Mobilizing grass-root community development practitioners to empower women and enhance

improved maternal, adolescent, infant and young child nutrition

Experience of World Vision In Africa

Harnessing opportunities for production, access and consumption of nutritious, safe and diverse

diets

Kampala, Uganda November 29, 2015

Outline • WV Program in Africa

• Key Health and Nutrition Program Approaches

• Strategy for Mobilizing Community Health Workers • How we work with partners/community • How we build their capacity

• Evidence of success/Impact

• Lessons and recommendations

Background • World Vision aims to achieve sustained well-being of children within

families and communities, especially the most vulnerable children :• Long term community based and child focused

development programs (10-15 years)• Advocacy, Policy Influence and Engagement• Emergency Response and Disaster Risk Reduction

• In Africa, World Vision works with communities, governments and partners in 26 countries through its three regional offices:  • East Africa (9 countries): Burundi, Ethiopia, Kenya, Rwanda, Somalia,

South Sudan, Sudan, Tanzania and Uganda• Southern Africa (10 countries): Angola, DRC, CAR, Lesotho, Malawi,

Mozambique, South Africa, Swaziland, Zambia and Zimbabwe• West Africa (7 countries): Chad, Ghana, Mali, Mauritania, Niger,

Senegal, Sierra Leone,

• WV approach for food and nutrition security is a multi year integrated development program

World Vision Reach and Funding in Africa - World Vision is serving over 18 million children and their families

across Africa through 600 long term projects and 151 short term programs on • Health and Nutrition • Resilience and Livelihood • Education • Water supply and sanitation • Humanitarian emergency • Cross cutting themes

WV programs focus on food and nutrition security at the grassroots

• Out of the total global income of US$2.7 billion in 2013, World Vision International funded projects with over US$1.06 billion is in Africa

Integrated development approaches

Evidence based technical models as delivery vehicles

WV Key Health and Nutrition Approaches

WV Key Health and Nutrition Approaches

Timed and Targeted Counseling •Targets pregnant and lactating women through 13 household visits over the 1000-day window of opportunity •Garners support for behaviour change•Empowers families to make their own decisions without ‘giving instructions’

Nutrition Care Groups•Targets women and men with children aged 0 – 59 months•Provides training, supervision and support in Essential Nutrition Actions.•Curricula integrate key skills in WASH, FP, MNCH etc.•Volunteer women or couples act as peer educators for a cluster of households

WV Key Health and Nutrition Approaches

Positive Deviance Hearth • Identifies behaviors practiced by

caregivers of well-nourished children from poor families and transfers such practices to others with malnourished children.

• Same concept can be applied to other health-related behaviours

• Platform for integration of agriculture and livelihood skills

WV Key Health and Nutrition Approaches

Integrated Community Case Management•Accelerating control and management of diarrhea, malaria, pneumonia, neonatal sepsis and malnutrition in children under 5.•Contributes to halting the vicious cycle between malnutrition and illness in children.

WV Key Health and Nutrition Approaches

Strategy for Mobilizing Community Frontline Workers

• World Vision is committed to supporting 100,000 CHWs across the world in 2016

• Referred to differently in different countries (Uganda – Village Health Teams; Ethiopia – Community Health Extension Workers working hand in hand with the Women Development Army; Niger – Relais Communitaire etc.

• Guided by country CHW policies and guidelines, WV CHW programmes aim to strengthen existing community health structures through strong, long-term partnerships  

• Community system strengthening includes components of functionality, capacity building, motivation , linkage to the health system and country ownership.

• Community health workers and volunteers supported to deliver primary health and nutrition education and behavior change communication at household level, empowering caregivers and children

Individual/HH:

CHWs

Community:CSS

Environment:Advocacy, HSS

World Vision socio-ecological model focuses on individuals, systems, and the policy environment.

Nutrition Framework & Interventions

Evidence of Success

Uganda - Mother Care Groups

Children 6-59 months having 3 meals a day – Amuru area program

Uganda – Positive Deviance Hearth in Kiboga

Burundi: Positive Peer Couples promoting Family Planning• Contraceptive prevalence rate in Mushikamo Area Program =

50.6% (n=135) in 2015 from 17% in 2013 • Percent of women aged 15-49 who can name at least three

modern methods of family planning: 99.7%• Percent of women aged 15-49 who can name at least one long-

acting reversible contraceptive (LARC) or permanent method (LAPM) of contraception : 99%

Number of FP users by method

World Vision’s largest iCCM grant is in Niger ($10M). Funding by CIDA through WHO

Niger: CHWs contribution in iCCM

Niger’s experience working on iCCM

Number of districts 4

Number of CHWs 1074

Size of grant US$10M

Period of grant Five years

Diarrhea cases treated 24,080

Malaria cases with +RDT treated

24,080

Pneumonia cases treated 47,497

Visit at the 3rd trimester or at delivery (by peer mother) and initiation of BF within 1 hr, Colostrum feeding and pre-lacteal feeding

68.6 69.0

7.4

72.578.3

4.9

78.7

88.9

1.1

% initiated BF within an hourafter birth

% who fed colostrum % who pre-lacteal feeding

Control

Intervention (NOT Visitedat 3rd trimester or delivery)

Intervention (Visited at 3rdtrimester or at delivery)

Ethiopia - Using peer mothers to promote Infant and Young Child Feeding

Key messagesSituation: Progress on maternal, adolescent and infant and

young child nutrition remains slow due to due to inadequate access to services, sociocultural, economic and behavioural factors.

Sustainable solutions exist: Progress is possible but requires increased investments in mobilising communities and scale up of evidence based, community-driven multi-sectoral approaches.

Call to action: Nutrition cannot wait. Every delay has dire consequences for maternal and child survival, learning ability, population productivity and ultimately the economic development of Africa.

Recommendations

• Create effective policy and legal frame-works from national level to the grassroots for improved community mobilisation to support the scale-up of proven interventions in countries.

• Promote a strong and sustainable multi-stakeholder dialogue from national level to the grassroots for better accountability and strengthening community health systems.

• Governments and development partners should allocate more resources for CHW programming in Africa to reach the most vulnerable communities.

• Need to strengthen partnerships to increase demand creation and uptake of proven, high impact interventions using community health workers.

Thank You!Thank You!We bale!We bale!