Visiting the Product Access Initiative in Ethiopia

I visited Ethiopia last month to see first-hand our innovative Product Access Initiative (PAI) programme, which is now being rolled out in Ethiopia following a pilot in Liberia. The purpose of the visit was to observe the programme training and get a hands-on experience of how the data is being collected in community sites.

What is the Product Access Initiative?

With global malnutrition rates rising at the same time as the costs of treatment, it’s vital that every penny spent in nutrition is supported by research and data to qualify the investment. Such data however is often lacking. When tackling malnutrition, focus is often on delivering solutions at scale - listening and understanding the needs of the people at the community level is often ignored.

We’ve seen that despite large investments in improving supply of nutrition products, without the grassroots level research and understanding, uptake and demand hasn’t always improved.

The Access Initiative is an innovative new tool from The Power of Nutrition which aims to change this. By understanding local-community needs, it aims to promote community centred solutions for nutrition programmes to make them more accessible for the most in need and hard to reach households.

The Access Initiative is The Power of Nutrition’s new innovative monitoring, evaluation and strategy tool that uncovers and acts on the barriers communities face in accessing key nutrition services. Working at the community-level, nutrition programmes are then shaped to have the greatest impact.

The simple yet effective process starts with small and quick surveys to assess the coverage of nutrition services and uncover the barriers households face in accessing them. The data is then used to create community centred action plans, allowing more people to access and benefit from the nutrition programmes. The surveys are then repeated to continually test and improve the programme.

This innovative, relatively low-cost approach allows programmes to better target their resources to maximise impact in tackling malnutrition and provides learning to improve future programmes.

Piloting PAI in Liberia

We convened partners (including IrishAid who have generously donated to the research) to pilot the Product Access Initiative in Liberia last year. Through community-based surveys, we evaluated the barriers to treatment uptake for severe wasting, vitamin A, and micronutrient powders (MNPs) for children. We also reviewed compliance with the provision of iron and folic acid (IFA) supplementation for pregnant women.

The results were striking: it was found that only two out of every ten extremely undernourished children (defined as ‘wasting’ where their weight is too low for their height) received appropriate treatment. Vitamin A coverage was between 37% and 52%, and MNPs just 13%. The number one reason identified for not accessing wasting treatment, vitamin A or micronutrient powders was carers' lack of knowledge of the services available to them. Based on these findings, The Ministry of Health, UNICEF, and the University of Liberia are now working with community activists to understand more and address the barriers to the uptake of this vital nutrition services. An end-line survey will also be conducted to see the changes.

Expanding the pilot to Ethiopia

We are now following the same programme in Ethiopia. This survey is being conducted by the Ethiopian Public Health Institute (EPHI) and with the technical support of Haramaya University and funded by Irish Aid and International Medical Corps (IMC). The overall objective of the survey is to assess the SAM treatment coverage as well as other nutrition direct coverage and understand barriers and facilitators about coverage in the Babille district.

During my recent visit, I got to see how the team was getting ready for the survey in communities. We did a practice run (pilot survey) and the actual data collection. The trip taught us many useful things. When getting ready for a project like this, it's key to prepare ahead. That means getting all the stuff we need, like survey tools, tabs, and more. We also need to ensure our questionnaires are good to go in the local language and create software for collecting data. This way, we can start right away when we get the green light. We also learned that everyone needs good training, especially in anthropometry, to ensure everyone follows the same standards. In places like Ethiopia, security can be tricky, so it's smart to have backup spots for collecting data in case of safety issues. That way, we can quickly switch to a different place if we need to.

Overall, it was a very good learning experience, and I am optimistic about its success. The PAI programme has so much potential to improve the efficacy of our programmes – working at a community level, it chimes perfectly with the ‘localisation agenda’ that is so often talked about in our sector. We’re now proactively looking for partners to continue this vital research – the potential is huge. Together we can transform the impact of large-scale nutrition programmes – putting communities at the heart of decision making to tackle malnutrition in a sustainable and effective way.