Does Monetary Incentive Work to Improve IYCF Knowledge and Practices Among Mothers: A Qualitative Exploration in Two Alive and Thrive Upazilas in Noakhali

Poor infant feeding practices is one of the major causes of undernutrition and stunting
in <5 children in Bangladesh. BRAC, in partnership with AED, is implementing Alive and
Thrive (A & T) programme to promote optimum infant and young child feeding (IYCF)
practices in rural Bangladesh to address this issue. The frontline health worker for this
project is the community health worker of BRAC Shasthya Shebika (SS) who works on
a voluntary basis, but gets some monetary return from the delivery of health services
including sales of health products to the community. The A & T programme designed
an additional incentive package for staff motivation (especially the SS) based on some
performance indicators. Besides a quantitative survey, a qualitative study was also done
to supplement and complement it. This study used qualitative methods such as in-depth
interviews, informal discussion, and focus group discussions to collect relevant data the
pre-incentive baseline data is compared with the post-incentive data to find out how the
incentive worked in improving the situation, if any. From the study results, we found that
due to heavy work load, the SSs were demoralized, and also price hike in recent times
made their day-to-day life difficult. This lessened their interest to spare extra time for the
Alive and Thrive project. But, with the offer of monetary incentive, situation changed.
Positive changes were observed in colostrums feeding, initiation of breast-feeding within
first hour, responsive feeding and hygiene practices, but not exclusive breast feeding,
the knowledge and practice of age-specific complementary feeding, both composition
and consistency. The underlying reasons following incentives were improved
awareness, better support from family, job satisfaction, improved frequency and quality
of household visits. The study concludes that the performance-based incentive scheme
was instrumental in effectively sustaining the work for this very intensive and time
consuming behaviour change programme.

Related information

  • Writer Name: Umme Salma Mukta Md. Raisul Haque
  • Published Date: Monday, 11 May 2015
  • Country: Bangladesh