Indonesia: Nutrition Communication Behavior Change (NCBC) Project



In 1977 the government of Indonesia identified a series of priority nutrition problems for at-risk groups—children under 24 months and women who were pregnant or breastfeeding. To address this challenge, the NCBC pilot project was established as one component of a larger nutrition program supported by the World Bank. The objective of the project was to change the nutritional status of the at-risk women and children through a nutrition education intervention.

The program

The project was implemented in four stages. During the first two stages efforts focused on community preparation—selecting, training and equipping about 2,000 volunteer nutrition workers (kaders) and initiating a village weighing program to reach more than 52,000 children.

The Manoff Group assisted with the third and fourth stages: development of a communication strategy including research, testing and production of materials and training kaders on using them. The strategy was implemented and evaluated during the fourth stage.

The strategy had a number of features that were innovative and 25 years later are standard practice:
  • The preliminary research stage combined qualitative research with week-long trials of proposed behaviors which determined behavior change objectives and message content.
  • The results of the qualitative research with mothers influenced the media strategy and choice of materials. Because the kader network was extensive, the media plan emphasized kaders and used radio to repeat kaders' messages and to encourage people to seek their advice.
  • The target audience was carefully segmented by problems and needs for information. For example, the messages for pregnant women were distinct from those for nursing mothers.
  • To deliver these targeted messages, the growth monitoring session was used for individual counseling. An action poster—similar to the calendars people display in their homes—was developed for each of the principal target groups. This combination allowed the exact message to be given to the individual mother when she needed it.

Results

In 1981, an evaluation was conducted with 1,000 households, 600 in the Nutrition Education (NE) project areas and 400 in comparison areas. The results suggested that the project had considerable effect not only on the knowledge and attitudes of the families who participated but also on their practices. These practices favorably influenced the growth of young children. The NE project group differed positively and significantly from the comparison group for all indicators including mothers' participation in nutrition activities and their nutrition knowledge scores.

Some of the results included:
  • Parent in the NE villages offered their children more of the foods emphasized in the messages.
  • Children in the NE villages had higher protein and calorie intakes.
  • Children in the NE villages grew significantly better after five months of age than children whose families participated in other nutrition programs.
  • By 24 months of age, 40 percent of the NE infants were better nourished than infants in the comparison group.
In a review of World Bank-assisted programs, this project was singled out as demonstrating "that nutrition education alone can make a difference in improving nutritional status."