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    Collective Responsibility Action and Accountability for Improved Nutrition (CRAAIN)

    Learning, key results and best practices from CRAAIN project

    A: Basic information:

    B: Results:

    1. Improved nutritional knowledge and practice among all households with a particular focus on the poor and extreme poor in the target Upazilas
    2. Effective Public and Private sector relationships for pro-poor market based solutions to increase access to affordable, nutritious and diverse foods and WASH for the poor and extreme poor in target Upazilas.
    3. Strengthened capacity, multi-sectoral coordination, responsiveness and accountability of selected government departments and local institutions at District and Upazila level to align services and enhance access to and delivery of quality nutrition services
    4. Strengthened civil society organisations engaging with government, private sector and local media to increase demand for and monitoring of efforts addressing nutrition issues, including stunting of U5 childrens.

    C: Learning: How can we sustain changed behaviour among vulnerable communities?

    1. Cultural integration enhances the effectiveness of behaviour change initiatives:

    In the south-east coastal areas (Khulna-Bagerhat), cultural integration proved to be an efficient and time-saving method to encourage vulnerable and extremely poor communities to adopt healthier behaviours related to health, nutrition, and WASH. This approach is more sustainable compared to traditional house-to-house methods.

    1. Support through input distribution:

    Linking nutrition interventions with the provision of inputs such as seeds, saplings, vermin-compost, livestock, cash, and WASH materials, along with related technical orientations, increases the likelihood of sustaining behaviour change at the individual and community levels. In the CRAAIN project, 20,000 program participants received three rounds of different seasonal seeds, four ducks, fruit saplings, and vermin-compost.

    1. Improved access to clean drinking water:

    The project installed 12 Pond Sand Filters (PSF) to ensure a reliable supply of clean drinking water for the targeted community. This initiative benefited over 36,000 people and contributed to improved household water quality.

    1. Managing livestock to prevent mortality:

    To avoid significant livestock mortality, the CRAAIN project distributed 80,000 locally procured ducks (800 grams in 45 days) among 20,000 program participants. The mortality rate during the distribution process was minimal (0.05%). Any affected families were promptly replaced with healthy ducks, as per their expectations. Vendors were closely monitored by staff to ensure the quality of the distributed ducks for up to 7 days after distribution.

    1. Enhanced support for families with persons with disabilities (PwD):

    In addition to input support, the project provided one female goat each to 500 PwD households, promoting better livelihoods and nutritional outcomes. The procurement of goats from local vendors contributed to sustainability and economic improvement for these families.

    1. Impactful use of Mobile Money Transfer (MMT):

    CRAAIN facilitated two rounds of cash transfers (7,000 households) during the COVID-19 pandemic and at the project’s conclusion. Program participants used the cash for sustainable livelihood and nutrition improvements, considering it timely and useful during difficult times. The cash transfers were also viewed as a respectful means of support, allowing participants to choose based on their individual needs.

    1. Engagement of multipurpose health volunteers:

    Locally recruited multipurpose health volunteers played a crucial role in reaching out to mothers and children, enabling behaviour change and capacity building among other field-level workers. Their collaboration with local government institutions (LGIs) and elected representatives proved highly effective.

    1. Media engagement:

    CRAAIN actively engaged local and national print and electronic media, journalists, and related gatekeepers to publish quality reports and editorials on nutrition governance. Through long-term consultancy with a media-focused capacity-building organization, journalists received technical training from BNNC and DNCC. This systematic approach ensured continuous engagement on nutrition, governance, and related topics, including national observances. Outstanding journalists received recognition and awards for their contributions, establishing connections with BNNC and other government organizations for ongoing reporting. Key learnings include the importance of providing orientation to journalists before independent reporting and meaningful engagement with different government departments.

    1. System strengthening:

    Routine meeting with DNCC and UNCC were very effective. All relevant multisectoral participants were connected and raised their learning and challenges. Quick decisions and sharing were also possible from these platforms. On top, joint annual plan and budget allocation related discussions were helpful to get additional nutrition related budget allocation from relevant government departments.

    1. Youth engagement:

    The project created platforms for youth participation, establishing committees at the Upazila and union levels. Youth representatives actively participated in DNCC and UNCC meetings and other forums, amplifying their voices.

    1. Renovation of Community clinics for improved health and nutrition services:

    The CRAAIN project implemented various improvements in community clinics to enhance health and nutrition services. These included better water supply, drinking water facilities, and separate toilets for men and women, along with a menstrual hygiene management (MHM) system. Additionally, waiting areas and ramps were constructed to accommodate patients with ease, and rainwater harvesting systems were installed. The project also provided nutrition-related training to frontline service providers, as well as members of the Community Group (CG) and Community Support Group (CSG) committees. These interventions transformed the community clinics into trusted facilities for improved health and nutrition outcomes. The community now has greater confidence in seeking healthcare services from these renovated clinics. Following an assessment of all 63 community clinics, the twenty most in need of renovation were selected. The Civil Surgeon (CS) and Upazila Health and Family Planning Officer (UH&FPO) played a vital role in the assessment and selection process. The support and involvement of relevant officials were highly appreciated. During the final handover of all process-related documentation, the CS, District Deputy Family Planning (DDFP), and UH&FPO expressed their satisfaction and anticipated similar support in the future.

    1. Close engagement with Civil Society Organisation (CSO):

    Engaging local CSOs in activities related to nutrition governance proved to be effective, as they are well-known and respected individuals within the community. Involving CSO representatives in various government platforms resulted in better outcomes for establishing nutrition governance at the sub-national level. The project also established a platform called CSO for Nutrition in Bagerhat, which continues to hold monthly meetings even after the project ceased its support since January 2023.