title: Strengthiening systems to support mothers in infant and young child feeding at scale.
abstract: BACKGROUND
  Systems strengthening is essential for implementation of large-scale nutrition interventions, including infant and young child feeding (IYCF), since rapid geographic expansion places additional burdens on service delivery systems.
  
  
  OBJECTIVE
  To document approaches for building capacity and supporting programs to scale up IYCF counseling in three different country contexts.
  
  
  METHODS
  Situational assessments, stakeholder consultations, formative research, household and frontline health worker surveys, other related studies, and program monitoring in three countries identified gaps and opportunities for strengthening IYCF service delivery.
  
  
  RESULTS
  Variations in program platforms, level and roles of service providers, places of service delivery, community factors, and the needs of managers and frontline workers influenced the intervention mix used for strengthening IYCF services. The programs ranged from a highly structured and standardized package of IYCF counseling services in Vietnam delivered through government health facilities to counseling delivered at the doorstep by incentivized nongovernmental organization volunteers in Bangladesh. In Ethiopia, government health extension workers based at health posts conducted outreach visits with support from volunteers.
  
  
  CONCLUSIONS
  Guidelines and standards of care, training, job aids, supportive supervision, incentives, and monitoring data can enhance performance and strengthen systems for delivering IYCF counseling services in the community or at health facilities. Leadership, financing, partnerships, and logistics support are essential to support large-scale implementation of the IYCF counseling package in diverse service delivery environments.
authors.affiliation: Alive & Thrive FHI 360, Dhaka, Bangladesh. tsanghvi@fhi360.org
authors.forename: Tina
authors.initials: T
authors.lastname: Sanghvi
authors.forename: Luann
authors.initials: L
authors.lastname: Martin
authors.forename: Nemat
authors.initials: N
authors.lastname: Hajeebhoy
authors.forename: Teweldebrhan Hailu
authors.initials: TH
authors.lastname: Abrha
authors.forename: Yewelsew
authors.initials: Y
authors.lastname: Abebe
authors.forename: Raisul
authors.initials: R
authors.lastname: Haque
authors.forename: Ha Thi Thu
authors.initials: HT
authors.lastname: Tran
authors.forename: Sumitro
authors.initials: S
authors.lastname: Roy
mesh_terms: D001459:Bangladesh; D002662:Child Health Services / Q000379:methods* / Q000592:standards; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003906:Developing Countries; D005002:Ethiopia; D006266:Health Education / Q000379:methods* / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009035:Mothers; D052756:Nutritional Sciences; D015397:Program Evaluation / Q000379:methods*; D012944:Social Support; D014744:Vietnam