Graduation approach improves nutrition in Sri Lanka

In Sri Lanka, World Vision integrates a "graduation model" with its nutrition programming, for a sustainable path to better nutrition. This approach meets families where they are on the economic and nutrition scale to tailor interventions enabling graduation from one living standard ranking to the next, as well as enabling improved nutrition. Each household is categorised through a Participatory Living Standards Ranking.

Families with malnourished children are identified and supported with appropriate nutrition interventions, in addition to tailored economic interventions focusing on increasing diet diversity and livelihoods. Nutrition is the common objective for World Vision Lanka's economic, agricultural, health and nutrition programmes. Underweight children are referred to a Positive Deviance/Hearth programme, which identifies positive behaviours in poor families with well-nourished children, facilitates peer learning, and follows up implementation at home.

Each household also prepares a tailored family development plan, including activities to address its specific economic and nutritional needs (e.g. for the "poor" and "poorest of the poor" with malnourished children, plans could include efforts to access nutritious foods). Families aim to "graduate" to the next ranking through appropriate activities such as savings clubs, technology and skills transfer, business promotion, or access to microfinance, depending on their needs. Partnership with government is a key component and with the support of Government Livelihood Development, Medical, and Agriculture workers, and local authorities, as well as the private sector for market linkages, World Vision Lanka implements this graduation model with 7,620 households in 16 areas, with approximately 2,500 children in PD/Hearth. The model’s success is due to its tailored and multi-sectoral approach to economic resilience and improved nutrition. World Vision is also working to include other sectors such as Water, Sanitation and Hygiene (WASH) and Education in order to help households further improve their nutritional and economic status.

Learn more by reading this case study or watching the video above.

The components of the Graduation Approach are sequential and focussed on families:

1. Participatory Living Standard Ranking (PLSR) identifies living standards of families 
2. Nutrition assessment/growth monitoring identifies nutritional status of children and families
3. Family Development Plan prepared for all households and family members (incorporates Sustainable Livelihood Framework, WV Child Well-being outcomes, and health and nutrition indicators)
4. Positive Deviance (PD) Inquiry used to identify positive behaviours in poor families with well-nourished children
5. PD/Hearth programme for all caregivers with malnourished children (12-day session where mothers meet together and prepare local foods plus 2 weeks home practice, with follow up)
6. Regular growth monitoring promotion with government health service and follow-up by WV volunteers/facilitators
7. Integrated Graduation Model framework tailored to living standard category identified in PLSR process, through four graduation approaches. Interventions include combination of home gardens, business training, pre-microfinance (savings clubs), skills/technical/asset transfer and microfinance, depending on the PLSR ranking. Economic support is not dependent on nutritional status of children.

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