(P10-003-24) Improving Supply and Generating Demand for MIYCN Services in Jordan: An Assessment of Program Process and Its Barriers and Facilitators

Objectives: A community nutrition program, implemented currently, aims to improve maternal, infant, and young child nutrition (MIYCN) and post-partum family planning using a supply and demand approach in three governorates of Jordan.  It supports health facilities to institutionalize MIYCN services in a model service network (MSN), increase capacity of health care providers (HCPs), develop a cadre of lactation counselors (LC) while generating demand through intensive social and behavior change activities including community and  mid and mass media engagement. As part of longitudinal impact and process evaluation, we aimed to assess fidelity of program implementation and barriers/facilitators of adoption of behaviors by providers (HCP and LC), community-based agents (CBAs) and pregnant and lactating women (PLW)

Methods: Utilizing a convenience purposive sampling method, we conducted 20 key informant interviews and 14 focus group discussions targeting program staff, implementing partners, HCPs, LCs, CBAs, PLW, their mothers and mother in laws and husbands. Upon transcription and translation of the data, inductive analysis, followed by thematic analysis was conducted using NVivo 12.

Results: On the demand side, community activities supported PLW’s knowledge, yet barriers prevented translation into practice. These were linked to social norms and cultural expectations from the mother and her family. Distance from community activities and lack of incentives were significant barriers for PLW attendance as they limit wider participation. On the supply side, HCPs and LCs received robust training. Facilities worked towards MSN protocols to deliver MIYCN. But, variability in infrastructure and facilities (public versus private), motivation, interest from leadership and lack of sufficient personnel for nutrition services are critical concerns. Lack of an institutionalized position for LCs is likely to hamper professional interest in this crucial service.

Conclusions: Program implementation was on track and held to its theory, but there is need for recognition, incentives and/or compensation across participants and service providers to achieve impact. Wider outreach and attention are needed to address barriers to translate knowledge into practice for sustained behavioral change.

Funding Sources: United States Agency for International Development in Jordan