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Open Access

Lessons Learned From Integrating Infant and Young Child Feeding Counseling and Iron-Folic Acid Distribution Into Routine Immunization Services in Ethiopia

Natasha Kanagat, Adriana Almiñana, Belayneh Dagnew, Lisa Oot, Amare Bayeh, Daniel Girma, Tewodros Alemayehu, Getu Molla Tarekegn, Yohannes Lakew Tefera, Meseret Zelalem Tadesse, Hiwot Darsene Dimd and Zenaw Adam
Global Health: Science and Practice October 2022, 10(5):e2200166; https://doi.org/10.9745/GHSP-D-22-00166
Natasha Kanagat
aJSI Research & Training Institute, Inc., Arlington, VA, USA.
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  • For correspondence: natasha_kanagat@jsi.com
Adriana Almiñana
aJSI Research & Training Institute, Inc., Arlington, VA, USA.
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Belayneh Dagnew
bJSI Research & Training Institute, Inc., Addis Ababa, Ethiopia.
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Lisa Oot
aJSI Research & Training Institute, Inc., Arlington, VA, USA.
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Amare Bayeh
bJSI Research & Training Institute, Inc., Addis Ababa, Ethiopia.
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Daniel Girma
bJSI Research & Training Institute, Inc., Addis Ababa, Ethiopia.
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Tewodros Alemayehu
bJSI Research & Training Institute, Inc., Addis Ababa, Ethiopia.
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Getu Molla Tarekegn
bJSI Research & Training Institute, Inc., Addis Ababa, Ethiopia.
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Yohannes Lakew Tefera
cFederal Ministry of Health, Addis Ababa, Ethiopia.
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Meseret Zelalem Tadesse
cFederal Ministry of Health, Addis Ababa, Ethiopia.
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Hiwot Darsene Dimd
cFederal Ministry of Health, Addis Ababa, Ethiopia.
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Zenaw Adam
bJSI Research & Training Institute, Inc., Addis Ababa, Ethiopia.
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Key Findings

  • Integrated planning helped to maintain focus on both programs; infant and young child feeding (IYCF) counseling was done more regularly.

  • The service delivery experience was mixed. Health workers (HWs) initially struggled with the revised workflow, heavier workload, and data collection responsibilities. After receiving sustained technical assistance, they noted that their planning, reporting, and service delivery improved.

  • HWs noted that providing integrated services was easier during facility-based sessions than outreach or mobile services due to the increased need for human resources, supplies, and data recording.

Key Implications

  • For countries seeking to integrate additional services into immunization, we recommend an assessment to gauge feasibility related to health system inputs. Once the decision to offer integrated services is made, the district-level integrated microplan will help map out program requirements. Adjustments necessary for effective integration can be identified during microplanning and strategies to ensure broad engagement of stakeholders, especially community members and technical partners.

  • Countries may benefit from initially integrating IYCF counseling into facility-based immunization sessions since mobile and outreach sessions require more planning related to supplies, human resources, and data recording tools.

ABSTRACT

Immunization programs reach more children and communities than any other health intervention, thus making immunization a promising platform for integrating other essential health services. There is a dearth of literature on integrating nutrition interventions, such as infant and young child feeding (IYCF) counseling and iron-folic acid (IFA) supplementation, into routine immunization services.

To address this evidence gap, a 15-month pilot study (August 2019 to November 2020) tested the feasibility of integrating IYCF counseling and IFA supplement distribution into immunization service delivery in Ethiopia. The interventions focused on joint microplanning for integrated services (including estimating target populations for all services), revising client flows for service delivery, and providing on-the-job support to HWs for implementing and monitoring integrated service delivery.

Findings suggest that planning for and delivering IYCF counseling and IFA supplementation with immunization services is feasible. Integrating these services provided opportunities for collaborative planning and enabled health workers (HWs) to offer multiple services to clients through 1 interaction. However, HWs felt that additional human resources were needed to manage integrated services, especially during integrated outreach and mobile service delivery. HWs also reported that communities appreciated accessing 2 services in 1 visit but expressed reservations about the longer wait times.

Countries may consider expanding fixed and outreach immunization services to provide integrated service delivery provided that it is feasible, sustainable, of high quality, and incorporates the careful planning, follow-up, and increased human and financial resources needed to reinforce new practices and expand access to a broader array of health services.

  • Received: March 30, 2022.
  • Accepted: October 4, 2022.
  • Published: October 31, 2022.
  • © Kanagat et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-22-00166

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Global Health: Science and Practice: 10 (5)
Global Health: Science and Practice
Vol. 10, No. 5
October 31, 2022
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Lessons Learned From Integrating Infant and Young Child Feeding Counseling and Iron-Folic Acid Distribution Into Routine Immunization Services in Ethiopia
Natasha Kanagat, Adriana Almiñana, Belayneh Dagnew, Lisa Oot, Amare Bayeh, Daniel Girma, Tewodros Alemayehu, Getu Molla Tarekegn, Yohannes Lakew Tefera, Meseret Zelalem Tadesse, Hiwot Darsene Dimd, Zenaw Adam
Global Health: Science and Practice Oct 2022, 10 (5) e2200166; DOI: 10.9745/GHSP-D-22-00166

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Lessons Learned From Integrating Infant and Young Child Feeding Counseling and Iron-Folic Acid Distribution Into Routine Immunization Services in Ethiopia
Natasha Kanagat, Adriana Almiñana, Belayneh Dagnew, Lisa Oot, Amare Bayeh, Daniel Girma, Tewodros Alemayehu, Getu Molla Tarekegn, Yohannes Lakew Tefera, Meseret Zelalem Tadesse, Hiwot Darsene Dimd, Zenaw Adam
Global Health: Science and Practice Oct 2022, 10 (5) e2200166; DOI: 10.9745/GHSP-D-22-00166
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    • ABSTRACT
    • INTRODUCTION
    • UNIVERSAL IMMUNIZATION THROUGH IMPROVING FAMILY HEALTH SERVICES PROJECT
    • PILOT STUDY DESIGN
    • THEMATIC FINDINGS
    • DISCUSSION
    • CONCLUSIONS
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