ALIVE & THRIVE TOOL

SUPPORTIVE FOLLOW-UP CHECK LISTS FOR INFANT & YOUNG CHILD FEEDING IN ETHIOPIA

This tool provides checklists and guidelines for conducting, reporting on, and developing action plans as follow up to supportive visits by supervisors to observe nutrition services and counseling at multiple levels (zonal, health center, health post, and community). For more program design and implementation tools, please visit the Alive & Thrive tools library: http://aliveandthrive.org/resources-main-page/tools-library

Alive & Thrive is an initiative to save lives, prevent

illness, and ensure healthy growth and development

through improved breastfeeding and

complementary feeding practices. Good nutrition in

the first 1,000 days, from conception to two years

of age, is critical to enable all children to lead

healthier and more productive lives. In its first five

years (2009 to 2014), Alive & Thrive demonstrated

that innovative approaches to improving feeding

practices could be delivered with impact and at

scale in three contexts: Bangladesh, Ethiopia, and

Viet Nam.

Alive & Thrive is now supporting others to scale up

nutrition by applying and adapting tested, proven

approaches and tools in contexts such as Burkina

Faso, India, and Southeast Asia. With its emphasis

on learning and innovation, Alive & Thrive is

expanding its focus in Bangladesh to maternal

nutrition and taking a more multisectoral approach

in Ethiopia.

Alive & Thrive is funded by the Bill & Melinda Gates Foundation and the governments of Canada and Ireland and managed by FHI 360

www.aliveandthrive.org

Alive & Thrive Ethiopia Project

Infant & Young Child Feeding Supportive Follow-up Check Lists

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FORWARD

As it can be witnessed from various documents, IYCF areas are not included at all in

integrated supportive supervision manuals for health services. Most often, it is assumed

that IYCF issues are addressed when general health issues such as immunization or family

planning are addressed. This approach has its own challenge of either totally missing IYCF

issues or mixing them with other problems leading to the lack of obtaining lessons. Infant

and young child feeding issues are difficult to identify shadowed by nutritional, social as

well as behavioral problems. As a result, existing integrated supportive supervision tools

cannot fully address IYCF challenges. On the other hand, it is obvious that any integrated

supportive supervision checklist cannot address all health problems at once. However,

considering the seriousness of IYCF challenges, this IYCF supportive follow-up guideline is

developed for use by health service providers. However for the practical implementation, it

is suggested that a regular supportive follow-up can be done once in two -three months

based on regional plans.

The checklists for this supportive supervision guideline are based on existing IYCF

challenges and developed to address existing problems. Furthermore, assumption is made

that IYCF service at service delivery and community and household level is given using

the IYCF-BCC materials developed by Alive&Thrive with the financial support obtained

from Bill & Melinda Gates Foundation. At least for entry level to integrate IYCF indicators in

national documents, Alive&Thrive along with its implementing partner of the IFHP believes

that Regional Health Bureaus of the Amhara, Oromia, SNNPR and Tigray Regional States

will promote the use of this IYCF supportive supervision guideline in their respective

regions. Infant and young child nutrition is now becoming part of development efforts

more than ever before. It is believed this supportive supervision guideline and developed

checklists will enable conduct IYCF focused supportive follow up from health service

delivery system up to the community and household level.

___________________________________________________________________________

The phrase “supportive follow-up” as opposed to “supportive supervision” is used based on suggestions from regional IYCF officers

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ABBREVIATIONS AND ACRONYMS

ANC Antenatal Care

BCC Behavior Change and Communications

HC Health Center

HEWs Health Extension Workers

HP Health Post

HPDP Health promotion and disease prevention

IYCF Infant and Young Child Feeding

MNCH Maternal, newborn and Child Health

PNC Postnatal care

RHB

WDA/HDA

Regional Health Bureau

Women Development/Health Development Army

Table of Content

Forward ______________________________________________________________________________________________________ 2

Abbreviations and acronyms _______________________________________________________________________________ 3

1. Purpose of this supportive follow-up guideline ________________________________________________________ 5

2. Objectives and Levels of IYCF supportive follow-up ___________________________________________________ 5

3. The IYCF service delivery structure _____________________________________________________________________ 6

4. How to use the checklist _________________________________________________________________________________ 7

5. Supportive Follow-up implementation steps __________________________________________________________ 7

Step 1: Planning the supportive follow-up ................................................................................... 7

Step 2: Preparing for follow-up visits ............................................................................................. 8

Step 3: Conducting the supervision ................................................................................................. 9

Step 4: Recording and reporting the supervisory findings ................................................ 10

Step 5: Summarize and conclude the visit ................................................................................ 10

Step 6: Write report and submit .................................................................................................... 10

Step 7: Follow up after supportive supervision ....................................................................... 10

Annex G: Supervision Reporting Format _________________________________________________________________ 27

A. IYCF checklist for Woreda Health Bureaus

B. IYCF checklist for Health Centers

C. IYCF checklist for Health Posts/HEWs

D. IYCF checklist for W/HDA

E. IYCF checklist for households with children < years of age

F. Follow up action plan form

G. IYCF Follow-up Reporting Format

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1. PURPOSE OF THIS SUPPORTIVE FOLLOW-UP GUIDELINE

Supportive follow-up empowers health providers to monitor and improve their own

performances. It focuses on identification and resolution of problems and promotes quality at

all levels of service delivery by promoting high standards, and cultivating teamwork. Supportive

follow-up is also important for staff encouragement and motivation. It helps staff improve their

performance so that they meet the defined standards of their job. Supportive follow-up is

undertaken continuously while routine activities are carried out. During the follow-up,

performance is observed and immediate feedback is provided. The supervisor provides on job

assistance and comes up with solutions to solve performance problems together with the

supervisee.

It is a global evidence that optimal infant and young child feeding (IYCF) practices are

fundamental for enhancing child health and development. To improve the quality of IYCF

services and the performance of service delivery staff, continuous supportive follow-up is

required. Thus, this IYCF supportive follow-up guideline is designed to provide the necessary

tools for improvement of optimal IYCF practices through continuous monitoring and support

from health facility, community as well as household level.

2. OBJECTIVES AND LEVELS OF IYCF SUPPORTIVE FOLLOW-UP

IYCF supportive follow-up will be undertaken at the Worda/Zonal, Health Center, Health Post

as well as the community through the WDA structure and households with children under the

ages of 2 years of age.

The objectives of this supportive follow-up are:

1. To review the general state of IYCF service delivery at all level.

2. To promote provision of quality IYCF services

3. To improve the skills of IYCF service providers and provide opportunities for personal

development.

4. To assist service providers in the identification and resolutions of problems in IYCF

service delivery.

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3. THE IYCF SERVICE DELIVERY STRUCTURE

The table below describes the levels of and services provided

Level Service Provider

Services provided

Woreda/Zone

Woreda HPDP team

- Plan, implement, & monitor IYCF activities in the Woreda. - Supervise & support MNCH case team, HEW supervisors, HEWs &W/HDA. - Facilitate IYCF trainings. - Report IYCF implementation progress to RHB - Use IYCF monitoring data for improving service delivery. - Create linkage with other stakeholder. - Ensure availability of IYCF materials and supply. - Conduct IYCF advocacy and social mobilization.

Health Center

MNCH team

- Deliver IYCF messages to pregnant women during ANC /postnatal visits - Deliver IYCF messages in the under five clinic. - Give technical assistance, manage case referral of children by HEWs. - Catalyze discussions on IYCF with family & community members - Counsel & demonstrate to mothers age-specific IYCF practices at the HC

Health Center

Health center Staff

- Supervise, mentor and support HEWs in their effort to promote IYCF. - Solve problems of cases referred by HEWs and/or W/HDAs at community level. - Train, supervise, mentor and support HEWs - Assist HEWs in targeting audience and plan community level interventions. - Liaise with formal community leaders and associations to help HEWs organize

and facilitate community level advocacy - Report on their performance to the Woreda HPDP Team.

Health Post HEWs - Provide IYCF counseling in antenatal, postnatal contacts &household visits; Provide counseling on IYCF

- Provide counseling on age appropriate complementary feeding practices. - Demonstrate complementary feeding preparations. - Counsel on the importance of optimal child feeding during & after illness. - Conduct community mobilization and community conversation. Refer cases to

HC MNCH case team

Community WDA/HDA

- Support HEWS for community mobilization on health related issues - Provide IYCF counseling during home visits. - Provide counseling on optimal breastfeeding practices. - Provide counseling on age appropriate complementary feeding practices. - Demonstrate complementary feeding preparations - Counsel on the importance of child feeding during & after illness.

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4. HOW TO USE THE CHECKLISTS

The IYCF supportive follow-up checklists have been developed considering routine IYCF service

delivery at contact points and recommended IYCF practices. Checklists are designed for follow-up

at each level of service delivery. Each IYCF checklist starts with identification section, general

directions for using the checklist, identified key problems in the previous visits, action taken to

address gaps observed in the previous visit followed by the body of the checklist. The follow-up

action plan forms attached to the checklists will be used to record agreements reached between

the supervisors and the supervisees on what will be done to improve service delivery. At Woreda

level an interview with the Woreda Health Office Head/ HPDP team leader will be conducted.

Health Center visit will include service delivery interview with MNCH coordinator, facility record

observation, MNCH case team service delivery observation, client IYCF practices assessment,

interview with HEW supervisors and observation of logistics and supplies. Health post level visit

will include interview with HEW, observation of service delivery, logistics and supplies, interview

with members of the W/HDA and household interviews.

5. SUPPORTIVE FOLLOW-UP IMPLEMENTATION STEPS

STEP 1: PLANNING THE SUPPORTIVE FOLLOW-UP

Prepare an annual plan and budget to conduct quarterly (every three months) supportive

follow-up to service providers. The developed plan should determine where to conduct visits

and the main tasks to observe during the visit. The follow-up schedule should be

communicated to IYCF service providers so that they can take the follow-up into consideration

when developing their own work plans. Schedule for follow-up visits should allow the

observation of service delivery without interfering with routine activities.

There is a need to arrange a supportive follow-up team to carry out the activity. As this IYCF

the checklist for this supportive supervision guideline is new, it is important to have a prior

discussion with the team regarding the IYCF questions and how to use the checklist. The

follow-up team is expected to have knowledge and skills in IYCF so that they can provide

accurate and practical on-job information during supportive follow-up.

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Information on how to use the checklist can be provided during review meetings. It is

important to make sure the team understands that the checklists help them identify priority

areas that they should focus on and that they can also observe other IYCF related issues not included in

the checklists.

STEP 2: PREPARING FOR FOLLOW-UP VISITS

To make follow-up visits targeted at areas of need, supervisors should prepare for follow-up

plan by:

Review of the completed supportive follow-up checklists, follow-up reports and the

agreed follow up action plan from the last supportive follow-up visit.

Based on the review of the above items, decide on the priority areas that should be

followed up during the planned supervision.

Prepare sufficient copies of the IYCF supportive supervision checklists.

Preparing updates and/or refresher training to present during the visit.

Develop expectations and standards of performance.

Arrange necessary transport.

Supervisors should also prepare for the planned supervision by:

Reviewing their progress towards their annual service delivery targets, and the previous

supervisory report and associated action plan which were completed during the previous

supervision visit. Supervises should check whether they have completed tasks documented in

the last action plan. Before conducting the supportive supervision, important reminders that

help one to cultivate effective behaviors for encouraging performance improvement involve

the followings:

Supervision should always be facilitative not fault finding.

Always praise the job well done before raising problems.

If a problem is noted, see if the service provider also identifies that problem.

If there is a problem, analyze the problem with the service provider to understand

what is actually is the root cause of the problem.

Once you identify the cause of the problem, ask suggestions for solutions from the

service provider.

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STEP 3: CONDUCTING THE SUPERVISION

Greet the service provider and explain the objective of the visit.

Agree on how the supervision will proceed.

Make sure everyone has a copy of the IYCF supportive supervision checklist

Fill out the identification and background information.

3.1. Follow-up of issues from previous supervision: Together with the service provider

review the findings of the last supervisory visit and the resulting action plan that was

developed so that the service provider can explain the actions they have taken.

3.2. Review of progress in implementation plan: Together with the service provider review

progress against the targets set in the annual plan. This will provide the supervisor with a

view of overall performance of the facility being supervised.

3.3 Collect the data: Conduct Interviews and fill out the supportive supervision checklist:

Complete all questions on the checklist and make notes in the comments column to ensure

that the reasons for the assessments made can be referenced in the future. In addition to the

interview, observe the actual services delivery. While observing service delivery, the

supervisor should:

Ask questions to gather all relevant information about the area being observed to

understand reasons behind the actions taken by the heath extension worker.

Whenever the service provider has missed an important element or is giving

incorrect information or demonstrations to mothers, politely intervene and provide

the correct information or demonstration. At the end of service delivery review what

happened and confirm that the service provider understands what should have been

done.

3.4 Problem solving and action planning: After the supportive follow up visit is over, provide

appropriate and immediate feedback beginning with the strong points in an appreciative

manner. Together with the service provider identify problems. After prioritizing

problems by considering their importance and availability of the resources, jointly

analyze priority problems to determine the underlying causes. Jointly identify

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appropriate solutions to the problems and agree on/develop a follow-up action plan,

detailing who is going to do, what and by when in order to fix the problems identified.

Both the supervisor and the service provider should prepare a copy of the action plan;

each will keep a copy of the plan as a record for future reference.

Note: In regards to A&T/IFHP partnership, strong points and areas that need to be

improved needs to be identified and be addressed during review meetings with the

presence of all staff directly involved with the IYCF task.

STEP 4: RECORDING AND REPORTING THE SUPERVISORY FINDINGS

The service provider should be given immediate feedback on the supervision. The supervisor

should complete the visitor’s feedback register book highlight any special achievements and/or

problems found and a copy of the agreed follow-up action should be documented.

STEP 5: SUMMARIZE AND CONCLUDE THE VISIT

Thank the service provider for his/her good work and summarize general impressions on what

is going on well and what needs further improvement based on the supervisor’s findings.

STEP 6: WRITE REPORT AND SUBMIT

The supervisor should write summary report about the findings and submit to Regional Health

Bureau. In the case of the A&T/IFHP partnership the supportive supervision reports should be

shared to all cluster officers as well.

STEP 7: FOLLOW UP AFTER SUPPORTIVE SUPERVISION

The supervisor should have frequent follow up visits between quarter supervisions. Follow up

visits are important to ensure problems identified at a previous visit do not persist, to checking if past

on-the-spot training has been effective and to reinforce with the service provider that issues found

during the last visit are still important.

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ANNEXES A-G: IYCF FOLLOW UP CHECKLISTS, ACTION PLAN & REPORTING FORMATS

The checklist is prepared & tailored for each of the followings:

1. Woreda Health Office

2. Health Center

3. Health Post

4. Women Development/Health Development Army (WDA/HAD)

5. Household

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ANNEX A: IYCF CHECKLIST FOR WOREDA HEALTH OFFICES

General directions: Review the checklist and follow up action plan form from previous visit. When you begin the supervision, introduce the objective of your visit. Use the form as a guide to fill information. You could also fill additional information not indicated in the guide, if a need arise. After completing the checklist, review the form to make sure that all questions have been addressed accordingly.

Identified key problems in the previous visits (You can find this from follow up action plan form)

1. ______________________________________________________________________________________________________________ 2. ______________________________________________________________________________________________________________ 3. ______________________________________________________________________________________________________________

Action taken to address priority problems identified in the previous visit 1. ______________________________________________________________________________________________________________ 2. ______________________________________________________________________________________________________________ 3. ______________________________________________________________________________________________________________

Name of WHO Head ______________________________________Tel:_______________________________________________

Persons contacted at Woreda Health Office

Name Position Signature Data on community organizations & health facilities

1. # of kebeles :_______________________________________________

# of Health Centers __________________________________________ #of supervised Health Centers in the last quarter__________________ # of HPS :__________________________________________________ # of supervised Health Posts in the last quarter:___________________

2.

3.

4.

Names of supportive follow

up team

Organization Signature

1.

2.

3.

4.

Name of Woreda Health Office ( WHO): _________________________________________________________________ Region: ___________________Zone________________________ Woreda___________________________________________ Date of visit: ________________________________Date of last visit______________________________________________

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1. Interview to Woreda Health Officer

Assessment Action to be taken

( write notes) Yes No

1. Does the Woreda Health Office include IYCF activities for children less than 2 years of age in its annual plan? If yes check the plan & review it

2. Does Woreda Health office/ HPDP team monitor the implementation of IYCF related activities, especially the implementation of complementary feeding activities? If yes check the minute

- HCs(specify period) …………………………………………………………. - HEW supervisors (specify period)……………………………………... - HPs (specify period)…………………………………………………………. - HEWs(specify

period)………………………………………………………................................ - H/WDA (specify period)…………………………………………………….

3. Does the Woreda office document key IYCF performance and report progress to RHB? If yes, check the document

4. Does the Woreda HPDP team carry promotion, awareness creation & any social mobilization activities of IYCF?

If yes, check their document/report

5. Does the Woreda office team link IYCF activities with other stakeholders? If yes with whom please specify? _______________________

6. Are the following IYCF BCC materials available at the woreda to integrate with service delivery? ( Has the woreda health office received any of the following IYCF-BCC materials)

- Tool A (specify quantity available)…………………………………….. - Tool B (specify quantity available)…………………………………….. - QRB (specify quantity available)………………………………………... - Posters on how to process enriched complementary

foods................................................................................................................. - IYCF electronic messages such as:

Video on preparation of optimal complementary foods

Radio dramas on IYCF IYCF music

7. Has the Woreda staff received training on IYCF (ENA_BCC focuses complementary feeding)?

A. If yes how many? __________( write the No. trained) B. Total # of Woreda health office program staff_________________

8. What are the major constraints the woreda health office faces

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We thank you for providing us the information and your time

to promote IYCF? A)----------------------------------------------------------------------------------------------------------------------------------------------------------- B)----------------------------------------------------------------------------------------------------------------------------------------------------------- C)------------------------------------------------------------------------------------------------------------------------------------------------------------

9. What suggestions would you recommend to solve the above constraints?

A)--------------------------------------------------------------------------------------------------------------------------------------------------- B)--------------------------------------------------------------------------------------------------------------------------------------------------- C)---------------------------------------------------------------------------------------------------------------------------------------------------

10. Considering the importance of preventing stunting through optimal complementary feeding, what dynamic changes would you recommend for the WHO to do in terms of

A. Securing budget for promoting of IYCF just for

children under two years of age:

B. Enhancing the capacity of W/HDA members to

effectively promote optimal IYCF:

C. Multi sect oral linkages with relevant ministries ( eg. MOA, MOE, Women & child affairs, etc):

Othersuggestions:

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ANNEX B: IYCF CHECKLIST FOR HEALTH CENTER

General directions: Review the checklist and follow up action plan form from previous visit. When you begin the supervision, introduce the objective of your visit. Use the form as a guide to fill information. You could also fill additional information not indicated in the guide, if a need arise. After completing the checklist, review the form to make sure that all questions have been addressed accordingly. Identified key problems in the previous visits (You can find this from follow up action plan form)

1. ______________________________________________________________________________________________________________ 2. ______________________________________________________________________________________________________________ 3. ______________________________________________________________________________________________________________

Action taken to address priority problems identified in the previous visit 1. ______________________________________________________________________________________________________________ 2. ______________________________________________________________________________________________________________ 3. ______________________________________________________________________________________________________________

Name of health Center Head __________________________________________________Tel:_____________________________________

Persons contacted at Health Center

Name Position Signature Data on health center visited

1. # of Health Posts :_______

#of supervised Health Posts in the last quarter ______________________

2.

3.

4.

Names of supportive follow up team Organization Signature

1.

2.

3.

4.

Name of Health Center: ____________________________________________Region:_____________________________ Zone: ________________________________________________Woreda______________________________________________ Date of visit: ________________________________Date of last visit______________________________________________________________________________________________________

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No. Service delivery: MNCH case team coordinator Interview at_________________________________ Healh Center

Assessment Action to be taken Yes No

Instruction: Please interview MNCH case team coordinator to complete questions. 1. How many health workers worked in the MNCH case team in

the last quarter? _________________

2. How many of the health center staff received training on IYCF especially focused on optimal complementary feeding?

_________________

3. After the staff received the IYCF trainings in what ways have the IYCF services improved? Mention specific examples

4. How many of the MNCH case team members are you interested to be trained on IYCF in the coming six months?

________________

5. Which of the following Key IYCF Key messages have you used in counselling mothers ( Interviewer: mark as they discuses)

A. Breast feed within 1st

hr. of birth____ B. Exclusive breast feeding until 6 months___ C. Start complementary food at 6 month___ D. Enrich baby’s food with eggs, milk, meat___

E. Feed 3-4 times with snacks in between_____ F. Feed more & frequently during sickness & recovery____ G. Other_______________________________________

6. Did the last supportive supervision visit from the WHO include review of IYCF activities

yes No

7. Have you received a written feedback from last follow up visit? If yes see copy of the SS visit

8. Do you have IYCF tools in service delivery at the HC? Marx

A. QRB___ B. Tool A______; Posters on CF_____ B. IYCF CDs_________

9. Do MNCH case team members use the IYCF_BCC tools? If yes how do they evaluate

A. Very much helpful to promote IYCF counselling B. Helpful to some extent C. Not help full

10. How often do you use the IYCF –BCC tools?

Every day___; B) Once a week____; C) once a month______;

D) Have not used at all_______

11. Have you encouraged HEWs to promote IYCF? If so how?

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12. What are the major constraints that need to be corrected to carry out IYCF related activities in the HC?

13. What suggestions would you recommend to solve the above constraints?

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ANNEX C: IYCF SUPPORTIVE FOLLOW UP CHECKLIST FOR HEALTH POSTS

Name of Health Post Head

(HEW)_________________________________________________________________Tel:_____________________

Persons contacted at Health Post

Name Position Signature Data on health posts visited

1. # Households in the kebele :___________________

# of W/HDA in the kebele____________________

# of IYCF trained W/HDA in the kebele____________

# of children < years of age in kebele :____________

2.

3.

4.

Names of supportive follow up

team

Organization Signature

1.

2.

3.

4.

Name of Health Post: _________________________________ Woreda: _____________________________________________________ Region: _____________________ Date of visit: ___________________Date of last visit ______________________________________

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No. HEWs Interview at the health Post

Assessment Actions to be taken Yes No

Instruction: Please interview HEW to complete questions

1. Ask what a HEW would counsel for the following cases? I. Mother who is 7-9 months of pregnancy II. Mother who has a child less than six months age III. A mother having a child between 6 & 24 months IV. A mother with a sick child?

a Counsel her about early initiation of breast feeding within an hour after birth

b Counsel her about the importance of breastfeeding exclusively until baby is 6 months

c Counsel & demonstrate her about proper positioning and attachment.

d Counsel her about the timely introduction of complementary foods at 6 months

e counsel her about the importance of continued breast feeding up to 24 months

f counsel her about age appropriate consistency and meal frequency of complementary feeding

h If her child is sick counsel her to feed her child one extra meal her child for 15 days.

2. Do you educate mothers about HIV testing & refer to PMTCT clinics? If yes, check registration book

3. Do you demonstrate for mothers about the preparation of enriched complementary foods (specify period)? _________

4. Do you carry out community conversation on IYCF? (specify period)__________________________ If yes, check the program and document

5. How many child nutrition cards (Tool B) did you receive (during training / supervision) so far?

---------------

6. How many child nutrition cards have you distributed so far?

7. Do you have the family health card to give to mothers? ----------------

8. Does the Health Post have a home garden? Yes____No____ Y N

9. Do you have regular meeting with W/HDA? Specify period_______

10. When was the recent time that you received supportive supervision on IYCF? ( specify period)_______________________________

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We thank you for providing us the information and your time

11. What are the major constraints/challenges to carry out IYCF related activities in the HP?

12. What actions did you take to solve the above constraints/or what do you recommend?

13. What suggestion/comments do you have for increasing the number of families that carry out complementary feeding actions correctly in your kebele?

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ANNEX D: IYCF CHECKLIST FOR WOMEN/HEALTH DEVELOPMENT ARMY ( W/HDA)

Name of W/HDA:_______________________________; service year as W/HDA/month:_________________________

Name of supervisor(s) Organization & Position Signature 1. ________________________ 1. ________________________ 1.______________________________ 2.__________________________ 2. ________________________ 2.______________________________

Community level Interview : WDAs/HDAs Assessment Actions to be taken

Yes Partly No

Instruction: Please interview WDA/HDA to complete questions 1 to 13.

1. Have you been trained on IYCF (preparation of optimal CF preparation)?

2. Do you receive any child nutrition cards from HEWs?

A. Tool B

B. Family Health Card

3 What IYCF messages do you tell to a mother with a child less that 2 years of age ( Interviewer: Don’t read mark what the W/HDA mentions)

A. Timely initiation of breast feeding

B. Exclusive breastfeeding for the first 6 months

C. Continued breast feeding up to 24 months

D. Timely initiation of complementary foods at 6 months

E. Preparation of enriched complementary foods?

F. Feeding during sickness & recovery

3. Have you carried out any enriched porridge demonstration for infants so far? If yes, how many/how often? _____________

4. Have you assisted HEWs to mobilize the community for IYCF?

5. Do you have a regular meeting with HEWs on IYCF related activities? If yes, how often ________________

6. Have you held group discussion with the community members on issues related to IYCF? If yes, check document

Region: _______________________________________Zone: _______________Woreda________________________________________ Kebele: ________________________________________________Gott__________________________________________________________ Date of visit:_______________________________Date of last visit ______________________________________________________

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We thank you for providing us the information and your time

7. Which of the 7-IYCF actions is the easiest for parents to carry out? Interviewer: Use the child nutrition card. Specify………………………………………………………..Ask why?

8. Which of the 7-actions is the most difficult for parents to carry out? Specify:____________________ Ask why?

9. Once fathers learn about the importance of optimal IYCF (7 actions) how would you describe their reaction / support?

A. ____Not interested B. ____ A little interested C. ____ Helpful D. ____ very helpful

10. What is the most important reason that parents carry out the new child feeding actions?

A. ___Because I counseled them B. ___Because of the HEW C. ___Because of group meetings D. ___Their friends are carrying

out the actions 11. How many households do you counsel in IYCF in a week/month time?

Specify: _______( per week); about_________( per month); None on IYCF area_________

12. What suggestion do you have for increasing the number of families that carry out complementary feeding actions correctly in your kebele?

13. What are the major constraints to carry out IYCF related activities?

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ANNEX E: IYCF CHECKLIST FOR HOUSEHOLD INTERVIEW

Name of the mother:_____________________________________

No. Item Response

1. Sex of youngest child 1. Male 2.Female

2. Name of youngest child ___________________

3 How old is your youngest child ________________ Months

4 Birth date of child (verified from immunization card/Local

calendar of events) ___Day____Month ___Year

5 Have you ever breastfed (name of child)? 1. Yes 2. No

6 How long after birth did you put (name of child) to the breast?

A. __ Immediately / < 1 hr. B. ___ Within 24 hrs C. ___ > 24 hrs

7 Did you feed (name of child) the first breast milk? (colostrum)

1. Yes 2. No

8 Are you still breastfeeding (name of child)? 1. Yes 2. No

9 Since this time yesterday, has (name of child) received any liquids (including water) other than breast milk?

1. Yes 2. No

10 Have you ever used bottles to feed your baby? 1. Yes 2. No

11 Have you ever given any herbal medicine for your baby? If yes what? ______________________________________

1. Yes 2. No

12 Have you started giving foods other than breast milk to (name of child)

1. Yes 2. No

13 If yes how old was (name of child) when you started giving other foods?

___________ months

14 Since this time yesterday, has (name of child) received any other foods?

1. Yes 2. No

15 Since this time yesterday how many times have you fed complementary food to your child?

A. 1-2 times 1. Yes 2. No

B. 2-4 times 1. Yes 2. No

Region:______________________________________Zone:_____________________________ Woreda________________Kebele_________________Gottt__________________________ Date of visit__________________________Date of last visit_______________________ _______________________________________________________________

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C. 4-5 times 1. Yes 2. No

D. More than 5 times 1. Yes 2. No

16 Since this time yesterday, In your opinion how much has the baby eaten when you estimate it in the traditional coffee cup?

A. Less than one coffee cup

B. 2-3 coffee cups

C. 4-5 coffee cups

D. More than 5 coffee cups

Continue, if child is older than 6 months.

17 Since this time yesterday, has (name of child) received any of the foods listed blow? ( Circle all the foods the child ate)

A. Any foods made from cereals or root crops (e.g. maize, Sorghum, Wheat, Barley, Teff; Kocho, Bulla, Godrere, )?

1. Yes 2. No

B. Any foods made from legumes (e.g. peas, kidney beans, haricot beans, field peas, cowpeas, chick peas or others?)

1. Yes 2. No

C. Any dairy products (Milk, Yogurt, Cheese)? 1. Yes 2. No

D. Any flesh foods (meat, fish, poultry & liver/organ meats)?

1. Yes 2. No

E. Any eggs? 1. Yes 2. No

A. Any dark green leafy vegetables and orange fleshed fruits and vegetables (such as Papaya, Mango, kale, carrot,

Pumpkin)?

1. Yes 2. No

G. Any other fruits and vegetables? 1. Yes 2. No

18 How many times did (name of child) receive other foods during the previous day?

____________________ times

19 Tell me when should breastfeeding be initiated? __________________________

19 When should complementary foods be introduced? _____________________

20 Has anyone counseled you on carrying out the 7-feeding actions or about optimal IYCF?

1. Yes 2. No

21 If so, who has counseled you? And how many times in a month? Please Marx

A) ____HEW ( ______Times) ; B)____HDA (______Times); C)_____ A friend (___Time)

22 If the HEW/HAD/WDA counseled you, which tools were used to counsel you?

Specify, what she mentioned ………………………………………..

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23 Do you have the following counseling cards? If yes ask to see it?

Tool B ( Child Nutrition Card Family Health Card

1. Yes 2. No

1. Yes 2. No

24 Have you carried out any new complementary food preparation for your baby?

1. Yes 2. No

25 From whom did you hear about the new complementary food preparation?

A. ______ From HDA/WDA B. ______ From HEW C. ______ Group meetings D. ______ Through friends

26 Have you participated in your community on a demonstration of special baby porridge?

1. Yes 2. No

27 What are the major constraints to carry out IYCF related activities in the household?

28 What suggestions would you recommend to solve the above constraints?

29 What suggestion do you have for increasing the number of families that carry out optimal complementary feeding actions correctly in your community?

30 Has anyone counseled you on carrying out the 7-feeding actions or about optimal IYCF?

1. Yes 2. No

We thank you for providing us the information and your time

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ANNEX F: FOLLOW UP ACTION PLAN FORM FOR ENHANCING OPTIMAL IYCF

Kebele of Health post Visited: _________________________Date of Visit: _____________________

Region: _______________ Woreda: _______________________ Zone: _____________________________

Supervisor____________________________________________________________________________________

Identified problems

Agreed Action to be Taken

Time

(When)

Responsible person (who)

Expected outcomes

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ANNEX G: SUPERVISION REPORTING FORMAT

Kebele of Health post Visited: __________________Date of Visit: _________________________________

Region: ___________________Zonea: _____________________Woreda___________________________________

Name of Supervisor________________________________________________________________________________

Key issues from the last supervisory visit __________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________ Positive findings of the current visit __________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________ Gaps observed during the current visit __________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________ Follow up /agreed up on action to taken

__________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________