Project Factsheet
Tools for » Support for the fight against anemia in vulnerable groups in Cuba
Project ID 00067254 Description MDGF-2037-I-CUB Children
Fund
MDG Achievement Fund
Start Date *: 27 Oct 2009
Theme
MDGF SP-ChildFoodSec&Nutri
Project status Financially Closed
Country Cuba Participating Organization   Multiple
About

Overview:

The Programme’s goal was to address anemia and malnutrition with a focus on pregnant women and children under five years of age. This was done by ensuring increased availability of foods rich in micronutrients, particularly iron, and improving physical and economic access to them. The Programme also sought to improve their use while strengthening Government surveillance and monitoring mechanisms.

During the lifetime of the program the prevalence of general anemia decreased in both children under five years and pregnant women in the target areas. The prevalence of anemia in the target areas for pregnant women decreased from 38% to 28.7%, with 77.4% of cases being slight  anemia. A similar decrease was observed in children aged 24 months to 5 years of age, where the prevalence of anemia decreased from 49% to 17.1%, with a prevalence of slight anemia. The prevalence of anemia in children aged 6-24 months decreased from 43.4% to 32.8%. While the above results cannot be attributed entirely to the program, it can be concluded that the program was able to provide an enabling environment for the prevention and control of anemia.

The program was able to increase and diversify the availability of foods rich in micronutrients, particularly iron for pregnant women and children up to 5 years in the 24 municipalities of intervention. On one hand, it diversified vegetable availability, in particular those identified for their high iron content (lettuce, spinach, watercress, parsley, spinach and beans). On the other, there was an increase in the production of 35 and 38 percent in the second and third years of the program respectively, and 1,067.45 MT of fortified food (CSB), were procured and distributed. Capacity building ensures continued local production of fortified foods.

These actions were supported through capacity building of different stakeholder groups such as entrepreneurs, producers, health workers or women linked to the agricultural sector, as well as manuals to strengthen awareness and understanding on the importance of the use of these foods. Capacity building was also a key element in the establishment of 6 human milk banks, acting also as models for possible replication, strengthened through various trainings and experience exchanges.

As a result of training, physicians and nurses have increased increasing knowledge on healthy eating habits, nutrition and the prevention of anemia to guide their actions; and health promoters are better prepared to sensitize and advise families, parents and children on healthy eating, nutrition and more effective ways to prevent anemia.

 

Outcome 1:

Increased availability of foods rich in micronutrients, particularly iron, for pregnant women and children up to 5 years.

 

Outcome Achievements:

  • To increase and diversify the production of natural iron rich foods, a capacity building plan aimed at producers and directors of agriculture production units was designed and implemented.
  • Technical manuals and instructions on themes such as pest agro-ecological management, technical material on organic farms and orchards, postharvest handling and processing of fruits and vegetables in small and medium industries, and technical guidelines for the production of different plants  were printed and distributed.
  • Capacity building of women linked to the agricultural sector on gender and nutrition to serve as leaders and promoters of these issues in their municipalities.
  • Training courses on business management and cooperatives. An additional 7 groups were created to train on these subjects to further expand the coverage. In addition an exchange mission to the Dominican Republic was organized.

 

Outcome 2:

Improved physical and economic access to foods rich in micronutrients, particularly iron, for pregnant women and children up to 5 years.

 

Outcome Achievements:

  • A key component for improving physical access to food was the strengthening of management capacity and coordination at local and regional levels in the marketing and distribution of foods rich in iron, which included providing adequate equipment and training both on technical and management areas.
  • 17 municipal strategic plans for improving distribution channels and marketing of foods high in iron and other micronutrients were drafted.
  • Plans for self-sufficiency were developed and implemented in 10 municipalities and supported in 7 remaining municipalities.
  • Establishment and operation of the 6 human milk banks in Cuba, acting also as reference for possible replication, further supported through various trainings and experience exchanges.
  • The 1st Scientific Meeting on Human Milk Banks in Cuba ensured information was made available to those directly involved in this service in the provinces and other professionals within the health sector, in addition to raising awareness of the experience the country to the media.

 

Outcome 3:

Improved adequate use of foods rich in micronutrients, particularly iron.

 

Outcome Achievements:

  • A baseline was developed at the beginning of the programme to identify the needs and served as a basis for the programme’s actions.
  • Implementation of national and regional workshops to train trainers who can replicate the activities in their provinces and municipalities. In many cases, these meetings included a multi-sectoral composition. Topics included: steps to introduce successful breastfeeding; breastfeeding in special situations, manual removal and storage of breast milk, water and breastfeeding, breastfeeding and anemia, nutrition for lactating women, best practices on breastfeeding, etc.
  • Publishing, printing and distribution of various technical and support materials targeting different actors. These included: training manuals on iron deficiency anemia and nutritional anemia, a CD with interactive course on food and nutrition management of anemia, diet manual for Cuban children up to 5 years of age, dietary guidelines for Cuban girls up to two years, CD with supporting materials for implementing dietary guidelines for Cuban children.

 

Outcome 4:

Strengthened surveillance and monitoring mechanisms.

 

Outcome Achievements:

  • Support was provided to laboratories responsible for monitoring the quality of fortified foods through the acquisition of equipment and agents for determining the levels of iron in fortified foods.

 

Best Practices:

  • The program was in line with national priorities and built on the experiences and lessons learned from previous United Nations system programs in the country ensured relevance and sustainability.
  • The management model (constitution of a Steering Committee, a Program Management Committee and National Program Office) and the modifications which were incorporated during implementation (creation of a Technical Management Team, Program coordinating Team at Provincial and Municipal levels) proved effective in ensuring inter-sectorial coordination among all stakeholders and the strategic direction of the program.
  • The various joint initiatives and synergies among agencies, such as joint capacity building, and making use of  each partner’s competitive advantage, helped optimize resources and achieved a greater impact.
  • The regular annual workshops for monitoring and planning, which included actors involved at the municipal and provincial level, (initially involving all stakeholders and then by sector), proved to be an effective mechanism for managing the program and strengthened monitoring of the program.
  • The implementation of actions for knowledge management and capacity building such as the distribution of updated technical information on substantive items, local self-sufficiency plans, and the creation of human milk banks, as well as technical exchange missions and south-south cooperation had a significant impact in terms of capacity building and ensuring greater sustainability.
  • The flexibility to adjust the scope and/or reformulate activities and goals to changes in the context and the priorities identified by national partners, although in some instances delaying implementation, favored the achievement of results and contributed to their sustainability.

 

Lessons Learned:

  • A multi-sectorial approach addressing all causes for iron deficiency anemia is effective for achieving results. The program has effectively provided an enabling environment in terms of availability, access and utilization of iron-rich foods, while strengthening the surveillance and monitoring mechanisms for prevention and controlling anemia.
  • In designing interventions it is important to achieve a more realistic balance between geographic coverage and available resources.  A more limited geographic coverage would have achieved greater focus and impact.
  • The implementation time of three years was insufficient to measure impact level results. This is particularly true in the case of nutrition interventions where it is not enough to increase the availability of food, but requires time for people to access and consume it properly before impact can be measured.
  • A design context where participation from the local level is not ensured may negatively affect the ownership, slow the pace of implementation and diminish results.
  • Structures such as the Programme Management Committee, the Technical Team and Program Management, which were conducive to interaction, shared responsibility and mutual accountability, and promoted inter-sectorial coordination and the achievement of results. 

 

More details can be found in the documents below.

Recent Documents
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