Better diets for smallholder farmers and workers in the tea sector: leveraging business channels to reach vulnerable populations through a multi-component Behaviour Change Communications (BCC) approach

Summary:
Smallholder farmers and estate workers in tea supply chains in Kenya and India are affected by multiple facets of malnutrition. The Global Alliance for Improved Nutrition (GAIN) is testing innovative approaches using existing business channels to deliver programmes to increase demand, access, and consumption of nutritious foods amongst tea workers. The objective is to develop a cost-effective scalable model, with potential for impact, implemented through tea sourcing companies, supported by tea buyers. GAIN's programme, 'Seeds of Prosperity' (SOP), previously focused on raising awareness on dietary diversity and handwashing through one-hour training sessions for 9 weeks. No additional communication channels to create demand were in place, and issues with food access remained that could not be addressed through the promotion of kitchen-gardens. The SOP evaluation yielded mixed results; prompting a redesign. Current workforce nutrition (WFN) programmes include implementation through business and community channels as well as linkages to government initiatives to broaden the opportunities to intervene and strengthen access and demand for nutritious foods. The project targets 6,000 estate workers in India and 35,000 smallholder farmers in Kenya. Initial learnings suggest the semi-controlled living environment of tea estates make community engagement activities an efficient delivery medium. However, activities implemented beyond business delivery structures in smallholder settings, are more demanding while monitoring participants' exposure to multiple messages is challenging. The combination of stronger community-based activities and reinforced access components, alongside enabling environment actions, will likely render the intervention more effective and sustainable than previous iterations of SOP.

Background/Objectives:
The objective of GAIN's WFN programme is to deliver scalable and sustainable employer-led interventions to improve diets of tea workers. GAIN previously implemented the SOP approach to deliver nutritional and hygiene messaging to tea workers and their families through one-hour trainings over nine weeks. This approach was scalable in that it was cost-effective and easily integrated into existing business training channels. However, an independent evaluation yielded mixed and limited results in terms of behaviour change impact prompting a re-design to include stronger access components and work with government at enabling environment level to ensure sustainable change.

Description of Intervention and/or Methods/Design:
The re-designed BCC intervention is implemented through both business and community channels and consists of three elements: 1)Demand for Nutritious and Safe Foods (NSF), including community-based activities such as street plays, video clips shared through social media and nutrition information at retail points. 2)Access to NSF, including female entrepreneurs selling NSF at estates, distributing orange fleshed sweet potato vines, supporting community kitchen-gardens, and training food vendors. 3)Enabling environment for NSF, including linking to government initiatives such as the 'Eat Right' certification in India, or the training of county level health-workers in Kenya. Activities were identified and developed through a co-design process with the implementing businesses. Quality improvement (QI) is integrated in our approach, to ensure that program activities are contributing towards the aim of the intervention. QI committees frequently review process and outcome indicators and conduct testing cycles to inform course correction.

Results/Lessons Learned:
Initial learnings suggest community engagement activities are a promising delivery medium in tea estates where worker families live on site. In smallholder settings however, activities implemented beyond business delivery structures are often more challenging to implement and monitor. Working with businesses to co-design interventions is crucial to create company engagement but is challenging as internal competing priorities can favour simpler interventions that may not be as effective. Moreover, not all tea sourcing companies (tea estates and companies sourcing from smallholder farmers) are interested in reaching community members beyond their direct employees, which limits reach and hinders improvements in access to NSF which requires working with broader stakeholders such as food vendors. The use of CQI in implementation is promising as it enables regular tracking and testing of outcome indicators, and course-correcting when necessary, but can be challenging to sustain if monitoring capacity is limited.

Discussion/Implications for the Field:
Building on the learnings of Seeds of Prosperity, the WFN programme has promising elements in both country settings. The use of QI, at least at pilot stage, is useful to fine-tune the intervention components and ensure all are directly contributing towards the overall aim but requires good monitoring capacity and endorsement on part of company management. The combination of stronger community-based activities and reinforced access components, alongside efforts to work with government and private sector at the enabling environment level will likely render the intervention more effective and sustainable than previous iterations of SOP.

Abstract submitted by:
Mirjam Van Der Zijden-Kneepkens - Global Alliance for Improved Nutrition (GAIN)
Genevieve Stone - Global Alliance for Improved Nutrition (GAIN)
Biju Mushahary - Global Alliance for Improved Nutrition (GAIN)
Catherine Macharia-Mutie - Global Alliance for Improved Nutrition (GAIN)
Bärbel Weiligmann - Global Alliance for Improved Nutrition (GAIN)
Christina Nyhus-Dhillon - Global Alliance for Improved Nutrition (GAIN)