Project Factsheet
Tools for » Promotion of a multi-level approach to child malnutrition
Project ID 00067251 Description MDGF-2033-I-GNB
Fund
MDG Achievement Fund
Start Date *: 1 Sep 2009
Theme
MDGF SP-ChildFoodSec&Nutri
Project status Financially Closed
Country Guinea-Bissau Participating Organization   Multiple
About

Overview:

The Joint Programme was in line with National Strategy for Poverty Reduction (PRSP) and with the National Health Development Program (PNDS) for strengthening primary health care through a minimum package of activities; involving communities in management and decision-making for health issues and programs and greater access to health services.

The joint programme was designed to contribute towards Guinea Bissau achievements of Millennium Development Goals (MDGs), particularly 1 and 4 and also aligned with UNDAF priorities such as the improvement of the capacity of health system and the reduction of infant and maternal mortality.

The management of acute malnutrition cases was implemented and improved in all nutrition rehabilitation centres and health centres. The national Protocol for Integrated Management of Acute Malnutrition was revised according to new WHO standards, and 51 National trainers were trained in the use of the new Protocol.  As a result of the programmes’ actions cases treated for Severe Acute Malnutrition (SAM) significantly exceeds the number expected.

Community based nutrition promotion and surveillance activities were implemented in 161 communities with over 800 community health workers and over 200 baby friendly mothers trained to implement nutrition screening and surveillance as well as nutrition education to promote infant feeding practices and nutrition balanced diets. Nearly 600 children under five were screened for acute malnutrition and with those severally and moderately malnourished referred to nutrition recuperation centers for treatment.

On average 80% of children in 167 selected schools are aware of good practices in nutrition and 100% consumed vegetables at school at least once a day. 167 school gardens were established and produced vegetables for school and community consumption.

The programme strengthened national capacity to monitor and supervise interventions on nutrition and food security. Formative supervision and rapid evaluations were conducted in 43 Health Clinics. In addition, the JP motivated the designation of 11 Nutrition focal points at the level of the health regions. Their training and involvement in the implementation and monitoring of nutrition activities at the operational level is already achieving improved performance in terms of numbers of children screened, treated and reported.  Without the JP this would not have taken place.

 

Outcome 1:

Management and prevention of children malnutrition is improved at facility level (nutrition Rehabilitation / health centers).

 

Outcome Achievements:

  • The management of acute malnutrition cases was implemented and improved in all nutrition rehabilitation centres (24) and health centres (90) through provision of materials, equipment, nutrition therapeutic products and IEC material supported with regular formative supervision.
  • 97% health technicians (221 out of 228) were trained in the application of the old National Protocol for Management of Acute Malnutrition.
  • The National Protocol for Integrated Management of Acute Malnutrition (IMAM) was revised according to new WHO standards, and 51 National trainers were trained in the use of the new Protocol.
  • Monthly MoH reports indicate that since 2009 the total of 2,033 Severe Acute Malnutrition (SAM) cases were treated in the project area (4 health regions, 3 administrative regions) against 1,490 expected (SMART 2008).

 

Outcome 2:

Community-based nutrition promotion & surveillance activities established in 150 selected Communities.

 

Outcome Achievements:

  • Community based nutrition promotion and surveillance activities were implemented in 161 communities.
  • 816 community health workers and 240 baby friendly mothers were trained and are skilled to implement nutrition screening and surveillance as well as nutrition education for promotion of infant feeding practices and nutrition balanced diets.
  • 161 communities benefited from regular nutrition related messages through world breastfeeding week using different channels including radios, TV, drama groups, inter personal communication programs for education on infant and young child feeding practices, balanced diet, hygiene, etc and communication tools distributed to the same target groups.
  • Regular nutrition screening for under 5 children in 161 communities was conducted with referral of severe malnourished cases to facilities for proper care and treatment.
  • 5,911 under five have been screened for acute malnutrition and 248 and 555 severely and moderately malnourished were referred to nutrition recuperation centers for treatment.

 

Outcome 3:

Sustainable food production established in community schools to improve Nutritional status of school children and promote the education of children and their parents on food security and nutrition.

 

Outcome Achievements:

  • 29,114 out of 36,392 schools children (80%) in 167 selected schools are aware of good practices in nutrition.
  • 100% of school children (36,392) from 167 beneficiary schools consume vegetables at school at least once a day.
  • All 167 established school gardens periodically produce vegetables that are consumed by school children.
  • The over-achievement in terms of number of beneficiary schools and percentage of school children reached by the JP interventions is explained by the high levels of ownership from the national partners on the regional level and the school teachers, school children and communities.
  • The 83 communities gardens cultivated in 2012/2013 16.99 hectares and produced 96,463 kgs. of vegetables and of which at least 40% was given to the school and the communities for the consumption.

 

Outcome 4:

Intervention on children nutrition and food security are effectively monitored and supervised by government counterparts.

 

Outcome Achievements:

  • The capacity of MOH/Nutrition department to monitor and supervise interventions on nutrition and food security was reinforced through efficient and timely technical assistance.
  • The nutrition interventions were monitored and supervised by the MOH from Central and Regional level. A formative supervision on MAM and rapid evaluation on performance indicators was conducted in 43 Health Clinics.
  • 11 Nutrition focal points were appointed at each Health Region to monitor nutrition intervention. One vehicle, office materials and equipment was provided to the MOH/Nutrition department to support supervision efforts.
  • The effectiveness and regularity of monitoring and supervision of the interventions on child nutrition and food security at local and community levels needs still to be improved. 75% of supervision missions were completed by the central level (9 out of 12 planned) with 75 % supervision reports available.
  • A national SMART Nutrition Survey was conducted providing the updated nutrition situation showed that the situation remains critical even in the area of the JP. The level of exclusive breastfeeding increased from 38% (2010) to 67% (2012).

 

Best practices:

  • Volunteer mothers groups for breastfeeding: Supporting groups of volunteers (mothers) that promote exclusive breastfeeding and good child feeding practices were identified at the village level, based on criteria such as residence (in the same village), being a mother of at least one child and willingness  to participate in awareness activities. After receiving training provided by healthcare professionals, volunteers developed their activities at the village level, by identifying mothers who have problems on breastfeeding, providing advice on good practices and/or referring them to health centres in case of complications. Each year, the government of Guinea-Bissau organizes the national month of exclusive breastfeeding. These volunteer women continued to work even after the period of the national campaign. This practice has been especially advantageous when dealing with (food related) taboos and child feeding.
  • Joint Coordination Missions: All members of the Programme Management Team (PMT) and local authorities, participated in joint coordination missions that took place every quarter. The joint coordination missions had proven to be an efficient and concrete mechanism to increase Coordination at field level. This practice might be useful when projects are complex as they deal with several administrative levels (for instance line ministries, Regional authorities, local communities, etc.), include many actors and different geographic locations. It is possible (and desirable) to replicate this practice in complex coordination scenarios, especially in countries where coordination mechanisms are weak or not reliable.
  • Sustainable School Gardens: School gardens activities were a huge success. In total 167 school gardens were established in beneficiary school communities against 150 initially planned and 0 existent in the beginning of the JP. The volume of food production continued to increase and women associations in 71 communities replicated school gardens at the household level. There are 83 community gardens which effectively produce vegetables and provide 40% of production for school children consumption. Globally communities continued to enlarge the production area. The over achievement in terms of number of beneficiary schools and percentage of school children reached by the JP interventions is explained on the one hand by efficiency of national partners on the regional level plus support provided by the participating agency, the active involvement of the school teachers, school children as well as maintenance of first replicated gardens at community level by women associations. This practice might be useful in any Food Security Project.
  • The JP motivated the designation by of Nutrition focal points at the level of the health regions. Their training and involvement in the implementation and monitoring of nutrition activities at the operational level is already achieving improved performance in terms of numbers of children screened, treated and reported.

  

Lessons learned:

  • Community health worker involvement has proved highly complementary with the duties of over-burdened health personnel. Effectively assuming their roles has increased the numbers of children screened and referred to treatment centres.
  • The non-inclusion in the project for feeding assistance for mothers or caretakers of malnourished children admitted into nutrition treatment centres is responsible for a high dropout rate.  
  • When a Joint Programme is implemented, the key step that will determine its success is the program formulation phase. In this case the programme formulation phase was neglected, on the one hand due the tight deadlines required by the fund and on the other hand underestimating the implications of joint implementation by the agencies. The result is a vague logical framework with no impact and sustainability indicators. 

 

More details can be found in the documents below.

Recent Documents
Key Figures
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Contacts

If you have questions about this programme you may wish to contact the RC office in Guinea-Bissau or the lead agency for the programme. The MPTF Office Portfolio Manager (or Country Director with Delegation of Authority) for this programme:

The person with GATEWAY access rights to upload and maintain documents for the programme:

  • Jade-Mali Mizutani, Special Assistant to DSRSG/RC/RR; Telephone: 245 643 51 17; Email: jade.m.mizutani@one.un.org; Skype: jademali
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