Best Practices Guidelines No.15: Malnutrition-free communities

Consolation, 13 months, is breatsfed by her mother, Bibiche Bavelila at Kuakua Health Center, Bas-Congo. UNICEF / Benoit Almeras-Martino, 2014.

MALNUTRITION-FREECOMMUNITIES

Fighting childrens chronic malnutrition in the province of Bas-Congo

Chronic malnutr it ion poses a threat to the health

and development of young chi ldren. It compromises their

mental development; reduces their abi l i ty to learn; and

accelerates the development of diseases.

Throughout the Democratic Republ ic of Congo, almost

one chi ld under f ive years in two suffers from stunting, which is a sign of chronic malnutr it ion.

Despite efforts and progress made by the Congolese government between 2001 and 2013 in various chi ld development areas, chronic malnutr it ion has not been signif icantly reduced among young chi ldren.

In l ine with the national nutr it ion pol icy, which recognizes communit ies part icipation as one of the only ways to achieve last ing progress in the f ight

against malnutr it ion, UNICEF chose to revital ize Community-Based Nutr it ion projects throughout the country.

The Community-Based Nutr it ion approach aims to involve communit ies in the promotion of good chi ld nutr it ion practices, detection of malnutr it ion cases, and improve the health situation of every household. It also aims at f inding local solut ions to nutr it ion and health problems.

The Community-Based Nutr it ion is currently experimented in Bas-Congo, Bandundu, Equateur and Kinshasa provinces with the help of various NGOs.

CONTEXT

FONDS DES NATIONS UNIES POUR LENFANCE Rpubl ique dmocratique du Congo

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A young child, aged 2, is weighed at Kuakuas Health Center, in Bas-Congo.

In the province of Bas-Congo, f ive health zones have been targeted for the experiment. They are located in Tshela and Seke-Banza terr itor ies.

Within these health zones, the experiment covers half of the vi l lages, which represent an estimated populat ion of 220,000 people.

The project aims at reducing chronic malnutr it ion of young chi ldren, with a focus on the f irst thousand days of their l ives1. The effort also targets pregnant and breastfeeding women.

The projects activit ies intend to:

Enhance community dynamics by1) electing new Community Health Workers;2) creating Community Animation Cel ls in every targeted neighborhood or vi l lage;3) revital iz ing Development and Health Committees at health area level. Community Health Workers are in charge of counting neighborhoods residents and rais ing

1 from the pregnancy to the age of 2

awareness about malnutr it ion.

Bui ld the capacit ies of community stakeholders, through training on early identif icat ion of malnutr it ion issues.

Raise famil ies awareness on chi ld nutr it ion best practices, such as Infant and Young Chi ld Feeding (ANJE)

Identify nutr it ion issues in each vi l lages and neighborhoods; and f inding local solut ions to respond to these issues, within healthcare faci l i t ies and communit ies.

- Empower communit ies in preventing malnutr it ion and in monitor ing the chi ldrens growth.

LITTLE ANJE-LS - Infant and Young Child Feeding best practices

Infant and Young Child Feeding (or Alimentation du Nourrisson et du Jeune Enfant, ANJE) aims at ensuring young childrens optimal growth, development and health.

According to The Lancet, ANJE can reduce infant and child mortality by 13%.

ANJE is based on three principles: Breastfeeding is initiated within the first hour following the childs birth Children are exclusively breastfed during the first six months of their lives Children are given complementary foods while mothers breastfeed them until they reach the age of two.

In the Community Based Nutrition approach, ANJE is at the heart of the sensitization messages delivered to the families. It is one of the keys of the fight against malnutrition.

DESIGN: HOW IT WORKS

MALNUTRITION-FREE COMMUNITIES Fighting chi ldrens chronic malnutr it ion in the province of Bas-Congo

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In Vunda (Bas-Congo), community relays run support groups to teach parents childrens nutrition best practices.

Hello everyone! Today we are going to learn how to make porridge using cassava flour, palm oil, peanut and sugar ...

Every Sunday, Emeda Pemba runs an informal support group during which she teaches childrens nutrition best practices for the neighborhoods residents.

This time, she wants to teach parents the importance of complementary feeding. After washing her hands, she takes the ingredients, details the porridges recipe, and cooks the preparation in a large pan.

It will be ready in fifteen minutes! While waiting for the porridge to be ready, Emeda uses billboards to explain herself. In addition to breastfeeding, it is important to give complimentary foods to children older than 6 months. That allows them to grow well and healthy. But you have to give them nutrient-rich food, not cassava-only!

Some parents confide that they like the support group because Emeda teaches them using actual examples, not simple advices.

Emeda, a mother of five children, is far from being an anonymous person among the residents: she visits every family about three times a month since she has been elected Community Health Worker of her neighborhood.

I feel joy while helping my neighbors she says Im always welcome at their homes.

Many parents are embarrassed about going to the health center and ask questions about their childrens health. They dont know about malnutrition issues. My job is to give them information about their childrens health, but I also try to convince them to use the healthcare facilities. I want their children to have long lives!

Emeda distributes the porridge to the parents, who are not very enthusiastic about tasting it (its color is not very tempting). Yet, the children do not leave a single drop of it and swallow every spoonful they can.

EMEDA F IGHTS MALNUTR IT ION BY SERV ING HER COMMUNITY


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Prior to the projects implementation, a knowledge, attitudes and practices survey on nutrit ion was led in the targeted health areas. The results enabled UNICEF and its partners to set up local strategies to fight against malnutrit ion.

Elections were held in the vil lages. 617 Community Health Workers were elected in 597 communities. 597 Community Animation Cells were elected. 26 Development and Health Committees have been revital ized in the 26 health areas covered by the Community-Based Nutrit ion approach.

Every community stakeholder (members of the Development and Health Committees, Community Animation Cells and Community Health Workers) and 108 health facil it ies personnel were trained on child nutrit ions best practices and response to malnutrit ion.

Following the training, a census of the communities residents identif ied 9772 children aged from 0 to 23 months (including 2,972 children aged from 0 to 6 months) and 11,212 pregnant and breastfeeding women. This census is updated on a monthly basis thanks to the Community Health Workers work.

A community diagnosis was conducted in every health area to assess knowledge, attitude and practices towards child nutrit ion, sanitation and hygiene; to know more about the local agriculture production.

At the age of 43, Elyse gave birth to her fourth child, Grace.

When I was pregnant, our Community Health Worker came to visit me. She gave me advices on how I should exclusively breastfeed Grace. She told this would help my

childs growth.

I had never tried this before, so I decided to follow her advice and breastfeed Grace. I saw that he was healthy. He also grew better compared to his brothers at the same age.

In August 2014, during Elyse and Graces last visit to the health center, the baby boy weighed nearly 11 pounds. A source of pride for his mother:

What makes me happy is to see that Grace looks healthy, he does not get sick. My wish for the future is that mothers can continue to be well informed as I was.

I N T E RV I E WDELIVER: WHAT HAS BEEN ACHIEVED


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Local authorit ies involvement faci l i tated the organization of activit ies at community level.

THE EXPANDED NUMBER OF COMMUNITY STAKEHOLDERS, fol lowing the pr inciple of One Community Health Worker per neighborhood1, faci l i tates the effective monitor ing of chi ldren and famil ies. It also al lows the Community Health Workers to maintain a normal activity outside of his or her community work.

Establ ishing a SYSTEMIC MONITORING OF THE CHILDREN through the Community Health Workers work al lows early identif icat ion of possible health issues, which can be addressed at Health Area or Health Zone levels.

Community Health Workers reinforce PARENTS AWARENESS ON THE KEY FAMILY PRACTICES by directly sensit iz ing them at their homes.

THE SPIRIT OF SERVICE AND SOLIDARITY (salongo) that dr ives the Community Health Workers faci l i tates the transmission of malnutr it ion prevention messages to the famil ies.

SUPPORT GROUPS, run by the Community Health Workers, provide chi ld nutr it ion t ips to parents whi le strengthening social cohesion within communit ies.

1 1 neighborhood = 40 households

Dr. Bumba MuasoChief Medical Officer of Inga Rural Health Zone

I think Gandhi used to say What is done for me, but without me, is against me.Community-Based Nutrition involves

communities and seeks to find local solutions to prevent malnutrition.

Esprance PambuKuakuas Community Health Worker

In my opinion, supporting households is the most important thing to do. Parents accept my visit and the pieces of advice I can give them.

Joseph GemboHead of Kuakuas Community Animation Cell

We decided to cultivate a community field to diversify our food and to earn some money. Now we would like to breed livestock to get meat.

Within Inga health zone, five health areas (out of ten) have implemented the Community-Based Nutrition approach with the help of UNICEF. Its success lies in the appropriation of the approach by the local communities.

DISCOVER: WHAT IS WORKING


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By the end of 2017, UNICEF intends to ensure nutritional security for the most vulnerable groups of people, with a focus on provinces affected by malnutrition where stunting affect more than 5% of the children

Reducing malnutrition issues within communities is the main motivation of the local stakeholders.

To achieve this, various solutions were discussed:

- Accompanying behavior change 1) at household level, in the acceptance and application of appropriate feeding practices; 2) at agricultural production level, by encouraging the cultivation of other crops (soybean, maize) and livestock breeding.

- Empowering the community-based organizations through the development of income generating activities and social economy (health mutual, tontines).

Following the community diagnosis, local action plans will be developed at health area level. They are expected to find solutions to malnutrition issues, relying on locally available resources.

Mbongo Neka is an active Community Health Worker in Vunda - his work leads him to visit the famil ies of the neighborhood. El izabeth Vangu, thirty-two years, is the subject of his attention as she enters her f inal month of pregnancy.

This is also the fourth visit Mbongo in El izabeth. Even though I already know what to do thanks to the prenatal consultat ions, I l ike his vis its. Its easier for me than going to the Health Center. Mbongo gives me good advice about breastfeeding.

I N P I CT U R E S : A C o m m u n i t y H e a l t h Wo r k e r d u r i n g a h o m e v i s i t

DREAM: VISION FOR THE FUTURE


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Kuakuas residents feed their young children following a support group run by a Community Health Worker.UNICEF / Benoit Almeras-Martino, 2014.

Documents

Best Practices Guidelines No.15: Malnutrition-free communities