Where	Two rural and two urban areas of Madagascar
When	2013–2014 pilot, the programme is now being scaled up
MNP delivery strategy	Model: Mixed, social marketing for the rural areas and social franchising for urban areas Platform: Health sector; integration with IYCF programme Channel: Basic health centre staff in the rural districts; CHWs in the rural districts; private franchised providers in the urban areas. The distribution model used existing distributors and NGO sales staff to reduce training and operational costs.
Target population	Targeted approximately 15,000 children 6–23 months old
MNP schedule	Consume at least three sachets of MNP a week
SBCC	A social marketing strategy was developed around the 4Ps of marketing (product; place; price; and promotion) based on formative research. A communication strategy was used specifying key messages for caregivers and intermediaries in rural and urban areas, media channels, frequency of diffusion, and printed IEC tools. In the rural areas, CHWs promoted the product during home visits and community nutrition meetings. Recipe books and cooking demonstrations were also done, which helped mask the smell and taste of MNP that was problematic due to product quality issues. In the franchised clinics, doctors counselled mothers during initial and follow‐up visits. CHWs and doctors received different IEC tools including a flipchart for doctors; CHWs used a large poster with photos of foods that can be attached to the poster for foods consumed by the child during the day, to facilitate discussion on breastfeeding and IYCF. Key mass media and interprocess communication messages included reminders about long‐term benefits on repeated use as this was found lacking from CHW and doctors' counselling on repeated use. A survey was done to evaluate SBCC activities (n = 197 caregivers exposed to SBCC and 215 nonexposed). MNP use was higher when exposed to home visit/group talk by CHW (37% vs. 4%) and cooking demonstrations (42% vs. 13%). Culinary demonstrations also improved complementary feeding practices (59% vs. 39% for those not attending) as did receiving a home visit/group talk by a CHW (53% vs. 36%).
Training	CHWs received a 5‐day training on IYCF (refresher training for the majority), MNP, promotion and sales tips, monitoring tools, and water sanitation and hygiene. Doctors received 2.5 days of training on similar content adapted for their educational level. Doctors also received a detailed Frequently Asked Questions and Answers sheet.
Lessons learned	A sustainability element was built in from the start, with urban consumers paying five times the price as rural consumers. Sales revenues from the franchise providers were used to reinforce activities linked to the community‐based distribution, offsetting some of the operational costs. Providers needed regular retraining and perform best when a variety of nonmonetary incentives are offered. Due to continuous high investments in CHW training and frequent, close supervision, positive results were reported for sales and IYCF and MNP behaviours in rural areas. For urban areas, much depended on the individual provider's interest and motivation; sales and intake adherence were lower as providers had difficulty tracking caregivers to ensure adequate intake adherence.

^a CHW, community health worker; IEC, information, education and communication; IPC, inter‐process communication; IYCF, infant and young child feeding; MNP, micronutrient powders; NGO, non‐governmental organization; SBCC, social behavior change communication; WASH, water sanitation and hygiene.

^b Based on information from key informant 9.