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Field
Intervention (Public)
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Before
The Connect project designed light-touch interventions, called “enhancements,” that could be layered onto larger host projects working with the CHW cadre in Tanzania. Specifically, the initial enhancements leveraged a larger USAID-funded “host” project, called Lishe Endelevu. Lishe Endelevu (meaning “sustainable nutrition” in Kiswahili) operates in 493 wards and 1,755 villages in 23 districts of Dodoma, Iringa, Rukwa, and Morogoro regions and aims to achieve a 15% reduction in stunting in children under five and increase the minimal acceptable diet in women of reproductive age and children 6-23 months by 15 percent. Lishe Endelevu reaches breastfeeding and young mothers and their household and community influencers through community-based outreach activities. With the aim of leveraging Lishe Endelevu’s reach to improve use of PPFP among FTMs ages 15-24, Connect introduced light-touch, scalable enhancements to Lishe Endelevu’s community activities.
The Connect Community Level Enhancements include:
Community Support Groups (CSGs)*: Connect enhances Lishe Endelevu’s CSGs of pregnant and lactating mothers ages 15-49. The CSGs use a toolkit to provide information about nutrition over the course of six months. Once completing the group-based toolkit, group members graduate to other community activities (i.e., model farmer activities, village savings and loan associations). Women are recruited into CSGs by CHWs. CHWs aim to recruit 15 women per group, including 8 FTMs. Over the next four months after recruitment, the CSGs meet two times. After four months, the groups end and CHWs recruit new women to form new groups.
CSGs formed by Lishe Endelevu prior to 2021 had limited and varied enrolment of FTMs, with some CSGs not having any enrolled FTMs. Connect enhances Lishe Endelevu’s Standard Operating Procedures to require at least four FTMs to be recruited into each CSG established. In addition, Connect enhances the CSG toolkit to include FTM focused content, including information on birth spacing and PPFP.
Home visits*: As part of the Connect package of enhancements, the CHWs who facilitate the community support groups also conduct home visits to FTMs. CHWs are provided a job aid to counsel FTMs and their families on PPFP. Counseling addresses myths about FP, norms around fertility and spacing, and includes prompts to engage family and male partners when present. Counseling also integrates timely nutrition information from the support groups (i.e., exclusive breastfeeding, introduction of complementary foods) with PPFP information (i.e., discussing lactation amenorrhea method (LAM) and providing information on lactation-safe FP methods for FTMs who are breastfeeding, discussing transition to another modern method when complementary foods are introduced). CHWs can provide non-clinical FP methods (pills, condoms) and provide referrals for services at public health facilities.
In addition to the community level enhancements, which will be randomized at the village level, there are also facility level enhancements that will be implemented across all public facilities (both those in control and treatment).
Respectful care on-the-job training: A light-touch respectful care activity will complement planned Lishe Endelevu efforts that aims to strengthen interpersonal communication skills for facility-based health providers. Connect supported the Ministry of Health to introduce a three- to four-day on-the-job training approach on respectful care, which includes provider reflection to increase self-awareness on specific biases related to FTPs and PPFP.
Through a cascading training approach, national trainers are trained using Lishe Endelevu and Connect materials. These national trainers then go to public health facilities and train the lead provider. That provider then trains all other providers in that facility. The government provides supportive supervision to monitor the dissemination of the training.
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After
The Connect project designed light-touch interventions, called “enhancements,” that could be layered onto larger host projects working with the CHW cadre in Tanzania. Specifically, the initial enhancements leveraged a larger USAID-funded “host” project, called Lishe Endelevu. Lishe Endelevu (meaning “sustainable nutrition” in Kiswahili) operates in 493 wards and 1,755 villages in 23 districts of Dodoma, Iringa, Rukwa, and Morogoro regions and aims to achieve a 15% reduction in stunting in children under five and increase the minimal acceptable diet in women of reproductive age and children 6-23 months by 15 percent. Lishe Endelevu reaches breastfeeding and young mothers and their household and community influencers through community-based outreach activities. With the aim of leveraging Lishe Endelevu’s reach to improve use of PPFP among FTMs ages 15-24, Connect introduced light-touch, scalable enhancements to Lishe Endelevu’s community activities in two districts of Dodoma Region.
The Connect Community Level Enhancements include:
Community Support Groups (CSGs)*: Connect enhances Lishe Endelevu’s CSGs of pregnant and lactating mothers ages 15-49. The CSGs use a toolkit to provide information about nutrition over the course of six months. Once completing the group-based toolkit, group members graduate to other community activities (i.e., model farmer activities, village savings and loan associations). Women are recruited into CSGs by CHWs. CHWs aim to recruit 15 women per group, including 8 FTMs. Over the next four months after recruitment, the CSGs meet two times. After four months, the groups end and CHWs recruit new women to form new groups.
CSGs formed by Lishe Endelevu prior to 2021 had limited and varied enrolment of FTMs, with some CSGs not having any enrolled FTMs. Connect enhances Lishe Endelevu’s Standard Operating Procedures to require at least four FTMs to be recruited into each CSG established. In addition, Connect enhances the CSG toolkit to include FTM focused content, including information on birth spacing and PPFP.
Home visits*: As part of the Connect package of enhancements, the CHWs who facilitate the community support groups also conduct home visits to FTMs. CHWs are provided a job aid to counsel FTMs and their families on PPFP. Counseling addresses myths about FP, norms around fertility and spacing, and includes prompts to engage family and male partners when present. Counseling also integrates timely nutrition information from the support groups (i.e., exclusive breastfeeding, introduction of complementary foods) with PPFP information (i.e., discussing lactation amenorrhea method (LAM) and providing information on lactation-safe FP methods for FTMs who are breastfeeding, discussing transition to another modern method when complementary foods are introduced). CHWs can provide non-clinical FP methods (pills, condoms) and provide referrals for services at public health facilities.
In addition to the community level enhancements, which will be randomized at the village level, there are also facility level enhancements that will be implemented across all public facilities (both those in control and treatment).
Respectful care on-the-job training: A light-touch respectful care activity will complement planned Lishe Endelevu efforts that aims to strengthen interpersonal communication skills for facility-based health providers. Connect supported the Ministry of Health to introduce a three- to four-day on-the-job training approach on respectful care, which includes provider reflection to increase self-awareness on specific biases related to FTPs and PPFP.
Through a cascading training approach, national trainers are trained using Lishe Endelevu and Connect materials. These national trainers then go to public health facilities and train the lead provider. That provider then trains all other providers in that facility. The government provides supportive supervision to monitor the dissemination of the training.
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Field
Experimental Design (Public)
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Before
Two districts were selected by the President’s Office for Regional and Local Government (PO-RALG) through discussions with Save the Children.
We conducted village-level (cluster) randomization to reduce the possibility of crossover from treatment and control FTMs. We stratified randomization by district and urbanization to achieve sample balance across location and urbanization.
Out of the 143 total villages (87 villages in Kongwa and 56 in Bahi), 111 villages were available for randomization (56 in Kongwa and 55 in Bahi). The other villages were either used in the pilot (16), used in some initial testing during Phase II (14), prior to the baseline survey, or were excluded due to many other ongoing interventions. We purposely selected all urban and peri-urban villages for inclusion in the sample. We then randomly selected 31 rural villages from Kongwa and 33 rural villages in Bahi to get a total of 38 villages in each district.
The villages selected into the sample were then randomized into treatment and control by strata.
Subsequently, 4 villages had to be dropped from the sample because they did not have CHWs (n=3) or they were inaccessible (n=1). The final sample included 36 villages in Bahi (18 treatment, 18 control) and 36 villages in Kongwa (19 treatment, 17 control).
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After
Two districts were selected by the President’s Office for Regional and Local Government (PO-RALG) through discussions with Save the Children.
We conducted village-level (cluster) randomization to reduce the possibility of crossover from treatment and control FTMs. We stratified randomization by district and urbanization to achieve sample balance across location and urbanization.
Out of the 143 total villages in Dodoma Region (87 villages in Kongwa and 56 in Bahi), 111 villages were available for randomization (56 in Kongwa and 55 in Bahi). The other villages were either used in the pilot (16), used in some initial testing during Phase II (14), prior to the baseline survey, or were excluded due to many other ongoing interventions. We purposely selected all urban and peri-urban villages for inclusion in the sample. We then randomly selected 31 rural villages from Kongwa and 33 rural villages in Bahi to get a total of 38 villages in each district.
The villages selected into the sample were then randomized into treatment and control by strata.
Subsequently, 4 villages had to be dropped from the sample because they did not have CHWs (n=3) or they were inaccessible (n=1). The final sample included 36 villages in Bahi (18 treatment, 18 control) and 36 villages in Kongwa (19 treatment, 17 control).
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