Nutrition Communication Strategy

NUTRITION COMMUNICATION STRATEGY MINISTRY OF HEALTH AND CHILD CARE i The National Nutrition Communication Strategy was developed by the National Nutrition Department, Ministry of Health and Child Care. The funding to facilitate development of this strategy was provided by the Government of Zimbabwe (GoZ), Health Development Fund and United Nations Children’s Fund (UNICEF). Further information about this strategy can be obtained from the Ministry of Health and Child Care, National Nutrition Department, P.O Box CY1122, Causeway, Harare (Telephone: +263 4 792454) Recommended citation: Ministry of Health and Child Care (MoHCC). 2016. Zimbabwe Nutrition Communication Strategy. Harare, Zimbabwe: MoHCC ii FOREWORD The Government of Zimbabwe recognises the importance of addressing hunger and malnutrition and has set this as one of the top priorities of the country. This is highlighted in the National Nutrition Strategy (NNS) 2014-2018 aimed to inform evidence-based nutrition interventions and inclusion of nutrition in the Zimbabwe Agenda for Sustainable Socio Economic Transformation (ZIMASSET). Effective nutrition programming comprises both nutrition-specific interventions that include care and adequate infant and young child nutrition, adequate maternal and adolescent nutrition services, appropriate clinical nutrition services, enhanced quality of nutrition information systems and effective nutrition advocacy; and nutrition-sensitive interventions including strengthening multisectoral coordination and collaboration with other sectors such as Agriculture, Social Protection and Education for integrated nutrition response. These nutrition development programmes cannot produce change without an ongoing, culturally and socially relevant communication dialogue among nutrition-service providers and communities. The Ministry of Health and Child Care through coordination by the National Nutrition Department has developed a Nutrition Communication Strategy as a guiding instrument to comprehensive communication support towards implementation of the National Nutrition Strategy, National Food Fortification Strategy, and the Infant and Young Child Feeding National Policy to ensure positive and sustained behavior change in nutrition practices among population groups in Zimbabwe. The Nutrition Communication Strategy was developed through a highly multi-stakeholder consultative process intentionally done to broaden the ownership, responsibility and commitment towards its implementation among stakeholders. Ensuring nutrition security in Zimbabwe remains top on the agenda of Government, and as such Ministry of Health and Child Care is committed to provision of adequate communication strategies in nutrition programming and facilitating desired behavior change that promote optimal nutrition practices among communities. It is gratifying to note that all stakeholders and partners have committed to work together to support implementation of this Nutrition Communication Strategy to eliminate all forms of malnutrition and improve the health of the Zimbabwean population. Together we can do it! David P Parirenyatwa (Dr) Minister of Health and Child Care iii ACKNOWLEDGEMENTS The Ministry of Health and Child Care would like acknowledge with gratitude the following organisations and individuals that participated in the conception development and production of this document The Nutrition Communication Strategy. This strategy was developed with technical guidance from the Ministry of Health and Child Care with support from UNICEF. Special mention goes to the Nutrition Intervention Manager, Mrs M. Muti for coordinating the development of this strategy, Nutrition Advocacy and Communication Officer, Mr D. Chagwena for finalising the document and the Deputy Director Nutrition Mrs A Chigumira for oversight role in developing this strategy. 1. Ministry of Health and Child Care officers from the National Nutrition Department, Health Promotion Unit, Family Health Unit, Non-Communicable Diseases (NCDs) Department and Nursing Department (see Annexe 1 for the NCS National Taskforce) 2. Government Ministries and Agencies including Ministry of Women Affairs Gender and Community Development (MoWAGCD), Ministry of Public Service, Labour and Social Welfare (MoPSLSW), Ministry of Primary and Secondary Education (MoPSE), Ministry of Industry and Commerce (MoIC), Food and Nutrition Council (FNC) 3. U.N. Agencies including United Nations Children’s Fund (UNICEF) and World Health Organization (WHO) 4. Key stakeholders including United States Agency for International Development (USAID), Maternal and Child Health Integrated Program (MCHIP), Department of International Development (DFID), Adventist Development and Relief Agency (ADRA), Care International, ZVITAMBO, National AIDS Council (NAC), Harare City Health Department, World Vision, Goal as well as other organisations working on Nutrition in Zimbabwe 5. Ministry of Health and Child Care would also like to acknowledge H4+ funding received to support development of the Nutrition Communication Strategy The strategy development process was aided by women, men and adolescents/young people who were consulted and provided valuable insights around existing barriers to adoption of optimum nutrition practices. The Nutrition Communication Strategy is a reflection of collaboration required to effectively and sustainably implement the National Nutrition Strategy through a multi-sectoral approach. Brigadier General (Dr.) G. Gwinji Secretary for Health and Child Care iv Table of Contents 1. INTRODUCTION ....................................................................................................................................... 1 1.1 BACKGROUND ................................................................................................................................................... 1 1.2 THE NUTRITION COMMUNICATION PROBLEM ......................................................................................................... 2 1.3 RATIONALE ....................................................................................................................................................... 3 1.4 THE NUTRITION POLICY FRAMEWORK .................................................................................................................... 3 2. OVERVIEW OF NUTRITION COMMUNICATION IN ZIMBABWE ................................................................. 4 2.1 OVERVIEW OF NUTRITION PROGRAMME IN ZIMBABWE............................................................................................. 4 2.2 OVERVIEW OF COMMUNICATION STRATEGY DEVELOPMENT PROCESS.......................................................................... 4 2.3 STRUCTURE OF THE NUTRITION COMMUNICATION STRATEGY ..................................................................................... 4 2.4 KEY PLAYERS IN NUTRITION COMMUNICATION ........................................................................................................ 5 2.5 GAPS IN NUTRITION COMMUNICATION .................................................................................................................. 5 2.6 EXPOSURE TO MASS MEDIA ................................................................................................................................ 6 3. BARRIER ANALYSIS .................................................................................................................................. 7 3.1 IMPROVING THE QUALITY OF ADOLESCENT AND MATERNAL NUTRITION SERVICES .......................................................... 7 3.2 STRENGTHENING UPTAKE OF CLINICAL NUTRITION SERVICES ....................................................................................... 9 4. COMMUNICATION CHANNELS ............................................................................................................... 10 4.1 MASS MEDIA (TELEVISION, RADIO, PUBLIC ANNOUNCEMENT SYSTEM) ...................................................................... 10 4.2 THE INTERNET (SOCIAL MEDIA) ........................................................................................................................... 10 4.3 MOBILE PHONES (BULK SMS) ........................................................................................................................... 10 4.4 INTER PERSONAL COMMUNICATION .................................................................................................................... 10 4.5 POSTERS AND PAMPHLETS ................................................................................................................................. 10 5. AUDIENCES ............................................................................................................................................ 11 5.1 PRIMARY AUDIENCES ....................................................................................................................................... 11 5.2 SECONDARY AUDIENCES ................................................................................................................................... 11 5.3 TERTIARY AUDIENCES ....................................................................................................................................... 11 5.4 SEGMENTATION .............................................................................................................................................. 12 6. COMMUNICATION APPROACHES .......................................................................................................... 13 6.1 FOCUS ........................................................................................................................................................... 13 7. THE STRATEGY ....................................................................................................................................... 14 7.1 PURPOSE OF THE STRATEGY ............................................................................................................................... 14 7.2 OBJECTIVES OF THE STRATEGY ............................................................................................................................ 14 8. COMMUNICATION MATRIX ................................................................................................................... 17 9. MONITORING AND EVALUATION FRAMEWORK .................................................................................... 30 10. SAMPLE DISTRICT COMMUNICATION PLAN ........................................................................................... 40 v List of Tables, Figures and Annexes Table 1: Access to Mass Media and ICTs in Zimbabwe ........................................................................ 6 Table 2: Audiences at different levels ................................................................................................... 12 Table 3: Communication Approaches................................................................................................... 13 Table 4: Communication Matrix ........................................................................................................... 17 Table 5: Monitoring and Evaluation Plan ............................................................................................. 30 Table 6: Sample District Plan ............................................................................................................... 40 Figure 1: Perception on the causes of Malnutrition in Zimbabwe .......................................................... 2 Figure 2: Audience Mapping ................................................................................................................ 11 Annexe 1: Nutrition Communication Strategy National Taskforce Team ............................................ 48 vi LIST OF ACRONYMS ADRA Adventist Development and Relief Agency ANC Antenatal Care BCC Behaviour Change Communication BMFHI Baby and Mother Friendly Hospital Initiative BRTI Biomedical Research & Training Institute CBNCP Community Based Nutrition Care Programme cIYCF Community Infant and Young Child Feeding cMAM Community-based Management of Acute Malnutrition DFID Department of International Development DFNSC District Food and Nutrition Security Committee DHE District Health Executive FAO Food and Agricultural Organization FGDs Focus Group Discussions FNC Food and Nutrition Council GoZ Government of Zimbabwe HFSS Health Food Services Supervisor HIV Human Immunodeficiency Virus HPO Health Promotion Officer IEC Information, Education and Communication IYCF Infant and Young Child Feeding ICT Information Communication Technology KABP Knowledge, Attitudes, Beliefs, and Practices M&E Monitoring and Evaluation MCHIP Maternal and Child Health Integrated Program MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MIMS Multiple Indicator Monitoring Survey MoHCC Ministry of Health and Child Care MoIC Ministry of Industry and Commerce MoPSE Ministry of Primary and Secondary Education MoPSLSW Ministry of Public Service, Labour and Social Welfare MoWAGCD Ministry of Women Affairs Gender and Community Development NCDs Non-Communicable Diseases NAC National AIDS Council NCS Nutrition Communication Strategy NFNSP National Food and Nutrition Security Policy NGOs Non-Governmental Organizations NMNS National Micronutrient Survey NNPSP National Nutrition Policy and Strategic Plan NNS National Nutrition Strategy PFNSC Provincial Food and Nutrition Security Committee PHHE Participatory Health and Hygiene Education vii PMTCT Prevention of Mother To Child Transmission POTRAZ Postal and Telecommunications Regulatory Authority of Zimbabwe PPP Private Public Partnerships RNI Recommended Nutrition Intakes SAM Severe Acute Malnutrition SMS Short Message Services UN United Nations UNICEF United Nations Children's Fund USAID United States Agency for International Development USD United States Dollar VHW Village Health Worker WASH Water, Sanitation and Hygiene WBW World Breastfeeding Week WFP World Food Programme WHO World Health Organization ZDHS Zimbabwe Demographic and Health Survey ZIMASSET Zimbabwe Agenda for Sustainable Socio-Economic Transformation ZIMSTAT Zimbabwe National Statistics Agency ZIMVAC Zimbabwe Vulnerability Assessment Committee ZNASP Zimbabwe National Aids Strategic Plan 1 1. INTRODUCTION Zimbabwe faces several nutrition-related challenges. To address the challenges in a holistic manner, the Ministry of Health and Child Care (MoHCC) has developed the National Nutrition Strategy (NNS) (2014-2018) to inform evidence-based nutrition interventions. The overall objective of the communication strategy is to provide comprehensive communication support towards implementation of the NNS. 1.1 Background Globally, stunting, severe wasting and intra-uterine growth retardation are the major contributors to child mortality, accounting for about 3.1 million deaths of under-fives annually (The Lancet Series, 2013). Stunting remains a key challenge in Zimbabwe with nearly one in every three children under the age of five (27.6%) being stunted1. Evidence shows that the prevalence of stunting initially increases with a child’s age, with prevalence highest between 18 and 35 months of age, and declines thereafter1. Although stunting levels have decreased during the period 2011 to 2014, evidence from 2011 showed disparities between rural and urban populations with 33% of children living in rural areas being stunted, compared to28% for their urban counterparts. Stunting as at 2010/11 was higher in boys (36%) than in girls (28%). Although stunting prevalence was higher among the poor (36.8%) wealth does not protect children from stunting as nearly one in four (23.8%) children in the highest wealth quintile were stunted2. Effective nutrition-specific interventions to address stunting include care and adequate maternal nutrition, promotion of early initiation of breastfeeding, six months exclusive breastfeeding, continued breastfeeding from six months up to 24 months or beyond with adequate complementary feeding, micronutrient supplementation, deworming, management of moderate acute malnutrition and treatment of severe acute malnutrition (Lancet nutrition series 2013). However there are gaps in the provision and uptake of these services in Zimbabwe. Zimbabwe has near universal (98.1%) breastfeeding though there are still gaps in adoption of exclusive breastfeeding with less than half (41%) of infants under 6 months of age being exclusively breastfed. There are challenges in relation to complementary feeding with 17.3% of breastfed children age 6-23 months having a minimum acceptable diet1. Analysis of vitamin and mineral content of FAO Food Balance Sheets for Zimbabwe shows average intake of iron, zinc, folate, vitamin B12 and vitamin A among both children and women provided just 27%-64% of WHO Recommended Nutrition Intakes (RNI). These dietary deficits in micronutrient intake, along with other threats including infection, intestinal parasite, malaria, HIV and other factors, suggest very high risk of widespread micronutrient deficiencies3.The country has made progress in eliminating Severe Acute Malnutrition (SAM) with the MICS1 reporting 0.2% prevalence of Oedema which is a clinical sign of SAM. 1 Zimbabwe National Statistics Agency (ZIMSTAT). 2014. Multiple Indicator Cluster Survey 2014, Key Findings. Harare, Zimbabwe: ZIMSTAT. 2Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International. 2012. Zimbabwe Demographic and Health Survey 2010-11. Calverton, Maryland: ZIMSTAT and ICF International Inc. 3 Government of Zimbabwe, Ministry of Health and Child Care, (2014). National Food Fortification Strategy Feasibility Assessment, 2014) 2 1.2 The Nutrition Communication Problem Although key nutrition challenges have been well documented through various studies, there are still key gaps around generating evidence around nutrition communication approaches as well as their efficacy. A key source of evidence around nutrition communication in Zimbabwe is the Community Based Nutrition Care Programme (CBNCP) KABP Study4 which documented nutrition knowledge along with sources of nutrition information. As part of developing this communication strategy data was collected on nutrition knowledge along with sources of information. An average of 65.6% of the respondents had heard about malnutrition with the highest proportion coming from the resettlement areas (85.7%). Small scale farms had the highest proportion of respondents who had never heard about malnutrition (66.7%). The majority (75%) of respondents outlined that malnutrition was a result of deficiencies in food intake as well as eating an unbalanced diet. The figure below shows perceptions about causes of malnutrition: *Source: Community Based Nutrition Care Programme (CBNCP) KABP Study (2009) Figure 1: Perception on the causes of Malnutrition in Zimbabwe The KABP study4 concluded that sources of information varied for different aspects of nutrition with siblings being the most cited source of information on breastfeeding practices. Most of the respondents had heard about exclusive breastfeeding from a sibling (99%), followed by nurses 93.6%.In Kwekwe and Bulawayo, 97.8% got their information from the nurses. Few respondents had heard the information from a nutritionist (1.6%), village health worker (2.3%), doctor (1.9%) and 1.3% pamphlet/poster. None of the respondents in Gwanda, Kwekwe and Mutasa had heard the information from a doctor. None from Gwanda, Harare, Kwekwe and Mutasa had learnt about exclusive breastfeeding in school. Consultations with lactating mothers as part of the strategy development process showed that most of them received information on exclusive breastfeeding from clinics/health facilities. The 2009 KABP survey concluded that 37.5% of respondents had ever heard or seen messages on exclusive breastfeeding. The highest proportion of the respondents who had seen the messages were in Harare (69%) and the least proportion was in Mutasa and Gwanda (26%).All key strategic documents 4 Biomedical Research & Training Institute (BRTI), (2009). Community Based Nutrition Care Programme (CBNCP) KABP Study/Formative Research Study. Government of Zimbabwe Ministry of Health and Child Care 3 related to nutrition, outline the need for communication at different levels. This includes communication to health workers for them to adequately support women, communication with women to adopt optimum nutrition practices. However, there is no overall guidance on nutrition communication which presents challenges of harmonisation and consistency. 1.3 Rationale There is limited evidence around communication-specific gaps and there is no specific package or tool kit available to promote contextualized and standardized nutrition practices. This communication strategy is further necessitated by gaps in nutrition communication interventions related to key behaviours along with limited evidence around key messages for different target groups (for example breastfeeding mothers, mothers in law and youth). The nutrition communication strategy will respond to challenges emanating from the absence of standardised guidance relating to communicating nutrition related messages as well as monitoring and evaluation. 1.4 The Nutrition Policy Framework Preventing and reducing stunting, especially during the 1000 day period; (from conception to 2 years of age) is a national priority. This is reflected in its inclusion in the Zimbabwe Agenda for Sustainable Socio-Economic Transformation (ZIMASSET). The National Food and Nutrition Policy provides the basis for mobilizing all stakeholders towards investing in improving nutrition. The policy includes seven (7) commitments which includes Policy Advice and Analysis, Agriculture and Food Security, Social Assistance and Social Protection, Food Safety and Standards, Nutrition Security, Food and Nutrition Security Information, Enhancing and Strengthening national capacity for food and nutrition security. The seven commitments illustrate the breadth of stakeholders who are involved/should be involved within nutrition communication. 4 2. OVERVIEW OF NUTRITION COMMUNICATION IN ZIMBABWE 2.1 Overview of Nutrition Programme in Zimbabwe The National Nutrition Strategy (2014-2018) provides a guiding framework for nutrition interventions in the country. The strategy outlines main areas of investment to achieve results for nutrition and outlines the following six (6) key priorities: i. Improved adolescent and maternal nutrition ii. Infant and young child nutrition iii. Strengthened clinical nutrition services iv. Quality nutrition information systems and advocacy v. Strengthened multi-sectoral coordination and collaboration for integrated nutrition response vi. Capacity development for nutrition service delivery and resource mobilization. The country has conducted a Feasibility Assessment and background analysis for the Zimbabwe National Food Fortification Strategy3. This provides a Strategic Framework for addressing micronutrient deficiencies. The Ministry of Health and Child Care conducted a review of the Infant and Young Child Feeding programme 5(2012). The review documented key findings and recommendations which will guide IYCF programming. 2.2 Overview of Communication Strategy Development Process The Nutrition Communication Strategy was developed through a multi-stakeholder consultative process. This included inception discussions to agree on the overall purpose of the strategy as well as to agree on the approach. Initial processes included a comprehensive review of national and international literature. This included a data gap analysis and informed development of data collection tools to guide consultations on specific barriers, behaviours and communication for different target audiences including lactating mothers, males, mothers-in-law, and young people along with policy makers. Data gap analysis was conducted through identifying key nutrition communication strategy priorities, determining evidence required, reviewing available literature and understanding available evidence as well as noting key components lacking in evidence or requiring additional primary evidence. Consultations were conducted at national, provincial, district and community level. These were conducted using a combination of stakeholder workshops/meetings, key informant interviews (with experts, nutrition technical partners, development funding partners, academics and policy makers), focus group discussions (with lactating mothers, mothers in law, adolescents and adult males). Data from consultations was analysed through qualitative content analysis with a focus on communication gaps, channels, barriers along with motivational appeal. A draft strategy was developed and reviewed in a multi-stakeholder workshop. Feedback was incorporated into the final strategy. 2.3 Structure of the Nutrition Communication Strategy The nutrition communication strategy is organised into different sections starting with the introduction, background, rationale and an overview of the nutrition policy and programme framework. The second section presents the strategy purpose and objectives, gaps, communication approaches and challenges. It further presents audiences as well as messages for the different target groups. 5Ministry of Health and Child Care, (2012). Zimbabwe Infant and Young Child Feeding Programme Review (1991-2011) 5 2.4 Key Players in Nutrition Communication Promoting optimum nutrition practices cuts across different sectors and implementation of this communication strategy will include a broad range of stakeholders. These will include the Ministries responsible for Health, Education, Agriculture, Women Affairs and Youth, The Food and Nutrition Council, United Nations Agencies, Development Funding Partners, Non-Governmental Organisations and Communities. 2.5 Gaps in Nutrition Communication Evidence emanates from the Zimbabwe IYCF Programme Reviews (1991-2011) along with the Barriers and Facilitators of Optimal Infant and Young Child Feeding in Zimbabwe: Beliefs, Influences and Practices6 (2012). The study outlined broad categories of factors which mediate IYCF practices and behaviors and these are outlined below: i. Social context within which caregivers, primarily mothers, function determines feeding behaviors and practices while grandmothers and fathers/partners serve as support systems and influential actors in maternal and child health and nutrition; ii. Convenience as a factor shaping feeding behaviour and practice; iii. Mixed/conflicting messages on feeding age specific groups, and notably the issue of HIV and infant feeding; iv. Limited awareness/knowledge about optimal feeding or appropriate alternative foods; v. Interest in the welfare of the child influence feeding behaviors, practices and care; vi. Resource availability; and vii. Health providers as sources of advice and support, and potentially facilitating or constraining improved behaviors. The common barriers of optimal breastfeeding for 0-6 months were outlined as delayed initiation of breastfeeding which is attributed to knowledge gaps among health workers. Additional barriers include the perception that colostrum is dirty milk and the social acceptability of pre-lacteal feeds. The social acceptability of giving water, other liquids and foods in the first few months of life was cited as a key barrier to optimal breastfeeding practices. Findings further outline that some mothers noted sore nipples, ill-health, poor nutrition and not producing enough milk as reasons for supplementing the infant earlier with solid foods and liquids. Additional barriers noted relate to social influence especially of grandmothers/mothers-in-law, fathers and community members who influence mothers in giving pre-lacteals and early introduction of complimentary foods and liquids. Mothers and caregivers interviewed as part of the barriers and facilitators study further outlined that mixed messages on HIV and infant feeding sometimes entrench stigmatization and mothers are pressured to practice mixed feeding. The barriers noted on complementary feeding (6-23 months) include poor quality complimentary foods emerging from a general prevalence of limited knowledge and information on good quality complimentary feeding. This results in provision of bulky starches and relatively sub-standard foods. In addition, both parents and caregivers are often not capacitated to leverage locally-available foods and existing family diets as means to improve complimentary feeding. Additional barriers relate to 6 Ministry of Health and Child Care, (2012). Barriers and Facilitators of Optimum Infant and Young Child Feeding in Zimbabwe: Beliefs, Influences and Practices 6 resource constraints emanating from poverty, economic factors along with resource and time constraints. Beyond the barriers, there are also facilitators which can be leveraged in developing the communication strategy. These include health providers’ support, breastfeeding as a social norm, maternal knowledge and awareness of benefits of breastfeeding, social support, feeding sick children along with the social influence of family, health workers and community members. 2.6 Exposure to Mass Media Access to the mass media is critical in determining the communication channels for the different messages and audiences. Evidence shows that men have better access than women to mass media as shown in the table below. New Information and Communication Technologies (ICTs) have provided enhanced avenues for communication though their effectiveness as communication mediums depends largely on levels of access and penetration. Evidence shows that 21.6% of women (15-24 years) compared to 30.8% of men (15-24 years) reported using the internet during the 12 months preceding the MICS, 2014. Access to the mass media as well as ICTs provides key guidance on the channels to be utilised for the communication strategy. Table 1: Access to Mass Media and ICTs in Zimbabwe Men (15-54 years) % Women (15-54 years) % Newspapers 29.6 17.7 Radio 57.4 44.5 Television 41.9 37.6 *Source (MICS; 2014) 7 3. BARRIER ANALYSIS There has been work around determining barriers to optimum nutrition practices with one study6 confirming age and gender of infant, occurrence of diarrhoea and fever, age at union and age difference between parents, parity, mother’s religion, contraceptive usage, mother’s and father’s age, employment status of head of household, antenatal care (ANC) attendance, skilled birth attendance, availability of safe drinking water and area of residence as key determinants of exclusive breastfeeding7. The study concluded that mothers who were attended by skilled health workers during delivery were significantly more likely to exclusively breastfeed their babies and that appropriate messages about breastfeeding were being delivered by ANC staff. Another study on barriers and facilitators to optimal infant and young child feeding in Zimbabwe cited key barriers which include knowledge gaps among health workers, social acceptability of pre-lacteal feeds along with conflicting messaging around mixed feeding and HIV. Additional barriers noted in relation to complimentary feeding include poor quality complimentary feeds and resource constraints. At the system level, the NNS (2014-2018) 8highlights the absence of systematic nutrition communication for hospitals, schools, prisons, orphanages, military and police camps and institutional settings. The gaps outlined point to the need for targeted communication focusing on the individuals, communities and the broader environment. Consultations as part of the strategy development process demonstrate that different groups have different sources of information on nutrition while the sources also varied by location (urban/rural). Rural lactating women mostly cited the clinic, siblings and mothers-in-law as sources of nutrition information while those in urban areas cited nurses, nutritionists, doctors and the media as their sources of information. Young people on the other hand cited schools, health facilities, the media, text books and the internet as sources of nutrition information. Policy makers cited multi-stakeholder meetings as their sources of information on nutrition. Consultations with lactating mothers as part of the strategy development process showed that most of them received information on exclusive breastfeeding from health facilities. The section below provides key behaviours to be transformed as well as those to be reinforced in relation to the different thematic areas. 3.1 Improving the quality of Adolescent and Maternal Nutrition Services Uptake of and compliance to iron and folate supplementation Most of the women expressed positive attitudes towards uptake of iron and folate supplementation. However, there were challenges around compliance with various reasons being provided for non compliance along with limited uptake. These are outlined below:  The women cited that iron tablets cause nausea; and  There is limited information provided to women on the benefits of iron and folate supplements. This affects their compliance. Consumption of nutritious foods by adolescents Adolescents demonstrated high understanding of good nutrition as well as what constitutes a balanced diet. They further outlined the key benefits of a good nutritional status. Schools and NGOs were cited as key sources of nutrition information while some cited the internet. The key issues outlined relating to low consumption of nutritious foods by adolescents included: 7UNICEF/CCORE, (2011). Determinants of exclusive breastfeeding practices in Zimbabwe: An analysis of secondary quantitative data from the Multiple Indicator Monitoring Survey 2009 (MIMS 2009) and the National Nutritional Survey (NNS 2010) 8Government of Zimbabwe, (2014). Zimbabwe National Nutrition Strategy, 2014-2018 8  High availability of junk food especially at school “tuck shops”;  Limited availability of fruits and vegetables;  Limited information and communication on the importance of consuming nutritious foods and disadvantages of not doing so. To promote recommended breastfeeding practices Early Initiation of Breastfeeding There were variations on practices related to early initiation of breastfeeding. Mothers during FGDs outlined that breastfeeding was initiated within one (1) to three (3) hours of delivery. Similarly, attitudes towards feeding colostrum were largely positive. Reasons given for early initiation and feeding colostrum are summarised below:  Early initiation of breastfeeding ensures the baby is well fed and it is the basis for the long term health of the child;  Feeding colostrum is good and contributes towards ensuring the child’s immune system is strengthened;  Health workers encourage mothers to initiate breastfeeding early and to feed colostrum. Despite positive attitudes towards early initiation and feeding colostrum, some mothers expressed negative attitudes and reasons provided are summarised below:  Colostrum is dirty and the child should only start breastfeeding once the milk is clean;  Some cultural beliefs dictate that the child should have pre-lacteal feeds (usually including traditional medicines) before they start breastfeeding. Exclusive Breastfeeding Consultations revealed that lactating mothers practise mixed feeding with some reportedly starting when the child is 2 months old. Factors behind mixed feeding include:  The social acceptability of mixed feeding especially where mothers in law and the general community encourage young mothers to practise mixed feeding;  Perceptions that the mother did not have sufficient milk especially when the child cries a lot mothers felt it was because the milk would be inadequate for the child;  Mixed messages from health workers where in some instances mothers reported health workers encouraging mixed feeding and in some instances mothers reported not receiving any guidance on exclusive breastfeeding;  The positive effects of exclusive breastfeeding and the negative effects of mixed feeding are not well explained to mothers so that they understand why they are encouraged to adopt exclusive breast feeding over mixed feeding. While the practices above need to be transformed, there were also some attitudes and practices outlined by lactating mothers which should be reinforced. There are mothers who reported practising exclusive breastfeeding and the major reason cited was that exclusive breastfeeding is good for the overall health of an infant. Complementary feeding Women during consultations as part of strategy development expressed positive attitudes towards complementary feeding though the quality of complementary foods needs to be addressed. Attitudes expressed by women demonstrated that complementary feeding is done more as a way of ensuring that 9 the child “is full” not as a way of enhancing the child’s nutrition. The key communication focus should be on addressing the following issues:  The perception that it is not important to have minimum meal frequency for children;  The perception that feeding the child can only be done once all the other “important” chores have been completed;  Cultural practices that discourage feeding children animal source foods;  Limited knowledge on how to ensure the child has minimum dietary diversity;  Limited knowledge on how to ensure the child has a minimum acceptable diet; and  Lack of resources to ensure the child has minimum dietary diversity and a minimum acceptable diet. 3.2 Strengthening uptake of clinical nutrition services Based on literature review as well as consultations with experts, the following priorities were identified on strengthening uptake of clinical nutrition services:  Information of the health benefits of limiting consumption of alcohol, fats, salts, tobacco use and encouraging physical activity;  Information around the nutritional risk factors for non-communicable diseases (Nutrition related NCDs);  Information and communication around the preventive effects of nutrition on nutrition-related NCDs. Overall, most of the barriers above relate to the absence of information on the importance of adopting behaviours (motivational appeal)that promote optimum nutrition, limited information on the dangers associated with poor nutrition practices, the social acceptability of poor nutritional practices along with the misconceptions on the efficacy of optimal nutrition practices (for example exclusive breastfeeding). There are also factors that are not related to communication which will contribute towards successful implementation of the strategy. This includes supply side components like facilitating access to food. 10 4. COMMUNICATION CHANNELS Analysis of available evidence on nutrition communication shows that there are multiple communication channels which can be used. Barrier analyses (2014) conducted as part of the strategy development further showed that different audiences preferred different communication channels for different messages. The communication matrix will provide proposed communication channels for different messages but the overall determining factor will be the potential to deliver the message effectively and at the lowest possible cost. The communication channels are outlined below and the broader messages they are likely to be used to convey. 4.1 Mass media (Television, Radio, Public Announcement System) Although evidence shows limited access to the mass media, participants during consultations for the barrier analyses cited them as key communication channels especially for messages aimed at creating an enabling environment and reinforcing attitudes. The mass media was further suggested for advocacy messages and all messages that do not require adaptation based on the micro-context. 4.2 The Internet (social media) The internet and in particular social media was further cited as potential channels of communicating nutrition information. This would however require firstly determining levels of access for a specific group being targeted. Use of social media platforms have generally improved especially among young people through use of mobile phones to access the internet. About 22 percent of women and 31 percent of men aged 15-24 years were reported to have used the internet in the 12 months preceding the MICS survey (MICS, 2014). In Zimbabwe the internet penetration rate is currently estimated at 44% according to the Postal and Telecommunications sector performance report (POTRAZ, 2015). 4.3 Mobile Phones (bulk SMS) The high level of mobile phone penetration in Zimbabwe means that this is a potential communication channel to be utilised. Key approaches include sending bulk messages on nutrition especially for messages aimed at the entire population. Private-Public Partnerships (PPP) can be formed with telecommunication companies and have targeted messages for various population groups or certain geographic locations. The mobile penetration rate of active subscribers is increasing currently estimated at 91% (POTRAZ, 2015) and this highlights the potential of utilizing mobile phones for communication. 4.4 Inter Personal Communication Consultations and available evidence cited interpersonal communication as the key way through which people are receiving nutrition related information. Target audiences include health workers, friends, siblings, colleagues, parents, mothers-in-law, community and religious leaders. Interpersonal communication was the most preferred for messages that targeted behaviour change at the individual level for example encouraging exclusive breastfeeding, promoting uptake of and adherence to iron and folate supplementation as well as promoting consumption of nutritious foods. 4.5 Posters and Pamphlets These were cited as potential communication channels and use of simple language easy to understand was emphasized. Posters were proposed for use within institutions where the targeted population often visits like the clinics where lactating mothers visit. In addition, pamphlets were proposed in circumstances where the health workers will be too busy to explain nutrition information. 11 5. AUDIENCES The communication strategy intends to provide knowledge, transform attitudes and ultimately influence behaviour change in relation to nutrition. Given the different communication requirements for the behaviour change continuum, there are primary, secondary and tertiary audiences. 5.1 Primary Audiences These are target groups whose behaviour is expected to change as a result of the communication messages. They include the pregnant and lactating mothers, mothers in law, and adolescents along with health workers. 5.2 Secondary Audiences The secondary audiences are those who will be critical in ensuring positive interpersonal support to the primary audience. The role of secondary audiences is to ensure positive behaviours are adopted or that existing positive behaviours are reinforced. These will include mothers-in law, parents, husbands, health workers and others depending on the context. 5.3 Tertiary Audiences These are found at the macro-level and they will be critical in creating an enabling environment for adoption or reinforcement of desired behaviours. These will include policy makers, opinion leaders, traditional leaders along with key health workers, teachers and others as will be identified within specific contexts. The figure below shows the audience mapping and communicative focus as described above. Figure 2: Audience Mapping 12 5.4 Segmentation Audiences will be targeted at different levels starting with the household level, followed by the community level, district and provincial levels and finally at national level. Different audience groups will be identified for each of the levels as outlined below: Table 2: Audiences at different levels HOUSEHOLD LEVEL COMMUNITY LEVEL  Pregnant Women  Adolescents  Lactating Mothers  Women in the family  Elderly women  Mothers in law  Husband  Siblings (sisters)  Mother and Child  Men and women  Adolescents  Elderly women in the family  Grassroots service providers  Community workers  NGO workers. DISTRICT AND PROVINCIAL LEVEL NATIONAL LEVEL  Partners  NGOs  Government officials  Policy makers  Traditional leaders  Decision makers  Partners  NGOs, Government officials  Policy makers  Decision makers 13 6. COMMUNICATION APPROACHES The strategy is based on three key mutually reinforcing communication approaches which are advocacy, social mobilisation along with social and behaviour change communication. Advocacy will focus on influencing decision makers and opinion leaders to support messages communicated by the nutrition strategy as well as creating an enabling operating environment. Social mobilisation will involve enlisting the participation of institutions, community networks and social and religious groups to use their membership and other resources to raise awareness of optimum nutrition practices. Social and behaviour change communication will focus on interpersonal dialogue with individuals and groups to inform, motivate, problem-solve or plan, with the objective of promoting optimal nutrition related behaviour change. The table below shows communication approaches, focus and target audiences. Table 3: Communication Approaches COMMUNICATION APPROACH FOCUS TARGET Advocacy (Influencing policy/decision makers to support objectives of the nutrition strategy) Creating an enabling environment for adoption and sustenance of optimal nutrition behaviours Parliamentarians, Religious Leaders Traditional/Community Leaders Research Institutions, NGOs, Private Sector Social Mobilisation (Enlisting the participation of institutions, community networks and social and religious groups to use their membership and other resources to strengthen participation in activities at the grass-roots level) Utilising social networks and structures to introduce, reinforce or sustain optimal nutrition behaviours Religious groups, Community Groups, Schools, NGOs Behaviour Change Communication (Interpersonal dialogue with individuals and groups to inform, motivate, problem-solve or plan, with the objective to promote nutrition related behaviour change) To equip individuals with the knowledge and skills necessary for adoption of optimal nutrition behaviours Mothers, Mothers in law, Husbands, Adolescents, Women of child bearing age 6.1 Focus The strategy focuses on changing behaviour of individuals on the following four thematic areas: i. Adolescent and Maternal nutrition ii. Infant and Young Child nutrition iii. Strengthening uptake of clinical nutrition services iv. Mainstreaming nutrition in multi – sectoral interventions 14 7. THE STRATEGY 7.1 Purpose of the Strategy The communication strategy is a package to promote behaviour change focusing on changing behaviours of individuals on adolescent and maternal nutrition, infant and young child nutrition, strengthening uptake of clinical nutrition services along with mainstreaming nutrition in multi-sectoral interventions. 7.2 Objectives of the Strategy THEMATIC AREA 1: - IMPROVING ADOLESCENT AND MATERNAL NUTRITION. ISSUES TO BE ADDRESSED BY THE COMMUNICATION STRATEGY: a) Lack of knowledge on the benefits of iron and folate supplementation b) Adherence to iron and folate supplements c) Non- availability of fortified foods d) Low demand for nutritious foods among adolescents and women of child bearing age OBJECTIVE 1.1 To contribute towards adoption of improved adolescents and maternal nutrition practices among women of child bearing age and adolescents by 2018 OUTCOME 1.1 Women of child bearing age and adolescents adopting recommended nutrition practices ACTIONS i. Raising awareness on the benefits of iron and folate supplementation ii. Promoting adherence to iron and folate supplementation iii. Advocacy for ensuring availability of fortified foods iv. Raising awareness and promoting consumption of nutritious foods among adolescents and women of child bearing age v. Advocacy to promote improved adolescents and maternal nutrition practices THEMATIC AREA 2:- INFANT AND YOUNG CHILD NUTRITION. ISSUES TO BE ADDRESSED BY THE COMMUNICATION STRATEGY: a) Low exclusive breastfeeding rate b) Low minimum acceptable diet c) Low continued breastfeeding levels d) Low coverage of vitamin A supplementation e) Low consumption of iron rich foods – animal source foods OBJECTIVE 2.1 To contribute towards adoption of improved infant and young child nutrition practices by communities by 2018 OUTCOME 2.1 Improved infant and young child nutrition practices by communities 15 ACTIONS i. Increasing knowledge on and promoting adoption of exclusive breastfeeding ii. Increasing knowledge on and promoting adoption of a minimum acceptable diet for infants and children iii. Increasing knowledge on and promoting continued breastfeeding iv. Increasing knowledge on and promoting uptake of vitamin A supplementation-annually v. Increasing knowledge of the benefits and promoting consumption of a variety of foods from different food groups vi. Advocacy to promote improved infant and young child nutrition practices THEMATIC AREA 3: STRENGTHENING UPTAKE OF CLINICAL NUTRITION SERVICES ISSUES TO BE ADDRESSED BY THE COMMUNICATION STRATEGY a) Low adoption of healthy lifestyles (diversified diets and decreased consumption of sugary beverages) b) Limited awareness on ways of preventing Nutrition-related NCDs c) Limited access to infrastructure and equipment for screening and treatment of Nutrition-related NCDs d) Low health worker knowledge and skills on the prevention and management of Nutrition related NCDs e) Limited adoption of physical activity OBJECTIVE 3.1 To promote uptake of clinical nutrition services among the population by 2018 OUTCOME 3.1 Adoption of behaviors that contribute towards prevention of non-communicable diseases ACTIONS i. Raising awareness and promoting adoption of healthy lifestyles ii. Advocacy towards prevention of Nutrition-related NCDs THEMATIC AREA 4: MAINSTREAMING NUTRITION IN MULTI-SECTORAL INTERVENTIONS. ISSUES TO BE ADDRESSED a) Low awareness of the 1000 days window of opportunity for preventing stunting b) Limited mainstreaming of nutrition in all multi-sectoral plans c) Use of contaminated/unsafe water d) Unhygienic practices in food preparation e) Unhygienic practices in disposal of human and animal excreta OBJECTIVE 4.1 To promote mainstreaming of nutrition in multisectoral interventions by 2018 OUTCOME 4.1 Improved mainstreaming of nutrition in multisectoral interventions by 2018 16 ACTIONS i. Increasing knowledge on the importance of 1000 days for preventing stunting ii. Advocacy to ensure mainstreaming of nutrition in all multi-sectoral plans iii. Raising awareness on the health hazards of using contaminated water and unhygienic practices in food preparation and disposal of excreta iv. Promoting use of safe water v. Promoting adoption and sustenance of hygienic food preparation practices vi. Promoting adoption and sustenance of hygienic disposal of excreta vii. Advocacy to promote adoption and sustenance of safe water, sanitation and hygiene practices 17 8. COMMUNICATION MATRIX Table 4: Communication Matrix OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS To contribute towards Improved quality of adolescent and maternal nutrition services To increase knowledge on the benefits of iron and folate supplementation. Improved uptake of iron and folate supplementation. Limited information on the benefits of iron and folate supplementation Taking iron and folate supplements improves your health and your chances of delivering a healthy baby. Women of child bearing age and adolescents. Interpersonal communication (with Health Workers, Village Health Workers etc.) Utilising platforms like ANC clinics, PMTCT sessions; Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations, Media Organisations. Women should ensure the health of their children by taking iron and folate tablets which are provided for free at health facilities. Women of child bearing age and adolescents Interpersonal communication Utilising platforms like ANC clinics, PMTCT sessions; Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations, 18 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS Media Organisations. Health workers should be able to give health education to adolescents and Women of child bearing age on the benefits of iron and folate supplementation Health workers Interpersonal (trainings) Job aids Posters Pamphlets Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations. To promote compliance for iron and folate supplements. Improved compliance for iron and folate supplements. Adverse effects after taking iron and folate tablets Ensuring compliance for iron and folate supplements is the only way to safeguard your child’s health. Take iron and folate tablets after eating to reduce nausea and vomiting. Women of child bearing age and adolescents. Interpersonal communication (with Health Workers, Village Health Workers etc.). Utilising platforms like ANC clinics, PMTCT sessions; Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. Males, Interpersonal communication (with Health Workers, Village Health Workers etc.), Development partners, NGOs 19 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS Community opinion leaders, role models, Radio and Television; Social Media; Pamphlets, Billboards. working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. Elderly women Interpersonal communication (with Health Workers, Village Health Workers etc.), Posters at health facilities, community centres and churches);Radio and Television; Social Media; Pamphlets, Billboards. Community Members Radio and Television; Social Media; Pamphlets, Billboards. Health Workers etc.); Posters at health facilities, community centres and churches). To create demand for fortified foods by the community. Communities to have fortified foods as their first choice. Lack of knowledge on benefits of fortified foods. Perceptions of possible side effects Fortified foods have enhanced nutrition value. Fortified foods are safe and approved for human consumption All members of communities including women of child bearing age Interpersonal communication (with Health Workers, Village Health Workers etc.) Utilising platforms like ANC clinics, PMTCT sessions; Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards; Retailers. Community media (edutainment) Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations; Private Sector. 20 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS Creating demand for consumption of nutritious foods among adolescents. Consumption of nutritious foods by adolescents. Lack of information on the benefits of consuming nutritious foods by adolescents. Consumption of a variety of nutritious foods is important for healthy growth and development Adolescents Interpersonal communication (with Health Workers, Peer Educators) Utilising platforms like Youth Friendly Centres, Posters at Youth Friendly Centres, Community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards, edutainment. Ministry responsible for Education Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. Limited access to nutritious foods. Providing a variety of nutritious foods for children is important for ensuring their healthy growth and development Policymakers, Parents, Communities. Interpersonal communication Utilising opinion leaders; Radio and Television; Social Media; Pamphlets, Billboards. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. 21 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS To contribute towards improved Infant and Young Child Nutrition by 2018 To promote adoption of recommended breastfeeding practices Initiating breastfeeding within the first hour of delivery Exclusive breastfeeding for the first six months of life Continued breastfeeding from 6 months up to 24 months and beyond with adequate complementary feeding Perception that mothers will be tired and need rest soon after delivery The social acceptability of giving water, other liquids and foods in the first few months of life. Limited communication on the benefits of recommended breastfeeding practices. Starting to breastfeed soon after delivery is the first immunization. Feeding children breast milk only in the first 6 months helps brain development and prevents diseases. Continued breastfeeding to two years and beyond helps in a child’s growth and development and prevents disease Lactating Mothers, Women of child bearing age Elderly women. Interpersonal communication (with Health Workers, Village Health Workers etc.). ANC clinics, PMTCT sessions; Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. Mothers in law Interpersonal communication (with Health Workers, Village Health Workers etc.), Radio and Television; Men Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Communities Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Negative attitudes by health providers. Supporting women to practise exclusive breastfeeding shows Health workers. Interpersonal communication through in-service trainings, Job AIDS, Posters, Information Packs. Development partners, NGOs working on 22 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS excellence in healthcare provision. Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. To promote uptake of a minimum acceptable diet for children 6-24 months. Families feed children 6 24monthsthe minimum number of meals per day. Families feed children 6-24 months the minimum number of food groups per day Food security Limited information on how to plan meals for children. Caregivers lack time to prepare meals for children. Limited information on use of locally available foods, fruits and vegetables in season Feeding children the right number of meals and the right food groups ensures adequate growth and development. Lactating mothers; Interpersonal communication (with Health Workers, Village Health Workers etc.). ANC clinics, PMTCT sessions; Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. Mothers in law; Interpersonal communication (with Health Workers, Village Health Workers etc.), Radio and Television; ANC, support groups Men Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards, workplace. 23 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS Community members; Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. To promote improved uptake of vitamin A supplementation Biannual uptake of vitamin A supplementation for children 6 59months. Limited knowledge about frequency of Vitamin A supplementation and benefits. Vitamin A supplementation improves eyesight, and reduces the likelihood of dying from childhood infections Lactating mothers Interpersonal communication (with Health Workers, Village Health Workers etc.). ANC clinics, PMTCT sessions; Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. Mothers in law Interpersonal communication (with Health Workers, Village Health Workers etc.), Radio and Television; Men Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Community members Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. 24 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS Religious beliefs Religious leaders Interpersonal communication (with Health Workers, Village Health Workers etc.). Poor documentation of vitamin A supplementation To promote improved consumption of iron rich foods – animal source foods. Improved uptake of iron rich foods and animal source foods. Negative myths that discourage feeding children iron rich foods and animal source foods. Lack of knowledge and skills to prepare iron rich foods and animal foods for children (mothers fear children can choke) Iron deficiency reduces an individuals’ wellbeing, causes fatigue and lethargy, and impairs physical capacity and work performance. Lactating mothers Interpersonal communication (with Health Workers, Village Health Workers etc.). ANC clinics, PMTCT sessions; Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. Mothers in law. Interpersonal communication (with Health Workers, Village Health Workers etc.), Radio and Television; Men Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Community Members Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. 25 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS To promote a culture of having a child’s growth assessed regularly. Regular child growth assessments. Limited information and communication on the importance of regular growth assessment. Attitude of service provider to growth assessments. Long distance to health facility Take your child for regular growth assessments to ensure they grow up healthy. Lactating mothers, community members, husbands and Mothers in law. Interpersonal communication (with Health Workers, Village Healthy Workers etc.). Utilising platforms like ANC clinics, PMTCT sessions; Posters at health facilities, community centres and churches); Radio and Television; Social Media; Pamphlets, Billboards. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. To contribute towards strengthening uptake of clinical nutrition services To promote the practising of at least one or a combination of the top 5 healthy lifestyles(limiting consumption of alcohol, fats, salts, tobacco use and encouraging physical activity). Improved practice of healthy lifestyles (limiting consumption of alcohol, fats, salts, tobacco use and encouraging physical activity). Diet at home, work and at institutions (hospitals, commercial catering services, schools, prisons, old people’s homes, orphanages) A balanced diet ensures the long term health of the nation. Entire Population. Radio and Television; Social Media; Pamphlets, Posters, Billboards and Role Models. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. Attitude towards a healthy life style Practising healthy lifestyles is important for long term health. Entire Population. Radio and Television; Social Media; Pamphlets, Posters, Billboards and Role Models. 26 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS  Reduce consumption of fats, salt and alcohol  Limit tobacco use.  Do moderate intensity exercise (30mins a day for at least 5 days a week) Religious / cultural dietary restrictions. A balanced diet is important for long term physical and spiritual well-being. Religious groups Religious leaders Umbrella organisations for religious groups. To contribute towards improved awareness and prevention of Nutrition-related NCDs. Improved awareness of and prevention of Nutrition-related NCDs. Limited information on prevention of Nutrition-related NCDs. Regular health checks and healthy lifestyles helps prevent Nutrition-related NCDs. Entire Population. Radio and Television; Social Media; Pamphlets, Posters, Billboards and Role Models. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. To promote mainstreaming of nutrition in multi-sectoral interventions by 2018 To increase knowledge on the importance nutrition within Prioritisation of the first1000 days of a child’s life in all social Limited awareness on the importance of the first 1000 Good Nutrition is an outcome of multiple stakeholders. All stakeholders involved in social Policy dialogue platforms, Policy advocacy briefs, regional and international conferences, Provincial Minister’s monthly Development partners, NGOs working on 27 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS the first 1000 days of a child’s life protection targeting days of a child’s life protection interventions meetings parliamentary breakfast meetings, newsletters. Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. To promote mainstreaming of nutrition in all multi-sectoral plans. Mainstreaming of nutrition in all multisectoral plans Limited information on the importance of mainstreaming nutrition in multisectoral plans and the benefits of good nutrition for other sectors. Multisectoral plans that address nutrition have more potential to contribute towards multisectoral outcomes. Good nutrition contributes to development of Zimbabwe. Water and Sanitation, Agriculture, Health, Social Protection, Women Empowerment stakeholders. Policy dialogue platforms, Policy advocacy briefs, national and international conferences, provincial ministers’ monthly meetings, parliamentary breakfast meetings, newsletters. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. Promoting use of clean and safe water Improved use of clean and safe water Limited access to safe water; Limited knowledge about household level water purification. Make your water safer before drinking to prevent diseases. Lactating mothers, Interpersonal communication (with Health Workers, Village Health Workers etc.); ANC clinics, Posters at health facilities, Radio and Television; Social Media; Pamphlets, Billboards. 28 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS Women, Interpersonal communication (with Health Workers, Village Health Workers etc.); ANC clinics, Posters at health facilities, Radio and Television; Social Media; Pamphlets, Billboards. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, Community Based Organisations; Media Organisations. Community members. Community role models, Community centres and religious groupings Providing access to safe drinking water contributes towards improving the overall health of the country Policy makers; Policy advocacy briefs Encouraging households to drink clean water prevents disease outbreaks. Health workers, community based NGOs Interpersonal communication through in-service trainings, Job AIDS, Posters, Information Packs. Promoting adoption and sustenance of hygienic food preparation practices. Adoption and sustenance of hygienic food preparation practices. Limited cleaning resources and knowledge on hygienic food preparation practices; Hygienic food preparation practices contribute towards good health and well being. Pregnant and Lactating women Interpersonal communication (with Health Workers, Village Health Workers etc.); ANC clinics, Posters at health facilities, Radio and Television; Social Media; Pamphlets, Billboards. Development partners, NGOs working on Nutrition, NGOs working on PMTCT, 29 OBJECTIVE DESIRED BEHAVIOUR/ PRACTICE BARRIERS TO ADOPTION OF DESIRED BEHAVIOUR/ PRACTICE OVERALL MESSAGE AUDIENCES COMMUNICATION CHANNEL POTENTIAL PARTNERS Absence of social structures that support hygienic food preparation practices. Women Interpersonal communication (with Health Workers, Village Health Workers etc.); ANC clinics, Posters at health facilities, Radio and Television; Social Media; Pamphlets, Billboards. Community Based Organisations; Media Organisations. Community Members, Community role models, Community centres and religious groupings. 30 9. MONITORING AND EVALUATION FRAMEWORK The monitoring of this strategy will be tracked on monthly basis by implementation partners and reported on quarterly basis to the Ministry of Health and Child Care Nutrition Department at district, provincial and national levels. An indicator performance tracking table will be developed and shared with all stakeholders. The Communication Strategy will conduct a Mid Term Evaluation at the end of 2016 and End of Term Evaluation at the end of 2018. Table 5: Monitoring and Evaluation Plan THEMATIC AREA Activities Process Indicator (s) Output Indicator (s) Outcome Indicator (s) Means of Verification Target Timeframe Responsible 2015 2016 2017 2018 1. IMPROVING ADOLESCENT AND MATERNAL NUTRITION. OBJECTIVE 1.1 To contribute towards adoption of improved adolescent and maternal nutrition practices among women of child bearing age and adolescents by 2018 OUTCOME 1.1 Women of child bearing age and adolescents adopting improved nutrition practices i. Increasing knowledge of and promoting the benefits of iron and folate supplementation;  Number of awareness raising activities conducted on the benefits of iron and folate supplementation  Number of Women of child bearing age reached with awareness activities on the benefits of iron and folate supplementation  Proportion of women of child bearing age aware of the benefits of iron and folate supplementation  Proportion of women of child bearing age with favourable attitude towards using iron and folate supplements.  Proportion of women of child bearing age expressing the intention to use iron and folate supplements;  Proportion ofwomen of child bearing age using iron and folate supplements. Awareness and promotion Reports; Materials distributed; National Nutrition Survey; ANC records X X X X MoHCC, Food & Nutrition Council, Stakeholders, Partners ii. Increasing knowledge on and promoting  Number of awareness raising activities conducted on consumption of consuming fortified foods  Proportion of women of child bearing age and adolescents aware  Proportion of women of child bearing age and adolescents Awareness and promotion Reports; X X X X MoHCC, Food & Nutrition 31 THEMATIC AREA Activities Process Indicator (s) Output Indicator (s) Outcome Indicator (s) Means of Verification Target Timeframe Responsible 2015 2016 2017 2018 consumption of fortified foods;  Number of women of child bearing age and adolescents reached with awareness activities on consumption of fortified foods of the benefits of consumption of fortified foods expressing the intention to consume fortified foods;  Proportion of women of child bearing age and adolescents reporting favourable attitude towards consuming fortified foods.  Proportion of women of child bearing age and adolescents who believe that consuming fortified foods will reduce risk of micronutrient deficiencies.  Proportion of women of child bearing age and adolescents consuming fortified foods Materials distributed; National Nutrition Survey Council, Stakeholder, Partners iii. Increasing knowledge of and promoting consumption of nutritious foods among adolescents;  Number of awareness raising activities conducted on consumption of nutritious foods among adolescents  Number of adolescents reached with awareness activities on consumption of nutritious foods  Proportion of women of child bearing age aware of the benefits of consumption of nutritious foods  Proportion of adolescents expressing the intention to consume nutritious foods;  Proportion of adolescents encouraging others to Awareness and promotion Reports; Materials distributed; National Nutrition Survey X X X X MoHCC,, Food &Nutrition Council, Stakeholders, Partners 32 THEMATIC AREA Activities Process Indicator (s) Output Indicator (s) Outcome Indicator (s) Means of Verification Target Timeframe Responsible 2015 2016 2017 2018 consume nutritious foods.  Proportion of adolescents consuming nutritious foods iv. Advocacy to promote improved adolescent and maternal nutrition practices.  Number of advocacy activities to promote improved adolescents and maternal nutrition practices  Number of decision/ policy makers reached with advocacy activities to promote improved adolescents and maternal nutrition practices  Development of food fortification regulatory framework  Food fortification regulatory framework in place  Number of industry decision makers reached with food fortification advocacy activities  Number of decision/ policy makers publicly speaking on the importance of adopting improved nutrition practices by women of child bearing age and adolescents  Proportion of women of child bearing age using iron and folate supplementation  Proportion of food manufacturers reporting favourable attitude to initiate fortifying their food products.  Number of food manufacturers producing fortified foods  Proportion of women of child bearing age and adolescents who believe Advocacy activities Reports; Food fortification regulatory framework in place; Parliamentary Reports X X X X MoHCC, Food & Nutrition Council, Stakeholders, Partners 33 THEMATIC AREA Activities Process Indicator (s) Output Indicator (s) Outcome Indicator (s) Means of Verification Target Timeframe Responsible 2015 2016 2017 2018 consuming fortified foods will prevent them from developing micronutrient deficiencies.  Proportion of women of child bearing age and adolescents consuming fortified foods  Proportion of adolescents consuming nutritious foods 2.INFANT AND YOUNG CHILD NUTRITION OBJECTIVE 2.1 To contribute towards adoption of improved infant and young child nutrition practices among lactating mothers by 2018 OUTCOME 2.1 Improved infant and young child nutrition practices among lactating mothers. i. Increasing knowledge on the benefits of exclusive breastfeeding;  Number of awareness raising activities conducted on the benefits of exclusive breastfeeding  Number of lactating mothers reached with awareness activities on the benefits of exclusive breastfeeding  Proportion of lactating mothers aware of the benefits of exclusive breastfeeding  Proportion of women of child bearing age expressing intention to practice exclusive breastfeeding;  Proportion of women of child bearing age encouraging other women to practice exclusive breastfeeding.  Proportion of lactating mothers practising Awareness and promotion Reports; Materials distributed; National Nutrition Survey X X X X MoHCC, Food & Nutrition Council, Stakeholders, Partners 34 THEMATIC AREA Activities Process Indicator (s) Output Indicator (s) Outcome Indicator (s) Means of Verification Target Timeframe Responsible 2015 2016 2017 2018 exclusive breastfeeding ii. Increasing knowledge of and promoting adoption of a minimum acceptable diet for infants and children;  Number of awareness raising activities conducted on a minimum acceptable diet for infants and children  Number of child bearing women reached with awareness activities on a minimum acceptable diet for infants and children  Proportion of child bearing women aware of a minimum acceptable diet for infants and children  Proportion of women of child bearing age expressing intention to provide a minimum acceptable diet for infants and children;  Proportion of women of child bearing age who believe feeding children with minimum acceptable diets improves prevents malnutrition.  Proportion of children having minimum acceptable diet Awareness and promotion Reports; Materials distributed; National Nutrition Survey X X X X MoHCC, Food & Nutrition Council, Stakeholder, Partners iii. Increasing knowledge of and promoting continued breastfeeding up to 24 months  Number of awareness raising activities conducted on continued breastfeeding  Number of women reached with awareness activities on continued breastfeeding.  Proportion of women of child bearing age aware of the importance of continued breastfeeding  Proportion of women of child bearing age expressing intention to prioritise continued breastfeeding;  Proportion of women breastfeeding up to 24 months. Awareness and promotion Reports; Materials distributed; National Nutrition Survey X X X X MoHCC, Food & Nutrition Council, Stakeholders, Partners 35 THEMATIC AREA Activities Process Indicator (s) Output Indicator (s) Outcome Indicator (s) Means of Verification Target Timeframe Responsible 2015 2016 2017 2018 iv. Increasing knowledge on and promoting consumption of the benefits of consuming iron rich-animal source foods  Number of awareness raising activities conducted on the benefits of consuming iron rich animal source foods  Number of child bearing women reached with awareness activities on the benefits of consuming iron rich-animal source foods  Proportion of child bearing women aware of the benefits of consuming iron rich-animal source foods  Proportion of women expressing intention to consume iron rich animal source foods;  Proportion of child bearing women consuming iron rich-animal source foods Awareness and promotion Reports; Materials distributed; National Nutrition Survey X X X X MoHCC, Food & Nutrition Council, Stakeholders, Partners v. Advocacy to promote improved infant and young child nutrition practices  Number of advocacy activities to promote improved infant and young child nutrition practices  Number of decision/ policy makers reached with advocacy activities to promote improved infant and young child nutrition practices  Number of decision/ policy makers publicly speaking on the importance of adopting improved infant and young child nutrition practices  Proportion of decision/ policy makers publicly speaking on the importance of adopting improved infant and young child nutrition practices;  Proportion of child bearing women adopting a minimum acceptable diet for infants and children  Proportion of child bearing women taking vitamin A supplementation  Proportion of lactating mothers practising exclusive breastfeeding Advocacy activities Reports; Parliamentary Reports District Mentorship reports National Nutrition Survey X X X X MoHCC, Food & Nutrition Council, Stakeholders, Partners 36 THEMATIC AREA Activities Process Indicator (s) Output Indicator (s) Outcome Indicator (s) Means of Verification Target Timeframe Responsible 2015 2016 2017 2018  Proportion of lactating mothers practising continued breastfeeding for two years or beyond.  Proportion of child bearing women consuming iron rich-animal source foods 3.PREVENTIO N OF NON COMMUNICA BLE DISEASES (Nutrition related NCDs) OBJECTIVE 3.1 To contribute towards strengthening uptake of clinical nutrition services among the population by 2018 OUTCOME 3.1 Improved uptake of clinical nutrition services i. Increasing knowledge on and promoting adoption of healthy lifestyles(limiting consumption of alcohol, fats, salts, tobacco use and encouraging physical activity)  Number of awareness raising activities conducted on adoption of healthy lifestyles  Number of people disaggregated by age and gender reached with messages aimed at promoting healthy lifestyles  Proportion of the population demonstrating awareness of 2 of the 5 healthy lifestyles (limiting consumption of alcohol, fats, salts, tobacco use and encouraging physical activity)  Proportion of the population expressing intention to adopt healthy lifestyles  Proportion of the population who believe adopting 2 of any 5 healthy lifestyles will improve their health (limiting consumption of alcohol, fats, salts, tobacco use and encouraging physical activity)  Proportion of the population adopting 2 of the 5 healthy lifestyles (limiting Awareness and promotion Reports; Materials distributed; National Nutrition Survey; X X X X MoHCC, Food &Nutrition Council, Stakeholders, Partners 37 THEMATIC AREA Activities Process Indicator (s) Output Indicator (s) Outcome Indicator (s) Means of Verification Target Timeframe Responsible 2015 2016 2017 2018 consumption of alcohol, fats, salts, tobacco use and encouraging physical activity) ii. Increasing knowledge on and promoting prevention of Non communicable diseases.  Number of activities on raising awareness and promoting prevention of Nutrition-related NCDs;  Number of people by age and gender reached with awareness raising and prevention messages. Proportion of the population demonstrating awareness of 2 of the 5 healthy lifestyles Proportion of the population with favourable attitude towards preventing nutrition-related NCDS. Proportion of the population adopting 2 of the 5 healthy lifestyles (limiting consumption of alcohol, fats, salts, tobacco use and encouraging physical activity Awareness and promotion Reports; Materials distributed NCDS department reports X X X X MoHCC, Development partners, Food & Nutrition Council, Stakeholders, Partners 4.PROMOTING ADOPTION OF SAFE WATER, SANITATION AND HYGIENE PRACTICES OBJECTIVE 4.1 To promote mainstreaming of nutrition in multisectoral interventions by 2018 OUTCOME 4.1 Adoption and sustenance of safe water, sanitation and hygiene practices among households. i. Increasing knowledge on and promoting prioritization of 1000 days in all social protection targeting.  Number of awareness raising activities conducted on promoting prioritization of 1000 days in social protection  Number of stakeholders reached with information on the first 1000 days.  Number of stakeholders with an understanding of the importance of the first 1000 days  Proportion of stakeholders who have prioritised the 1000 days in their sector plans. Activity Reports; Social Protection targeting criteria; X X X X ii. To promote mainstreaming of nutrition in all multi-sectoral plans.  Number of activities implemented to mainstream nutrition in all multi-sectoral plans  Number of stakeholders reached through activities  Number of stakeholders with an understanding on the importance of mainstreaming nutrition in all  Proportion of multisectoral plans that mainstream nutrition. Activity Reports; Multi-sectoral plans X X X X 38 THEMATIC AREA Activities Process Indicator (s) Output Indicator (s) Outcome Indicator (s) Means of Verification Target Timeframe Responsible 2015 2016 2017 2018 on mainstreaming nutrition in all multi-sectoral plans. multi-sectoral plans. iii. Increasing knowledge on the health hazards of using contaminated water and unhygienic practices in food preparation  Number of awareness raising activities conducted on the health hazards of using contaminated water and unhygienic practices in food preparation  Number of child bearing women reached with awareness activities on the health hazards of using contaminated water and unhygienic practices in food preparation  Proportion of child bearing women aware of the health hazards of using contaminated water  Proportion of child bearing women aware of the health hazards of using unhygienic practices in food preparation  Proportion of women expressing the intention to use safe water and practice safe food preparation practices;  Proportion of marginalised/vuln erable women of child bearing age demanding safe water  Proportion of women of child bearing age using contaminated water  Proportion of women of child bearing age using unhygienic practices in food preparation Awareness and promotion Reports; Materials distributed; National Nutrition Survey; X X X X MoHCC, Food & Nutrition Council, Stakeholders, Partners iv. Promoting adoption and sustenance of hygienic disposal of excreta  Number of awareness raising activities conducted on hygienic disposal of excreta  Number of child bearing women reached with awareness activities on hygienic disposal of excreta  Proportion of child bearing women aware of hygienic disposal of excreta  Proportion of women of child bearing age who believe hygienic disposal of excreta will reduce risk to illnesses.  Proportion of women of child bearing age employing Awareness and promotion Reports; Materials distributed; National Nutrition Survey; X X X X MoHCC, Food &Nutrition Council, Stakeholders, Partners 39 THEMATIC AREA Activities Process Indicator (s) Output Indicator (s) Outcome Indicator (s) Means of Verification Target Timeframe Responsible 2015 2016 2017 2018 hygienic disposal of excreta v. Advocacy to promote adoption and sustenance of safe water, sanitation and hygiene practices  Number of advocacy activities on promotion of safe water, sanitation and hygiene practices  Number of decision/ policy makers reached with advocacy activities on promotion of safe water, sanitation and hygiene practices Number of decision/ policy makers publicly speaking on promotion of safe water, sanitation and hygiene practices  Proportion of decision/ policy makers publicly speaking on promotion of safe water, sanitation and hygiene practices  Proportion of child bearing women using safe water  Proportion of women of child bearing age employing hygienic practices in food preparation  Proportion women of child bearing age adopting hygienic disposal of excreta Advocacy activities Reports; Parliamentary Reports X X X X MoHCC,, Food & Nutrition Council, Stakeholders, Partners 40 10. SAMPLE DISTRICT COMMUNICATION PLAN Table 6: Sample District Plan Specific objective Activities Resources Responsibility Time-frame OBJECTIVE 1.1 To contribute towards adoption of improved adolescents and maternal nutrition practices among women of child bearing age and adolescents by 2018 OUTCOME 1.1 Women of child bearing age and adolescents adopting improved nutrition practices Specific objective Activities Resources Responsibility Time-frame Women of child bearing age and adolescents having increased knowledge on the benefits of iron and folate supplementation Edutainment (road shows, Drama) Financial resources (fuel, - DFNSC Partners Quarterly Inter-personal communication (nutrition counselling, Community visits) Fuel, IEC material Financial resources Nutritionist HPO Community Nurse On-going School health programmes - Fuel , IEC material - Nutritionist HPO Community Nurse Quarterly Media campaigns (newspaper articles, radio programmes and TV programmes) Financial resources - National Department of Nutrition Health promotion unit Monthly In-service refresher trainings for health workers Financial resources for trainings for health workers, job aids and information flier Nutritionist HPO Community nurse Annually Advocacy at policy level and community leaders (parliamentarians, Chiefs, Village Heads) Fuel, refreshment - Nutritionist HPO Community nurse Annually Women of child bearing age consuming iron and folate supplements Edutainment - Financial resources - DFNSC Partners Quarterly Inter-personal communication - Fuel, IEC material - Nutritionist HPO Community Nurse On-going School health programmes - Fuel , IEC material - Nutritionist Quarterly 41 Specific objective Activities Resources Responsibility Time-frame HPO Community Nurse Media campaigns (newspaper articles, radio programmes and TV programmes) Financial resources - National Department of Nutrition Health promotion unit Monthly In-service refresher trainings for health workers Financial resources for trainings for health workers, job aids and information flier Nutritionist HPO Community nurse Annually Advocacy at policy level - Fuel, refreshment - Nutritionist HPO Community nurse Annually Increasing knowledge on and promoting consumption of fortified foods Edutainment - Financial resources - DFNSC Partners Quarterly Inter-personal communication - Fuel, IEC material - Nutritionist HPO Community Nurse On-going School health programmes - Fuel , IEC material - Nutritionist HPO Community Nurse Quarterly Media campaigns (newspaper articles, radio programmes and TV programmes) Financial resources - National Department of Nutrition Health promotion unit Monthly In-service refresher trainings for health workers Financial resources for trainings for health workers, job aids and information flier Nutritionist HPO Community nurse Annually Advocacy at policy level - Fuel, refreshment - Nutritionist HPO Community nurse Annually Increasing knowledge of and promoting consumption of nutritious foods among adolescents Edutainment - Financial resources - DFNSC Partners Quarterly Inter-personal communication - Fuel, IEC material - Nutritionist HPO On-going 42 Specific objective Activities Resources Responsibility Time-frame Community Nurse School health programmes - Fuel , IEC material - Nutritionist HPO Community Nurse Quarterly Media campaigns (newspaper articles, radio programmes and TV programmes) Financial resources - National Department of Nutrition Health promotion unit Monthly In-service refresher trainings for health workers Financial resources for trainings for health workers, job aids and information flier Nutritionist HPO Community nurse Annually Advocacy at policy level - Fuel, refreshment - Nutritionist HPO Community nurse Annually Advocacy to promote improved adolescents and maternal nutrition practices Advocacy dialogues, Edutainment Financial resources - DFNSC Partners Quarterly Inter-personal communication - Fuel, IEC material - Nutritionist HPO Community Nurse On-going School health programmes - Fuel , IEC material - Nutritionists HPO Community Nurse Quarterly Media campaigns (newspaper articles, radio programmes and TV programmes) Financial resources - National Department of Nutrition Health promotion unit Monthly In-service refresher trainings for health workers Financial resources for trainings for health workers, job aids and information flyers Nutritionist HPO Community nurse Annually Advocacy at policy level - Fuel, refreshment - Nutritionist HPO Community nurse Annually 43 Activity Target Audience Output Resources Responsibility Time frame OBJECTIVE 2.1 To contribute towards adoption of improved infant and young child nutrition practices among lactating mothers by 2018 OUTCOME 2.1 Improved infant and young child nutrition practices among lactating mothers Activity Target Audience Output Resources Responsibility Time frame Launch the nutrition communication strategy Different stakeholders Number of village leaders, legislators and advocacy persons reached Copies of the strategy Venue Refreshments Fuel Stationary IEC materials (banners, t shirts, caps, wraps (mazambia), rulers for school children, pamphlets) Allowances HPO Nutritionist 3rd quarter of 2015 Training of health workers on IYCF Health workers Number of health workers trained Training manuals Venue Refreshments Stationary Fuel Allowances Nutritionist By end of 4th Quarter 2015 Counsel pregnant and lactating women on IYCF Pregnant and lactating women Number of pregnant and lactating women reached (register) Counselling registers IEC material Health workers On going Training or refresher courses on cIYCF Village health workers Number of village health workers trained Training manuals Venue Refreshments Stationary Fuel Allowances Nutritionist By end of 4th quarter 2015 44 Activity Target Audience Output Resources Responsibility Time frame Community activities by village health worker (Home visits, individual counselling, action oriented groups, support groups and mobilisation for growth monitoring) Pregnant and lactating women, men, elderly, adolescence Number of households visited Number of people attending support groups and action oriented groups Counselling cards Picture rolls IEC materials (pamphlets,) Models e.g. breast and food models cIYCF registers Nutritionist HPO Nurse in charge ongoing Branding on IYCF (erect a billboard at district hospital/town centre, ) Smaller billboards erected at rural health centres and growth points, economic centres (cattle sales, fruit and vegetable markets) Branding of shops, kombis, MOHCC vehicles, schools and rural health centres on IYCF Branded stationary (books, rulers, pens) Community Number of books, pens and rulers distributed subscriptions for billboards and kombis stationary stickers artists paint fuel maintenance Nutritionist HPO Branding, by end of year Maintenance once a year Edutainment activities (dramas, roadshows) use of social role models Community School children Number of people reached Number of school children reached and those who participated Fuel Allowances T-shirts, caps, wraps (mazambia) Social role models Nutritionist HPO annually District commemoration of WBW Community Venue Refreshments Fuel Nutritionist HPO Every 1st week of August 45 Activity Target Audience Output Resources Responsibility Time frame Stationary IEC materials (banners, t shirts, caps, wraps (mazambia), rulers for school children, pamphlets) Allowances Support and supervision activities Health workers Villager Health Workers Fuel Allowances stationery Nutritionist HPO DNO Quarterly CD4 review meeting Health workers Venue Refreshments Stationary Fuel Allowances nutritionist Annually Activity Inputs Outputs Responsibility Time Frame OBJECTIVE 3.1 To promote uptake of clinical nutrition services among the population by 2018 OUTCOME 3.1 Adoption of behaviors that contribute towards prevention of non-communicable diseases Activity Inputs Outputs Responsibility Time Frame Advocacy meeting with multi sectorial team (DFNSC, DHE, PFNSC, partners) Refreshments Stationery Number of people reached Nutritionist Biannually Sensitisation meeting with community leaders (political, church and traditional leaders) Fuel, Bus fares, Stationery, Refreshments Number Leaders reached Nutritionist HPOs Community sister Biannually Community sensitisation meetings Allowances, refreshments Number of community members reached HPO On going 46 Activity Inputs Outputs Responsibility Time Frame Commemorate nutrition related NCD days e.g. World Diabetes Day, Cancer Month, Refreshments, Fuel, IEC materials Number of commemorations done Number of people reached HPO On going Training of health workers on healthy lifestyle modification Allowances, fuel, stationery Number of health workers trained Nutritionist Quarterly Developing and distributing IEC materials on healthy lifestyles Allowances Production and distribution costs Materials produced HPO On going Counselling of clients with nutrition related NCDs Stationery Proportion of clients reached Nutritionist HFSS On going Activity Inputs Outputs Responsibility Time Frame OBJECTIVE 4.1 To promote mainstreaming of nutrition in multisectoral interventions by 2018 OUTCOME (s) 4.1 Mainstreaming of nutrition in different sectors To increase knowledge on the importance of nutrition within the first 1000 days of a child’s life Conduct stakeholder social protection meetings Venue Stationery Refreshments T & S Number of stakeholders reached DFNSC Partners Nutritionist Quarterly Promoting mainstreaming of nutrition in all multi-sectoral plans. sensitise stakeholders on nutrition communication strategy Stationery Venue Refreshments T & S Number of stakeholders sensitised DFNSC Partners Nutritionist Monthly Promoting use of clean and safe water Training of VHWs on PHHE IEC materials Number of VHWs trained Nutritionist Quarterly 47 Activity Inputs Outputs Responsibility Time Frame PHHE tools T & S Stationery venue HFSS DFNCs, Community based workers Standalone text messaging on hygiene Funds Messages meetings Number of people reached by text messaging Partners Nutritionist Service Providers Monthly Promoting adoption and sustenance of hygienic food preparation practices. Training of women on hygienic food preparation during women gatherings (churches, wards, exhibitions, clubs) Video programmes on hygienic preparation of food. Training manuals IEC material Venue Stationery T & S, CDs Recording equipment, Food ingredients Home setting venue Number of women participating in hygienic preparation of food trainings. Number of CDs distributed to households on hygienic preparation of foods Community based NGOs, DFNCs, Community based workers, City health departments DFNCs, City health departments, District health workers e.g. HFSS Monthly 48 Annexe 1: Nutrition Communication Strategy National Taskforce Team Name Designation Name Designation MOHCC Head Office Ancikaria Chigumira Deputy Director Nutrition Siboniso Chigova HFSS Training Coordinator Monica Muti Nutrition Interventions Manager Sharon T. Mvududu HFSS Training Officer Dexter Chagwena Advocacy and Communication Officer Machacha Lloyd Monitoring & Evaluation Officer Miriam Banda National Nutritionist Samuel Tsoka Deputy Director Health Promotion MoWAGCD Loyce M Kadzunge Principal Admin Officer Richard Chinjeke Principal Admin Officer UNICEF Vandana Argawal Nutrition Manager Natsayi Nembaware Nutrition Officer Charity Zvandaziva Nutrition Specialist Dr Mandi Chikombero C4D Specialist Thokozile Ncube Nutrition Specialist MoHCC Provincial Medical Directorate Representatives Zanele Moyo Provincial Nutritionist Emily Mbanga Provincial Nutritionist Nhemachena K Provincial Health Promotion Officer Chigumbu Walter Provincial Nutritionist Rutendo Kandawasvika Provincial Nutritionist Elizabeth Katuruza Provincial Nutritionist Sifelani Kudehama Health Promotion Officer Cynthia Ncube Provincial Health Promotion Officer Chamunorwa Kahomwe Health Promotion Officer Faith Kamusono Nutritionist George Kambondo Provincial Health Promotion Officer Innocent Mazarura Provincial Nutritionist Charity Chikwiriro Nutritionist Sitshengisiwe Ruzibe Health Promotion Officer Austin Chivaraidze Nutritionist Ruvimbo Danda Dietician Lenin Makenga Nutritionist Cashington Siameja Nutritionist Honest Mahlatini Nutritionist Handrea Njovo Provincial Nutritionist 49 Servious Mudyangwe Nutritionist Isheunesu Matimbira Nutritionist Getrude Simbarewamwe Provincial Health Promotion Officer Mercy Marimirofa Biostatistician Mufaro Chiriga Nutritionist Rumbidza Chituwu Nutritionist Zephenia Gomora Provincial Nutritionist Nemaramba Mildred Nutritionist