To document lessons learned from a multi-phase strategy designed to implement Home Fortification with MNP at scale in six countries: Rwanda, Burundi, Sierra Leone, Cameroon, Lao PDR, and Zambia.
We developed a multi-phase strategy to implement a scalable protocol in each of the six countries. Phase one included focus groups and interviews with caregivers, health workers and community; phase two, a community-based trial and; phase three, a pilot study, with a nested effectiveness component in two of six countries. At each phase we documented lessons learned from which we modified training materials, designed communication and monitoring and evaluation strategies, and gave input on supply and distribution. We provided support for advocacy and capacity building activities to establish a sustainable network.
A diverse set of challenges and opportunities were presented in each country. Awaiting national approvals, conflicting regional priorities, logistical issues related to trainings, supply and distribution and the establishment of effective monitoring caused delays in several countries. In Sierra Leone and Burundi, the Ebola epidemic and conflict halted piloting.Rwanda provided a unique opportunity for implementing and modifying protocols due to its small size, strong community health worker network and government support, although the time from initial government approval to scale-up took several years. Currently Cameroon is mid-pilot, Sierra Leone is piloting, and Zambia and Lao PDR are ready for scale-up.
Home Fortification with MNP is advocated by international agencies, yet implementing at scale presents numerous challenges in countries where health systems are rudimentary and integration is essential for success.