Overview:

The primary objective of the Joint Programme (JP) was to support the achievement of the MDGs in Senegal with a focus on reducing extreme poverty and hunger, focusing on national policies to ameliorate the nutritional status of children under 5 years of age, pregnant and breastfeeding women.

The JP addressed these issues through four results, mainly: strengthening the capacity of local communities to fight against child malnutrition, with a focus on vulnerable groups; fortifying integrated programmes to prevent childhood diseases while strengthening clinics for the treatment of acute malnutrition; promoting communication programs for behavior change in terms of health; and improving early warning systems at different levels to allow for quick decision making in crisis situations. The programme also sought to promote behavioral change and key family practices.

The JP helped improve food security by promoting increased food production, the provision of kits and training for better treatment of foodstuff such as cereals, fruits and legumes. It promoted techniques for the production of enriched flour resulting in flour with increased micronutrients, lifespan and quality. This in turn led to increased sales.

With the support of the JP, community nutritional services were extended to 167 collectives. As a result, over 100,000 children under 10 years benefitted from regular growth monitoring and over 200,000 house visits were undertaken to support mothers or caretakers with children 0-5 years of age. 

Training to over 2,000 health workers on new World Health Organization (WHO) standards; therapeutic support and anthropometric measurements and essential medications, contributed to the operationalization of the centers and units for management of malnutrition leading to the intake in 2012 of several of the 12,601 cases of malnutrition in the regions covered by the programme.  Over 700 health workers received training on triage and emergency treatment and nearly 5,000 women benefitted from training on horticultural practices.

Advocacy and awareness raising initiatives included social mobilization and the creation of radio programmes on health issues such as diarrhea, malnutrition screening, growth monitoring. Other activities included organized visits for parliamentarians, and the creation of advocacy materials on prevention.

The JP helped to strengthen the surveillance system through the design and/or revision of the different management tools for malnutrition and child survival of the national sanitary system (SNIS). This included a methodological revision to include indicators for tracking malnutrition, which will allow for regular collection and analysis of data, as well as identification of areas of prevalence.

Outcome 1:

The capacity of local communities, vulnerable groups in particular, to fight against child malnutrition is strengthened.

Outcome Achievements:

• Communities were provided with information and ready-to-use materials for prevention of malnutrition, with mothers and grandmothers being the primary focus of these outreach activities.
• The JP supported regular screenings (every three months) to identify severe and moderate cases of malnutrition.  When appropriate, cases were referred to the proper authorities.
• Nutritional support in the form of vitamin A, oils, flour and folic acid were provided.
• Supplementary feeding and deworming were provided to 90% of the infants 6-59 months of age in the intervention area.
• The JP supported the production of dietetic flour through capacity building of women associations.
• Fortified support and deworming took place every 6 months.
• 48,000 women benefitted from capacity building on horticultural production and diversification with a focus on small livestock.
• With the support of the JP, community nutritional services were extended to 167 collectives. As a result 101,821 children under the age of 10 benefitted from growth monitoring.

Outcome 2:

The Integrated management of childhood diseases programme (Prise en Charge Intégrée des Maladies de l’Enfant (PCIME)) and community clinics manage acute malnutrition in all targeted districts.

Outcome Achievements:

• The protocol to address acute malnutrition and nutrition policies for young children were revised, as were screening materials.
• Trainers were trained on HIV transmission.
• Over 2,000 health workers were trained on new World Health Organization standards, therapeutic support and anthropometric measurements and essential medications. 
• Over 700 providers received training on triage and  emergency treatment to strengthen the health system with a focus on diseases linked to malnutrition such as diarrhea, pneumonia and malaria.
• The JP trained 4,800 women in horticultural practices. In addition 40 women were trained on aviculture, 50 on transformation of fruits and legumes, support was provided to 70 market gardeners to increased vegetable production.
• Local and regional authorities were also trained on transformation of fruits and vegetables as well as aviculture techniques.

Outcome 3:

Communication programs for behavior change in terms of health are strengthened.

Outcome Achievements:

• The JP supported social mobilization initiatives and radio programmes on health issues such as diarrhea, malnutrition screening and growth monitoring.
• Review of studies in media and outreach led to the elaboration and dissemination of communication materials on key family practices by the Department of Education.
• The JP supported increased advocacy for journalists and local elected officials in the fields of nutrition and child survival. Field trips and workshops on these subjects were organized for parliamentarians.
• The JP also supported the creation of advocacy materials to increase awareness and understanding on malnutrition prevention in the communities.
• Training sessions for radio hosts were organized.

Outcome 4:

The early warning system is improved at all levels and allows for quick decision making in crisis situations.

Outcome Achievements:

• Design/revision of tools in the national sanitary system (SNIS) for the management of malnutrition and survival.
• Methodological revisions were undertaken to include malnutrition indicators.
• Revision were made and new tools created to promote national integrated surveillance. This should allow for the collection, analysis and weekly distribution of progress according to the indicators, and to identify areas of prevalence.

Best Practices:

• The programme promoted coordinated response amongst different actors to address malnutrition promoting a multi-sectorial approach. Institutional anchoring of the coordination function was key for steering the joint programme.
• The JP promoted sustainability and stronger results by building on existing institutions and strategies.
• Strong focus on capacity building at the local level increased ownership and with it sustainability.
• The involvement of national actors in the formulation of the program reinforced ownership and accountability.
• A participatory approach in the process of design of training manuals proved key to ensure their inclusion in other programmes.

Lessons Learnd:

• Anchoring of programme activities within institutions proved key to move forward programme objectives.
• Constant advocacy at the local level and a strong coordination function are crucial to ensure smooth implementation.
• More time than had been planned was needed for the establishment of processing units for the local production of flour enriched with micronutrients.
• Need to strengthen the synergies with village cereal banks to achieve lower cost of grain in times of welding and to help stabilize prices.
• Inclusion of a communication strategy in the formulation of joint programs is essential to guarantee its visibility. 

More details can be found in the documents below.