Maximising the nutritional impact of
FSL interventions
TRAINING KIT
Facilitator Guidance Introduction & Session
notes
Version 1.0 – February 2012
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
1
Table of content
1. Course overview .................................................................................................................... 3
Aim of the training ......................................................................................................................................................................... 3
To whom this guidance is designed ........................................................................................................................................ 4
Time Frame ....................................................................................................................................................................................... 4
Prior consideration........................................................................................................................................................................ 4
Learner Profile................................................................................................................................................................................. 4
Prerequisites .................................................................................................................................................................................... 4
Course Norms .................................................................................................................................................................................. 4
Course agenda (2 days) ............................................................................................................................................................... 5
Readings ............................................................................................................................................................................................. 7
2. Course Preparation ................................................................................................................ 8
Pre-course Logistics ...................................................................................................................................................................... 8
Retro-planning ................................................................................................................................................................................ 8
Training Material Checklist ........................................................................................................................................................ 9
Content of the Resources Folder ........................................................................................................................................... 10
Content of the CD/USB key to distributed to participants ......................................................................................... 10
3. Session Guidance Notes ..................................................................................................... 11
0.0 Opening and Objectives ............................................................................................................................................................... 12
1.1 Overview of undernutrition ....................................................................................................................................................... 15
1.2 ‘Nutrition-sensitive’ assessment .............................................................................................................................................. 22
1.3 ‘Window of Opportunity’ ............................................................................................................................................................. 29
2.1 Programme Theory Pathway (PTP) ...................................................................................................................................... 32
2.2 Nutrition-oriented indicators ................................................................................................................................................... 36
3.’Do no harm’ ......................................................................................................................................................................................... 42
4. Nutrition promotion & Behaviour Change Strategy......................................................................................................... 45
Conclusion & Closing ............................................................................................................................................................................ 48
This training kit was developed by Géraldine Le Cuziat, with the support of Julien Morel and Sabrina Silvain
from October to December 2011. It benefited from precious contributions and feedbacks from a number of
ACF Food Security and Livelihoods Coordinators and Advisors during the ACF FSL Workshop held in
Kenya in October 2011.
The format used for this Facilitator Guidance and some other tools of the training package are largely
inspired by materials developed by the CaLP – Cash Learning Partnership.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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1. Course overview
Aim of the training
The training has two broad complementary goals:
1. To increase participant’s knowledge, skills and aptitudes in maximising the nutritional impact of food
security and livelihood interventions.
2. To share and disseminate lessons learnt, experiences and best practices of ‘nutrition-sensitive’
interventions.
N°
Module
Title
Session
n°
Specific learning Objectives
1. Define undernutrition and explain its consequences & determinants
2. Define nutrition security and explain the linkages between food
Session 1
1
Acknowledging
&
understanding
food security
through the
lens of nutrition
3. List the resources and key sources of information related to
undernutrition
4. Design and conduct a ‘nutrition-sensitive’ assessments
Session 2
Session 4
2
5. Explain how the findings from nutrition-sensitive assessment can be
used to plan and adapt FSL programmes
Session 3
Aiming for
Nutrition
impact
security, livelihoods, agriculture, nutrition and health
6. Define the concept of ‘window of opportunity’ and explain its
operational implications
7. Define the ‘programme theory pathway’ and explain its purpose in
the programme’s design
8. Identify nutrition-related indicators to measure outcomes & impact’s
intervention
Session 5
9. Explain the purpose and process of collecting individual dietary
information using IDDS and IYCF.
10. Define the ‘do no harm approach’ and list key steps of ‘a do no harm
3
approach’ strategy
Do no harm
Session 6
11. Explain the purpose and process of using the IYCN Nutritional
Impact tool assessment
4
Including
Nutrition
promotion
and/or
Behaviour
Change
Strategy (BCS)
12. Explain the purpose of nutrition promotion and how this should be
used
Session 7
13. Explain the purpose of Behaviour Change Strategy (BCS) and how
this should be used
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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To whom this guidance is designed
This guidance is designed for ACF technical advisors, coordinators and programme managers already
experienced in food security and livelihoods with some knowledge in nutrition. The training course is based
on the ACF International manual published in July 2011: Maximising the Nutritional Impact of Food Security
and Livelihoods Interventions, A manual for field workers. It is not intended as a training of trainer guide;
users are expected to already be fluent in course content and delivery from prior experience with similar
initiatives.
Time Frame
The course is currently designed to last 2 days; however they can be adapted for shorter time frames by
removing modules. In addition of the two-day course, one optional day is being developed as an introduction
to nutrition for FSL coordinators and/or programme managers who have limited knowledge and
understanding of nutrition. The nutrition coordinator/programme manager (if any in the country) may conduct
the session of this optional day.
Prior consideration
Is the Training
needed?
Before organising the training check that it is the right training for your intended
target audience.
Who will be in charge
of organising the
training?
Two essential roles to sort out from the start are the role of course administrator
in charge of the overall management of the course and the training team (which
should preferably be two trainers).
Budget
The overall budget needs to be agreed and allocated from the start. Typical
costs are the venue, meals and refreshments, per diem, accommodation,
training and organising fees, printing, stationery and equipment such as a
projector.
Learner Profile
The training targets ACF national and international staff, coordinators and programme managers who need
to plan, design, implement and monitor FSL interventions whether in emergency or in protracted relief and
rehabilitation operation. It is expected that participants will have limited or no experience in maximising the
nutritional impact of FSL. The training can also be conducted with partner and stakeholder staff with similar
roles, skills, and experience as ACF participants. It is highly recommended that the nutrition staff
(programme manager and coordinator) also attend the training in order to increase collaboration,
understanding, synergy and expertise within both teams.
This course however, is not about integration between the different technical sectors per se but aims to
mainstream nutrition into the standard FSL activities and practices, by increasing collaboration between
sectors. It aims to raise awareness of ACF staff and other humanitarian practitioners on the impact they can
have on nutrition by implementing nutrition-sensitive interventions and by promoting adequate nutrition
practices.
Prerequisites
1. Nomination and acceptance based on role and experience.
2. Reading the ACF manual Maximising the nutritional impact of FSL interventions in addition to other
compulsory readings listed below. (Section Readings)
Course Norms
1. 7 hours (4 sessions of 1.45 minutes) of active participation and homework per day.
2. Participants agree to capitalise on the opportunity to enhance their skills and experience.
Successful course completion will be required for a certificate. A final evaluation will be completed by each
participant at the end of the course to assess the relevancy of the training and contribute to the improvement
of the material.
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Course agenda (2 days)
The sequence of sessions is recommended, but can be adapted if time or process make this appropriate.
The course is based on adult learning principles and is intended to provide a balance of theory and practice,
of passive and active learning. Most of the PowerPoint presentations are structured around a series of openended questions to encourage on-going participants’ contribution and discussion throughout the session.
The materials are intended as a framework. They were designed for use in contexts where FSL interventions
are required but it is up to the trainer to make them realistic for the specific context in which they are training,
by providing illustrations and examples from the context. As a trainer you may also decide that certain
exercises/case-studies are not suitable for your audience and adjust accordingly.
The course is divided in 4 modules. The module one lasts one full day meanwhile module 2, 3 and 4 are
done during the second day. The latter can be further expanded if need be. Given the limited knowledge and
understating in nutrition, one optional day is being developed as an introduction to nutrition, which should be
conducted prior to the course.
It is a tight agenda with many sessions, notes, and exercises. Training facilitation should therefore be shared
between two people. One of the main challenges for facilitators will be to keep the sessions as active as
possible. Regular review sessions are conducted for continuous reinforcement of course content. All outputs,
field tool formats, and session slides should be given to participants on a CD or flash drive at the end of the
training
.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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AGENDA
TIME
8.30 10.15
10.4512.30
OPTIONAL DAY



Basics of Nutrition
Macronutrients & Micronutrients
Healthy diet

Nutritional needs of specific
groups (e.g. PLW, children under
two, PLWHIV)
NutVal exercise

DAY 1
Opening




Welcome & game
Participants & Facilitators presentation
Training objectives
Participants expectations & specific
learning objectives

Agenda & training rules

Individual pre-test on Nutrition
Module 1: Acknowledging & understanding
through the lens of nutrition
Session 1

Overview of undernutrition
BREAK

Group exercise 1 & group presentation

Scale, trends and variations

Nutrition security

Case-study 1 - Exercise

Ccl and operational recommendations
DAY 2
Recap of the previous day -15’

Ball game
Module 2: Aiming for nutrition impact
Session 1

Programme theory pathway

‘Porridge Mum’ in Guinea

Case study 3 - Exercise and group
presentation
Session 2


Nutrition-oriented indicators & tools
Group exercise 2 & group
presentation
END MODULE 2 – Main Recommendations -10’
LUNCH
1.30 –
3.15


Nutritional Assessment &
interpretation (i.e. GAM, SAM,
MAM)
Case-study
Session 2


‘Nutrition-sensitive’ assessment
Case-study 2 - Exercise
Module 3: Do no harm

Do no harm

IYCN presentation (Nutritional Impact
Assessment Tool)
END MODULE 3 – Main Recommendations – 10’
Module 4: Including nutrition promotion and
Behaviour Change Strategy

Overview of nutrition promotion and
BCS

‘Health gardens in Mali & group
discussion
END MODULE 4 – Main Recommendations – 10’
3.45 –
5.30


Direct nutrition interventions
Case-study


BREAK
Case-study group presentation
Ccl and operational recommendations
Session 3



Story telling
Window of opportunity
Group brainstorming & discussion about
operational implications
END MODULE 1 – Main Recommendations -10’
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
Conclusion

Film video (J.Hoddinott) – 15’

Action plan – 60’

Oral & written feedbacks from
participants – 30’
6
Readings
Hereafter is the list of compulsory and optional readings to accompany the training. Participants should get
familiar with the readings and read the compulsory ones before attending the session. Most of the readings
are also mentioned in the ACF manual. These documents are all available in the folder 5.Readings of the
Training Kit.
Compulsory
1. ACF, 2012, Glossary of terminology commonly used to prevent, diagnose and treat undernutrition
2. Scaling Up Nutrition (SUN), 2010, Scaling Up Nutrition: A Framework for Action; Available at:
http://www.unscn.org/files/Annual_Sessions/2009_Brussels/SUNframework_sept2010.pdf
3. WFP, 2006, NutVal 2006 – V2.2
4. IFPRI, 2008, Investing in early childhood nutrition. Policy Brief ; Available at:
http://www.ifpri.org/publication/investing-early-childhood-nutrition
5. IFPRI, 2011, Leveraging Agriculture for Improving Nutrition and Health: Highlights from an
International Conference, Washington, DC
6. ACF Mali, 2011, Health Gardens – A nutrition centred Approach. Impact and capitalisation study
Optional
1. ACF, 2007, Basics of nutrition, 2007
2. UNSCN, 2010, 6th report on the World nutrition situation, Geneva.
3. WFP, 2010, Revolution: From Food Aid to Food Assistance, Innovations in overcoming Hunger,
Edited by Omano, Gentilini and Sandström, WFP, Rome
4. FAO, 2010, Combating Micronutrient Deficiencies: Food-based Approaches, edited by Brian
Thompson and Leslie Amoroso, FAO, Rome.
5. UNSCN, 2010, Policy Brief on Climate change and Nutrition Security
6. LINKAGES Factsheets, Breastfeeding, Maternal nutrition, Infant Feeding, 2003-2004 (3 documents)
7. European Commission, 2011, Addressing Undernutrition in External Assistance, An integrated
approach through sectors and aid modalities, Reference Document, Tools and Methods Series
8. DFID, 2010, The neglected crisis of undernutrition: Evidence for action
9. DFID, 2011. Scaling Up Nutrition. The UK's Position on Undernutrition
10. AED & LINKAGES, 2003, Formative Research, Skills and Practice for Infant and Young Child
Feeding and Maternal Nutrition, AED/LINKAGES India
11. IYCN, 2011, Behavior change interventions and child nutritional status, Evidence from the promotion
of improved complementary feeding practices, Literature review, USAID/IYCN, Washington
12. IYCN, 2011, Nutritional Impact Assessment Tool. Electronic Worksheet & Guidance (2 documents)
13. Save the Children, 2009, Hungry for Change, an eight-step, costed plan of action to tackle global
child hunger, Save the Children, London
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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2. Course Preparation
Pre-course Logistics
Choosing
location and
dates
A wide range of considerations need to be taken into account when
deciding where to run the course (country and city) and in which dates:
accessibility of the place, visas, season, cultural/religious festivities, etc.
Selecting the
venue
Before advertising the course, make sure you have identified and booked
the appropriate venue to run the course.
Things to check are space for the amount of participants you have in mind,
including for exercises, space to hang flip charts on the wall, natural
daylight and basic facilities for photocopying, email etc.
Retro-planning
a. 2 month before the course
 Send invitation including all relevant information regarding the aims, objectives and rationale of
the course, expectations and methodology and conditions to participate.
 The pre-communication also contains a preliminary questionnaire to tailor the training to the
needs and experience of interested/potential participants.
b. 1 month before the course
 Collect info on country context and strategy, projects on-going related to the topic, potential
contributions/presentation from participants, assessment data
 Update training content if need be (e.g. undernutrition trends per region/country – see Slide 2
session 1.1) and update slide accordingly.
 Once participants have been confirmed, they should be sent:
- A revised agenda (according to needs and expectations -> make sure to change accordingly
Handout 1 – Agenda before printing)
- Logistics information relating to the venue, transport arrangements etc.
- A participant list
- An invitation to make a presentation if need be
- Documents to read before the course
 Order training material and resources. All necessary stationary, technical equipment and training
materials (See Training Material Check List below) need to be ordered as soon as possible
before the training.
 Order printing of needed resources (See Training Material Check List – a. Printing below)
c. 1-week before the course
 Divide participants in working groups (e.g. minimum 3 groups and maximum 6; groups should be
composed of 4 to 6 people). Make sure participants’ background and level are mixed within the
groups.
 Select who will write minutes during the course (if need be)
 Ensure that material, equipment and stationary will be available in a timely manner
 Read the training material and content and make changes/updates accordingly
d. 1-2 days before the course starts
 Prepare the room
 Check all equipment, materials and printing
 Test video and speakers
 Print all remaining documents
 Prepare material for exercises (Key words exercise 1 – plan for 1 hour of preparation)
e. During the course
 Burn and distribute the CD/USB key with material and additional reference documents to be
distributed to participants at the end of the course
 Print and fill up the Attendance List
 Take a picture of the group
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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


Take notes and debrief daily amongst facilitators in anticipation of the training report writing
Keep record of any remarks/ideas to change/improve the training materials
Update participants list with contact details and add to participants CD/USB Key
f. After the course



Analyse participants evaluation form
Prepare and share a short report with relevant stakeholder (e.g. ACF-F Food Assistance &
Policy Senior Advisor, HR department)
Send a follow-up e-mail 1 month after the course to participants
Training Material Checklist
*: Non-compulsory
a. Printing
 ACF Manual ‘Maximising the nutritional impact of FSL interventions’: 8 copies (B&W printing).
Note: ideally participants should come with their own copy. ( 4.Ressources\Manuals)
 FAO and EC, 2011, Guidelines for measuring household and individual dietary diversity: 4
copies (B&W printing) ( 4.Ressources\Manuals)
 WHO et al, 2008, IYCF Definitions: 4 copies (B&W printing) ( 4.Ressources\Manuals)
 WHO et al, 2010, IYCF Measurement: 4 copies (B&W printing) ( 4.Ressources\Manuals)
 Copies of Handouts : 1/participant) (3.Handouts)
 Tool - Exercice 1- Key Words: 7 copies (4.Ressources\Tool)
 Tool - Team Numbers: 2 copies (4.Ressources\Tool)
 Tool – Timing: 2 copies (4.Ressources\Tool)
 Participant list (name, org, role, sector, phone and e-mail contacts) : 1 copy for facilitator
 Participant Attendance List (2 copies) and Evaluation Forms : 1/Participant
(4.Ressources\Template)
 Participants Evaluation Form : 1/Participant (4.Ressources\Template)
 Participants Certificate: 1/participant (4.Ressources\Template)
b. Stationary
 Name tags/stickers (1/participant)
 Notebooks/pads (1/participant)
 Pens (1/participant)
 3 Packs of A4 paper
 Marker pens: 3 boxes, mixed colours (black, blue, red, green);
 Post-it medium size (12,7 x 7,6 cm): 2 to 3 colours, 4 packets of each
 3 blue tacks
 2 tapes
 Blank CDs or USB Key (1/participant + office, training centre, and headquarter copies)
c. Equipment (to be lended by the mission, the venue or if need be rented)
 Laptop computer
 Projector, screen, remote control* with laser pointer*, spare batteries
 2 multi-plug extension cables (with universal plug holes), 5m metres
 Attachable microphones for facilitators and hand held for participants*
 1 Printer with installation software and extra toner cartridge
 2 flipchart stands (+ 5 additional recommended for group work)
 3 rolls of Flip chart papers
 1 scissors (large)
 1 stapler
 1 ball
 5 MUAC tapes
d. Other
 Video 1: Linkages between Agriculture, Nutrition and Health available at Available at
http://www.youtube.com/watch?v=VKciI1RexvA or in tool folder.
 Memory stick/CD with all reference materials and course content (Training Kit)
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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Content of the Resources Folder

-
Manuals
ACF, 2011, ‘Maximising the nutritional impact of FSL interventions, a manual for field workers’
FAO & EC, 2011, Guidelines for measuring household and individual dietary diversity
WHO, UNICEF, FANTA, 2008, IYCF Definitions
WHO, UNICEF, FANTA, 2010, IYCF Measurement

-
Templates
1.Participants Attendance List_EN.doc
2.ACF PowerPoint Template_EN.ppt
3.Participants Evaluation Form_EN.doc
4.Participants Evaluation Database_EN
5.Training Report_EN.docx
6.Participants Certificate_EN.doc

-
Tools
Tool - Exercice 1 - Key Words.docx
Tool - Team Numbers.docx
Tool - Time_keeper.ppt
Tool - Timing.docx

-
Other
VIDEO - 2020 conference - Day 2 - 1B Plenary - Part I.flv
Content of the CD/USB key to distributed to participants
All the following folders and their content should be provided to participants on a CD or USB Key by the end
of the course:





2.Presentations folder
3.Handouts folder
4.Ressources\Manuals folder
4.Ressources\VIDEO - 2020 conference - Day 2 - 1B Plenary - Part I.flv
5.Readings folder
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3. Session Guidance Notes
Each session is supported with a set of Facilitator Notes in this same format. While the overall direction,
content, and flow of each session is included, facilitators are nonetheless encouraged to modify these as
much as possible or relevant so that the course they deliver is in fact their own. The first section provides an
overview of key information, including the equipment or materials required for the session. The second
section proceeds through each PowerPoint slide independently, with supporting commentary to assist
session facilitation. Some sessions also include an exercise, in which case it is discussed in the third part of
the Guidance Notes.
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0.0 Opening and Objectives
Objectives
Duration
Seating Plan
Exercise(s)
Reading(s)
Handout(s)
Equipment(s)
Material(s)
1. Open the training & welcome participants
2. Introduce & present participants
3. Clarify training objectives
4. Compare participants’ expectations to learning objectives
5. Present the agenda and training rules
6. Assess the pre-training knowledge level of participants
85’ (reminder - Aan introduction should last 10% of the total duration of the training).
Timekeepers are available in the folder ‘Resource’.
Chairs in a circle, with tables
5/6 persons per group
Keep in mind that groups should not be the same all along the training session. Mix the
groups! Put some music when the participants are coming into the meeting room to get a
nice atmosphere. The room should be comfortable and prepared before the training
starts. An extra table should be dedicated to ‘resources/readings”, that are of interest for
the training (see further readings and websites in the manual).
Warm up ‘Optical illusions’
 Optional Reading 1: Basics of Nutrition
 Handout 0: Training & specific learning objectives
 Handout 1a: Agenda
 Handout 1b: Readings List
 Handout 2a: Individual pre-test ‘Basics on nutrition’
 Projector
 Remote control
 Flip chart for writing expectations
 Flip chart with learning objectives – already written.
 Name tags
 Markers
 Training schedule
 Recording sheet to note questions that caused confusion or should be revised.
Output(s)
Session Plan
Slide #
1.
Welcome 5 ‘
Guidance Notes
Welcome participants and thank them for their participation.
As a facilitator, it is crucial to be ready, on time, positive, welcoming, energetic to
capture the audience attention. Keep in mind that the first 15 minutes will set the
tone of your course.
Suggested intro:
- Burning topic with increasing evidence-based and research towards maximising
the nutritional impact of FSL interventions. The guidance/training draws on the
outcomes of the conference that took place in New Delhi in February 2011
“Leveraging agriculture for improving nutrition and health” to sustainably
prevent and reduce undernutrition. This forum brought over 1,000 policy makers,
practitioners, politicians, NGOs, international organisations, academics,
researchers, representatives from ministries of health and agriculture to look for
synergies among initiatives to improve nutrition and health through agriculture. A
number of publications, brief policies, discussions were issued and are available at
http://2020conference.ifpri.info/ and http://2020conference.ifpri.info/publications/
- Dispel the myth that increased agricultural production or income necessarily
translates into improved nutrition. Not true as other factors affect the nutritional
status.
- Manual needs to be field-tested and opportunity to develop new and more
nutrition-sensitive interventions all along the project cycle. Remains country
specific and requires adaptation to local and cultural context.
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2.
GAME 5 ‘
6.
Participants
facilitators
presentation 20’
&
7
Training Objectives
5‘
8.
Participant
expectations & specific
learning objectives 10’
for writing specific
objectives & 20’ for
presentation
9. Agenda & training
rules 5’
10.
Individual pre-test
15’
- The intention of the training is not to make FSL staff nutritionist but raise the
awareness about optimal nutrition knowledge and practices.
‘Warm up game’ to create a working and enabling environment. This will allow
participants to ‘get into the course’ and leave some extra time to the late birds.
Note that it does exist many other ice-breaker/games to start a training session and
encourage participation. Well-selected icebreakers and openers can help members
feel “associated with” group members and the facilitator and could be created or
adapted to the context.
Pick of the following options or create new ones to introduce participants &
facilitators.
 “Name Game”
Ask each person to compare herself or himself to an animal or thing
that exemplifies some trait of his/her personality and explain the
choice. Examples: “I am like an ant because I am always on the
move,” “I am like a horse because I swiftly do my tasks,” “I am like a
bird because I like to dream.”
 “Commonalities”
Divide participants into pairs. Ask participants to share their names
and positions and to try to find three things they have in common.
Allow 10 minutes for this exercise. In plenary, have each pair introduce
each other to the group and share one commonality they discovered.
1. To increase participant’s knowledge, skills and aptitudes in maximising the
nutritional impact of food security and livelihood interventions.
2. To share and disseminate lessons learnt, experiences and best practices of
‘nutrition-sensitive’ interventions.
Whenever possible, ask participants in plenary session to name their expectations
for this training. Alternatively, ask every group to define 3/4
objectives/expectations. Every group leader will present the group’s findings to the
others. Write participants’ responses on the flipchart. Present learning objectives
and tell participants whether their expectations will be addressed in the design of
the training. Compare participants’ expectations to learning objectives and allow
participants to ask questions. If realistic, add any additional objectives
recommended based on participants’ expectations.
Distribute Handout 0
Distribute Handout 1a and Handout 1b.
Facilitator will walk participants through the workshop structure and content. It is
essential to agree upon norms and ground rules that respect individual rights and
responsibilities, build trust among participants and between participants and
facilitator. Both participant & facilitator will contribute to a successful learning
experience and this should be decided on as a group in the beginning.
List the agreed rules on a paper board (if not mentioned, add punctuality, mobile
phones silent, respect of each other and listening to others etc.).
In addition, participants will receive the list of compulsory and optional readings;
this aims at increasing participation and experience sharing during the training.
Distribute Handout 2a
This is to briefly assess the pre-training knowledge level of participants as well as
an opportunity for participants to assess their own level.
Distribute pre-test sheets and ask them to complete the pre-test. Tell participants
they have 15 minutes to complete the test. Give them a 5-minute and 2-minute
warning. No restitution is planned, as the answers will come up during the two-day
sessions.
It is very important to IDENTIFY topics that caused disagreement or confusion that
need to be addressed: ask after completion of the test which questions were
particularly difficult to answer. Remind them to go back to the handout during the
course to correct or precise their answers (in the right column).
Encourage participants to have a look at optional Reading 1: ‘Basics of
nutrition’ to get familiar with macronutrients, micronutrients and
recommended nutrient intakes.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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Module 1: Acknowledging & understanding food security through the
lens of nutrition
No
Module
Title
Specific learning Objectives
Session
no
1. Define undernutrition and explain its consequences & determinants
Session 1
1
2
Acknowledging
&
understanding
food security
through the
lens of nutrition
Aiming for
Nutrition
impact
2.
3.
4.
(knowledge)
Define nutrition security and explain the linkages between food security,
livelihoods, agriculture, nutrition and health (knowledge)
List the resources and key sources of information related to undernutrition
(knowledge)
Design and conduct a ‘nutrition-sensitive’ assessment (skills &
aptitudes)
Explain how the findings from nutrition-sensitive assessment can be used
to plan and adapt to FSL programmes (skills & aptitudes)
Define the concept of ‘window of opportunity’ and explain its operational
implications (knowledge & aptitudes)
Session 2
5.
Session 3
6.
Session 4
7. Define the ‘programme theory pathway’ and explain its purpose in the
programme’s design
8. Identify nutrition-related indicators to measure outcomes & impact’s
Session 5
intervention
9. Explain the purpose and process of collecting individual dietary
information using IDDS and IYCF
10. Define the ‘do no harm approach’ and list key steps of ‘a do no harm
3
Do no harm
Session 6
approach’ strategy
11. Explain the purpose and process of using the IYCN Nutritional Impact tool
assessment
4
Including
Nutrition
promotion
and/or BCS
12. Explain the purpose of nutrition promotion and how this should be used
13. Explain the purpose of Behaviour Change Strategy (BCS) and how this
Session 7
should be used
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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1.1 Overview of undernutrition
Objectives
Duration
Facilitator
Minutes Writer
Seating Plan
Exercise(s)
Reading(s)
Handout(s)
Equipment(s)
Material(s)


Define undernutrition and explain its consequences & determinants.
Define nutrition security and explain the linkages between food security, livelihoods,
agriculture, nutrition and health.
 List the resources and key sources of information related to undernutrition.
125’
Chairs in a circle, with tables
5/6 persons per group
Group exercise 1 (40’)
Case-study 1 (35’)
 Manual – See Section 1 & Annex 2
 Compulsory Reading 1: Glossary of terminology commonly used to prevent, diagnose
and treat undernutrition
 Compulsory Reading 2: Scaling Up Nutrition (SUN): A Framework for Action.
 Compulsory Reading 5: IFPRI, Leveraging Agriculture for Improving Nutrition and
Health: Highlights from an International Conference.
 Optional Reading 2: UNSCN ‘6th report on the World nutrition situation’.
 Handout 3: Life cycle of nutrition challenges
 Handout 4: Where to get information on undernutrition?
 Handout 5: Size of the nutrition problem in South Africa
 Projector
 Remote control
 Flip charts and cards with key-words (already filled in – see exercise notes below)
 Markers
 Blue tack or glue/tape
Output(s)
Session Plan
Slide
0. Opening
1’
1. Session objectives
1’
2. What is
undernutrition
5’
3. Picture 1
30 seconds
4. Picture 2
30 seconds
Guidance Notes
Benefits for participants:
 Increase collaboration and interaction with technical departments and
colleagues (especially with nutrition) by leveraging knowledge in nutrition.
 Save time and resources especially when comes the time of identifying needs,
conducting an assessment or writing proposals/reports.
 Define undernutrition and explain its consequences & determinants.
 Define nutrition security and explain the linkages between food security,
livelihoods, agriculture, nutrition and health.
 List the resources and key sources of information related to undernutrition
What is it?
Ask in plenary session some key words related to UNDERNUTRITION and how do
they relate to each other? Facilitator will write them on a paperboard and will be
able to gauge the existing level of knowledge and understanding among
participants. Note: the level of understanding will depend on participant’s exposure
to nutrition programmes and individual sensitivity.
FYI, participants should be familiar with the word ‘undernutrition‘ as they were
asked to read the manual before coming to the training and this is thoroughly
detailed in section 1 of the manual.
Human face of food insecurity, hunger and undernutrition
Human face of food insecurity, hunger and undernutrition
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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5. Estimates
1’
6. Definition
2’
7. Graph
2’
8. Determinants
3’
Facilitator should look for updated estimates (worldwide/regional/country) prior
starting the training. There is no need to provide a bunch of estimates, but
participants should bear in mind that undernutrition is widespread and remains one
of the world’s most serious but least addressed socioeconomic and health
problems.
At that stage, the facilitator provides a brief definition and will put not only focus on
acute malnutrition but on others as undernutrition encompasses a broad range
of conditions:
 Acute malnutrition
 Chronic malnutrition
 Micronutrient deficiencies or hidden malnutrition
 Maternal undernutrition
 Low birth weight
 Underweight
Make sure that participants are able to distinguish malnutrition/undernutrition.
There is no need to broadly detail every component, as this will be done later
during the exercise. (Facilitator support: refer to solution to question 1 pre-test
– handout 2b for short definition of each condition).
Mention to participants compulsory Reading 1 to get familiar with technical
terms related to undernutrition.
Graph on undernutrition
Participants are usually very familiar with the conceptual framework of malnutrition
and less familiar with the revised one from Black (2008) or World Bank (Draft 2011not yet released).
Immediate determinants: inadequate dietary intake and disease.
Underlying determinants: food insecurity, inappropriate care practices and an
unsafe environment including access to water and hygiene, and inadequate health
services.
Basic determinants: rooted in poverty and involve interactions between social,
political, demographic, and societal conditions
All these factors result in increased vulnerability to shocks and long-term stresses.
Add a focus on seasonality, as this is one of the major contributing factors of
undernutrition.
Example: Facilitator can recall ACF publication ‘Seasons of Hunger: Fighting
Cycles of Quiet Starvation Among the World’s Rural Poor’. In many places, the
lean season is associated with low food stocks, reduced job opportunities and
increased risk of morbidity (rainy season will increase risk of malaria/diarrhoea).
9. Consequences
4’
Distribute Handout 3
SHORT and LONG TERM consequences.
Facilitator needs to emphasise on the vicious circle of undernutrition and
poverty.
Example: Nutritional needs of girls/women during the life cycle are rarely met and
they are vulnerable to malnutrition throughout the life cycle for both biological and
social reasons. Facilitator presents the maternal undernutrition through the
different stages: infancy/early childhood/ adolescence/ pregnancy and lactation.
Conversely, there is strong evidence that good nutrition can lead to an impressive
range of benefits (e.g. improved health, cognitive development, and work capacity,
greater economic and agricultural productivity, better education, and better
workforce development, as well as greater resilience to shocks induced by social,
economic and natural causes.) Powerful tool in poverty reduction and livelihood
improvement (World Bank 2007).
10. Exercise
15’
Refer to compulsory Reading 2 (Scaling Up Nutrition) and briefly outline the
aim and objective of the SUN.
See exercise notes below.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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11. Exercise
correction
25’
12. Nutrition security
4’
Each group will present and explain the results to other participants. This is the
opportunity for the facilitator to recall the definition for each condition.
Refer to manual p.2 for additional information.
Nutrition security goes beyond the traditional concept of food security (access,
availability, stability and utilisation of food). Dependent on a wide and multi-sectoral
array of factors.
+ This is again the opportunity to dispel the myth that improved agriculture
production or income improves the nutritional status.
Example: Agriculture as a main source of food can influence health positively
through enhanced nutritional status, but also negatively by increasing human
exposure to toxicants, food-borne and zoonotic diseases related to agriculture and
food chains. Conversely, good nutrition improves agricultural productivity.
Keep in mind that participants may only see one way (positively through enhanced
nutritional status) and tend to overlook the other way around.
13. Nutrition security
1’
14. Nutrition security
definition
2’
Refer to compulsory Reading 5 ‘Highlight from an international conference
‘Leveraging Agriculture for improving Nutrition and Health’.
Figure on Nutrition Security
Definition
‘A household has achieved nutrition security when it has secure access to food
coupled with a sanitary environment, adequate health services, and knowledgeable
care to ensure a healthy life for all household members’ (Benson, 2004).
Nutrition security is not a new concept but has gained significance over the past
years. (e.g. used to receive far less attention in the literature than has food
security). However, there is no international consensus on what is nutrition
insecurity.
According to Benson, a household is food secure if it can reliably gain access to
food in sufficient quantity and quality for all household members to enjoy a healthy
and active life. It is possible, however, for individuals in food-secure
households to have deficient or unbalanced diets. A person may have reliable
access to the components of a healthy diet, but because of poor health or care,
ignorance, or personal preferences with negative nutritional implications, he
or she may not be able to or choose not to use the food in a nutritionally sound
manner. Just as food production and availability are necessary but not sufficient
conditions for food security, food security itself is a necessary but not sufficient
condition for nutrition security and a healthy and active life.
Moreover, the availability of nutrition resources and the degree to which an
individual has access to such resources are a function of how society is organized
in terms of economic structure, political and ideological expectations, and its
institutions. The determinants of nutrition security extend far beyond the control of
the household itself. Unlike food security, nutrition security is the concern of many
more institutions, sectors, and other actors than those typically found in the food
sector. Nutrition security must be a subject for political debate and an issue of
immediate concern to any national development strategies.
15. Scale and
determinants
5’
Facilitator will review the types of primary and secondary data to be collected to
gain understanding of undernutrition, its magnitude and determinants. This is the
first step in designing relevant interventions and encouraging synergies among
initiatives to improve nutrition. This is done in collaboration with the whole
technical team under the supervision of the Country Director.
16. Public health
threshold of
significance
3’
It is important to remind the audience that there is no official agreement on what is
a ‘nutrition emergency’ (i.e. commonly we use the 10% cut-off threshold for acute
malnutrition). It does exist thresholds of public health significance for
undernutrition.
Refer to p. 12 of the manual + Annex 2.
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17. Trends & variation
5’
Important to understand undernutrition trends and how changes over time can
reveal a deteriorating/improving the nutritional situation. This will also show
nutrition in its seasonal cycle. Facilitator adds on the need to desegregate data
whenever possible per age, sex, region.
Example: Figures/estimates can mask disparities between men/women, boys and
girls. In some countries, boys will get access to more nutritious food because they
are perceived as ‘future’ breadwinner of the family.
Refer to handout 4 for sources of information related to undernutrition.
18. Working together
5’
19. Case study 1
35’
20. Summary of key
points &
Operational
implications
5’
This is the opportunity to discuss about unknown/unfamiliar sources of information
such as the WHO database on vitamins and minerals or the Demographic Health
Survey (DHS), provides relevant websites (e.g. UNSCN, SUN etc) and operational
tool with the distribution of handout.
Distribute Handout 4
Make sure again participants are not worried about their ‘new tasks’.
The objective of the training is not to have nutritionist per se’but nutrition-sensitive
FSL staff. Cooperation and collaboration between sectors is a requirement. There
is need to speak the same language. Nutrition outcomes may be intuitive/obvious
for nutritionist but not for agriculturalist.
FSL field workers cannot do it ALONE!
See notes below
Distribute Handout 5
Why maximising the nutritional impact of FSL interventions?
 Increasing the nutritional benefits and minimising the potential harm
What does it mean?
 Acknowledging, understanding and acting through the length of nutrition and at
the intersection of Agriculture, FS Nutrition and health sectors, all along the
project cycle. FSL can bring about short and long term benefit by providing the
right intervention as the right time.
 Looking at UNDERNUTRITION at a whole and not only ACUTE malnutrition.
 Working in close collaboration with all departments – especially NUTRITION to
identify data, sources of information, and gain understanding of causality and
trends. Identifying specific secondary data of relevance.
 MAPPING nutrition and non-nutrition interventions in the area of intervention.
Keep in mind: no need of being an expert in nutrition but still need background and
basics to ensure relevant FSL interventions to fight undernutrition.
Exercise 1:
 What is the learning objective?
Be familiar with technical terms and key words that describe undernutrition
 How long this exercise be done?
15 minutes group work and 25 minutes for group presentation (5’ per group)
 What materials are needed?
One flip chart per technical term: acute malnutrition, chronic malnutrition, micronutrient deficiencies, maternal
undernutrition, low birthweight and underweight.
The following 25 terms are written separately on pieces of paper for each group.
Blue tack or tape to stick pieces of paper on flip chart.
 Where to find the materials and preparation needed
The material is available in the folder ‘Resources’. Print the whole word document in 6 copies, cut the
different 25 terms of each, and put them in a box/envelope (Each of the 6 groups should receive an envelope
with the 25 terms). In the meantime, stick the key technical term on a separate flip chart. (e.g. one set per
group)
 Instructions:
The participants are asked to match technical terms that describe undernutrition to keywords. Each group
will work on one specific condition (i.e. group 1/acute malnutrition, group 2/chronic malnutrition, group 3/
micronutrient deficiencies etc.). Cards with key words are already filled up, are picked one by one and stuck
under the condition they have been assigned on a flip chart.
Note: some key words may be associated to more than one condition.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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Acute
Chronic
Micronutrient
Maternal
Malnutrition Malnutrition deficiencies undernutrition
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Low
birthweight
Underweight
Wasting
“Too thin for the height”
Bilateral oedema
MUAC < 115 mm
Rapid weight loss
Food shortage
Inappropriate childcare and feeding practices
Stunting
“ Too small for the age”
Growth failure
Long-term consequence
Prolonged/repeated episodes of nutritional deficiencies/illnesses
Mineral
Vitamin
Iron Deficiency Anaemia
Goitre
Vitamin A
Hidden malnutrition
Poor diet diversity
Low body mass Index
Pre-conception, pregnancy, postnatal
Intrauterine growth retardation
Small baby
Inadequate pregnancy gain weight
Low weight-for-age
MODEL ANSWER







Acute Malnutrition
Wasting
“Too thin for the height”
Bilateral oedema
MUAC < 115 mm
Rapid weight loss
Food shortage
Inappropriate childcare and
feeding practices






Chronic Malnutrition
Stunting
“Too small for the age”
Inappropriate childcare and
feeding practices
Growth Failure
Long-term consequences
Prolonged/repeated episodes of
nutritional deficiencies/illnesses








Maternal undernutrition









Low body mass Index
Pre- conception, pregnancy,
postnatal
Mineral
Vitamin
Iron Deficiency Anaemia
Goitre
Vitamin A
Hidden malnutrition
Poor diet diversity
Low birthweight



Intrauterine growth retardation
Small baby
Inadequate pregnancy gain
weight
Micronutrient deficiencies
Mineral
Vitamin
Iron Deficiency Anaemia
Goitre
Vitamin A
Hidden malnutrition
Inappropriate childcare and
feeding practices
Poor diet diversity
Underweight

Low weight-for-age

Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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Case study 1: Size of the nutrition problem in South Africa (adapted
from the nutrition cluster harmonized training package)
Case study is presented from South Africa. Case studies are useful for getting participants to think through
real-life scenarios. They also provide an opportunity for participants to work in a group and develop their
analytical and decision-making skills. Trainers are encourages developing their own case studies,
which are contextually appropriate to the particular participant group.
 What is the learning objective?
To give participants an overview of the size and distribution of the problem of undernutrition in their country
 How long should the exercise take?
35 minutes
Give the groups 20 minutes to answer the questions and prepare a 3-minute presentation of their answers.
 What materials are needed?
Handout 5: Size of the nutrition problem in South Africa (questions)
 Instructions:
Each group is requested to answer the two following questions and prepare a brief presentation of the
discussion.
1. What do these graphs tell us about the distribution of undernutrition in South Africa?
Table 1: Underweight (weight-for-age) and Stunting (height-for-age) rates in % by Province
Province
Underweight
Stunting
Eastern Cape
7.1
20.5
Free State
14.3
29.6
Gauteng
8.8
20.4
KwaZulu-Natal
6.0
18.5
Mpumalanga
4.2
26.4
Northern Cape
23.7
29.6
Northern Province
15.0
23.1
North West
15.3
24.9
Western Cape
8.3
14.5
Source: Labadarios, D (ed). The National Food Consumption Survey (NFCS): Children aged 1-9 years,
South Africa, 1999.
2. What do you notice about the distribution of micronutrient deficiencies?
Table 2: Mean Intake of Vitamin A by Province and Age Group
Nutrient
Age Group
1
Vitamin A
1-3 years
4-6 years
7-9 years
Highest levels
Western Cape
Western Cape
Mpumalanga
Gauteng
Gauteng
Northern Cape
Northern Province
Northern Cape
North West
Lowest levels
Mpumalanga
Mpumalanga
KwaZulu-Natal
Northern Province Free State
Gauteng
Western Cape
North West
North West
Source: Labadarios, D (ed). The National Food Consumption Survey (NFCS): Children aged 1-9 years,
South Africa, 1999.
1
RDAs: Vitamin A = 1-3 yrs (400 RE); 4-6 yrs (500 RE); 7-9 yrs (700 RE) respectively.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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Table 3: Mean Intake of Iron by Province and Age Group
Nutrient
Age Group
Iron2
1-3 years
4-6 years
7-9 years
Highest levels
Northern Province Northern Province Northern Province
Western Cape
Western Cape
Western Cape
KwaZulu-Natal
KwaZulu-Natal
KwaZulu-Natal
Lowest levels
Northern Cape
Free State
Eastern Cape
Northern Cape
Free State
Eastern Cape
Northern Cape
Free State
North West
MODEL ANSWER: Size of the nutrition problem in South Africa
1. What do these graphs tell us about the distribution of under-nutrition in South Africa?
Northern Cape, North West and Northern Provinces have high rates of underweight and also high rates of
stunting. Remind participants that stunting is related to long-term undernutrition when children fail to grow
taller due to chronic (or long-term) undernutrition as a result of the poor quality of their diet and/or frequent or
chronic illness.
2. What do you notice about the distribution of micronutrient deficiency?
The distribution is rather similar to underweight and stunting.
Undernutrition is common in low-income groups in developing countries and is strongly associated with
poverty. Discuss the situation of undernutrition and its causes in South Africa (and in the provinces/regions,
in particular, where the training and/or programme is being conducted/implemented). Poverty results in not
having enough to eat or limiting dietary variety. Thus the manifestations are indicative of a problem further
“up the line”, food insecurity in this case.
Note: in many developing countries, under and overnutrition occur simultaneously reflecting the
consequences of a poor diet. This phenomenon is referred to as the double burden of malnutrition.
2
RDAs: Iron = 10 mg for all age groups considered.
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1.2 ‘Nutrition-sensitive’ assessment
Objectives
Duration
Seating Plan
Exercise(s)
Reading(s)


Design and conduct a ‘nutrition-sensitive’ assessment
Explain how the findings from nutrition-sensitive assessment can be used to plan and
adapt to FSL programmes.
105’
Chairs in a circle, with tables
5/6 persons per group
Case-study 2 (60’)









Handout(s)
Equipment(s)
Material(s)






Manual – See Section 2 – Guidance 2
Annexes 5a and 5b: IYCF protocols (Definition and Measurements)
Annex 6: Helen Keller dietary assessment tool to measure vitamin A intake
Annex 7: HarvestPlus dietary assessment tool to measure iron and zinc intake
Annex 10: Overview of the cost of a healthy diet by Save the Children UK
Compulsory Reading 3: NutVal 2006 (V3)
Compulsory Reading 5: IFPRI, Leveraging Agriculture for Improving Nutrition and
Health: Highlights from an International Conference (p.5-8)
Optional Reading 3: WFP, Revolution: From Food Aid to Food Assistance,
Innovations in overcoming Hunger.
Optional Reading 4: FAO, Combating Micronutrient Deficiencies: Food-based
Approaches.
Optional Reading 5: UNSCN, Policy Brief on Climate change and Nutrition Security.
Handout 6: Linking food security and nutrition data
Projector
Remote control
Flip chart
Markers
Output(s)
Session Plan
Slide
0. Opening
1’
1. Session objectives
1’
2. ‘Nutrition-sensitive’
assessment
Definition
3’
Guidance Notes
Benefits for participants:
Save time and resources especially when comes the time of conducting an
assessment. It increases collaboration among technical departments and reduces
risk of programme’s failure.
 Design and conduct a ‘nutrition-sensitive’ assessment
 Explain how the findings from nutrition-sensitive assessment can be used to
plan and adapt to FSL programmes.
The facilitator re-introduces the concept of NUTRITION SECURITY if not
mentioned by the participants. ‘Nutrition-sensitive’ assessment looks not only at
‘standard FSL indicators’ (household economy, livelihoods, coping mechanisms
etc.) but also at OTHER VARIABLES that affect the nutritional status.
ACF is capable to conduct technical joint assessment that includes all immediate
and underlying factors of undernutrition and this is a chance!
Examples: Nutritional Causal Analysis, Joint assessment.
Note: NCA guidelines are not ready yet at the time of writing.
Field workers can overcome the operational/timing/donor constraints of joint
assessment by conducting food security assessment in the same communities
where nutrition, Mental Health & Care Practices and WASH teams did their
assessments or incorporating more detailed questions into a stand-alone standard
SMART nutrition survey.
FOCUS on strong technical and geographical collaboration towards a same
objective. This requires expertise in some field (care practices – not always
implemented in every mission) but this should not prevent the team from
conducting joint & comprehensive assessment.
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3. Why is it
important?
4’
4 main reasons to be highlighted:
- Comprehensive overview and undernutrition pathways
Example: care and feeding knowledge and practices have been for a long time
overlooked but are key-contributing factors in children malnutrition.
Example: low birth spacing in Bangladesh or mothers do not take adequate weight
gain during pregnancy because they believed a small baby will facilitate the deliver
and avoid birth complications.
- Encourage synergies and integration between sectors.
Example: need to work at the intersection of agriculture, food security health and
nutrition to achieve tangible progress in nutrition and MDG-1.
- Reduce the risks of programme’s failure & conversely increase chance of
programme’s impact.
Example: distribution of livestock as physical capital/asset and not for
consumption; or, the livestock production is not ‘fairly’ allocated within the
household and women tend to eat the less nutritious parts. Need to gain
understanding of food intra-household allocation patterns.
4. Variables
4’
5. Nutritional status
2’
6. Food consumption
& dietary intake
5’
7. Tools
5’
- Milestone for the ‘do no harm approach” – will be further explained later.
Example: gender considerations should be addressed during the assessment as
women may not be the decision maker within the households about food
purchase/preparation, income allocation etc. Mother-in-law usually plays a key role
within the household.
The facilitator mentions the main variables to collect. Once again, participants
should be reminded that only variables related to nutrition are included and not the
other ‘core’ FSL variables/indicators.
Need to consult ACF guideline on food security and livelihoods assessment +
Refer to Manual Section 2, guidance 2 for additional information.
 Nutritional status
 Food consumption patterns & dietary intake
 Care practices
 Nutritional needs of specific groups
 Gender considerations
 Health and sanitary environment
The following will only provide details on the nutritional status, food consumptions
patterns and care practices. Refer to the manual for the others
The nutrition team is in charge of collecting key-nutritional data such as
anthropometry, MUAC, micronutrient deficiencies. FSL assessment does not
include anthropometric measurement per se. However, there may be some
exceptions (MUAC when FSL team is the first to arrive).
Taking anthropometric measurements requires TRAINING and SKILLS.
It does exist field-friendly and cheap method to detect IDA with Hemocue.
Broad concept and very country-specific!
This includes:
 Local perception of a “healthy diet’ might be very different from a
nutritionist perception
 Cultural beliefs around food (e.g. food restrictions during
pregnancy/lactation time)
 Meals frequency (very much affected by seasonality effects)
 Dietary diversity (number of different food groups consumed by an
individual/household over a given time).
Household level = proxy for food security and food access
Individual level= proxy for nutrient adequacy
 Dietary intake (caloric and nutrient intake against the Recommended
Dietary Allowances)
 Food utilisation (storage, processing and preparation)
Ask participants to raise their hands if already using the following tools:
 Seasonal calendar
 Household Dietary Diversity Score/Individual Dietary Diversity Score
 FFQ to measure micronutrient adequacy/dietary intake. See Annex 6
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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and 7 for dietary assessment models.
New tools i.e. Cost of the Diet developed by Save the Children. See
Annex 10 – Overview of the cost of a healthy diet by Save the
Children.
Note: On-going efforts to develop field-friendly tools to measure adequate dietary
intake and micronutrient adequacy. Problems of measuring micronutrient adequacy
with FFQ is partly due to nutrient’s interaction (e.g. iron utilisation is enhanced with
the vitamin C intake)
Have a look at NutVal – useful tool to calculate a balanced food ration.
Care refers to the behaviours and practices of caregivers (mothers, siblings,
fathers and childcare providers) to provide the food, health care, stimulation, and
emotional support necessary for children’s healthy survival, growth, and
development (Engle, 1995).
 Practice + Environment + Resources
It does exist measurable indicators for infant and children feeding practices.
Ask participants to raise their hands if they already used IYCF in their programme.

8. Care
practices
Definition
3’
9. IYCF
3’
 What are IYCF?
IYCF stands for Infant and Young Children Feeding.
IYCF practices directly affect the nutritional status of children under two years of
age and, ultimately, impact child survival. Improving infant and young child feeding
practices in children 0–23 months of age is therefore critical to improved nutrition,
health and development of children.
During a long period of time, the only indicator to measure IYCF mainly focused on
breastfeeding practices. Following new evidence about what constitutes optimal
breastfeeding and complementary feeding practices a new set of indicators was
recommended.
2 key-documents were recently published on IYCF resulting from a 5-year
collaboration from a range of agencies including WHO, UNICEF & FANTA.
1.
IYCF Definition. It presents a set of simple, valid and reliable indicators to
assess infant and young child feeding practices that should be considered
together (because of the multi-dimensional aspects of appropriate feeding
at this age). The document provides a list of 8 core and 7 optional
indicators (Refer to slide 10 below).




10. IYCF
Core indicators
3’
This set of indicators looks at breastfeeding practices BUT not only
and look at other feeding practices (e.g. complementary feeding, and
feeding of non-breastfed infants and young children less than 2 years
of age) at population level.
They are food-related (no about other optimal feeding aspects and do
not investigate ‘responsive feeding’ or adequate food texture.
They can be used during (i) assessment to describe trends, but also
for (ii) targeting to identify populations at risk, target interventions, and
make policy decisions about resource allocation and lastly (iii) M&E to
monitor progress in achieving goals and to evaluate the impact of
interventions
They should not be translated into messages for improved feeding
practices. Field practitioners should refer to WHO guidance for
feeding recommendations.
2. IYCF Measurement. This guide on measurement provides tools for data
collection and calculation of the indicators. IYCF are usually part of larger
surveys, are collected through 24h recall (to reduce recall bias) and
administer to mothers/caregivers. See a model of questionnaire in the
guide. Questions should be also adapted to the local context.
Core indicators. IN BOLD are the most important ONES.
1.
Early initiation of breastfeeding
2.
Exclusive breastfeeding under 6 months
3.
Continued breastfeeding at 1 year
4.
Introduction of solid, semi-solid or soft foods
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5.
6.
7.
8.
Minimum dietary diversity
Minimum meal frequency
Minimum acceptable diet
Consumption of iron-rich or iron-fortified foods
Optional indicators – not mentioned in the slide
9.
Children ever breastfed
10.
Continued breastfeeding at 2 years
11.
Age-appropriate breastfeeding
12.
Predominant breastfeeding under 6 months
13.
Duration of breastfeeding
14.
Bottle feeding
15.
Milk feeding frequency for non-breastfed children
11. Differences
with
standard
FSL
assessment
3’
12. Integration
of
findings
into
programme’s
design
5’
13. Case study 2
60’
14. Summary of key
points
&
Operational
Implications
3’
Refer to Manual Annex 5a and 5b for detailed explanations.
a. More comprehensive (look at individual > household)
b. Increased focus on food utilisation
c. IYCF
d. Women (maternal cares, gender considerations etc).
Number of ways.
Provides concrete examples from case studies or participants experiences.
- Types and modalities of intervention (e.g. short-term fresh food vouchers
in Haiti including access to proteins)
- Timing (e.g. cash for work intervention as safety nets during the lean
period)
- Targeting (e.g. blanket distribution for PLW)
- Do no harm approach (i.e. seasonal calendar to include women’s
workload)
- Complementary interventions (e.g. linking to health/de-worming
interventions)
Refer to compulsory reading 5 and optional readings 3, 4 and 5 for examples of
‘nutrition-sensitive’ interventions.
See notes below and  distribute the Handout 6.
- Linking with other sectors when designing and conducting assessment
- Requesting technical support if need be
- Spending more time on understanding food consumption patterns
- Using IDDS and IYCF as tools for assessment.
- Including other core FS variables
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Case study 2: Linking Food security and nutrition data: Zimbabwe 2001
(adapted from the nutrition cluster harmonized training package)
 What is the learning objective?
Appreciate the importance of linking food security and nutrition data.
 How long should the exercise take?
60 minutes
Give the groups 40 minutes to answer the questions and prepare a 3-minute presentation of their answers.
 What materials are needed?
Handout 6: Linking food security and nutrition data: Zimbabwe 2001
 Instructions:
Each group should answer the following questions and prepare a brief presentation of the discussion.
The situation in Zimbabwe spiralled into crisis as a result of complex underlying factors. Firstly, the political
environment was unstable and the government was accused of poor governance. Secondly, the economic
situation was deteriorating with high inflation, high unemployment, and closure of factories and businesses.
Thirdly, the impact of HIV/ AIDS was affecting over 30 per cent of the population. These factors had a major
impact on food security. In response, the Vulnerability Assessment Committee (VAC) – a conglomeration of
government and humanitarian agencies carried out an assessment in August 2002. The aims of the
assessment were to determine whether households were able to meet their immediate food needs (i.e. any
food deficit), and to identify vulnerable households and their coping capacities. A survey approach was
adopted that integrated analysis of the household economy, coping strategies, dietary intake, agricultural
inputs, and nutritional anthropometry. A complementary Household Economy Analysis (HEA) was also
conducted in four Food Economy Zones (FEZs).
Part 1
The VAC assessment found a prevalence of wasting (global acute malnutrition or GAM) of 7.3% in children
under five using standard cut-off points for weight-for-height Z-scores. This was similar to national surveys
using random sampling methods as table 1 illustrates. The United Nations classifies a prevalence of GAM
between 5-8% as a worrying nutritional situation, and prevalence greater than 10% as a serious nutritional
situation.
Table 1: Prevalence of malnutrition in children in Zimbabwe
Survey
Sample size
GAM %
Date
Demographic Health Survey
3,566
6
1999
Ministry of Health/UNICEF
23,400
6.4
May 2002
VAC
695
7.3
Aug 2002
Address the following questions:
1. What can you conclude from this information?
2. What interventions would you recommend to international agencies and donors to address the situation?
Part 2
Crop production
The 2001/02 crop-growing season was among the worst three since 1990 and cereal crop production was
seriously reduced due to:
 The dry spell experienced during the second half of the season
 The resettlement programme that disrupted commercial farming
 The Government agricultural input programme that delivered inputs late
 Draft power shortages
 The high cost of inputs, which farmers could not afford.
The VAC assessment concluded that Zimbabwe was facing a severe food crisis, which would become a
humanitarian crisis in the next seven months unless urgent action was taken. Cereal availability was a critical
factor with an initial cereal deficit of 1.65 million MT. The Grain Marketing Board had imported only 335,000
MT, and humanitarian food relief 70,600 MT. Private sector commercial imports were negligible. The
assessment found that 75% of households had less than ½ bag (50kg) of maize in stock. Furthermore 94%
of farmers did not have enough seed for the following agricultural year.
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Cash crop production
The major cash crops grown in Zimbabwe include tobacco, flowers, vegetables, fruits, cotton, soya beans,
groundnuts, sunflower, sugarcane, coffee, tea and paprika. Most of the cash crop production had decreased
in the past three years.
Market prices
The annual inflation rate at the beginning of 2001 was 57%. By January 2002, it had doubled to 116% and
further increased to 124% in July. The increase in inflation rate was compounded by the shortage of basic
consumer goods, agricultural inputs, fuel and foreign currency.
The assessment found that 70% of households were dependent on purchasing their cereals, and yet 64% of
the communities stated that cereal was not, or seldom, available.
Livelihoods and coping strategies
The assessment confirmed the impact of the crisis on peoples’ lives and livelihoods. Most rural income
strategies are dynamic throughout the year. The community analysis indicated that 83% of the communities
expected casual labour availability to decrease this year—severely limiting income opportunities especially
for the poor. The casual labour averaged $200 per day. Half the households interviewed reported incomes of
less than $5,000 per year. Even if all of the $5,000 were spent on cereal alone, this could only purchase
enough cereal for a typical family size to meet their needs for 7 ½ months.
Households were asked if they had engaged in any of seventeen distress coping strategies within the past
two months. These include: borrowing food, purchase food on credit, get food from relatives or friends from
outside the household, regularly limit size of portions at mealtimes, regularly reduce the number of meals
eaten during the day, skip whole days without eating, reduce expenditure on health care, reduce expenditure
on education, reduce expenditure on beer and tobacco, sell all poultry to get food, sell all goats to get food,
sell breeding and draft power cattle to get food, sell land or gave up rights to land, sell other assets to get
food, take children out of school, send children away to friends or relatives, forced to migrate to find work or
food.
The most commonly cited strategies involved reduction in consumption, with 86% of the households limiting
portions of meals, and another 86% reducing the number of meals eaten in a day. A total of 18% of the
households had removed one or more children from school. A majority (68%) of households were employing
multiple distress coping strategies.
Other commonly mentioned coping strategies included illegal gold panning (often involving removing children
from school to assist, and also leads to environmental damage), prostitution, and eating wild foods that were
new to the households and can sometimes lead to health complications.
Public health
The assessment found that the incidence of diarrhoea and acute respiratory infection (ARI) had increased
dramatically. This increase could be attributed to deteriorating health conditions due to lack of water and
proper sanitation and possibly complications of HIV/AIDS. Vitamin A deficiency (VAD) was 35.8% among
children aged 12-71 months and anaemia was 19.3% in the same age group. In a crisis situation VAD is
exacerbated and other vitamin deficiencies such as pellagra can surface.
Address the following question:
3. How do these findings alter your conclusions and recommendations?
4. Which non-nutritional data did you find most compelling with regard to determining the severity of the
situation and why?
5. What lessons can be learnt from doing this case study?
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Case study 2 MODEL ANSWER
Part 1:
What can you conclude from this information?
These levels of wasting on there own do not indicate a deteriorating situation although the fact that the three
surveys presented are undertaken at different times of the year makes rigorous comparison difficult
What interventions would you recommend to international agencies and donors to address the
situation?
A follow up nutrition survey in three months would be valuable to determine whether the situation is
deteriorating and also some sentinel site monitoring of MCH programmes and paediatric wards in order to
determine whether number of cases of children presenting with malnutrition is increasing. No other
interventions are indicated by these data alone.
Part 2:
How do these findings alter your conclusions and recommendations?
It is clear that the population is under considerably more stress than indicated by the anthropometric survey
alone. Food availability (crop production) and access (through markets) is considerably compromised while
diverse coping strategies are being employed some of which are damaging to long-term livelihoods, e.g.
selling draft animals and land or land rights. It also appears that coping strategies are limited and are being
exhausted.
A number of interventions are needed to address the situation. However, detailed analysis is needed to
assess the feasibility and appropriateness of each option. A SWOT analysis is useful (strengths,
weaknesses, opportunities and threats). Possible response options include;
Implementation of general rations
Gearing up to selective feeding programme implementation
Market support initiatives, e.g. subsidised sale of cereals, in order to improve access to cereals
Livestock de-stocking and restocking programmes
Seed fairs
Water and sanitation programmes
Which non-nutritional data did you find most compelling with regard to determining the severity of
the situation and why?
Although there is a subjective element to the question the most compelling non-nutritional data must in some
way relate to extreme non-reversible coping strategies as well as predictions of how long population groups
can hold out using available coping strategies. Other compelling evidence includes data which shows a
change from the normal, e.g. market prices, less casual labour available.
What lessons can be learnt from doing this case study?
The importance of linking anthropometric data with food security and livelihoods data.
The importance of data that may indicate the need for interventions, which go beyond feeding and address
recovery, e.g. sale of seeds and livestock.
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1.3 ‘Window of Opportunity’
Objectives
Duration
Seating Plan
Exercise(s)
Reading(s)
Handout(s)
Equipment(s)
Material(s)

Define the concept of ‘window of opportunity’ and explain its operational implications.
45’ + 10’ (end of module 1)
Chairs in a circle, with tables
5/6 persons per group
None
 Manual – See Section 2 – Guidance 3
 Compulsory Reading 4: IFPRI, Investing in early childhood nutrition.
 Optional Reading 6: LINKAGES Factsheet about breastfeeding, complementary
feeding and maternal nutrition.
 None
 Projector
 Remote control
 Flip chart
 Markers
 Record sheet to note scores and questions to be revised.
Output(s)
Session Plan
Slide
0. Opening
1’
1. Session objectives
1’
2. Story telling
3’
3. Definition
4’
Guidance Notes
Benefits for participants:
Raise awareness about the nutritional needs of pregnant and lactating women and
children under two. This could be very useful for them and their own families.
Increase programme’s accuracy (delivery of inputs, targeting, messages)
 Define the concept of ‘window of opportunity’ and explain its operational
implications.
Ask the participants to relax and close their eyes.
The
facilitator
tells
a
story
of
Farida
available
at
http://www.thousanddays.org/success-story/maternal-undernutrition-a-mothersstory/
Farida, a 23-year-old Bangladeshi woman, lives with her husband and in-laws in a
sub district near Dhaka. Like many women in rural Bangladesh, Farida is a
housewife. Married at the age of 17, Farida became pregnant within a year. During
her pregnancy, Farida had no access to skilled prenatal care or education. Instead,
she took tabij (amulet) and pani pora (chanted water) for minor problems. She went
into labor prematurely at home, and lost her baby. Two year after, she got pregnant
again but sadly, Farida’s baby was stillborn. Several months later, Farida met
Nurunnahar, a Community Nutrition Worker of an NGO in Bangladesh.
Nurunnahar encouraged her to attend nutritional information sessions. At these
sessions, Farida learned about the importance of prenatal care, a nutritious diet
and proper rest during pregnancy. The lessons learned in the nutrition sessions
were complemented by regular household visits with Nurunnahar, during which
Farida could consult with her on questions or concerns.
When Farida became pregnant, she went to medical centers near her home for
regular prenatal visits. At the time of delivery, Farida went to a hospital, where she
gave birth to a healthy baby boy. She breastfed after delivery, and continued
exclusive breastfeeding until her son was six months old. Now 17 months old,
Farida’s son is happy, healthy and keeps her very busy!
Before giving the definition of the window of opportunity, try asking participants to
give their own definitions, which will help facilitators understand existing capacity in
the workshop.
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Evidence shows that the “window of opportunity” for addressing child nutrition
needs is short and lasts from conception to the age of two. After the consequences
of undernutrition are irreversible - this is also the window of opportunity for combat
undernutrition;
Make sure that participants are familiar with the different terminologies: ‘1,000
days’, pre-conception to the age of two.
Example: iron deficiency between 6 to 24 months impairs child cognitive
development.
Refer to compulsory reading 4: Investing in early childhood nutrition Policy Brief’
4. Operational
implications –
small group
discussion
20’
Ask participants to brainstorm about the operational implications for FSL
interventions with 4 guiding questions and make a 3-minute presentation of their
discussions.
 What does this mean in terms of need’s assessment?
 What does this mean in terms of targeting?
 What does this imply for programme’s design?
 What are the potential challenges?
5. Operational
implications presentation
15’
Needs assessment: This requires getting specific data for PLW and children under
two (anthropometric, food consumption) and to a broader extent for women of
reproductive age.
Targeting: combination of criteria (vulnerability + window of opportunity) or
exclusive/unique criteria. This will depend on the type of the programme (e.g.
blanket feeding or agricultural programming)
Programme’s design: pay specific attention to the nutritional needs of PLW and
children under two (e.g. encourage home food fortification, cash transfers depend
on women attending ante natal care consultation)
Potential challenges: not always feasible and desirable. Create tensions within the
communities and ultimately depends upon objectives and need’s assessment.
6. Summary of keypoints &
Operational
Implications
1’
 End of MODULE
1 10’

The ‘window of opportunity’ period starts with a mother’s pregnancy
until a child is two years old and also refers to the window of
opportunity to take action to combat undernutrition as consequences
after this period are irreversible.
 Including this target group in your next intervention.
Ask participants to recall the main recommendations and key points of the module
1. This could be done in small groups or in plenary session.
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Module 2: Aiming for nutrition impact
No
Module
Title
Session 1
1
Acknowledging
&
understanding
food security
through the
lens of nutrition
livelihoods, agriculture, nutrition and health
Session 2
Session 4
2
1. Define undernutrition and explain its consequences & determinants
2. Define nutrition security and explain the linkages between food security,
3. List the resources and key sources of information related to undernutrition
4. Design and conduct a ‘nutrition-sensitive’ assessment
5. Explain how the findings from nutrition-sensitive assessment can be used
Session 3
Aiming for
Nutrition
impact
Specific learning Objectives
Session
no
Session 5
to plan and adapt to FSL programmes
6. Define the concept of ‘window of opportunity’ and explain its operational
implications
7. Define the ‘programme theory pathway’ and explain its purpose in the
programme’s design (knowledge & skills)
8. Identify nutrition-related indicators to measure outcomes & impact’s
intervention (knowledge & skills)
9. Explain the purpose and process of collecting individual dietary
information using IDDS and IYCF (skills)
10. Define the ‘do no harm approach’ and list key steps of ‘a do no harm
3
Do no harm
Session 6
approach’ strategy
11. Explain the purpose and process of using the IYCN Nutritional Impact tool
assessment
4
Including
Nutrition
promotion
and/or BCS
12. Explain the purpose of nutrition promotion and how this should be used
13. Explain the purpose of Behaviour Change Strategy (BCS) and how this
Session 7
should be used
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2.1 Programme Theory Pathway (PTP)
Objectives

Duration
Seating Plan
95’
Chairs in a circle, with tables
5/6 persons per group
Group exercise (’)
Case-study 3 (’)
 Manual – See Section 2 – Guidance 4
 Handout 7: Programme Theory Pathway in Myanmar
 Projector
 Remote control
 Flip chart
 Markers
 Tape
 Post-it
 Presentation - Module 2.1 Field Experience Guinea - Porridge mums.ppt
Exercise(s)
Reading(s)
Handout(s)
Equipment(s)
Materials(s)
Define the ‘programme theory pathway’ and explain its purpose in the programme’s
design.
Output(s)
Session Plan
Slide
0. Opening
1’
1. Session objectives
1’
2. Programme
Theory Pathway
definition
8’
Guidance Notes
Benefits for participants:
Reduce the risk of programme’s failure with the identification of the PTP. No more
struggle when comes the time to design the log-frame. Save time, resources and
headache!
 Define the ‘programme theory pathway’ and explain its purpose in the
programme’s design
Before introducing the concept of programme’s pathway, ask participants to list the
main steps of the PROJECT CYCLE. What SHOULD they do at designing and
formulation stages?
Problem tree, solution tree, logic chain, log-frame with definition of general and
specific objective.
Participants should bear in mind that the project’s outcomes will not be achieved
automatically.
Example: the potential of egg, meat, fish or dairy products to alleviate
micronutrient deficiencies as part of a food-based strategy is well recognised
especially in countries where the main staple food is cereal. However, the
promotion of animal rearing will not automatically lead to improved consumption.
Experience shows for instance that the livestock will sometimes be kept as an
asset (e.g. cattle or small ruminant such as goats), or sold in the market to cover
other expenses (e.g. school fees, health care) and not be used to improve the diet
diversity.
Give a concrete example of programme that failed to reach the expected specific
objective/improve the nutrition status because enhancers/inhibitors factors were
not well taken into account.
Example: livestock is distributed to increase the consumption of micronutrient-rich
food but the goat is kept as an asset/capital and used for other expenses (school
or medical fees). The project would rather have given guinea fowls for consumption
rather than goat.
The Programme Theory is the pathway from an intervention input through
programmatic delivery, household and individual utilisation to its desired impact. It
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puts a stronger FOCUS on the intermediary outcomes and problems that may arise
alongside the intervention to bridge the gap between the concept of an intervention
and the reality of its impacts.
The introduction of livestock in the household may also negatively impact the
family if adequate hygiene promotion is not undertaken or mitigation measures are
not taken.
3. Example 1
3’
Example: livestock potentially increases the nutritional benefits in the long run but
at the same time may increase wasting among children because of a contaminated
environment (e.g. children are in contact with animal’s faeces).
Livestock activities can also impact the social dynamics within the household if
significant income is generated by the project and women are not able to take
decisions in relation to the management of household finances.
Vulnerable households may benefit in a short term from a livestock intervention but
not be able to afford the related costs induced by the intervention in the longer run
(e.g. veterinary costs); this can be offset by providing vouchers or taking part in a
IGA programme.
Make sure that participants understand the difference with a ‘standard solution’
tree. In a PTP, it is needed to highlight the intermediary outcomes and
potential bottlenecks that may arise at each stage of the project.
Note: this figure is missing the bottlenecks, as it is the subject of the next exercise.
Keep in mind that it is very difficult to assess the contribution of each pathway to
the specific objective (e.g. improved production or additional purchase). Up to now
little evidence is available due to a combination of factors (poor study design, up to
now low interest).
4. Example 2
3’
Long pathway from food preparation to food intake.
Getting the programme theory ‘RIGHT’ is particularly important for nutritionsensitive interventions because they involve complex biological, psychosocial,
individual and social factors (i.e. food taboos or restriction, norms etc.)
6. Project
presentation
10’ + 5’ group
discussion
Facilitator should recall the nutrition security concept. There are many other
determinants that affect the relationship between diet diversity/food intake and
nutritional status. For instance, when the absorption of nutrients is impaired by
parasites. These considerations may lead to complementary interventions, such as
de- worming.
Discuss with participants the main questions to highlight
 How is the intervention going to bring about a change of the nutrition
status?
 What is happening as the intervention moves along the pathway from
initial input to impact?
 What are the primary impact pathways?
 What are the intermediary outcomes?
 What are the bottlenecks? How to solve them?
 How will seasonality affect the programme impact pathways?
 What are the barriers and enhancers to achieve impact on nutrition?
Project presentation ‘Porridge Mum’ in Guinea. Refer to PowerPoint presentation.
This presentation aims at providing an example of PTP analysis and identifies
barriers to impact on nutrition. This exercise was conducted as a mid-term project
revision highlighting new recommendations and guidance.
7. Exercise
40’
Distribute Handout 7.
See exercise notes below.
8. Exercise
correction
20’
Each group will present the results to other participants.
In addition to the group’s presentation, the facilitator comes back to slide 4 with the
potential bottlenecks.
5. Key-questions
2’
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9. Summary of key
points and
operational
implications
2’




Crucial step for ‘nutrition-sensitive’ intervention.
Easier if you have conducted a ‘nutrition-sensitive’ assessment.
Other factors that may affect the nutritional status – make sure that
you have a broad understanding of the determinants of undernutrition.
The PTP should also be used during the programme implementation
as M&E tool.
Case study 3: Programme Theory Pathway in Myanmar
 What is the learning objective?
Be familiar with the PTP by designing one.
 How long should the exercise take?
60 minutes
Give the groups 40 minutes to answer the questions and prepare a 3-minute presentation of their answers.
 What materials are needed?
Handout 7: PTP in Myanmar
 Instructions:
Each group should answer the following questions and prepare a brief presentation of the discussion.
Although Myanmar is considered as a food-surplus country with agriculture potential and natural resources, it
is one of the poorest countries in Asia and ranks 132 on the 2010 HDI. Chronic food and nutrition insecurity
is the consequence of unfavourable economic policies, rural underdevelopment coupled with vagaries of
weather, seasonality and the marginalisation of some sectors of the population. This situation is affecting the
ability of many households to access sufficient levels of nutritious food as well as basic services such as
clean water, health and education and is particularly pronounced in the border areas and among ethnic
minorities. The official data related to chronic and acute malnutrition are largely outdated and indicates that
41% of children under five years are chronically malnourished while 11% suffer from acute malnutrition in
2003.
The percentage of population suffering from inadequate micronutrient intake (especially vitamin A, iodine,
iron, zinc, and thiamine/vitamin B1) is expected to be high, as the dietary diversity and the basic knowledge
of what constitutes a healthy diet are low.
Against this background, you decide to support households in implementing homestead and community
gardens with the production of micronutrient-rich foods. The crop selection will not only be based on
agronomic and environmental factors, but will also take into account the nutritional content of the crop and
the prevalence of micronutrient deficiencies in the area (e.g. plant rich in vitamins A, iron, B-vitamins, polyunsaturated fatty acids and phytochemicals).
Address the following questions:
1. List the different mechanisms/pathways by which the nutritional status of the targeted households is
expected to improve.
2. List the intermediary and final outcomes.
3. List the potential problems that may arise.
4. Draw on a flip chart the whole programme pathway.
MODEL ANSWER
Agriculture and nutrition are intrinsically linked through five different pathways that should be considered
when designing agricultural interventions:
1.
Household production for own consumption is the most fundamental and direct pathway by which
increased production leads to greater food availability and food security.
2.
Income generated by the sale of (surplus) production that is used to buy more food and/or nutritious
foods.
3.
Empowerment of women who are the gatekeepers for household nutrition, food security, health and
care.
4.
The decrease of food prices for consumers through increased food production and availability.
5.
Increased national revenue, used to support provision of improved state services and reduce
poverty.
Potential problems may raise and prevent the programme to achieve a nutrition impact.
At outcome level:
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






Taxation by the government
Women workload
Priority given to income > diet diversity /decision maker within the household
Intra-food allocation patterns (in quantity and quality)
Cultural food beliefs
Knowledge of optimal nutrition and feeding practices
Lack of caregiver or female headed household
At impact level:
 Food selection, preparation and hygiene
 Feeding practices
 Closure of health facilities run by other NGOs
 Parasite infestation
 Health-seeking behaviour
Remind participants that some constraints are common and others may be country and project specific.
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2.2 Nutrition-oriented indicators
Objectives
Duration
Seating Plan
Exercise(s)
Reading(s)
Handout(s)
Equipment(s)
Material(s)


Identify nutrition-related indicators to measure outcomes & impact’s intervention.
Explain the purpose and process of collecting individual dietary information using
IDDS and IYCF.
95’ + 10’ (end of module 2)
Chairs in a circle, with tables
5/6 persons per group
Group exercise 2 (60’)
 Manual – See Section 2 – Guidance 4
 Compulsory Reading 5: IFPRI, Leveraging Agriculture for Improving Nutrition and
Health: Highlights from an International Conference (p.11-12)
 Compulsory Reading 6: ACF, Impact and capitalisation study, Health Gardens –
nutrition centred Approach.
 Optional Reading 8: DFID, the neglected crisis of undernutrition.
 Optional Reading 7: EC, Addressing Undernutrition in external assistance, an
integrated approach through sectors and aid modalities.
 Optional Reading 13: Save the Children, Hungry for Change, an eight-step, costed
plan of action to tackle global child hunger.
 Handout 8 – IDDS/IYCF
 Projector
 Remote control
 Flip charts
 Markers
 FAO & EC, 2011, Guidelines for measuring household and individual dietary diversity
4 copies (B&W printing)
 WHO, UNICEF, FANTA, 2008, IYCF Definitions: 4 copies (B&W printing)
 WHO, UNICEF, FANTA, 2010, IYCF Measurement: 4 copies (B&W printing)
Output(s)
Session Plan
Slide
0. Opening
1’
1. Session objectives
5’
2. Guiding principles
10’
Guidance Notes
Benefits for participants:
No more struggle when comes the time to design the log-frame and the M&E
system. Save time, resources and headache!
 Identify nutrition-related indicators to measure outcomes & impact’s
intervention.
 Explain the purpose and process of collecting individual dietary information
using IDDS and IYCF.
In plenary session, ask participants about the difference between an outcome and
an impact.
•
Outcome refers to the short/medium term change induced by the project.
•
Impact is the long-term benefit for targeted groups and the wider society.
FSL interventions have great potential to improve the nutritional status of an
individual BUT other factors will intervene before these positive effects are
translated into an improved nutritional status.
1. Type
2. Duration
3. Feasibility
4. Expertise
Ask the participants to think about their project in their countries and brainstorm in
plenary session about nutrition-indicators. Ask participants to raise their hands if
already using nutrition objectives and indicators in the log-frame.
Refer to compulsory reading 5: Leveraging Agriculture for Improving
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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3. Log-frame with a
nutrition objective
3’
Nutrition and health.
The nutrition objective in the log frame refers to the direct or indirect improvement
of nutritional status by the project beneficiaries as a result of utilising the services
provided by the programme. This objective explicitly demonstrates how the project
contributes to improve the nutritional status of the population. Make sure, however,
that the objective is attainable within the framework of the project.
Different scenarios are possible depending on if the intervention includes only FSL
activities or is integrated with other sectors.
FSL interventions have great potential to improve the nutritional status of an
individual (e.g. by increasing access to nutritious food, by improving the diversity of
diet and/or by improving household incomes), but other factors will intervene
before these positive effects are translated into an improved nutritional status (e.g.
access to health care and child care patterns). Integrated programming is hence
more likely to show impacts on the nutritional status as the intervention seeks to
tackle a variety of the underlying determinants.
Example 1: Improve the intake of micronutrient-rich foods of vulnerable
households by X % points in rural areas of Shan State through the consumption of
Animal Source Food.
Example 2: Reduce the prevalence of Global Acute Malnutrition (GAM) by X %
points in Maungdaw by 2013.
Refer to DFID (optional reading 8) and Save the Children plan of action
(optional reading 13) for detailed guidance on nutrition-sensitive
interventions.
4. Nutrition-oriented
indicators
5’
The chosen nutrition outcome or impact indicators will vary according to the nature
and the duration of the intervention. The measurable effects of stand-alone FSL
interventions on the nutritional status are likely to be less significant (with the
potential exception of food aid interventions) than multi-sectoral interventions, thus
most changes will be detected at outcome level. The duration of the intervention
will also play a significant role (short vs. long term).
Participants should use dietary diversity to measure the outcome of a shortterm (<1 year) standalone FSL intervention. Dietary diversity is one of the
determinants of nutritional status but is not an indicator per se of the
nutritional status.
Participants should use anthropometric measurements to measure the
impact of long-term FSL programming or multi-sectoral interventions.
Refer to EC strategy (optional reading 7) for detailed guidance on nutritionoriented indicators.
This is difficult and requires time and skills and a number of conditions should be
met (e.g. context stability, at least 3-year intervention, SMART surveys at start and
conclusion of the intervention, statistic treatment of confounding factors and
determinants etc.).
Refer to manual p. 30 for detailed guidance.
5. Example 1
2’
6. Example 2
2’
Important to account for nutrition promotion and changes in knowledge and
practices. Changes may be accounted for through pre-post KAP surveys. It is
however relatively easy to measure change in knowledge, but it is difficult to
measure sustainable change in practices and behaviours.
Concrete examples of short and medium term indicators
Concrete examples of long-term indicators
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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7. Methodologies &
tools
5’
8. Group exercise
40’ and exercise
correction
20’
9. Summary of keypoints
2’

END of MODULE
2
10’
The facilitator will mention some relevant and helpful tools:
Put a strong focus on DDS and anthropometric measurements.
Make sure that participants are aware of limitations and constraints of both.
Refer to manual for additional information on limitations p.29 (Quantity and caloric
intake, substitution effects, data disaggregation, food use and absorption by the
body).
Refer as well to ACF FSL Assessment (2009) and FSL M&E (2011) manuals
for guidance on core indicators and methodology of measure.
Distribute Handout 8
See notes below.
Each group will present the results to other participants.
 No ready-to-use solutions but guiding principles to keep in mind
 The effects FS standalone interventions on the nutritional status are likely to be
less significant
 Most changes will be detected at outcome level.
 FSL teams are trained on HDDS/IDDS/IYCF as well as KAP and should request
technical support for anthropometric measurements.
Ask participants to recall the main recommendations and key points of the module
2. This could be done in small groups or in plenary session.
Exercise 2:
 What is the learning objective?
Be familiar with dietary diversity tools: IDDS/IYCF.
 How long should the exercise take?
60 minutes
Give the groups 40 minutes to answer the questions and prepare a 3-minute presentation of their answers.
 What materials are needed?
Handout 8: IDDS/IYCF
1 guideline (per group) for measuring household and individual dietary diversity
1 guideline (per group) for measuring IYCF
Instructions:
Split the participants in small groups. Half of the groups will work on IDDS meanwhile the other one will work
on IYCF. Each group should answer the following questions and prepare a brief presentation of the
discussion.
TEAM 1- Individual Dietary Diversity Score
You plan to conduct a FSL assessment in a rural and remote area. One of the main determinants of
undernutrition is the poor diet diversity resulting in high rates of maternal undernutrition and micronutrient
deficiencies. You will therefore investigate the dietary quality and variety at individual level, especially
women of reproductive age. Use the FAO/EC guidelines on HDDS/IDDS to address the following
questions:
1. Design an Individual Dietary Diversity questionnaire – including food groups reflecting locally
available foods.
Refer to the FAO manual for further guidance (p 7-8 and 15-19).
2. Select one member of the team that will play the role of the respondent (for example, a woman of
reproductive age) and administer the questionnaire in ‘real conditions’.
Refer to the FAO manual for further guidance (p 21-22).
3. Collect the answer, compute and analyse the data. Final score should be between 0-9.
Refer to the FAO manual for further guidance (p 23-26).
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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MODEL ANSWER
Individual Dietary Diversity Questionnaire (adapted from FAO guidelines)
Please describe the foods (meals and snacks) that you ate yesterday during the day and night whether at
home or outside the home. Start with the first food eaten in the morning.
Question
Food group
Examples
YES= 1
number
NO= 0
CEREALS
1
2
WHITE TUBERS
AND ROOTS
VITAMIN A RICH
VEGETABLES
AND TUBERS
DARK
GREEN
LEAFY
VEGETABLES
OTHER
VEGETABLES
VITAMIN A RICH
FRUITS
OTHER FRUITS
ORGAN
MEAT
(IRON-RICH)
FLESH MEATS
3
4
5
6
7
8
9
10
11
12
EGGS
FISH
LEGUMES, NUTS
AND SEEDS
MILK and MILK
PRODUCTS
OILS and FAT
SWEETS
13
14
15
16
SPICES,
CONDIMENTS,
BEVERAGES
Bread, noodles, biscuits, cookies or any other foods
made from millet, sorghum, maize, rice, wheat + insert
local foods or other locally available grains.
white potatoes, white yams, cassava or foods made
from roots.
pumpkin, carrots, squash, or sweet potatoes that are
yellow or orange inside + other locally available
vitamin-A rich vegetables
sweet pepper, dark green/leafy vegetables, including
wild ones + locally available vitamin-A rich leaves such
as cassava leaves etc.
other vegetables including wild vegetables
1
ripe mangoes, papayas + other locally available
vitamin- A rich fruits
other fruits, including wild fruits
liver, kidney, heat or other organ meats or blood-based
foods
beef, pork, lamb, goat, rabbit, wild game, duck or other
birds
0
0
0
1
1
1
0
1
0
0
0
fresh or dried fish or shellfish
beans, peas, lentils, nuts, seeds or foods made from
these
milk, cheese, yogurt or other milk products
1
1
0
oil, fats or butter added to food or used for cooking
sugar, honey, sweetened soda or sugary foods such as
chocolates ,sweets or candies
tea (black, green, herbal) or coffee
1
YES=1
No=0
B
0
Did you eat anything (meal or snack) OUTSIDE the home yesterday ?
Aggregation of food groups from the questionnaire to create IDDS
Question number(s)
1,2
4
3,6
5,7
8
9,11
10
12
13
Food group
Starchy staples
Dark green leafy vegetables
Other vitamin A rich fruits and
vegetables
Other fruits and vegetables
Organ meat
Meat and fish
Eggs
Legumes, nuts and seeds
Milk and milk products
Yes = 1
No= 0
1
1
0
1
0
1
0
0
1
IDDS= 5/9
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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TEAM 2- Infant and Young Children Feeding (IYCF)
One of the main determinants of undernutrition is due to lack of knowledge on nutrition and appropriate
practices related to Infant and Young Children Feeding (IYCF). Children are most vulnerable to malnutrition
and growth faltering during the period when complementary foods are initiated, as it often coincides with
decreased breast milk consumption, increased micronutrient deficiencies, diarrheal illness and suboptimal
IYCF practices. Common inappropriate complementary feeding practices include introducing foods too early
or too late, limiting the diversity of foods, and providing an inadequate quantity of food.
You decide to gain a better understanding of the IYCF in the area you work by including some questions
related to IYCF in your assessment.
Use the two IYCF guidelines (Definition & Measurements) to address the following questions:
1. Start by reading the definition of indicators in the Definition guideline (p.5-9)
2. Select three members of the team that will play the role of the respondents.
Respondents are free to answer the question as they like but they have to make sure that answers are
coherent. The respondent is the primary caregiver of the child and is the person that knows the most about
how and what the child is fed.
First respondent is a 25-year-old mother who has a 5-month baby and a 22-month child.
The second respondent is a 19-year-old woman. Sadly, her baby was stillborn when she delivered two
months ago. The third one is 34-year-old and has 4 children. One is 4-month; the others are respectively 19
months, 3 and 6 years.
3. Administer the questionnaire in ‘real conditions’ to the 3 respondents.
Refer to the questionnaire p 5-10 in the Measurement guideline.
4. Collect the answers, compute and calculate the indicator of early initiation of breastfeeding.
Refer to the Measurement guideline for further guidance (p. 32-33)
MODEL ANSWER
Early initiation of breastfeeding
Definition
Proportion of children born in the last 24 months who were put to the breast within one hour of birth
2 infants are less than 6 months (<730 days).
1 was put to the breast within one hour of birth; the other was put to the breast after 4 hours.
Calculation
(1/2) * 100 = 50%
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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Module 3: Do no harm
No
Module
Title
Session 1
1
Acknowledging
&
understanding
food security
through the
lens of nutrition
livelihoods, agriculture, nutrition and health
Session 2
Session 4
2
1. Define undernutrition and explain its consequences & determinants
2. Define nutrition security and explain the linkages between food security,
3. List the resources and key sources of information related to undernutrition
4. Design and conduct a ‘nutrition-sensitive’ assessment
5. Explain how the findings from nutrition-sensitive assessment can be used
Session 3
Aiming for
Nutrition
impact
Specific learning Objectives
Session
no
to plan and adapt to FSL programmes
6. Define the concept of ‘window of opportunity’ and explain its operational
implications
7. Define the ‘programme theory pathway’ and explain its purpose in the
programme’s design
8. Identify nutrition-related indicators to measure outcomes & impact’s
Session 5
intervention
9. Explain the purpose and process of collecting individual dietary
information using IDDS and IYCF
10. Define the ‘do no harm approach’ and list key steps of ‘a do no harm
3
Do no harm
Session 6
approach’ strategy (skills & aptitudes)
11. Explain the purpose and process of using the IYCN Nutritional Impact tool
assessment (skills & aptitudes)
4
Including
Nutrition
promotion
and/or BCS
12. Explain the purpose of nutrition promotion and how this should be used
13. Explain the purpose of Behaviour Change Strategy (BCS) and how this
Session 7
should be used
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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3.’Do no harm’
Objectives
Duration
Seating Plan
Exercise(s)
Reading(s)
Handout(s)
Equipment(s)
Material(s)

Define the ‘do no harm approach’ and list key steps of ‘a do no harm approach’
strategy.
 Explain the purpose and process of using the IYCN Nutritional Impact Assessment
tool.
45’ + 10’ (end of module 3)
Chairs in a circle, with tables
5/6 persons per group
None
See Manual – Section 2, Guidance 6 and 7
 Handout 9: Relationship between infection and undernutrition
 Handout 10: IYCN Nutritional Impact Assessment Tool
 Projector
 Remote control
 Flip charts with FSL intervention (overall, agriculture, livestock, food assistance, CBI,
IGA)
 Markers
 Presentation - Module 3. Presentation IYCN Nutritional Impact Assessment Tool.ppt
Output(s)
Session Plan
Slide
0. Opening
30 seconds
1. Session objectives
1’
2. Why a “do no harm”?
10’ Brainstorm and 10’
Feedback
Guidance Notes
Benefits for participants:
Ethic & Humanitarian values
Reduce risk of programme’s failure
 Define the ‘do no harm approach’ and list key steps of ‘a do no harm
approach’ strategy.
 Explain the purpose and process of using the IYCN Nutritional Impact tool
assessment.
Growing interest on the subject and a lot of research is currently on going.
Ask participants to brainstorm and discussion about the potential adverse
effects of FSL interventions on the NUTRITIONAL STATUS. One group will
work on adverse effects that are common to all FSL interventions meanwhile
the other groups will work on a specific type of FSL intervention (i.e. overall,
agriculture, livestock, food aid, CBI, IGA)
Each group will write down the adverse effects on flip charts.
Remind the participants that some will be obvious/intuitive/direct; others are
more difficult to detect and very country specific. Some are common to all
FSL interventions and some are intervention-specific.
Give a 5 and 2 minutes warning. Each group has 2 minutes to present their
main findings to the rest of the assembly.
4. Why a “do no harm”?
3’
Main findings that should come up from the discussion:
- Women workload
- Child labour
- Project’s timing compromising other livelihoods or not addressing seasonality
- Agricultural and/or zoonotic diseases
- Breastfeeding’s displacement
- Food safety
- Inadequate conditionality etc.
FSL interventions have the potential to negatively impact on food
security, human health and the nutritional status of the beneficiaries,
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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5.
Picture
30 seconds
care practices, women’s and men’s status to name a few.
ETHIC + ACCOUNTABILITY
Women working in gardens. Put a strong focus on ‘WOMEN workload.
Women should directly benefit from the intervention as much as possible
because i) they already have less access to resources and opportunities than
men, and ii) they play a key role as the gatekeeper of household food security,
health and nutrition. It is CRUCIAL to avoid increasing the already heavy work
burden of women. Manual work in agro-sylvo-pastoral or in for-work activities
is usually time consuming and physically demanding, which may put strain on
their nutritional status and the time dedicated to childcare.
6. Infection/Undernutrition
2’
7
IYCN Tool
8’
8 Mitigation Measures
8’
9…..Summary of keypoints & Operational
Implications
2’

END of MODULE 3
10’
The project should not hamper women from doing their essential normal
tasks or lead to any major additional workload for women or conflict
within the family.
Planning of the intervention should be carefully designed taking into account
the normal workloads (e.g. duration of the programme; number of hours/time
of beneficiaries involvement, distance between the place of intervention and
women’s home should be addressed through open dialogue with mothers of
the project.
Distribute Handout 9
Recall links between the vicious circle of infection/undernutrition.
Undernutrition and infection often occur at the same time because one can
lead to another, and creates a vicious circle. A malnourished child, whose
resistance to illness is poor, falls ill and becomes more malnourished which
reduces his capacity to fight against illness and so on.
Distribute Handout 10
“Nutrition Impact Assessment Tool” to detect any harm to the nutritional status
of beneficiaries. Refer to ICYN presentation.
The presentation is lengthy (22 slides) but can be reduced to include the key
steps of a ‘do no harm approach’.
Examples of concrete preventive/corrective mitigation measures per FSL
interventions
Example:
Agriculture
 Provide protective clothes and/or equipment (e.g. impregnated
bed net) if the intervention involves irrigation schemes in areas
with a high prevalence of malaria or exposure to microbial and
pollutants from wastewater irrigation.
Livestock
 Systematically investigate the risk of zoonotic infections and
facilitate access to drugs and vaccines for the animals along with
information about prevention of zoonotic diseases.
CBI
 Use conditionality with precaution, as there are some significant
disadvantages. For instance, the most vulnerable households may
not be able to participate if compliance is too costly (e.g.
transportation costs too high, clinics too far away, or opportunity
costs of labour are too great).
FA
 Do not put groups at risk of ingesting too many micronutrients (e.g.
vitamin A which is toxic in very high doses, especially for pregnant
women).
 Vital to dedicate enough time/resources to the topic during the designing
and planning stages.
 Using the IYCN tool whenever feasible/do no harm approach at designing
stage but also include it into the M&E system to detect any adverse effect
of the intervention.
Ask participants to recall the main recommendations and key points of the
module 3. This could be done in small groups or in plenary session.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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Module 4: Nutrition promotion and Behaviour Change Strategy
No
Module
Title
Session 1
1
Acknowledging
&
understanding
food security
through the
lens of nutrition
livelihoods, agriculture, nutrition and health
Session 2
Session 4
2
1. Define undernutrition and explain its consequences & determinants
2. Define nutrition security and explain the linkages between food security,
3. List the resources and key sources of information related to undernutrition
4. Design and conduct a ‘nutrition-sensitive’ assessment
5. Explain how the findings from nutrition-sensitive assessment can be used
Session 3
Aiming for
Nutrition
impact
Specific learning Objectives
Session
no
to plan and adapt to FSL programmes
6. Define the concept of ‘window of opportunity’ and explain its operational
implications
7. Define the ‘programme theory pathway’ and explain its purpose in the
programme’s design
8. Identify nutrition-related indicators to measure outcomes & impact’s
Session 5
intervention
9. Explain the purpose and process of collecting individual dietary
information using IDDS and IYCF@
10. Define the ‘do no harm approach’ and list key steps of ‘a do no harm
3
Do no harm
Session 6
approach’ strategy
11. Explain the purpose and process of using the IYCN Nutritional Impact tool
assessment
4
Including
Nutrition
promotion
and/or BCS
12. Explain the purpose of nutrition promotion and how this should be used
(knowledge & aptitudes)
Session 7
13. Explain the purpose of Behaviour Change Strategy (BCS) and how this
should be used (knowledge & aptitudes)
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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4. Nutrition promotion & Behaviour Change Strategy
Objectives
Duration
Seating Plan
Exercise(s)
Readings(s)
Handout(s)
Equipment(s)
Material(s)


Explain the purpose of nutrition promotion and how this should be used.
Explain the purpose of Behaviour Change Strategy (BCS) and how this should be
used
45’+ 10’ (end of Module 4)
Chairs in a circle, with tables
5/6 persons per group
None
 See Manual – Section 2 Guidance 8
 Compulsory Reading 6: ACF, Gardens of Health impact and capitalization study
 Optional Reading 10: AED & Linkages, Formative Research, Skills and Practices for
IYCF and Maternal nutrition.
 Optional Reading 11: IYCN, Behaviour Change Interventions and child nutritional
status.
 None
 Projector
 Remote control
 Flip charts
 Markers
 Presentation - Module 4. Field Experience Mali - Health Gardens.ppt
Output(s)
Session Plan
Slide
0. Opening
30 seconds
1. Session objectives
30 seconds
2.
Why
1’
3. Gender/Women
empowerment
2’
4. Nutrition promotion
vs. BCS
2’
Guidance Notes
Benefits for participants:
Learn/promote optimal practices for your health, and well-being and family.
Increase the impact of the intervention.
 Explain the purpose of nutrition promotion and how this should be used.
 Explain the purpose of Behaviour Change Strategy and how this should be
used
Increasing evidence suggest that agricultural interventions are more likely to
contribute to positive nutritional outcomes if they address gender/women
empowerment, nutrition education and the five livelihood capitals (World Bank,
2007).
This is the opportunity to highlight again why and how women should be
empowered.
 Less access to resources and opportunities than men (e.g. access to
land, livestock, education, childcare, financial services, extension
services, technology, markets and employment)
 Gatekeeper of household food security, health and nutrition.
WARNING:
Fathers/men/boys should not be forgotten. It is necessary to educate them to
become more supportive of women as they often are the decision makers in the
communities and within the households.
Be careful about the terminology that can be confusing!
Nutrition promotion aims at increasing knowledge & potentially practices of
participants about optimal nutrition.
Example: participants during cooking demonstrations can learn some cooking
and food handling tips that are useful to preserve the quality of the nutrients.
 Vegetable and fruits are eaten raw to increase vitamin and mineral
intake.
 Vegetables are not overcooked and preferably steamed until just
tender. Other cooking methods for vegetables that preserve nutrients
are stir frying (e.g. frying very quickly over high heat), or sautéing
(e.g. cooking in fat or oil in a pan or on a griddle)
 Food is eaten soon after cooking.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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5. Nutrition promotion
vs. BCS
2’
6. Nutrition promotion
and BCS
1’
7. Key-steps
2’
8. Limitations
2’
However, giving someone information is not usually enough to change behaviour.
Example: Smoking
BCS fosters positive behaviour change at the individual, household, and
community levels, with the goal of improving the nutritional status/health through.
It encourages sustainable changes and maintains optimal behaviours.
BCS mainly relies on:
 Behaviour Change Communication (BCC) which is a multi-level
tool for promoting and sustaining risk-reducing behaviour change in
individuals and communities by distributing tailored specific
nutrition/health messages in a variety of communication channels:
mass-media
campaigns,
print
materials,
interpersonal
communication, group talks, health fairs, drama, or story telling.
 Formative research: consists of assessing the behaviours, attitudes
and practices of a community, and understand the target group’s
perspective, which influence their behaviours, and determines the
best ways to reach them. Several formative research methods may
be used to develop BCS including barrier analysis, trials of improved
practices, positive deviance, focus groups, in-depth interviews,
supporting groups for accompanying the change, reinforcing the
positive practices, and finding coping strategies. Formative research
occurs before a program is designed and implemented, or while a
program is being implemented.
Various theoretical models are appropriate for considering the forces that affect
change at the individual level (e.g. Health belief model, Theory of reasoned
action, Transtheoretical, social learning theory).
Irrespective of the label given, the aim should be to understand the key
constraints that operate at the individual level within the target population,
so that the optimal intervention can be developed to address these
constraints.
Dietary and care practices are embedded in people’s beliefs, norms, habits and
traditions, and convincing people to change behaviour requires time and
expertise! Need to see a benefit to change!
This is a very innovative feature for ACF interventions that requires time,
expertise and may be controversial. Changing long-rooted behaviours requires
time. Does it fall within ACF mandate? This could be discussed among
participants during the discussion after the case studies.
WARNING: the objective is not to go in detail of BCS but explains the purpose
and provides main recommendations/readings.
Vital to improve nutrition and care of children, women and household.
Targets women of reproductive age and decision makers related to food and
children decision.
Who is responsible for designing and conducting nutrition promotion and BCS?
This will differ from one mission to another. The care practices and nutrition team
(if any) will help in conducting formative research and design adequate messages
for care and IYCF. The FS team will be in charge of conducting the nutrition
promotion session. This can also be done in collaboration with the nutrition team.
Ask for external expertise if need be.
1. Understand context, norms and levers related to dietary and care
practices
2. Design actionable and well-tailored messages
3. Use existing channels of dissemination & cooking demonstrations
4. Measure the changes with KAP surveys
1. Feasibility: context, duration and objective of the intervention
2. Expertise and skills (e.g. nutritionist, care practices, formative research
etc.)
3. M&E system (e.g. KAP as means of verification for change in practice is
not the best methodology. This can be coupled with field observation).
Request support from the Wash team, as they are very familiar with KAP
surveys.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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9. Project presentation
15’ + 15’ group
discussion
Project presentation ‘Health gardens in Mali. Refer to ppt presentation.
Mention here the impact study and capitalisation report (compulsory Reading 6).
This project is an innovative and sustainable approach that seeks at improving
knowledge and practices of optimal nutrition. It is based on vegetables gardens
coupled with education nutrition sessions and cooking demonstration. The project
targets in priority mothers and caregivers.
10. Summary of key
points & operational
implications
2’
- Nutrition-sensitive assessments are helpful to identify norms, beliefs related to
food, nutrition and decision-making.
- Modalities will differ whether it is long or short-term strategy but focus on a set
of messages using the existing/new channels of dissemination and
communication.
- KAP on nutrition and practices as a baseline/endline to monitor some changes.
- Be aware of limitations.
Ask participants to recall the main recommendations and key points of the
module 4. This could be done in small groups or in plenary session.

END of MODULE 4
10’
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Conclusion & Closing
Objectives
1.
2.
3.
4.
Duration
Seating Plan
Reading(s)
Exercise(s)
Handout(s)
105’
Chairs in a circle, with tables / 5/6 persons per group
None
None
 Handout 11: Conceptualizing the linkages between agriculture, health and nutrition
 Participants Evaluation Form
Note: no PowerPoint presentation for conclusion.
 Projector
 Remote control
 Speakers (for movie)
 Flip chart
 Markers
 Participant’s pre test
 Participant’s evaluation form
 VIDEO FILM - 2020 conference - Day 2 - 1B Plenary - Part I.flv
Equipment(s)
Material(s)
Close the training
Review the course
Draw Action plan
Collect participant’s feedbacks
Output(s)
Session Plan
Slide
1. Film video
14‘
2. Action plan
60’
3. Feedbacks
30’
4. Closing
1’
Guidance Notes
Distribute Handout 11
Film video – AGRICULTURE, HEALTH AND NUTRITION
Conceptualizing the Linkages
Available at http://www.youtube.com/watch?v=VKciI1RexvA
J. Hoddinnot – Feb 2011
John Hoddinott is deputy division director and a senior research fellow in the
Poverty, Health, and Nutrition Division of the International Food Policy Research
Institute (IFPRI), Washington, DC. Although a bit tough, this 12-minute video is a
very good summary of the training. Make sure that the quality of the video is all
right before broadcasting it!
Participants are requested to draw an action plan to incorporate the lessons learnt
and recommendations from the training in their interventions.
Action plans should be SMART. This exercise can be done individually or in
groups. The action plan should consider the following aspects:
 What steps or actions need to be taken?
 Necessary resources
 Necessary support
 Timelines
 Constraints/foreseen challenges
 Others
Participants are encouraged to use the manual.
Facilitator will send an email to participants in 1-month time to assess the
implementation of the action plan by the participants.
The feedback session is done in plenary session (10’) and through an individual
written evaluation form (20’). Distribute Participants Evaluation Form.
Encourage participants to give positive and negative feedbacks to improve the
content and design of the training tool kit.
Ask participant to get back to their pre-tests to assess any progress.
Thanks the participants for their participation and collaboration.
Encourage participants to get in touch with the facilitator or key-person in the
mission if there is a need for support in the coming months while maximising the
nutritional impact of FSL interventions.
Maximising the Nutritional Impact of FSL interventions - Facilitator Guidance. V1.0
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