We are an international leader in designing and implementing programs that effectively promote good nutrition and allow populations to enjoy improved nutritional status. Our approach helps families set specific behavioral goals that address the many determinants of nutrition such as availability of diverse wholesome foods, feeding practices, use of health services, safe use of water and sanitation, budgeting for the purchase of nutrient-rich foods, and women’s sense of empowerment and self-confidence. Within the broad field of Nutrition, our areas of expertise include:
Since the 1980s, we have been at the forefront of efforts to improve breastfeeding practices, particularly promoting exclusive breastfeeding for the first six months of children’s lives and, once food is introduced, complementing feeding with continued breastfeeding until two years of age. Breastfeeding promotion is one example of how The Manoff Group encourages national programs to consider the strategic use of mobile phones for Social and Behavior Change. We supported the Tanzania Food and Nutrition Center (TFNC) and its local NGO partner, Counsenuth, to implement Maziwa, Tanzania’s first national nutrition campaign using mobile phones and radio promotions. The campaign, which was designed to encourage women’s optimal breastfeeding practices and elicit supportive behaviors from their male partners reached 8000 new subscribers in its first seven days.
Community Based Growth Promotion (CBGP)
We are known for developing the CBGP model, which focuses on preventing malnutrition by first establishing monthly, community-wide weighing sessions to detect growth faltering (a proxy for nutritional status) in children under the age of two. Then, in response to instances of poor growth, families are provided with targeted counseling on improved care and feeding practices. Collective community actions to address the causes of malnutrition are also a key aspect of CBGP. We have guided the adoption and adaptation of this approach in multiple countries, including: Bolivia, Colombia, the Dominican Republic, Ecuador, El Salvador, Ethiopia, Ghana Guatemala, Honduras, India, Indonesia, Madagascar, Malawi, Nicaragua, Panama, Rwanda, Senegal, Uganda, and Zambia. CBGP can be scaled up nationwide while still remaining participatory, community-based, and effective in reducing young child malnutrition. It can also serve as a platform for other child health interventions such as immunization, Community Integrated Management of Childhood Illnesses, and family planning and reproductive health interventions.
With technical assistance from the Manoff Group through USAID’s BASICS project, the government of Honduras adopted CBGP as the primary intervention for its nationwide Integrated Childcare Program (AIN). Among numerous successful results, a 2004 evaluation found that increased participation in AIN was strongly associated with improved height-for-age, weight-for-age and weight-for-height; and that enrolled children aged 6 to 23 months were 1.6 times more likely to be adequately fed than non-enrolled children.
The Manoff Group recently introduced a new behavior-enabling technology to the growth promotion program mix: a child length mat that is designed to improve awareness of stunting and help visualize the growth potential of young children. First tried in Bolivia, we introduced the length mat to Cambodia in 2015 as a critical part of our Social and Behavior Change strategy for USAID’s NOURISH project.
Infant and Young Child Feeding (IYCF)
The Manoff Group led USAID’s early efforts in IYCF, which were focused on improving home-made complementary foods. We demonstrated that offering consumer-tested products—ranging from homemade to locally-manufactured foods—has an impact on food intake and thus on child growth. Today our efforts continue with a new focus on the First 1,000 Days of life (the critical growth period from conception to a child’s second birthday). We have developed the Social and Behavior Change components of national programs in Guatemala, Ethiopia, Tanzania, Uganda and Zambia.
At the heart of our IYCF approach is a strategic mix of media. One example is how we work with national counterparts to develop innovative audio technologies to expand the reach of nutrition information and support. For example, in Ethiopia, Tanzania, and Zambia we developed audio materials to support community volunteers in conducting group meetings. The materials function as virtual facilitation for group discussions, skills-building games, songs, and other activities. This helps ensure that meetings are structured similarly and that the same quality information is shared with participants, regardless of where they’re held and who is leading them.
Nutrition can be a tricky concept for beneficiaries to understand because it is ever-changing during the First 1,000 Days. In Tanzania, we developed a concept that relates the different stages during the 1,000-day period to the lifecycle of a sunflower. The categories include seed (pregnancy), sprout (birth to 6 months), bud (6 – 12 months), and flower (12-24 months).
Another important aspect of The Manoff Group’s approach to Behavior Change is providing behavior-enabling technologies. To overcome the communication problem of conveying the corrects amounts of food to give different aged children, we designed a graduated child feeding bowl for use in Central America beginning in the early 1990s. The bowl is specially marked with measurements corresponding to the correct amount of food that young children should be given according to their age. This locally-produced technology can now be found in six Latin American countries and was most recently introduced in Zambia.
We promote improved nutrition for pregnant and nursing mothers, including better diets and iron supplementation Our programs have included developing a nutrient-dense meethi biscuit in India, a maternal nutrition strategy for inclusion in the National Nutrition Plan in Madagascar and an effort in Ethiopia to support women’s nutrition under a concept of women as Queen Bees whose needs must be catered to. For USAID’s IYCN project, TMG produced “Guidance for Formative Research on Maternal Nutrition.”
Micronutrients and Fortified Foods
We worked extensively to promote improved access to and consumption of micronutrients; primarily iodine, vitamin A and iron. Our work began in Ecuador in the late 1970s, when we boosted the consumption of iodized salt among rural families in the Sierra through mass media and point-of-sale promotions. Later, we supported iodized salt campaigns in Bolivia, El Salvador and Eritrea. With the Micronutrient Initiative, we designed and implemented a global iron advocacy campaign, primarily for combatting childhood anemia. Under the USAID MotherCare project, we supported groundbreaking research and program interventions to improve women’s access to and compliance with iron-folate tablets in Bolivia, Honduras, Indonesia, Malawi, Nicaragua, and Pakistan. Under USAID funding, we provided intensive technical assistance to Helen Keller International projects to promote increased vitamin A consumption in Bangladesh, Indonesia, and the Philippines. Under USAID’s OMNI project, we worked intensely with private sector producers and marketers to introduce vitamin A-fortified sugar in Bolivia and Zambia.
More recently, The Manoff Group developed materials to support compliance with micronutrient powders (commonly referred to as Sprinkles), ensuring that they are used appropriately to improve IYCF. For USAID’s anemia task force, we developed a framework outlining how health, nutrition, and agriculture stakeholders can think and act across sectors to contribute to reducing maternal anemia. This framework can be adjusted by country, based on specifics such as malaria incidence, antenatal care programs, and the local agriculture context.
Nutrition and Agriculture
Raising agriculture production and income does not always result in improved nutrition, especially for the most vulnerable families. Under USAID’s Infant and Young Child Nutrition Project, we became one of the first organizations to develop a set of materials that assists agriculture decision makers in integrating nutrition goals and the needs of the most vulnerable families into implementation plans. Our eight-step process guides the assessment of proposed and alternative plans based on what is known about vulnerable groups’ participation in agriculture, whether they are net purchasers or sellers of crops, their consumption patterns, women’s time constraints, and nutritional status. A scoring system is proposed to estimate the likely impact of the plan and how to select alternatives or put in place impact mitigation activities. Additional supporting documents include an ‘ag-nutrition’ literature review, fact sheet, and program planning guidance.
Also to strengthen the nutritional impact of agriculture programs, we provide support for the training of agriculture extension agents. Under USAID’s Urban Gardens Program in 2011 in Ethiopia, The Manoff Group developed materials and curricula to better serve the needs of urban families who must make decisions about selling or using the produce from their small gardens, and about how to improve complementary feeding practices. We continue to work with agriculture extension workers in Ethiopia and have engaged with Agriculture Extension in Bangladesh, Guatemala, Tanzania, and Zimbabwe.
At the operational level, there is little guidance on how to integrate nutrition into agriculture assistance. We thus developed a user-friendly framework known as HANDs that pivots on pro-nutrition social change in gender norms and family dynamics to focus on household actions that increase access to and use of diverse, quality foods.
School health and Nutrition
The Manoff Group has assisted a number of partners in the development and implementation of nutrition-related actions through school health and nutrition (SHN) programs. SHN offers the opportunity to both address the nutrition and health needs of the school-age population and contribute to improvements in future generations’ nutrition by effectively reaching adolescent girls. Recently we assisted the government of Indonesia with a comprehensive SHN situational analysis and action plan for improving their SHN approach. In the past we worked with NGO and government partners on SHN programming in Malawi, the Dominican Republic as well as in the United States on school-based obesity prevention.