Learning from the implementation of the Child Nutrition Program

Holt International launched the Child Nutrition Program (CNP) in 2012 to combat malnutrition risks in its global programmes. The programme operates in community-based settings, foster care systems, and health care and institutional based care facilities. It targets vulnerable children including orphans and abandoned children, many of whom have significant disabilities. The CNP aims to enhance nutrition and feeding practices for vulnerable children via training, resources, and support to caregivers and facilities, using a ‘training of trainers’ approach. This study retrospectively analyses CNP implementation in Mongolia and the Philippines, aiming to identify key learnings through a mixed methods evaluation. 

The CNP spans 8 countries, with 68 sites serving over 7,500 children in total. Mongolia and the Philippines were selected for analysis due to a combination of logistics and data availability. The study utilised primary and secondary data. Participants were selected for key informant interviews (KIIs) via purposive sampling (one per site and per country programme). Secondary data was collected during routine programme audits between 2016 and 2020 and included Knowledge Attitude and Practice Surveys (KAPS) and nutrition and feeding pre-/post-training tests completed by staff from all levels at CNP sites. 

Analysis of nutrition and feeding tests in both Mongolia and the Philippines indicated statistically significant (p <0.0001) improvement following training. While KAPS showed changes in desired practices after training, there were no statistically significant differences (p=0.67) in post-training outcomes. Thematic analysis of KIIs highlighted the essential components for programme implementation and effectiveness, including strong leadership, buy-in, secure funding, reliable supply chains, training, and adequate staffing. Overall, findings supported the importance of ongoing support, frequent participatory training, and reinforcement for caregivers to achieve sustained behaviour change and desired outcomes. 

This study contributes to the limited evidence on nutrition and feeding programme implementation. The study utilised a convenience sampling approach and remote interview format, both of which are efficient methods but may introduce bias. The principal investigator's involvement, though providing insight, could influence the findings. Analysis limitations include independent test samples and smaller sample sizes, both impacting the interpretation of the results. The routine nature and unknown validity of KAPS and pre-/post-training tests warrant further examination. The study did not involve other important stakeholders, such as children, caregivers, community members, families, or government partners in KIIs, presenting another key limitation.

Nevertheless, the CNP's implementation in Mongolia and the Philippines offers insight for comparable interventions in other settings, emphasising the importance of addressing barriers and fostering strong partnerships. Key factors for success include local government engagement, secure funding, adequate staffing, continuous training, robust support systems, and efficient supply chains. As malnutrition remains a significant challenge, the authors suggest programmes like the CNP should be prioritised. Using scaling frameworks in future research on CNP can increase understanding on how similar programmes can be scaled up globally to reach more vulnerable children.