LESSONS LEARNED REPORT

Improving Nutrition through Community-based Approaches (INCA) Activity

The Improving Nutrition through Community based days of life, from conception up until two years old.
Approaches (INCA) Activity implemented by Caritas The project was implementedwith targeted nutrition-specific
Bangladesh from May 2017 to May 2020, with technical and sensitive interventions at household and community level
support from United Purpose. The project aimed to address the that was leveraged and built on existing government, USAID
high levels of stunting and malnutrition in 11 selected Upazila and other donor efforts in the field of nutrition, healthcare,
under the districts of Bhola, Lakshmipur and Noakhali in WASH and agriculture. The project worked with health
south-central Bangladesh. The purpose of the project was to facilities which includes Community Clinics (CC), and Union
improve nutritional status of women and children in targeted Health and Family Welfare Centers (UH&FWC).
vulnerable areas with an objective of improved nutritional
practices during the first thousand days of life. The project Objective:
funded by the United States Agency for International
Development (USAID) works at health facility, community The specific objective of this activity wsto improve nutritional
and household level to improve nutrition among pregnant and practice during the first thousand days of life.
lactating women and children during the crucial first 1,000
Specific objectives: 'Community Nutrition Promotors' (CNPs) from the
communities who conducted monthly visits to targeted 1,000
1. Improved knowledge of communities on proper nutritional day households for vital one to one counseling on food,
requirements during the first thousand days of life. maternal nutrition, pregnancy care, IYCF, adolescent nutrition
• Increased access to nutrition knowledge at community and care according to specific needs.
level All CNP worked at community-based health facilities
• Increased dissemination of quality nutrition including 302 CCs and 70 UH&FWCs, to assist CHCP and
information from community based health facilities FWV in nutrition counseling, GMP, maternal health and
• Increased support to families through community nutrition services.
nutrition support groups Social Behavior Change Communication (SBCC) modules and
2. Increased access to and use of health and nutrition materials identified,adapted, developedand distributed during
services at community based health facilities. various community awareness events including courtyard
• Increased coordination between community nutrition sessions and quarterly Community Nutrition Day.
promoters and community based health facilities Government health facility service providersweretrained and
• Increased awareness of community about availability supported by the project and provided support in service
of health services at community level delivery.

• Increased capacity of health service providers in the

community

Beneficiaries & target areas:

The 11 targeted Upazila in Bhola, Lakshmipur and Noakhali

districts (Bhola Sadar, Daulatkhan, Burhanuddin,
Tazumuddin, Lalmohan, Char Fasson &Manpura;
Kamalnagar &Ramgati; Subarnachar & Hatiya).
The project beneficiaries were pregnant women, lactating
mothers, children under 2-years, husbands, fathers, in-laws,
adolescent girls, members of community nutrition support
groups of CC, health & nutrition service providers of
Community Nutrition Support Groups (CNSG)established
community based health facilities and local service
from the existing Community Group (CC) and Community
providers.
Support Group (CSG) of Community Clinic and trained to
ensure community engagement.
Approaches: Women's Information Centres (WIC) have been established in
Interventions: remote areas with limited access to health facilities.
The key interventions of the project were: An innovative App and Dashboard developed to track nutrition
• Maternal nutrition, and health status of target households for use by CNPs as well
as health facility staff.
• Infant and young child feeding practices (IYCF),
• Adolescent nutrition,
Major Achievements:
• Handwashing and personal hygiene,
• Strengthening community based health facilities, • Registered 226,454 one thousand days’ household
• Community Nutrition Support Group formation and • Reached 398,722 beneficiaries including pregnant
promotion women, lactating mothers, mother of children under age
• Women’s Information Centre (WIC) formation. 2 and adolescent girls.
• Provided service to 113,649 pregnant women, 94,010 Challenges and Action taken:
lactating mothers, 161,996 children under age 2 and
29,067 adolescent girls. • INCA project faced many challenges, which overcomes
gradually in collaboration government officials,
• Provided 1,600,376 individual counseling through
community leaders, local government representatives,
householder visit.
religious leaders and parents. The major challenges
• Conducted 196,553courtyard sessions with mothers, were:
fathers, mothers-in-law and adolescent girls’ groups.
• The project faced frequent drop out of CNP and other
• CNSG members assisted CNPs to facilitate 20,720 staff. Caritas adapted flexible recruitment policy and
courtyard sessions. arranged local recruitment, developed a panel of selected
• A total of 77,643 GMP services and 199,688 CNP for immediate replacement; assigned newly
individual counselling, 25,663 group counselling recruited CNPs with a trained and skilled CNP in
provided from the health facilities assisted by CNPs, adjacent area for on the job training before formal basic
training; assigned Field Supervisors for continuation of
vacant CNP’s regular activities.

• All CNSG members were not actively involved in project

• Community Nutrition Day (CND) was organized to activities. CMs are keeping in touch with less involved
engage community and fulfil community demand in members. Many of them were not literate and cannot
INCA areas. A total of 2,644Community Nutrition write on referral slip. They were oriented on importance
Day (CND) events have been organized with 167,310 of referral slip and CNP helped them to write on slip.
community participants during project period. • Pregnant women were not willing to take ANC services
from male service provider (CHCP) in Community
• Provided capacity building support to 1,237 service
Clinics. CNP has increased counselling on important of
providers of GOB facilities on nutrition.
ANC services and provided ANC/PNC support and or
• Provided support to health facilities to increase the
accompanied pregnant mothers when they visited CCs.
services received by the women and children through
• Lack of water and sanitation facilities at Community
77,847 referrals.
Clinic creates dissatisfaction among service recipients.
• Observed global handwashing day, world health day, Pregnant women were not willing to come when they see
international women day, celebrated national nutrition there is no facility. This demotivated them to receive
week and world breastfeeding week.A total of 6,310 services. Discussed issue with CNSG and UP Chairman
event organized with 149,656 community participants for their support to improve sanitation facilities.
during the project period. • Community Health Care Providers (CHCP) of
• Provided support to the Ministry of Health and Family Community Clinics all over the country went for strike
Welfare in organizing Vitamin A Plus Campaign all during January and February 2018 for their job
over the catchment areas and distributed Vitamin A to regularization for a month. Service was disrupted on that
407,173 children. time. INCA maintained liaison with the concern
authority to resolve the problem as earliest time.
Lessons Learned level institutions. Community members expressed their
• Community Nutrition Day (CND) helped in comfort and ability to install and use tippy-tap for their
mobilizing people from different level: Community own family. Family members, adults and children learned
Nutrition Day (CND) was organized to engage handwashing process from CNPs counseling and
community and fulfil community demand in INCA courtyard sessions. Installation of Tippy-Tap at household
areas. Community Nutrition Day was a unique activity level created opportunity for all family members to
of INCA and created a buzz in the community as a practice handwashing according to their learning.
popular local level campaign. This is an event that Similarly, students also learned handwashing through
engaged different level of people, including mothers Tippy-Tap installed at school and Madrassas. This
and adolescents, CNSG members.Particularly the event Tippy-Tap can be used in all WASH program.
brings together community elites, health and nutrition • Women Information Center (WIC) is an ideal model
actors, male group and health service providers and for women empowerment: WIC has now become a
promoted mass awareness on nutrition. This event may platform for rural women and real information hub in the
replicate in other areas as well. community, not just a sales center. This center established
• Adolescent girls’ involvement created long term its position as a platform of empowering women with
effects: Adolescents are future mothers. They can play information and services, involving women in income
the role of ‘catalysts’ or ‘change-makers’ for their generating activities and strengthening them in
community. They can mobilize and engage the participating decision making process in the family and
community for improving nutrition and hygiene community.
practices. Involvement of adolescent girls added value Recommendations:
to the project. They continue to disseminate messages
• The coordination with GOB and parnters should be
on nutrition and demonstrate hand washing to their
strengthend, organized frequently/regular basis to inform
neighbors’peers and younger brothers, sisters and
the stakeholders about progress and to identfy gaps and
family members. Adolescents also can apply their
mitigateion those.
knowledge and practice when they become mother. In
• Adolescent boys need to be included in nutrition program
all nutrition program adolescent girls’ involvement
as benefciries. They are the future husbands and fathers.
should be ensured for long term effect.
They will make decesions for their family.
• Community Nutrition Support Group helped in
• Along with adolescent nutrition activity, child marriage
community engagement and facility improvement:
issue need to be addressed as this is a concern for
Formation of Community Nutrition Support Group
adolecents health, risk of early pregnancy, malnutrition
(CNSG) at Community Clinics in INCA area has
and, maternal and child mortality.
created a platform to discuss issues concerning
• Capacity building of community group (CNSG) is critical
nutrition services as well as influencing CG, CSG and
to keep them active as volunteer.
local health and nutrition authorities to ensure nutrition
services at the community level. Before INCA • Female service provider should be available in health
intervention there was no such groups which can aware facilities for pragnent women and adolescent girls.
community people on nutrition. This group helped in • Real time online monitoring through mobile app&
engaging community in project activities, monitoring dashboard should be tested insmall area for gaining
service delivery and improving the facilities solving the experience, before scale up.
local level problems. • Gender awareness should be a part of healthand nutrition
• Tippy-Tap helped to develop handwashing to reduce malnutrition among women and adolescent girls
behavior: Tippy-Tap was accepted by the community by reducing discrimination and GBV.
as affordable handwashing tool for the promotion of • Long term project is vital to observe the sustainable
handwashing practice at household and community behavioral impact.

Prepared by: Rehan Uddin Ahmed Raju; Project Director-INCA; Assisted by: Lily A. Gomes; Md. Rafiqul Islam.
For information: Caritas Bangladesh, 2, Outer Circular Road, Shantibagh, Dhaka-1217, Bangladesh. Phone: +88-02-48315405-9; Email: info@caritasbd.org; Website:www.caritasbd.org

“This report/ publication is made possible by the support of the American people through the United States Agency for International Development (USAID). The opinions
expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Government or USAID or Caritas Bangladesh the implementing agency.”