Protection, Promotion and Support of Healthy Maternal, Infant and Young Child Feeding

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The Essential Nutrition Actions (ENAs) Approach

Service Quality Self Assessment Tools

These tools list recommended nutrition services and quality issues in line with updated standards and asks the service providers to assess their service against them.

They can provide an interesting feedback on the actual gap between the policy and the reality on the ground. The identity of the user will stay anonymous.

Tool 1: Facility Based

Performance self-assessment tool for use by Key Stakeholders at key contact points - The following Essential Nutrition Actions (ENAs) are recommended at:

• Ante-Natal Contact
  Key stakeholders: health workers, supporting staff, VHT
   
• Delivery and immediate post-partum contact
  Key stakeholders: midwifes/health workers  at health facilities and trained birth attendants for home delivery
   
• Well-Baby care, post-natal care, immunization and growth monitoring contact
  Key stakeholders: health-workers, supporting staff  and VHT
   
• Sick Child Contact (IMCI at facility and community level)
  Key stakeholders: health-workers, supporting staff and VHT
   
• Family Planning Contact
  Key stakeholders: health-workers, supporting staff  and VHT

Note:

1) Some nutrition essential actions are repeated under more than one contact point (i.e. maternal nutrition or exclusive breastfeeding) in line with the ENA aim to increase service coverage of women and children. Thus, the tool should help practitioners to recall if all identified key contact points are effectively used and, if not, why. We acknowledge that, practically, health workers may not counsel the same women/mother on the same issue over and over again at each contact point, unless required on a case-by-case basis.

2) In the text we use the term 'all pregnant women' and 'all mothers' to refer to those who come to the facility or in contact at specific points.

Tool 2: Community Based

Performance self-assessment tool for use at community level at 5 contact points - The following Essential Nutrition Actions (ENAs) are recommended:

• Women during pregnancy
   
• At delivery and immediate post-partum
   
• At Post Natal and during the first six months
   
• For young children between 6-59 months
   
• When child or mother is sick
   

Note: Community-based performance self-assessment tool for use by village-health-team members, group leaders, extension workers, etc. to look at key nutrition behaviours at critical stages in the life cycle of children and women.

Tool 3: Community Based - Infant Feeding in the Context of HIV/AIDS

Performance self-assessment tool for use at community level at 5 contact points:

• For HIV positive mothers during pregnancy
   
• At delivery and immediate post-partum
   
• At Post Natal and during the first six months
   
• For young children between 6-59 months
   
• When child or mother is sick
   

Note: Community-based performance self-assessment tool for use by people trained to assist persons living with HIV/AIDS to look at key nutrition behaviours to be applied at critical stages in the life cycle of children and women.

This tool includes key behaviours for HIV+ mothers, who opt to use breast-milk substitutes for infant under six months.

It should be used with extreme cautiousness to avoid spill-over effects in the wider community.

11 April, 2013