Health & Nutrition Technical Brief: Timed and Targeted Counselling (TTC): A Service Package of the CHW Project Model

World Vision’s Timed and Targeted Counselling (TTC) is a family-inclusive behaviour change communication (BCC) approach targeting families of young children, especially the most vulnerable and marginalized. TTC encompasses a wide range of life-saving health practices through appropriately timed messages delivered using interactive story-telling. It applies a dialogue counselling methodology based on the assessment of current needs and practices and negotiation of progressive improvements. Importantly, TTC seeks to engage both parents and decision-makers, embracing a family-inclusive and gender-transformative model of child health and development in which the positive contribution of fathers is emphasized. TTC can be delivered by a range of cadres including officially recognized community health workers (CHWs), guide mothers or volunteers.
THE ISSUES
Since 1990, global child mortality has dropped by 59%, but 5.4 million children still die each year, of which newborns account for one third, and children under five years for two thirds. Despite progress in medical science, 80% of child deaths are due to preventable causes, that can largely be averted by practices such as health facility delivery, prompt care-seeking for childhood illness, appropriate breastfeeding and child nutrition. In addition, studies in child development show that the first 1,000 days are a critical window where foundations for lifelong health and mental development are laid down.
During this period, undernutrition, poor care giver mental health, lack of stimulation, poor hygiene and high burden of disease can have permanent negative effects, and mean that children, fail achieve their full potential. CHWs are the most cost-effective way to reach vulnerable families and communities to transform child health. One study modelling community-based primary healthcare impact showed achieving 50% and 90% coverage of key interventions over the period of 2016-2020, could alone have averted between 3 and 6 million child deaths, with Africa predicting the greatest benefit (58% of the lives saved at 90% coverage would be in Africa) . However, CHWs often fail to achieve full impact due to lack of support structures and legitimation in healthcare systems endorsed in the WHO CHW guidelines, to whichWorld Vision’s future and existing CHW and TTC programmes need to lend their strength. Furthermore, Social Behavior Change Communication interventions can under-achieve for various reasons, which TTC aims to resolve:
a. Messages may be given too early or too late, whereas in TTC messages are “Timed” at the right time to act;
b. CHWs often target only women, and yet culture, gender and family dynamics can be barriers as lack of power, financial resources and influence prevent mothers from taking action, even with the right information – TTC is “Targeted” at women together with their supporters such as husbands, mothers-in-law or grandmothers. TTC uses positive male role models in stories to challenge gender norms;
c. CHWstypically giveinformation,without considering family context, value or feasibility. In TTC they use a barriers assessment interview technique to identify barriers and negotiate change based on circumstance;
d. CHWs often apply a ‘one size fits all’ approach, yet in reality only reach a portion of the community.
TTC (2018 Edition), now aims to assess and track vulnerable families, focusing on family context, especially adolescent mothers, those with physical and mental health or psychosocial difficulties.

Source: World Vision

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