NIDOS 10th Anniversary - Concern Worldwide present their child nutrition project in Rwanda
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Transcript of NIDOS 10th Anniversary - Concern Worldwide present their child nutrition project in Rwanda
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Concern Worldwide and Scottish Government funding
support of nutrition
Nov 2010
Murakaza Neza! Céad míle Fáilte! Welcome! Bien venue!
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Rwanda: Key Poverty Indicators
• The most densely populated country in Africa : 395 people / sq km
• Total population: over 9 million
• Agriculture is the main occupation of 80% of adults
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• 37% of the population are living in extreme poverty
• More than one-third of the population is unable to obtain the minimum food requirement
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Concern Rwanda in 2010
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Primary Health Care
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Nutrition
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Primary Education
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Livelihood Security
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HIV & AIDS
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Health Programme
• Covers 6 districts (20% of districts nationally)
• Goal: to reduce child mortality reaching over 300,000 children under 5 using CHWs
• Malnutrition is known to be a contributing factor in over 35% of all child deaths
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Why is a nutrition component necessary?
• Under nutrition a significant public health problem contributing to high infant, child and maternal mortality
• 50% of children are stunted, one in five are underweight, and 4% are wasted
• Access to services to address acute malnutrition was poor and MoH recognised the need for assistance to implement a nutrition component into the existed health programme
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CMAM definition
“The CMAM programme treats severe and moderate malnutrition in children using
the CTC model to treat SAM, and utilises the two models of Community Kitchens and PD/Hearth models to treat MAM, all
integrated into a community
based approach”
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Key CMAM activities
• Case identification and referral
• Rehabilitation of MAM cases using community-based nutrition approaches
• Small livelihood support for beneficiaries
• Rehabilitation of SAM cases at OTP sites
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Integration process
• Nutrition component fully integrated into health programme in 2009, using Scottish Government funding
• Process included national level advocacy on policy
• Government of Rwanda have made it part of their health service nationwide
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How was CMAM integration done?
• Close working relationship with MoH• Advocacy with MoH technical working group to
include CMAM in national protocol• Training of CHWs on screening with MUAC and
referral for malnutrition • Scale up from 2 health centres in one district to
43 health facilities across the six districts• Community Kitchens and sensitization on
prevention• Supervision and follow up of management at
health centre level
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Nutrition beneficiaries with their goats
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Impact of CMAM
• Successful advocacy, informed by the positive impact of the programme has resulted in the inclusion of the community management approach in the Rwandan national guidelines for treatment of acute malnutrition
• 43 health facilities have been supported to provide services for the management of severe acute malnutrition in 6 districts
• 2, 321 children have been admitted to the SAM programme since January 2009
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• 2,209 CHWs trained in, identfiiciation, referral treatment of acute malnutrition
• 263 community kitchens and 143 PD/Hearth sites have been opened since the beginning of the programme
• 3,818 moderately malnourished children have been treated at community kitchens and PD/hearth sites since January 2009
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Beneficiary case study 1: CTC
Mother Immaculee (34) with youngest child, Valentine (9 months) at CTC in
Gikore Health Centre
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Beneficiary case study 2: kitchen gardens
Kitchen gardens and community
kitchens/PD Hearth groups improve the motivation of model
parents and sustainability
Callixte & his wife Beatrice & 2 of their 3 children at a community kitchen garden
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The Future• Implement the Community Based Management
of Malnutrition strategy and contribute to district plans
• Emphasize prevention messages in particular, positive practices for infant and young child feeding
• Focus on providing livelihoods support to CMAM beneficiaries
• Greater integration across programmes with Livelihoods, Education, HIV and AIDS