The Essential Nutrition Actions (ENA) Framework

The Essential Nutrition Actions: JSI's pioneering program to scale up high impact nutrition interventions

The World Health Organization estimates that child undernutrition is associated to 45% of under-five death and that maternal short stature and iron deficiency anemia contribute to at least 20% of maternal deaths.

Developed in 1997, the Essential Nutrition Actions (ENA) Framework has been implemented in Africa, Asia, and Latin America. This tool is used for advocacy, planning, training and delivery of an integrated package of interventions to reach the high coverage (>90%) needed to achieve public health impact. The components are the proven actions identified by the 2008 and 2013 Lancet Series on Maternal and Child Undernutrition and encompass women’s nutrition, infant and young child feeding, control of micronutrient deficiencies (vitamin A, iron, zinc, calcium and iodine) and management of acute malnutrition. They target the first 1,000 days of life from conception through age two as well as adolescence.

In 2015, JSI coordinated the update of the training materials for health workers and community workers in collaboration with the CORE Group, Helen Keller International and the USAID-funded Technical and Operational Performance Support (TOPS).

The updated version builds on the ENA 2011 Training Trilogy. The 2015 version is aligned with the latest ENA recommendations from the  2013 World Health Organization report and includes promotion of the Essential Hygiene Actions (EHA), as these are inextricably linked to improved nutrition. These recommended actions go beyond hand washing to include food hygiene, animal hygiene, safe water, and simple hand washing stations.

The implementation entails a multi-channel social and behavior change communication (SBCC) to promote and support the adoption of “small, doable” actions, giving emphasis to interpersonal counseling and negotiation (supporting individual mothers and caregivers, especially in the context of their daily routines, to adopt new practices) community support group facilitation, and social mobilization events. The negotiation/counseling techniques are adapted from the Trials for Improved Practices (TIPS) and go beyond solely conveying messages to providing support for the adoption of optimal behaviors.


Training Guide: Health Workers and Nutrition Managers
Reference Manual: Health Workers and Nutrition Managers
Training Guide: Community Workers (all sectors)
Reference Materials on Key Practices: Community Workers (all sectors)

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Where JSI Implements ENA

SPRING Project

Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING), USAID’s global nutrition project (2012-2018) was managed by JSI and implemented with partners Helen Keller International, the Manoff Group, Save the Children, and the International Food Policy Research Institute. The SPRING project aimed to scale up high-impact nutrition practices and policies by providing technical support to maximize the US Government’s investment in global  nutrition. The multi-faceted causes of stunting and maternal and child anemia in the first 1,000 days between pregnancy and a child’s second birthday requires a multi-sectoral response for effective programming. SPRING leveraged social and behavior change, ENA and the linkages between agriculture and nutrition in 12 countries.

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LAUNCH Project

The Liberian Agricultural Upgrading, Nutrition and Child Health (LAUNCH) project aimed to improve food security and nutrition in Nimba and Bong counties, in rural Liberia. LAUNCH implemented the ENA Framework by training and supervising health workers. Between 2012 and 2015, JSI trained 1,087 health workers in ENA. LAUNCH, funded by USAID and implemented by ACDI VOCA in partnership with Project Concern International (PCI), JSI, and Making Cents, recognized that government community health workers were a crucial component to improve the delivery of quality nutrition services targeting pregnant and lactating women and children under two. A part of the toolkit used in health worker trainings is the Health Clinic Supportive Supervision Checklist, which equips supervisors with a resource to ensure that all clinical tasks are being completed appropriately.

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