nutrition, or “MinPak”) and under LINKAGES.
The ENA framework emphasizes action-oriented nutrition messages and support, and promotes a “nutrition through the life cycle” approach, addressing the following: women’s nutrition during pregnancy and lactation, optimal IYCF (breastfeeding and complementary feeding), nutritional care of sick and malnourished children (including zinc, vitamin A and ready-to-use therapeutic foods), and the control of anemia, vitamin A and iodine deficiencies.
The framework recommends that multiple program contact points at health facilities and beyond be used to reach mothers and children in order to give and reinforce ENA messages. To date, the ENA framework has been implemented in Bangladesh, Burkina Faso, Ethiopia, Liberia, Madagascar, Mali, Nepal, Niger, and Tanzania.
|In 2010, UNICEF developed a new set of generic tools for programming and capacity development on community-based IYCF counseling.
Designed for use in diverse country contexts, the tools guide local adaptation, design, planning, and implementation of community-based IYCF counseling and support services at scale.
The counseling package also contains training tools to equip community workers (CWs), using an interactive and experiential adult learning approach, with relevant knowledge and skills on the recommended breastfeeding and complementary feeding practices for children from 0 up to 24 months.
The tools focus on CWs’ counseling, problem-solving, negotiation, and communication skills, and prepare them to effectively use the related counseling tools and job aids.
To date, 21 countries are at various stages of adapting the materials to the local context, building capacity and rolling out community- based IYCF counseling and communication programs using the package.
|Both approaches promote a similar set of IYCF interventions, with minor variations in their key messages, training methodologies, and types of job aids.|
|1. For national and/or district teams or organizations and program managers||Understanding the Essential Nutrition Actions (ENA) Framework (6 pages)||
||The ENA framework provides tools and training materials for both community and facility based workers, while the UNICEF package is specifically created for community health workers. This background and orientation to ENA is brief but provides references and additional materials from adaptations of ENA used in specific countries or contexts.
The UNICEF package includes an adaptation guide. While the ENA framework emphasizes the need to adapt to local contexts, the authors do not include an adaptation guide.
|2. For facilitators/ trainers||
|3. For primary health care staff||
|4. For community workers / counselors||
|III. Job Aids|
|The Booklet on Key ENA Messages is intended as a resource for training community or facility-based workers, or for promoting behavior change at the household level. The goal of this booklet is to make a harmonized set of messages available across all implementing partners working across various programs and regions in a targeted country. The booklet summarizes the “key actions” that mothers and caretakers can take (with support from other family and community members) to improve nutrition and feeding practices, thereby preventing malnutrition. The booklet contains a mix of illustrations and photos supporting each action.||
||The UNICEF package contains counseling cards, a key message booklet and three take-home brochures. The ENA framework includes a key message booklet which is intended to be used as a reference for key messages and a job aid for counseling.|
|IV. Training Guides for Community-based Volunteers/Health Workers|
||The UNICEF package counseling cards are designed for community-based providers – the package does not include counseling materials for facility-based staff as ENA does. Though the UNICEF counseling cards have been adapted in several settings for facility use by changing the illustration on the cover with the same content.|
|2. Length of Training||Nine Sessions over three days: two days at training site, a half-day for a practical field visit, and a half-day for development of Action Plans||Nineteen Sessions over five days: four days at the training site and one day (two half days) for a practical field visit||The ENA training lasts three days, while the UNICEF training is five days with a three-day adaptation option.
Both trainings include practica.
|V. Training Assessments|
|Pre/post-test (written)||Pre/post-assessment (not written, participants respond by raising hands)|
|VI. Field Practica|
Two-and-a-half hour field visit and 45 minute feedback session, including:
|Sessions 11 and 13
One day-long (or two half-day sessions) field visit, including:
|The UNICEF package includes a more intensive practicum, with a full day of practice as compared to the half day included in ENA.|
|VII. Implementation Guidance|
|1. Supportive Supervision||Understanding the Essential Nutrition Actions (ENA) Framework (6 pages): Includes a reference for additional resources specific to supportive supervision.||Supportive Supervision, Mentoring, and Monitoring Module (62 pages)||The UNICEF package includes a module on supportive supervision and mentoring, which the ENA materials do not address directly. However, additional references are linked to from adaptations of the framework.|
|2. Planning and Scale||Understanding the Essential Nutrition Actions (ENA) Framework (6 pages): Includes a reference for an additional resources that contains nine modules on rational for ENA and steps for large scale implementation.||
||The Planning Guide and Adaption Guides included in the UNICEF package provide a more extensive tutorial for planning and adaptation compared to the ENA materials which provides links to additional resources from adaptations of the framework.|
Table 2: Side by Side Summary of the CORE Group’s ENA Framework Trilogy and the UNICEF Community IYCF Counseling Package: Topics Covered
|Topics Covered, By Category||ENA Framework||UNICEF Community IYCF Counseling Package|
|I. Women’s Nutrition||X||X|
|Nutrition of pregnant women||X||X|
|Iron supplementation during pregnancy||X||X|
|Nutrition of lactating mother||X||X|
|Early initiation of breastfeeding||X||X|
|Good attachment and positioning||X||X|
|Breastfeeding on demand/frequency||X||X|
|Common breastfeeding difficulties||X|
|Early childhood development as it relates to responsive feeding||X|
|Mother who is separated from her infant||X||X|
|Hand expression and cup feeding||X|
|Continue breastfeeding until 2 years and beyond||X||X|
|III. Complementary Feeding||X||X|
|Introducing complementary feeding at 6 months||X||X|
|Feed a variety of foods||X||X|
|Complementary feeding for various ages – frequency, consistency, variety and amount||Feeding from 6-11 m.
Feeding from 12-24 m.
|Feeding from 6-9 m.
Feeding from 9-12 m.
Feeding from 12-24 m.
|Available local foods||X|
|IV. Nutrition in Special Circumstances||X||X|
|Feeding of the sick child during illness||X||X|
|Feeding of the sick child after illness||X||X|
|Nutritional care of infants and children with diarrhea||X||X|
|Nutritional care of infants and children with moderate acute malnutrition||X|
|Feeding a low birth weight baby||X|
|When to bring your child to the health facility||X|
|IYCF in emergencies||X|
|V. HIV and Nutrition||X|
|Exclusively breastfeed and take ARVs||X|
|Exclusively breastfeed even when there are no ARVs||X|
|Conditions needed to avoid all breastfeeding||X|
|VI. Micronutrient Deficiencies||X||X|
|Addition of micronutrient powders (MNPs) to complementary foods||X*|
|Prevention of malaria and anemia||X||X|
|Importance of Vitamin A||X||X|
|Preventing anemia from parasites||X|
|VII. Water, Sanitation, and Hygiene||X|
|VIII. Nutrition Counseling Skills||X||X|
|Counseling and negotiation||X||X|
|IYCF support groups||X|
|Development of action plans||X||X|
|IX. Other Skills||X||X|
|Regular growth monitoring and promotion||X|