The first component of the SPRING/DG collaborative approach, Initiation, has three distinct steps: mobilization, situational analysis, and capacity building (Figure 1). Complete information on all steps can be found in the DG SOPs.
Figure 1 below details the steps in the initiation process with bolded emphasis on the elements specific to the MIYCN approach detailed in this guide. Other steps not specific to MICYN activities are only briefly summarized and are further explained in the DG SOPs.
Figure 1: Initiation1
Click on the "Read section ..." buttons below and the corresponding steps in the process will appear.
- Hold a strategy meeting with all partners to clarify roles and responsibilities and develop detailed implementation plans.
- Identify villages and local teams to undertake video production, editing, screening and data collection, and reporting.
- Share the approach with the local community.
- Procure and allocate equipment based on specifications.
- Conduct a landscape or background review to understand the nutrition situation.
- Conduct a rapid formative research assessment to understand current practices and determinants of behavior.
- Train key partner staff and local village teams in video production, dissemination, and data collection and entry.
- Conduct nutrition sensitization trainings for key partner staff and local village intermediaries to include SBCC concepts.
1.1 Mobilization
Mobilization, the first step in designing a community video activity, entails convening a joint strategy meeting of key stakeholders, including the local partner institution. If this stakeholder group lacks MIYCN technical capacity, it is important to identify a health and nutrition technical partner to determine the scope for introducing the approach in identified villages and to develop clarity around roles and responsibilities and detailed implementation plans. At this meeting, agree on the following objectives:
- Partners’ roles and responsibilities
- Defining mutual expectations
- Creating a detailed work plan, with tasks, subtasks, indicators and metrics, and timelines
- Scheduling events primarily for training (creating a training calendar)
- Community group/organization selection criteria
- Local intermediaries’ selection criteria
- Village selection criteria
An illustrative project Gantt chart can be found in Appendix 1 of this Guide to assist with planning your community video activity and to provide you with a sense of the time commitment necessary for each step in the process.
Village Identification and Local Teams
Regardless of the subject matter of your community-video project, choosing the right local community organization as a partner is critical to success. An appropriate community organization has a good relationship with and/or membership comprising the project target audience, has an interest in the intervention topic, has sufficient human resource capacity, and shares the intervention objective. Choosing a local partner with technical expertise in MIYCN is preferable, to ensure local ownership, sustainability, and ease with technical content reviews. The local community organization will ideally already be working through village groups, which could be agrigroups, SHGs, farmer clubs, livelihood groups, savings and loan groups, mothers’ groups, or others. The community video approach functions best when integrated into an already well-established local group structure, but if none exists, you can consider working with local partners to form a group specifically for this intervention. Alternatively, this approach can also function with the Ministry of Health as the primary implementing partner, assuming an extension system with established supportive supervision and oversight infrastructure exists. The group may not be comprised solely of those in your target audience (e.g., pregnant and lactating women) but may also include key influencers to behaviors related to MIYCN who are critical to stimulate social change and who facilitate individual behavior change among their family members and peers. It is important that you meet with these village groups and organizational leaders to share the goals and objectives of the project. You should use this meeting to help define village groups’ interest, commitment, and incentive scheme or willingness to pay (local agents are sometimes compensated through community structures in order to ensure sustainability and commitment, but may also be paid by partners, government, the project itself, or not at all as volunteers). This is also the time to discuss how they will be responsible for taking ownership of the rollout of the approach in their community, as well as other accountability and sustainability issues.
The local partner is responsible for identifying staff, community members, or frontline workers who have an interest in the topic and the ability to become resource persons for implementing the approach in their community groups and villages. It is critical that these individuals are trusted, local community members, available for continued and meaningful engagement, and that they have the ability to connect individuals to any products, services, or resources that might be needed in order for certain behaviors to be adopted and promoted within their communities. Select individuals for video production and dissemination teams based on the following guidelines:
- Video Production: You will need approximately four to six individuals in each district (this will vary depending on the geographic scope and homogeneity of the population of your project). They will develop storyboards, arrange locations and actors, and shoot and edit videos. Each video shoot requires a video production team or crew consisting of a camera operator, a facilitator, and a director. The facilitator guides the interview or discussion with the featured community member by asking probing questions or providing complementary information. For a MIYCN project, the facilitator requires basic nutrition knowledge, either from previous experience or from intervention capacity building sessions (Section 1.3). Because video editing involves specialized software, the person identified for this role must be computer literate.
- Video Mediators: You usually need one or two video mediators for each village, depending on the number of groups and participants. Video mediators facilitate video screenings in the community by stimulating community interest, moderating audience discussion, responding to questions, and clarifying doubts. Video mediators should be able to provide follow-up support at the household level and to document community feedback and behavior change. Select mediators with care. They should be well respected in their communities and dynamic personalities able to conduct the disseminations effectively so as to stimulate social and behavior change. The credibility and success of dissemination is largely dependent on the skills of the mediator in facilitating the video screenings and their ability to effectively engage the audience and encourage the adoption of practices.
Detailed steps and tools for village identification and facilitation of local organizations and teams can be found in the DG SOP.
Specifications and Allocation of Equipment
Tools
Appendix 2: Specifications for Video Production and Dissemination Equipment Sets
The technology for the community-video approach is more widely available and affordable in low-resource settings than ever before. The video production and dissemination activities do require specific software and hardware (Appendix 2), but this equipment has been tested and shown appropriate in low-resource settings with limited Internet connectivity and irregular access to electricity. The local partner organization managing day-to-day project operations should maintain this equipment. Dissemination equipment is often shared among multiple groups and mediators locally. The logistics vary depending on population density, terrain, partner saturation in a particular geography, and other factors. Therefore, the required number of sets and who shares a single set of equipment depends on the number of groups in a village or district, the number of mediators in the project, the number of screenings each month and their timing, and groups’ geographic proximity. Aim for a balance among factors: the sharing of the equipment among as many groups as possible; ensuring that community videos are disseminated on a regular schedule for each group, over a sustained period; and provision of equipment down time for proper maintenance.
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1.2 Situational Analysis
After the local partner organization has identified target villages and established the video production and dissemination teams, the technical partner should begin gathering information needed to inform the next step—specifically, the development of the videos. For community-video projects relating to MIYCN, the first step in the situational analysis is to conduct a literature review or landscape analysis to understand and identify the major community nutrition issues and the cultural nuances of the intervention area; to assist in identifying target audiences; and to inform the development and/or selection and adaptation of formative research tools.
Subsequently, evaluate the findings from desk research against project goals to determine priority behaviors to be promoted that will yield potential or projected impact. This exercise will help identify the primary audience to target as well as any secondary audiences who have significant influence.
The next step is to tailor formative research specifically to investigate barriers to, and facilitators for, these priority behaviors and audiences. (This step may be unnecessary if you are embedding community-video activities within an existing health or nutrition intervention, which presumably has already implemented this step to inform current programming priorities, recommended behaviors, target audiences, and behavioral determinants.)
Tools
Appendix 3: Formative Research Protocol and Tools
Formative Research
Formative research is a fundamental step to gain understanding of local practices and contextual realities (i.e., sociocultural and economic) and how certain determinants may promote or hinder adoption of key practices. The research should also explore how to best link MIYCN with the partner’s ongoing interventions (e.g., agriculture with MIYCN). The results of the formative research will contribute to the subsequent development of video content through the package of practices that highlights the specifics of the behaviors and key messages. In many cases, before designing and conducting additional research, it is appropriate to collect and review formative research previously conducted with the target audiences in the intervention area. If no relevant or existing formative research exists for the specific area of implementation, you should conduct your own formative research to clarify relationships among target groups and identify priority behaviors. Ideally, the local partner organization and community agents should be involved in the research to shape an understanding of local issues and to foster ownership of the intervention from the very beginning. Participating in formative research, with the close interaction that the research requires, can also help build trust between community agents and community members. Conducted collaboratively, formative research will also expand participants’ understanding of nutrition and health issues and build the local partner organization’s confidence in working with these health concepts.
It is important not to assume that local agents, even those who live in the community, can provide the voice of the target audiences without conducting formative research and incorporating opportunities for community engagement throughout the approach. In many cases, local agents are often better educated, wealthier, or more socially connected than the typical target audience member. Even when local agents live in the community, they do not necessarily share the same values, experience, or perspective as target groups. These differences introduce their own set of biases that must be taken into account.
Project Experience: Formative Research
Specific objectives of the formative research conducted for the SPRING/DG project included:
- Identifying how familial relationships, gender, and social status affect decision making on issues relating to health and nutrition.
- Prioritizing MIYCN practices and barriers that need to be addressed (e.g., misconceptions and taboos about food, nutritional knowledge related to children under age 2, and how to leverage influential individuals).
- Recognizing major nutritional issues faced by adolescent girls and women and any related societal structures, taboos, barriers, and promising practices to build on.
- Understanding current hygiene practices, with a focus on hand washing with soap.
- Identifying positive deviant households or individuals that might be featured in future videos.
- Identifying information sources of your target group (i.e., adolescents, pregnant women, breastfeeding mothers) as well as how local health and nutrition services and providers are perceived and how this information may be relevant to your videos.
A Rapid, Low-Cost Research Methodology
The formative research is intended to be a rapid assessment that engages both the local partner and community agents; can be easily analyzed; and is inexpensive, as it uses local partner staff already in place. The scope of the research depends on the scale of the project but should remain small enough that the results can be analyzed on the spot to the greatest possible degree and used immediately.
Conduct your formative research using a participatory approach in a subset of intervention villages to represent the diversity of cultures and socioeconomic status and to account for other factors relevant to priority groups. A sample research protocol and tools—developed by SPRING in collaboration with DG and VARRAT—are included in Appendix 3 and can be adapted and translated into local languages. This adaptation should be informed by the results of the literature review conducted as part of the situational analysis to better understand the nutritional situation and cultural nuances of the intervention area.
Tools
Appendix 4: MIYCN and Hygiene Training Materials
Research teams should include lead program managers or researchers and local partner staff who speak the local language/dialect and have extensive experience working in the selected communities, to ensure trust during the research process. Engaging community leaders and using participatory methods can help ensure community buy-in. Consider using research techniques such as focus group discussions and in depth-interviews with a representative sample of the target populations (i.e., pregnant women, breastfeeding mothers, mothers-in-law, fathers, community health agents, local health authorities, and local leaders) using purposive sampling. If feasible given the scale of the implementation, have research teams meet each evening to conduct initial analyses and build consensus around key findings. Summarize key themes or findings emerging from the formative research and discuss them with the local teams so as to address them during technical trainings and ensure they are reflected in the design of the community-video storyboards and recruitment of actors.
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1.3 Capacity Strengthening
A critical piece of the initiation phase includes training the video production and dissemination teams convened by the local partner. The four major trainings to conduct during the initiation phase include:
- Video production and editing
- Video dissemination
- Data management
- MIYCN sensitization
Additional trainings include quality assurance, monitoring and evaluation, concept seeding and refresher trainings. The MIYCN sensitization training is detailed below; other trainings are outlined in the DG SOPs.
Sensitization Training on Maternal, Infant, and Young Child Nutrition and Hygiene
Given that nutrition is a topic with limited technical understanding in many rural areas, it is optimal for the local partner staff, especially the local video production and dissemination teams, to themselves possess basic knowledge of nutrition principles and recommended MIYCN behaviors. Additionally, to ensure support for video messages and alignment of messaging on nutrition to mothers, fathers, and other community members, local health and extension workers should be oriented to a single set of principles and recommended behaviors to the greatest extent possible. You should plan to ask community health workers not already engaged as video mediators to participate in the overall process of program development and implementation and/or to be featured as actors in the videos themselves, depending on the presence and role of community health workers in your context. Incorporating the community health workforce ensures coordination between local government and project staff and helps prevent duplication of effort and conflicting messaging. The community-video approach is intended to complement, not contradict, ongoing community health and nutrition work in the region and can serve to provide valuable linkages between nutrition and agriculture, or other non-MIYCN, activities.
The MIYCN and Hygiene training materials (Appendix 4) are comprised of four elements: the Facilitator Guide, facilitator training tips, training aids, and handouts, which you should adapt to your project’s local context. The training module, designed to be delivered over two days, was adapted from the globally recognized UNICEF community infant and young child feeding counseling training package.2
The goal of the training is to begin to build the capacity of local agents in MIYCN-related counseling, problem-solving, and negotiation skills. The training is not intended to make the local teams instant nutrition experts but instead to help them begin to understand the concepts and importance of nutrition during a child’s first 1,000 days, the window of opportunity from pregnancy through the second birthday. The subsequent dissemination preparation meetings (Section 3.1) will serve as refresher trainings and opportunities for supportive supervision related to the specific MIYCN topics in the next videos to be disseminated.
Pre- and post-training assessment tests are integral to the nutrition training. The first assessment establishes a baseline for pre-training knowledge about MIYCN. The post-training assessment measures newly acquired knowledge. Both tests are conducted anonymously and are suitable for low-literacy populations as they are not written. The facilitator asks participants to stand in a circle facing outward and answer “yes,” “no,” or “I don’t know” to questions by raising their hands above their heads. The difference between pre- and post-training scores both shows possible knowledge gain from the training and highlights areas to focus on during supportive supervision and reinforcement trainings, which should occur during regular dissemination preparation meetings with local teams.
Adapting the Nutrition Training Package
Ensure that trainings focus on behaviors identified during formative research and on MIYCN behaviors globally recommended for a child’s first 1,000 days. These behaviors include: hygiene, maternal nutrition practices, breastfeeding, and complementary feeding for children up to age two. Expect to adapt the training based on significant findings from the formative research. For example, take into account sociocultural characteristics unique to the local ethnic population(s), relating to dietary behaviors (e.g., for food preparation and feeding), clothing, and language. Illustrations in the training package (e.g., of hairstyles, dress colors, or household items depicted) may need to be adjusted or replaced completely with locally appropriate images. You may also need to translate materials into the local language.
Adaptation Steps:
- Systematically review each element of the training package and determine what adjustments or adaptations are required, based on available information and relevant data, for alignment with national norms, protocols, customs, and other recommendations.
- Consider which words and expressions need to be adapted to reflect local terminology and whether the package needs to be translated into local languages (and if so, which ones).
- Consider whether you need to adapt or adjust illustrations and other graphics for the trainees’ sociocultural context and local feeding challenges (see below).
- Consider the time available for training, participants’ varying knowledge levels, and other characteristics of the proposed audience. Determine whether adjustments to the training schedule will be required (e.g., whether the training needs to be spread out over a longer period of time).
- Identify potentially controversial technical elements (e.g., whether certain foods or practices you are promoting—family planning or changing gender roles and norms—are culturally taboo in the locality). Discuss any controversial issues among all partners until consensus is reached.
Visual Adaptations
As resources allow, adapt or replace graphics and illustrations within the Facilitator Guide and handouts following the thorough explanation at the UNICEF package Web site (PDF, 1.46 MB). Replacement images can often be found and borrowed from other regional or local nutrition projects or by simply using clip art or taking photographs in local markets and households. Whenever possible you should use visuals and materials already available and approved by national stakeholders. If no suitable visuals already exist, adaptation may mean incurring a graphic design expense that will stretch a resource-constrained budget. However, at a minimum, you should always plan to adapt the visuals included in the training aids to the local context.
Elements to Review and Evaluate for Local Relevance for Adaptation or Adjustment
Local Foods: Locally available and affordable foods should always be promoted
- Animal source foods (e.g., flesh foods, dairy products, and eggs)
- Staples (e.g., grains, roots, and tubers)
- Legumes and nuts (e.g., pulses—that is, the edible seeds of various legumes—and oil seeds)
- Fruits and vegetables
- Fats and oils
- Consider whether to add discussion of the following: high-fat and high-sugar foods; wild foods, grubs, snails, and insects; use of fortified foods.
Characteristics of the Local Population
- Facial features
- Skin tones
- Hairstyles
- Dress and clothing
Local Community and Environmental Characteristics
- Cooking pots, dishes, and utensils
- Housing styles
- Furniture, specifically stools, beds, and mats for sitting on
- Latrines
- Water sources
