The Access Initiative – a monitoring tool that puts local communities at the heart of decision making

Introduction

Global malnutrition rates are rising at the same time as the costs of treatment. Budgets are also being squeezed from every angle - it’s therefore vital now more than ever that every penny spent on nutrition is supported by research and data to maximise both the provision of service and its uptake.

Such data to monitor this is however, often lacking. When tackling malnutrition, focus is often on service provision: training staff and providing ready to use therapeutic food - listening to and understanding the needs of the people who use the services at community level can be ignored.

We’ve seen that despite large investments in improving supply of nutrition products, without the grassroots level research and understanding, uptake and demand will not significantly improve.

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.

How it works

The Access Initiative is The Power of Nutrition’s 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 reach and 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 the initiative in Liberia

We convened partners (including Irish Aid who have generously funded this project) to pilot the Access Initiative in Liberia in 2022. Through community-based surveys, we evaluated the barriers to treatment uptake for severe wasting, vitamin A, and micronutrient powders for children. We also reviewed compliance with the provision of iron and folic acid supplementation for pregnant women.

The results were striking: it was found that only two out of every 10 extremely undernourished children (defined as ‘severely wasted’) received appropriate treatment – despite it being widely available. Coverage of Vitamin A was between 37% and 52%, and micronutrient powders just 13%. The number one reason identified for not accessing wasting treatment, vitamin A or micronutrient powders was identified as carers’ lack of knowledge of the services available to them.

Based on these findings, the Ministry of Health, UNICEF, and the University of Liberia School of Public Health are now working with communities to understand more and address the barriers to the uptake of these vital nutrition services. An endline survey will also be conducted to see the changes.

Expanding the initiative to Ethiopia

We are now following the same process in Babille District, Oromia, Ethiopia. This survey is being conducted by the Ethiopian Public Health Institute, with the East Haraghe based Haramaya University. The overall objective of the survey is to assess coverage for severe and moderate acute malnutrition treatment, mid and upper arm circumference screening, and vitamin A coverage for children, and uptake of antenatal care and iron and folic acid for pregnant women. The quantitative part of the survey assesses why women and children are not accessing services. This information gives greater understanding to service providers and communities on how to address these barriers, with the aim of achieving a higher update of health and nutrition services by families in the district.

Opportunities for partnership

This simple initiative is an innovative, low-cost, but highly effective way to uncover the barriers to uptake of nutrition services. It can be a ‘bolt-on’ to any nutrition (although it’s not specific to this sector) programme to tackle malnutrition and transform the impact sustainably by putting communities at the heart of decision making. We’re looking for partners to scale up the initiative; for more information, contact Shelley Pigott.