Hi Vicky, There is not a lot documented yet, but from discussion with others that have tried to integrate both it works best if they are not introduced together. In a new CMAM programme it is likely to work better if IYCF is added once CMAM established, or do IYCF and phase in CMAM after a period of using the new skills. It is important to be clear on the objective of the CMAM and IYCF interventions to ensure the right groups are reached. Valid has started to look at adding IYCF indicators to coverage assessments, but this is still early days and more field testing is needed.

Hi Anne Thanks for your reply, which is very interesting. We would often look at introducing IYCF programming alongside CMAM. Would you be able to give a bit more information about the problems that have been encountered with doing this? It would be great to learn from others' experience. Many thanks.

Dear vicky, in fact IYCF activities can fit well into cmam sites when the health center has antenatal/post natal care and epi activities. With this integrated approach, it is easier to put in place monitoring indicator.

Hi Vicky In the pilot of the IYCF in CMAM training content in Sierra Leone a few years ago (with Valid and UNICEF), the content was added on in around 1.5 days (including practical sessions) to a CMAM refresher training. Feedback from this pilot and from the trainers since, is that it is a lot for trainees to take on if you try to do both a first CMAM training and a first IYCF in CMAM training together. The value of a stepped approach reported was that the trainees participated in the IYCF in CMAM training having had some experience in CMAM programming. This helped them to see the relevance of the IYCF content, as they had first hand experience of cases to apply this to. So not so much a 'problem' that Anne described above, but a way of maximising what you get out of a training. Another thing to mention, is that it is good to be clear about the objectives of integrating IYCF in CMAM. It should be about strengthening IYCF practices and supporting the dietetic management and recovery of children with SAM but it shouldn't be the strategy to address IYCF issues in the community - it complements these. A good example of this is in Zimbabwe, where IYCF in CMAM was also piloted but they found made no difference to IYCF practices in the community (this was no great surprise given the small proportion of children that would have been exposed to the IYCF in CMAM intervention). For this context, with a low level of GAM, strengthening IYCF programming more generally is now the strategy with IYCF the entry point for CMAM, and is described in Field Exchange 43 (now online at www.ennonline.net) Finally, Alive and Thrive Ethiopia is involved in a 2.5 year project to look at the feasibility, process and some outcomes of integrating IYCF in CMAM in World Vision supported CMAM sites. There should be content to draw upon there, I will alert the team involved and see if they can contribute further to your request. Best regards, Marie