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Guatemala[1999-2001, 2004-Present]Over the past decade, FANTA has worked with USAID/Guatemala, the Ministry of Health (MOH), USAID/University Research Corporation (URC)/Calidad en Salud and Title II Awardees to improve scale-up and replication of the Community-Based Integrated Child and Women's Care program (Atención Integral a la Niñez y la Mujer [AINM-C]) throughout the country. FANTA-2 continues to help strengthen the formative research and behavior change efforts of the Awardees, which work in maternal and child health and nutrition, water and sanitation, agricultural production, marketing, credit and natural resource management. In addition, FANTA-2 also continues to assist with monitoring health activities supported by the Mission. FANTA-2 is also planning two key studies in Guatemala: one on the effectiveness of lipid-based nutrient supplements (LNS) in preventing chronic malnutrition and the other on the Preventing Malnutrition in Children Under 2 Approach (PM2A). Formative Research and Behavior Change: To strengthen AINM-C and other efforts, FANTA provided training in formative research and behavior change interventions to Title II Awardees, the MOH and other nutrition and food security partners. Training included frameworks and methods such as the BEHAVE framework, Positive Deviance Inquiry (PDI), Manoff's Behavior-Centered Programming and Process for the Promotion of Child Feeding(ProPAN), which offers a step-by-step process for investigating nutrition and dietary problems and provides tools to design and evaluate appropriate behavior change interventions. Outcome Monitoring (OM) Surveys: These annual surveys involve collecting data on a set of indicators to monitor outcomes of key health activities that the US Government supports. The population-based survey includes data on malaria, maternal and child health and nutrition, family planning/reproductive health, HIV/AIDS and water/sanitation. FANTA-2 has been helping to conduct OM, a method the Mission uses to monitor health activities it supports, in Guatemala since 2007. FANTA-2 trained two local organizations, USAID/URC/Calidad en Salud and Centro de Investigaciones en Nutrition y Salud (CIENSA) to carry out the surveys. The two organizations now conduct OM with only limited assistance from FANTA-2. LNS Effectiveness Study: FANTA-2 and the University of California‐Davis are laying the groundwork for a study to compare the health, development and nutritional status of children who receive LNS for 12 months (from 6‐18 months of age) to that of children who do not receive LNS during that same period. Children and their mothers in both groups will be participating in a community-based health and nutrition program managed by Fundación de la Caficultura para el Desarrollo Rural (Funcafé), an nongovernmental organization that provides services under the MOH’s Extension of Coverage program. Other outcomes to be evaluated include the LNS intervention’s cost and cost-effectiveness as related to child growth and “willingness-to-pay” estimates for LNS. PM2A Study: Previous research has shown that PM2A is effective in preventing child malnutrition by targeting all children under 2 years of age, but its relatively high cost is an issue, and other questions remain. FANTA-2 and the International Food Policy Research Institute (IFPRI) are collaborating on a study of PM2A programs in Guatemala and Burundi to learn whether the duration of program benefits or size of rations can be reduced without affecting the positive outcomes documented in a previous study, whether it is always necessary to give rations to pregnant women to ensure optimal delivery outcomes and reduce early child malnutrition, and what is the added benefit of food rations to PM2A’s behavior change communication and health components. FANTA-2 and IFPRI also hope to learn whether new specialized food products – LNS or micronutrient powders – can replace an individual ration in a PM2A program. Expanding Layers: Layers is a tool designed to facilitate monitoring of Title II programs and help strengthen implementation. To help strengthen monitoring of Title II programs in the field, USAID’s Bureau for Democracy, Conflict and Humanitarian Assistance Office of Food for Peace (DCHA/FFP), asked FANTA-2 to expand Layers (currently operating in Haiti, Madagascar and Ethiopia) to all 20 DCHA/FFP priority countries. FANTA-2 has begun the roll-out process in three countries – Guatemala, Mali and Uganda – by training subrecipient Technical Assistance to NGOs (TANGO) in Layers and introducing the Layers system to the relevant Mission and Title II Awardee staff. FANTA-2 also developed a comprehensive manual on the Layers process that includes implementation tools such as sampling spreadsheets and Lot Quality Assurance Sampling (LQAS) calculators.
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