Overview:

The Joint Programme has been able to reach a large number of families in Totonicapán through a holistic and integrated approach to chronic malnutrition that was inclusive of aspects such as agricultural extension, behaviour change communication, learning about food security and nutrition, improving productive schemes and diversification of the production, learning how to capitalize on the returns from the investments made. Among the families that diversified their food production and consumption habits through the JP, the prevalence of chronic malnutrition decreased by 4% compared to the baseline in the same group of families. The JP was successful in including to a large extent the local and municipal actors from the various ministries (Agriculture, Health) plus the municipal commission in a positive and constructive manner that ensured the support to the JP. It was more difficult to include the national level structures, particularly health, as other activities were given priority. However the support given to the families through the development of local networks and alliances across a range of actors, including private sector operators, allowed for the achievement of  the project objectives. A major achievement was the use of municipal and community-based promoters who advocated and disseminated information regarding the multi-dimensional causes of malnutrition, and the need to understand better based on the local context the drivers of chronic malnutrition. The success of the JP in this approach is shown by the fact that a similar approach is going to be extended in a first phase to 30 additional municipalities, and to 66 in a second phase, after the end of the JP.

Outcome 1:

Improved production capacities, economic access and family food consumption habits, particularly in rural and indigenous communities living in vulnerable physical and social conditions in 8 municipalities of Totonicapan.

Outcome achievements:

• The JP had set a goal to assist 3750 families under the subsistence level and 750 families above the subsistence level, for a total of 4500 families in 40 communities in Totonicapan department in order to gain awareness on good nutritional and food consumption practices. 3946 families improved and diversified their food production for self-consumption and storage practices. A baseline characterization was established with participating families in order to identify the improvements needed and introduce new technology to improve the efficiency of the family-based production systems. Several activities and workshops based on the learning by doing methodology were undertaken and as a result 36 alternative agricultural practices to diversify production were promoted. 139 Vocational Training Centers (CEA) were established to facilitate knowledge transfer. Management, municipal community-based promoters and the Ministry of Agriculture (MAGA) will ensure monitoring and oversight of the groups to ensure continuity and sustainability.  At least 3825 families are implementing good consumption and nutritional habits based on the support of the community-based promoters. Further a strategy of community education was successfully implemented in 42 communities based on the mother counselors model on human rights, reproductive health and nutrition. 5979 school centers were reached through Healthy Schools outreach to promote good health practices. Initially ten groups that increased to 18 based on additional participation requests were targeted to develop agricultural projects and commercialize its products to finance access to proper nutritional habits through income generation. In total there were 742 families (55% of women) beneficiaries with the support and coordination of the Ministry of Agriculture, SOSPE and IFDA.

Outcome 2:

 Increased access to health and nutrition basic services for girls and boys under 3 years of age and women of reproductive age, particularly among indigenous and rural population in 8 municipalities of Totonicapan.

Outcome achievements:

• 33 communities developed their own processes of capitalization of incentives, defined as “the effect or product that is transformed in goods or services to the benefit of the participants, families and communities”, through targeted capacity development support to both families and community organizations.
• The objective was to create a model of quality assurance for integrated health services, but the Ministry of Health did not consider this component a priority and the results were essentially the development of the system that was discussed but not yet implemented. Support was given to 27 health posts to increase the quality of the attention for mother and child care. 90% of children of participating families in the JP received a growth card and nutritional attention, while 80% of women of reproductive age received micronutrient supplementation and 73% of pregnant women going to their first control (compared to a baseline of 29.7%). 330 health staff were trained for the first and second levels of attention. Specific material support was given to the health services for the three levels of attention, and support in the implementation of a nominal list and the development of tools to analyze the information. All activities were geared towards the strengthening of the quality and coverage of the Ministry of Health (MSPAS).  Primary technical support took the form of support to MSPAS micronutrient supplementation for children under five, the development of an automated tool for monitoring and supervision of the hospital nutritional pediatric assistance strategy, and another diagnosis tool for health and nutrition for first and second levels of attention. Also support was provided to the Human Milk Bank at Totonicapán national hospital with a view to reducing neonatal infant mortality.

Outcome 3:

Increased capacity of the Secretariat for Food Security and Nutrition (SESAN) and the municipal entities  to implement the ENRDC.

Outcome achievements:

• One of the major outcomes has been to build alliances among local actors, particularly at the local and municipal level, which lead to the achievement of the results. An important result was the participation of the Food Security Municipal Commissions in 8 municipalities that support implementation of the national strategy (ENRDC).  The efforts to disseminate and communicate results and activities have led the Secretariat for Food Security and Nutrition (SESAN) to extend the experience to an additional 66 municipalities in the course of 2013. This shows the buy-in and ownership of the government, in addition to contributing to the sustainability of the results. Both SESAN and MSPAS have hired additional staff in order to continue the on-going processes.

Outcome 4:

Management, monitoring, progress, systematization and dissemination of the JP.

Outcome achievements:

• The JP allowed the UN system to work in coordination in order partners to achieve common objectives. The office of the resident coordinator (ORC) played a clear catalytic role in coordination and in securing private sector alliances.  The OCR further played an important role in reporting and information management. The design and implementation of the JP was done jointly with the various participating UN agencies, and the technical team was able to monitor the achievements of the JP. However actions were not undertaken as an integrated programme, since each agency was tasked with a specific result.

Best practices:

• Engage stakeholders at the local level (families and community leaders) to play an active advocacy role has led to ownership and motivation in the implementation of the JP.
• Having the capacity of responding effectively to the needs of the families has been a key factor of success of the JP.
• Identifying and tackling chronic malnutrition in a holistic and integrated manner brings the participation of all the relevant government agencies.
• Keeping an open and sustained communication and information system about the activities of the JP was key in gaining the trust of local and municipal authorities and the beneficiary families, as well as contributing to their sense of ownership and active participation.
• A request of government institutions was to document the intervention processes used by the JP, as there are products likely to be replicated by the government with its own funding.
• The model of Communication for Development used by the JP had a different entry point regarding communication and behavior change, something that facilitated the fact that changes of behavior were done consciously and with the commitment of the families.
• The inclusion in the Plan Zero Hunger (PHC) of actions and indicators linked to reproductive health contributed to show the relationship between reproductive health and chronic malnutrition.

Lessons learned:

• The need to share the analysis and provide evidence that allows to position important issues such as reproductive health and woman health as a key factor in the chronic malnutrition of children.
• It was necessary to identify at the community and municipal levels the problem of chronic malnutrition and its effects on children. This allowed the local actors to fully address the problem as families agreed to organize themselves to work for the SAN.
• The monitoring system should be owned by the government institutions for the data collection and the decision making as regards to rural development.
• The mid-term evaluation was useful to improve the implementation of the JP and allowed to identify bottlenecks.

More details can be found in the final project report: http://mptf.undp.org/document/download/10654