Case Study 2

Improving food security and nutrition policies through programme outreach

In partnership with CARE Malawi

Dates of Project: Food and Nutrition Security Program 2015 - 2022

Location: Salima, Malawi

The SUN-1000 Special Days Initiative is a multisectoral approach in which the Malawian government partners with organizations to eliminate under-nutrition of children, and ultimately eradicate childhood stunting nationwide. In accordance with the SUN - 1000 Special Days Initiative, CARE Malawi sought the expertise of illuminAid to assist in the creation and dissemination of behavior change communication videos related to reducing childhood under-nutrition. 
The “Improving food security and nutrition policies through programme outreach” (IFNS) project is piloting the delivery of digitized community videos of the CARE Malawi nutrition curriculum, which is in accordance with key outcomes outlined in SUN - 1000 Special Days. The pilot project will test the effectiveness of video in ensuring the accuracy and quality of messaging at the household level and influence uptake and adoption of key behaviors and practices. In addition, a goal of the pilot project is to improve male participation in nutrition activities. A key challenge was the inconsistency between messages delivered to cluster leaders and at the household level. Due to limitations of health extension workers, the cascading of SUN key messages at the household level was not the same quality as messages delivered to CARE Group Promoters and Household Cluster leaders. As the cascades deepens, the number of people to be trained increases and messages begin to suffer from issues of quality due to time and resource constraints.
Volunteer cluster leaders are discouraged in cluster meetings and there is poor delivery of door to door nutrition messages. This results in low adoption rates of the practices being promoted and eventually very little impact on the behaviors and nutrition status of households. 
illuminAid facilitated the Video Education Workshop in Salima for 13 CARE staff members and seven Malawian government officers on October 1-4, 2018. In November 2018, CARE Malawi conducted a baseline survey learning assessment to assess the current challenges with CARE group cascade model, determine the level of engagement of men and understand the experience of community videos by the community members. CARE Malawi also assessed the willingness of community members and cluster leaders to participate in community videos. 
CARE Malawi hosted screenings of its initial community video in May 2019 at three pilot centers in Malawi. The video focused on complementary feeding for children under two years of age. It was a drama which illustrated how specific household behaviors can lead the child malnutrition as well as emphasizing the role of the husband in the child’s health. The video was filmed in three locations which corresponded with the locations of screening. Thus the video was filmed in each of the communities in which the screenings took place to maximize community engagement. The following section details the feedback from attendees of the initial screenings at three pilot centers.
Sixty-three attendees completed the attendee feedback survey (see Figure 1) and 73% were female respondents. Average age of the respondents was 33, with the oldest attendee reporting 80 years old and the youngest reporting 19 years old. Additionally there were many children below the age of 18 present at the screening, but they did not complete the feedback survey. Out of the 63 participants, 44 (70%) reported that they are married while 30% indicated they were not married.
The topic covered in the video was familiar to community members. Community members have been exposed to training and education material focused on complementary feeding for children under the age of two to reduce malnutrition for the past three years. Thus the results of feedback survey indicate that prior to the video screening 54% of attendees reported the highest level of comprehension of the material, however the number of attendees reporting the highest level of comprehension post video screening increased to 70%. Similarly, prior to the screening of the video 17% of attendees reported low levels of comprehension of the material (ranked their knowledge 3 or less on a scale of 1 - 5), as compared to only 6% of attendees reporting a low level of comprehension post video screening. The screening of the video and subsequent discussion accounted for a 16% increase in attendees reporting the highest level of comprehension of the material. A large majority of attendees (81%) reported that the information gained from the video would be helpful in their lives. Also 84% of attendees reported that the use of video improved the messages.

Figure 1: Results of CARE Malawi Attendee Feedback Survey May 2019

CARE Malawi staff articulated their sense of accomplishment and pride for beneficiaries that were featured in the video, thus increasing community ownership of the project. The feedback from the survey revealed that beneficiaries appreciated inclusion during the creation of the video as part of their learning process and, as a result, it was easier to understand the material and more men were engaged in the children’s health. As one male beneficiary reported, he sometimes thought his wife was lying about six food groups but the video had enlightened him. Staff concluded that illuminAid’s intervention was successful at overcoming the challenges of disseminating a message across a large population and reliance upon volunteer health workers. The video standardized messages and enabled learning can take place in a controlled environment and reduce dilution of the messages.