Nutrition Impact and Positive Practice

GOAL designed the Nutrition Impact and Positive Practice (NIPP) approach as a gendered, grass-roots approach, directly tackling a package of the underlying behavioural causes of malnutrition, irrespective of the particular manifestation.

NIPP is agile and adapted to the context of its implementation. It uses positive deviance and is focused around there being easy and viable solutions to improve and protect household health and nutrition within the community. GOAL field-tested the approach in 2012 and rolled it out since 2013 in five GOAL country programmes – Sudan, South Sudan, Niger, Malawi and Zimbabwe. Although GOAL takes a systemic approach to programming, direct interaction with beneficiaries remains an integral part of the NIPP approach.

Impetus for designing a new nutrition approach

The original stimulus for designing a new nutrition approach was to find an alternative to heavily input focused food-based aid programmes that have either not been found effective in reducing rates of malnutrition or have only had short lived effects, whereby their sustainability is usually untenable. GOAL also identified other programming issues, including the difficulty of implementing truly multi-sectoral initiatives, due to the inherently siloed approach of sectors. Therefore, by designing an initiative that innately incorporates sectorally sensitive elements (Health, Water-Sanitation-Hygiene and Livelihoods), GOAL removed the need to get “buy-in” from other sectors to work collaboratively.

Currently, many nutritional programmes focus solely on the curative element of malnutrition. However, the rates of malnutrition at the global level make a compelling case for the implementation of interventions that, as well as improving the nutritional status of those already malnourished, also focus more holistically on attempting to ‘prevent’ the occurrence of malnutrition in the first instance, through changes in behaviour and practice.

Our solution are NIPP circles.

GOAL has created a framework to improve the nutrition security and care practices of households either affected by, or at risk of malnutrition.

NIPP circles are male and female gatherings of community members who meet on a regular basis for a recommended period of 12 weeks to share and practice positive behaviours. NIPP circles aim to improve the nutrition security and care practices of households either affected by, or at risk of suffering from malnutrition, through participatory nutrition/health/hygiene-sanitation learning and diet diversity promotion (including small-scale agricultural production). The circles aim to facilitate knowledge and skills sharing of both men and women using locally available resources with discussion, practical exercises and positive reinforcement to help families adopt sustainable, positive behaviours. The concept is focused around there being easy and viable solutions accessible to all participating families.

To ensure a holistic approach, the circles provide participants with knowledge and skills through 3 main components, including a package of ‘must-have’ or ’non-negotiable’ extras:

  1. Practical behaviour change sessions

    Focused on key causes of malnutrition for improved awareness and practice.

  2. Micro-Gardening

    For improved households nutrition security.

  3. Participatory cooking demonstrations

    For improved nutritional status, feeding and care practices.

A different approach

Our NIPP approach focuses on reducing malnutrition in the long term. It aims to supports communities, both men, women and leaders, in the sharing and practice of positive behaviours to reduce malnutrition.




A highly impactful initiative

Since the beginning of NIPP implementation in 2012, the approach has reached over 19,000 direct beneficiaries in Malawi, Niger, South Sudan, Sudan and Zimbabwe. Across these countries, NIPP has had a positive impact on nutrition-specific and sensitive behaviours.

From 2012 to 2016, diet diversity in 2,991 children aged 6-23 months who reached graduation increased from 28% on admission to 71% on graduation; and of 3,328 children aged 6-59 months admitted to NIPP with moderate acute malnutrition, 82% were discharged cured.

  • No. and % of children 2-5 months admitted with Moderate Acute Malnutrition (MAM) reaching graduation non-MAM: 9 (28%).
  • No. and % of children 6-59 months admitted with MAM reaching graduation non-MAM: 2,741 (82%).
  • No. and % of Pregnant and Lactating Women admitted with MAM reaching graduation non-MAM: 1,200 (75%).

Who is the NIPP toolkit for?

The toolkit aims to meet the needs of Ministry of Health and other organisations nutrition programme managers, coordinators, and advisors who wish to implement the NIPP approach. In addition to the implementation guidelines for the NIPP approach supporting the roll out and the monitoring of NIPP circles, the toolkit contains planning, costing and communication tools.

In countries with existing national protocols for the treatment of acute malnutrition and the prevention of chronic malnutrition, this toolkit should be adapted to be aligned with and to support the existing nutrition policies.

What's Inside?

Implementation guidelines for the NIPP approach

A comprehensive guide for the implementation of NIPP circles has been developed, including information on the rationale behind the development of the approach, target groups, targeting of area of intervention, formative research, human resources requirements for monitoring, evaluation, accountability and learning and reporting. A detailed overview of what the toolkit includes is presented below. If you would like to access the below annexes, please contact us on: nipp@goal.ie

Annex 0: Programme planning tools

Tools for planning NIPP activities and estimating the budget required for the roll out of the approach.

Annex 1: NIPP volunteer Information

Terms of reference of NIPP volunteers including their responsibilities and template of agreements between the implementing body and the volunteers.

Annex 2: Training and pre-implementation materials

Training materials as well as guidance and tools for setting up NIPP circles including a list of essential materials needed, guidance for the admission of infants below 6 months, guidance for nutritional assessment and measurement of anthropometrics, key information to consider at the pre-implementation stage, example of NIPP session guide.

Annex 3: Behaviour change communication and counselling

Guidance on the methods used to elicit behaviour change, rational and guidance for behaviour change communication and counselling sessions, rational and guidance for the promotion and construction of fuel efficiency stoves and hygiene-enabling facilities such as tippy-tap, rational and guidance for food processing, preservation and storage methods.

Annex 4: Micro-gardening guidance notes

Rational and guidance for setting up various types of micro-gardens according to the local context.

Annex 5: Cooking demonstration

Rational and guidance for conducing cooking demonstrations, including tools to aid food selection for recipe development.

Annex 6: Monitoring, Evaluation, Accountability and Learning

Key forms, formats and templates for data collection during project implementation and follow-up. A database template and guidance on database quality management, guidance and standard processes for monitoring the NIPP approach activities and indicators, guidance for conducting rapid assessment of food security and nutrition situation in the areas of intervention, formats and templates for reporting including review meetings, checklists for supervision and home visits as well as a learning review.

Annex 7: Communication materials

Materials including a brochure, posters, presentation, video and a compilation of frequently asked questions on NIPP, aiming at supporting nutrition officers or coordinators communicating on the NIPP approach.

Download Guideline (English) 6.1 MBDownload Guideline (French) 5.7 MBDownload Guideline (Arabic) 3.01 MB

Keresenzia Mutembedzi, a female NIPP participant in Matonhodze Village, Hurungwe District, Zimbabwe, managed to control malnutrition through other interventions, proper sanitation, handwashing and general hygiene. Asked why malnutrition was a problem in the household she replied, "Frequent diarrhea coupled with worm infestations subsequently resulted in malnutrition among family members." Keresenzia fluently narrated how her household through NIPP circles rapidly moved up the Sanitation Ladder, using her own household’s resources, from bush to upgradable Blair Ventilated Improved Pit (uBVIP)latrine level with a tippy tap in a very short space of time after starting the NIPP sessions. Further asked about the nutrition status for her family members she referred to her daughter Judith, "My 39 month old daughter, Judith’s health was monitored throughout the three-month-cycle period and had her MUAC measurements greatly improved from 127mm to 143mm by now."

Keresenzia Mutembedzi

Keresenzia Mutembedzi, a female NIPP participant with her two children.

Adam Yahya Hamed, a native of Um Lyona, has been a male NIPP circle volunteer since 2014 inKutum and Gharbia, North Darfur, Sudan. He has been facilitating three NIPP male circles, reaching a total of 46 male participants over a one-year period. Adam described how he had found the NIPP sessions useful considering the knowledge he gained on dietary diversity and impact of the positive nutrition and health behaviours on the health and nutrition status of his family, especially his children. He said he is a supporter of programmes that can benefit women especially, "Because women’s work to support the community is evident andthey work honestly."

Adam Yahya Hamed

Adam Yahya Hamed, Male NIPP volunteer.

Dora Nyanga has facilitated a female NIPP circle during 3 months in Joswa village, Malawi. Malnutrition was a problem in Dora’s village, mainly due to the lack of knowledge of how families could prepare nutritious foods for their children and how frequent the children were to be fed especially using the Malawian food groups.

Backyard gardening is another component of NIPP that she commended, saying "having a backyard garden has helped me to have vegetables at home and has also helped me make money as I am able to sell the excess vegetables I grow." Dora mentioned the benefits of the NIPP approach for herself, her household and her whole community.

Dora Nyanga

Dora Nyanga, a female NIPP volunteer, with her healthy five month old child in her backyard garden.

Kanta Matu and his wife Nana Zumo, have participated in a NIPP circle in their village in Zinder, Niger. The couple were interested in participating in NIPP as they had heard through the community that it would assist them in protecting the health of their family using local resources.

She described how she had found the education sessions of the NIPP programme very useful. "I have not exclusively breastfed my other four children until 6 months as I gave them water and animal milk from birth. However after participating in NIPP, I have exclusively breastfed my youngestchild from birth." The couple described how they have had no health issues with their youngest child, unlike their older children who had diarrhoea and fever in early life.

Kanta Matu

Kanta Matu and his wife Nana Zumo, two NIPP participants, with their five children.

There is a need to continue to build a robust evidence-base upon which the effectiveness of the NIPP approach can be evaluated. Therefore, your inputs, lessons learnt and best practices will be welcome by GOAL in order to ensure this toolkit is kept updated with useful and practical information.

Send us your comments
Donate

Our work is supported by: