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NATIONAL SOCIAL AND BEHAVIOUR CHANGE COMMUNICATION STRATEGY FOR
INTEGRATED EARLY CHILDHOOD DEVELOPMENT, NUTRITION AND WASH (2018-2024)
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LIST OF ACRONYMS 4
FOREWORD 5
ACKNOWLEDGMENT 7
1. Introduction 9
2. National integrated SBCC Strategy 11
3. Overview of relevant policies and key literature 13
4. Situational analysis and problem statement 17
5. Priority behaviors to address 26
6. National SBCC Strategy communication framework 31
7. National SBCC Strategy audience analysis 35
8. National SBCC Strategy communication objectives 37
9. Analysis of relevant communication channels 39
10. National SBCC Strategy implementation arrangements 44
11. Monitoring and evaluation framework 47
12. Conclusion 49
13. Annexes 51
Contents
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ANC :Antenatal CareCHW :Community Health WorkersCRS :Catholic Relief ServicesDHS :Demographic and Health SurveyDPEM :DistrictPlantoEliminateMalnutritionECD :Early Childhood DevelopmentEICV 4 :IntegratedHouseholdLivingConditionSurveyFAO :FoodandAgricultureOrganisationHMIS :HealthManagementandInformationSystemHSSP :Health Sector Strategic PlanHSWG :Health Sector Working GroupsICT :InformationandCommunicationTechnologyIEC :Information,EducationandCommunicationINWA :IntegratedNutritionandWASHActivityIYCF :Infant Young Children FeedingJDAF :JointActionDevelopmentForumKAP :Knowledge,AttitudesandPracticesMCH :Maternal and Child HealthMIGEPROF :MinistryofGenderandFamilyPromotionMINAGRI :Ministry of Agriculture and Animal Resources MINALOC :Ministry of Local GovernmentMINEDUC :MinistryofEducationMININFRA :Ministry of InfrastructureMIYCN :Maternal,InfantandYoungChildNutritionMOH : Ministry of HealthNCC :NationalCommissionforChildrenNECDP :NationalEarlyChildhoodDevelopmentProgramNST1 :NationalStrategyforTranformationNTWG :NutritionTechnicalWorkingGroupNWC :NationalWomen’sCouncilPNC :Post Natal Care PSF :PrivateSectorFederationRBC :Rwanda Biomedical Center RHCC :RwandaHealthCommunicationCenterSBCC :SocialandBehaviorChangeCommunicationUNICEF :UnitedNationsChildren’sFundUSAID :UnitedStatesAgencyforInternationalDevelopmentWASH :Water,SanitationandHygieneWFP :World Food ProgrammeWHO :WorldHealthOrganisation
LIST OF ACRONYMS
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The National SBCC Strategy will build on the integration of Early Children Development,Nutrition and WASH sectors which provides opportunities of benefiting from integratedECD,nutritionandWASHsocialbehavior and communication servicesaimingat improvingknowledge,attitudeandpracticesatcommunityandhouseholdlevels.
Early Childhood Development (ECD) refers to a comprehensive approach to policies and programmes for children from 0 to 6 years of age, their parents and caregivers. Lifetimebehaviorpatternsareformedduringthisperiodwhenbraindevelopmentismostactive.Assuch,whathappensordoesnothappenduringtheseearlyyearsofachild’slife,influencestheirgrowthanddevelopmentoutcomesaswellasopportunitiesinadulthood.Aschildrenacquiretheabilitytospeak,learnandreasoninearlyyears,cornerstonesarelaidandlateraffecttheirorientationtodevelopmentandthrivinginlife.Investmentintheearlyyearsofachildisthereforecriticalforbothsurvival,growthanddevelopmentofthechild,communityandnationalduetothepredictablegainsandproductivityinadulthood.
ConsideringthevalueofECD,theGovernmentofRwandadevelopedacomprehensiveECDPolicy (2016), Food andNutrition Policy (2013-2018) and other child development relatedpolicies,offeringgovernmentorientationoninterventionstosupportchildren’sfullphysical,cognitive, language,social,emotionalandpsychologicaldevelopment.Thepolicy isalignedwithrenewedgovernmentcommitmentsundertheEDPRSII(2013-18),theNationalStrategyforTransformation(NST)2017-2023,andtherevisedVision2020targets.
TheGovernmentofRwandaisalsocommittedtoimprovingthehealthofallRwandansandhas shown these commitments through several policies and strategies,whichhavegreatlyimproved the overall health sector and the health and well-being of the population. TheRwandangovernmenthasinvestedinthehealthandwell-beingofitspeoplethroughtheThirdandfourthHealthSectorStrategicPlan(2012–2018;2018-2024).Thisstrategyseekstoaddresskeydeterminantsrelatedtoearlychildrendevelopment,malnutritionandwater,sanitationandhygiene(WASH)mostlyrelatedtoknowledge,attitudeandpracticesatcommunityandindividual levels.
There aremany impediments within the health systems that prevent people from havingproductiveandhealthy lives.SocialandBehaviorChangeCommunication(SBCC)addresseskeybarrierspreventingpeoplefromadoptingimprovedhealthpractices.TheEarlyChildrenDevelopment, nutrition andWASH sectorswithin the health system can benefit positivelyfromanSBCCstrategy.ECD,NutritionandWASHhavemulti-sectoraldimensionsthatrequirecontributions from different disciplines including but not limited to agriculture, economicstrengthening,publichealth,gender,medicine,andsocialscience.ThetheoriesandmodelsfromthesedifferentdomainscanbeextractedtodevelopanddelivereffectivebehaviorchangecommunicationsparticularlyinthecontextofpromotingpositiveECD,nutritionalandWASH
Foreword
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relatedpracticesathouseholdandcommunity level inRwanda.ByaddressingkeybarriersrelatedtoECD,NutritionandWASHbypromotingCommunityandHouseholdintegratedbestpractices,thiswillensureoptimumhealthstatusofthepopulationofRwanda.
Thesechangesinbehaviorandhealthoutcomesarevitalforthewell-beingofchildren(0-6yearsofage)andpregnantandlactatingwomen.IntegratingECD,nutritionandWASHSBCChasthepotentialtodramaticallyimprovethehealthsectorthroughbetterECDnutritionandWASH-relatedoutcomes.ThisSBCCstrategytypifiestheGovernmentofRwanda’scommitmentto promote positive health and ECD, nutrition andWASH outcomes as stipulated inmanynationalframeworksincludingtheThirdandFourthHealthSectorStrategicPlan(2012-2018,2018-2014).ThisstrategyisdeemedhighlyrelevanttopromoteEarlyChildrenDevelopmentpractices, infightingmalnutrition inRwandawithspecialattentionbeinggiventoreducingstuntingamongchildrenunder5yearsofage.
Dr. Anita AsiimweCoordinator, National Early Childhood Development Program (NECDP)
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TheprocessofdevelopingtheNationalSBCCStrategyforIntegratedECD,NutritionandWASHwas led byMinistry of Health (MoH) in collaborationwithMinistry of Gender and FamilyPromotion(MIGEPROF)throughNationalEarlyChildhoodDevelopmentProgram(NECDP)andRwandaBiomedicalCenter/RwandaHealthCommunicationCenter(RBC/RHCC).
WearegratefultotheMinistryofLocalGovernment(MINALOC),theMinistryofAgricultureandAnimalResources(MINAGRI),MinistryofEducation(MINEDUC),MinistryofInfrastructure(MINIFRA)andothergovernmentinstitutionsnamelyLocalAdministrativeEntitiesDevelopmentAgency(LODA),NationalItoreroCommission(NIC)NationalCouncilofPersonswithDisabilities(NCDP),OfficeofGovernmentSpokesperson(OGS),andWaterSanitationcorporation(WASAC)fortheirusefulcontributionindevelopingthisSBCCstrategy.
TheIntegratedECD,NutritionandWASHstrategywassupportedbytwomajorprograms.TheIntegratedNutritionandWASHActivity(INWA)programlocallynamed“Gikuriro” is fundedby the United States Agency for International Development (USAID) in Rwanda and beingimplementedbyCatholicReliefServices(CRS)inconsortiumwithNetherlandsDevelopmentOrganization (SNV). The ECD programme led by UNICEF is funded by the Embassy of theNetherlands.CRSandUNICEF facilitated theprocessofdraftingandfinalizing thisNationalSBCC Strategy technical approach.
Therefore, we would like to recognize the generous technical and financial support fromUNICEF,theEmbassyoftheNetherlands,USAIDanditsimplementingpartnersCRSandSNV,andtheWorldBankthroughouttheprocessofdevelopingthisimportantNationalIntegratedSBCC Strategy.
Wearealsoextremelygrateful to the following institutions for theiractiveparticipation inthereviewandvalidationofthestrategythroughtheextendedHealthPromotion,Nutrition,WASH,andECDTechnicalWorkingGroups:AEE,CARITASRwanda,C4Development,DUHAMICADRI,FVA,FXBRwanda,GlobalCommunities/Twiyubake,KigaliHopeAssociation,MaternalChildHealth(MCH),RICH, ImbutoFoundation,SFHRwanda,URUNANADC,WFP,WHOandYWCA.
Acknowledgment
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1. INTRODUCTION 1.1TheoverviewofintegratedECD,nutritionand
WASHinthefightagainststunting
Scientificevidenceaffirmsthatthefirstthreeyearsofachild’slifearethemostimportantinthechild’sdevelopmentandgrowth(Lancet).Eightypercentofbraindevelopmentoccurswithinthefirst threeyears,making itaperiodofgreatestsensitivity toenvironmental influences.Anydeficienciesduringthistimeaffectsubsequentchilddevelopment,soinvestinginachild’slifeduringthiscriticalphaseensuresabetterlifeforthechildandthenation.Itiscurrentlyestimatedthat,worldwide,250millionchildrenundertheageoffivearefailingtomeettheirdevelopmentpotential.Arangeofriskfactorsleadtothislossofhumanpotential.Delayedcare-seekingforillness,malnutrition,lackofaccesstocleanwaterandsanitation,childabuseandneglect,alackofstimulationandlearningopportunitiesandmanyotherchallengesresultincompromisedchilddevelopment.Theleversforchangerestinlocalandcommunityeffortstoprovideaminimumpackageofsocialservicestoyoungchildrenandtheirfamilies,coupledwith national and global action. Recognizing the interconnectedness of poverty reduction,health,nutrition,education,agriculture,protection,WASH,genderequality,social inclusionand development should place children and families at the heart of the government vision for developmentandtheworkonSustainableDevelopmentGoals.
EarlyChildhoodDevelopment(ECD)interventionsareameansofprovidingholisticcareandstimulationtochildrenduringtheirformativeyears.InRwanda,ECDisdefinedasarangeofchangesthroughwhichachildundergoesduringtheirearlyyearsoflifefromconceptiontosixyears,aswellassupportthatcaregiversneedtoprovidechildcare.ECDinterventionsdevelopsensory-motor,social-emotionalandcognitive-languageskillsforyoungchildren,whilebuildingthecapacityofparentsandothercaregiverstofulfiltheirparentingobligations.AccordingtoRwandaDemographicandHealthSurvey(DHS)2014-15,63percentofchildrenaged36-59months are developmentally on track in literacy-numeracy, physical, social-emotional, andlearningdomains.Thisindicatesthataboutonethirdofchildrenneedmorecareandsupportfordevelopment.Intermsofstunting,38percentofchildrenunderfiveyearsoldarestuntedcontributingtothedevelopmentaldelaysamongchildren.
The 2014 Knowledge, Attitude, Practice assessment on early nurturing of children report illustrated the many social and behaviour change determinants that contribute to theseissues.Whiletheprimarypointofcareandsupportoccuratthehousehold,itisrecognized
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thatparentsalonecannotprovideanoptimalenvironmentforchildren.InlinewiththeAfricanbeliefthat“ittakesavillagetoraiseachild”,communities,socialservicesandlocalleadersallplayimportantrolesinachild’slife.Thisiswherecommunicationplaysanimportantroleinachievingaconcertedeffortfrommulti-sectoralstakeholders.
ThisnationalSBCCstrategysetoutinthisdocumentisintendedtoguideECD,NutritionandWASHstakeholdersbyanalyzingthecurrentsituationandmakingconcreterecommendationson the targetaudience, keymessagesandcommunicationchannels. TheAnnexof thekeyinterventions, which will be updated annually, includes a summary of key interventionsin relevantfields (health, nutrition,WASH, early learning, parenting, childprotection). Thedocumentwillguidetheconcertedeffortsofthegovernment,policymakers,UN,civilsocietyorganizations(CSOs)andtheprivatesectortojoinhandsforthepromotionofIntegratedECD,NutritionandWASHservicesinRwanda,andfostersupportivesocialandbehaviorchangetogiveeverychildthebeststartinlife.
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2. NATIONAL INTEGRATED SBCC STRATEGY
2.1.Definition
SocialBehaviorChangeCommunication (SBCC)isabehavior-centeredapproachtofacilitatingindividuals,households,groups,andcommunitiesinadoptingandsustainingimprovedhealthandnutritionrelatedpractices.Itprovidesa“roadmap”forchangingbehaviorsandsocialnormsandidentifiesallthebehaviorsthatneedtobechangedtoattainpositivehealthandsocialimpacts.Itisamulti-leveltooloperatingthroughthreekeystrategicdimensions:aplanningcontinuum includingadvocacy, socialmobilizationandbehavior changecommunication forpromotingandsustaininghealthy,risk-reducingbehaviorsamongindividualsandcommunities.It achieves this objective by disseminating tailored health messages to specific audiencesthrough a variety of communication channels, based on evidence driven communicationobjectives.
2.2.NationalIntegratedSBCCGoal
Thegoalof thisNational IntegratedSBCCStrategywillcontributetostrengthen leadership,accountability,partnershipandcoordinationinthedeliveryofcommunicationinterventionsrelated to ECD, Nutrition andWASH at all levels. Such interventions will effectively buildcapacityamongparentsandfamilies,raiseawarenessamongcommunities,formsupportivesocialnorms,guidethelocalauthoritiesandstrengthentheprovisionofallsocialservicesthatsupportEarlyChildhoodDevelopmentandimprovingnutritionandWASHbestpractices.
Towardsthegoalofoptimalchilddevelopment,theinterventionswillensure:
● Parentshaveparentingskillsandengagewithchildrenwithloveandcare;
● Parentsandcommunitiesareequippedwithknowledgeandskillsonmaternalandchildhealth,ECD,nutritionandWASH;
● Parentsaresupportedbyenablingsocialnormstopracticepositivebehaviors,includingemphasisonmaleengagementinchildcarepractices;
● Centralgovernmentand localauthoritiesunderstandtheir rolesandresponsibilities inpromotingECD,NutritionandWASHinterventions
● Parentsusepositiveparentingtoguidechildrenandthecommunitytoparticipateinchildprotectionfromanyphysical,moralorpsychologicalharm;
● Families with young children increase demand for social services including health,
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nutrition,WASH,ECD,childprotectionandsocialprotection;
● Childrenwithdisabilitiesandspecialneedswillhaveequalaccesstothesesocialservicesand special care;
● KeyintegratedECD,nutritionandWASHmessages,appropriatecommunicationchannelsand tools to disseminate messages are harmonized, coordinated and implementedeffectively;
● Childrenhaveaccesstoearlystimulationandage-appropriatecommunicationchannels,tools and messages for school readiness;
● Monitoring framework is inplace forabetter followupof the implementationof theStrategy.
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3. OVERVIEW OF RELAVANT POLICIES AND KEY LITERATURES
This National SBCC Strategy will be based on the Rwanda National Policies to guide theimplementers at all levels with generalmissiontocoordinateandimplementallinterventionsthatsupportadequatedevelopmentforchildrenandeliminatestunting.Thefollowingpoliciesandstrategiesareofparticularimportance.
3.1.NationalECDPolicy:
The government elaborated the first ECD policy in September 2011 under theMinistry ofEducation(MINEDUC).In2014,theMinistryofGenderandFamilyPromotion(MIGEPROF)wasassignedtorevisetheECDpolicyandcoordinatepolicy implementation,given itsmandateof familypromotionand childprotection. Themission, goals andobjectivesof the revisedECDpolicyestablishthecountry’svisionforitsyoungestcitizens.Themissionemphasizesthedeliveryof credible interventions that caneffectively support children’sdevelopment fromconception to six yearsofage inRwanda.Themission is alignedwith theoverall visionofprovidingchildrenwith integrated interventionsthatenabletheirholisticdevelopmentandincreasetheirlearningopportunitieswhilealsoengagingthecommunity.
Thegeneralobjectiveofthepolicyemphasizesprinciplesofequity,accessandqualityofECDservices, and requires systems that are coordinated and provide sustainable services. Thespecificobjectivesare:(1)toincreasechildren’spreparednesstocopewithprimaryschool;(2)toenhancepositiveparentingandcommunityparticipationinchildprotection;(3)toreducemalnutritionandstuntedgrowthamongyoungchildren;(4)toreduceunder-fiveandmaternalmortalityrates;(5)todevelopchildren’sself-awareness,self-esteemandself-confidence;(6)toeliminatephysical,moralandpsychologicalabuseofyoungchildren;and(7)toenhanceequalaccessbychildrenwithspecialneedstoECDservices.TheECDpolicyissupportedbyastrategicimplementationplan,whichcomprisesfivekey areas of program investment and focus: (1) parenting education and support; (2) school readiness and transitions; (3) childprotection and family promotion; (4) health, nutrition and WASH; and (5) coordination,governance,resourcing,monitoringandevaluation.TheECDpolicywasofficiallyadoptedbythe Government of Rwanda in May 2016.
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3.2.FoodandNutritionPolicy(2013-2018)
TheNationalFoodandNutritionPolicydevelopedin2013buildsonseveralachievementsthathaveimprovedthestatusofnutritionandhouseholdfoodsecurityinRwanda.ThevisionoftheNationalFoodandNutritionpolicyistoensureservicesandpracticesthatbringoptimalhouseholdsecurityandnutritionforallRwandan.Thispolicyfocusesonthenationalresolvetosubstantiallyreducetheprevalenceofstuntinginchildrenundertwoyearsofage,andtoimprovehouseholdfoodsecurityparticularlyamongthemostvulnerablefamilies.Substantialreductionofacutemalnutritionhasoccurred inrecentyears,however,problemswithhighlevelsof chronicmalnutritionandmicronutrientdeficiency stillexist.Thepolicy recognizesthat,whenpregnantwomendonothaveappropriatenutritionalintakeduringpregnancy,andchildrendonotreceivethefoods,feedingandcarerequiredfornormalgrowthduringtheirfirsttwoyears’chronicmalnutritionoccurs.Thepolicyalsooutlineskeyeventsandinformationsources that influenced the dramatic rise of nutrition and household food security on thenationalagenda,notablyJointActionPlantoEliminateMalnutrition(JAPEM)atcentrallevelandDistrictPlanstoEliminateMalnutrition(DPEM)atlocallevel.
3.3.NationalHealthPromotionPolicy
TheNationalHealthPromotionPolicy(NHPP)wasdevelopedtopromotediseaseprevention,empower communities to translate health information into desired action, and encouragecommunityparticipationandownershipofhealthpromotionrelatedactivities.TheNationalHealthPromotionpolicyplays a very important role in influencingbehavior changeofourpopulationtherebyenhancingtheadoptionofpositivelifestylesbyindividuals,familiesandcommunitiestopromotetheirhealth.However,behaviorchange isacomplexprocessthatcouldtakealongtimetoberealizedeffectively.Therefore,itrequirestheprovisionofadequateresourcesonasustainedbasisand foranextendedperiodoftime inorder toachieve thedesired impact countrywide. TheHealth Promotion Policy has been developed taking intoconsiderationtheHSSPIII,vision2020,EDPRSIIandtheWHOrecommendationstomembercountriesontheneedforformalpoliciesonhealthpromotion.TheNHPPprovidesanoverallframeworkforhealthpromotiondevelopmentandpracticesinRwanda,ithighlightsthefactthatdeterminantsofhealthofthepopulationgobeyondhealthservicesandcallsformulti-sectorpartnershipapproachesasthewayforwardtoattainingeffectivehealthpromotion.
3.4.RwandaHealthSectorStrategicPlanIV(2018-2024)
This National SBCC Strategy is guided by HSSP IV priorities for health programwhich arecommunity education and awareness on dietary and complementary feeding practices;establishmentandusingECDasanentrypointinprovisionofhealthinterventions(specificallyearlychildhooddevelopment,nutritionandWASHservices);preventionandmanagementofmalnutrition(acuteandchronic)andimprovementofmulti-sectoralcollaboration.
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3.5.NationalStrategyforTransformation(2017-2024)
NationalStrategyforTransformation(NST1)isbuiltonthreepillars:EconomicTransformation,SocialTransformation,andTransformativeGovernance.TheEconomicTransformationpillaraimstoaccelerateinclusiveeconomicgrowthanddevelopmentfoundedontheprivatesector,knowledgeandRwanda’snaturalresources.TheSocialTransformationpillaraimstodevelopRwandansintoacapableandskilledpeoplewithqualitystandardsoflivingandastableandsecuresociety.TheaimofTransformationGovernancepillaristoconsolidategoodgovernanceandjusticeasbuildingblocksforequitableandsustainablenationaldevelopment.TheNST1alsoembracestheSDGs,andAfricaUnionAgenda2063.
3.6.SanitationPolicy(2016)
Sanitationplaysavitalroleinpreventivehealthcareandqualityoflife.Forthatreason,theGovernment of Rwanda has made provision of sustainable sanitation services one of thepriorities of theNational Development Agenda and is establishing supportive policies andlegislation.TheMinistryofInfrastructurehasdevelopedtheNationalSanitationPolicytoensureproperimplementationofactivitiesinthesanitationsub-sector.ThePolicyoutlinesinitiativestoovercomechallengesandexploitexistingopportunitiesinanintegratedmannerandwilleffectivelycontributetowardsachievingthegoalsoftheNationalDevelopmentAgenda.TheGovernmentofRwandawillensureexpandedaccesstosafeandsustainablesanitationservicesthrough a number of means including: establishing District sanitation centers providing awide rangeof sanitation technologies; improvingoperationandmaintenanceof sanitationfacilities;andassistingDistrictsandtheCityofKigalitoplananddesignprojectstomitigateurbanstormwaterissues.TheGovernmentofRwandaisalsoencouragingactiveparticipationoflocalprivateserviceprovidersandoperatorsinthesanitationsub-sectorandwillensuretheprinciplesadvocatedbythispolicyareadheredtointhewholeprocessofsanitationservicesprovision. The Government further strongly recognizes the initiatives of the internationaland regional communities andwill continue to cooperate to achieve the 2030 SustainableDevelopment Goals.
3.7. Environmental Health Policy (2008)
AccordingtotheEnvironmentalHealthPolicy,themaincontributingfactorstoenvironmentalhealthrelateddiseasesinRwandaareinadequateandunsanitaryfacilitiesforexcretadisposal,poormanagementofliquidandsolidwastes,andinadequatepracticesofhandwashingwithsoap that leads to contaminationof foodandwater inboth rural andurbanareas. This ismainly due to a population, which lacks awareness, inadequate participatory hygieneeducation and environmental health promotion approaches in school and communities aswellasuncoordinateddeliveryofeffectiveenvironmentalhealthservices.Thenegativestateofenvironmentalhealthconditionsinfluencesthediseaseburdenwhich,inturn,contributestopoverty.Thechildren,theelderlyandtheimmuno-compromisedindividualsgetsickmorefrequentlyandmoreresourcesarespentoncurativeservicestorestoretheirstateofhealth,thus increasing poverty at household and community levels.
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3.8. Maternal, Neonatal and Child Health National Strategy (2013-2018)
The2013-2018Maternal,NeonatalandChildHealthNationalStrategy(MNCH)outlinestheroleofnutrition,particularlyduringpregnancy,lactating,andearlychildhoodtoeliminateallformsofmalnutrition ineveryRwandan family through implementationof the jointactionplan initiated for 2012 and strengthening of themulti-sectoral approach. It also highlightsthatmaternalundernutritionisoftenreflectedintheproportionofchildrenwithlowbirthweight(below2.5kilograms)andpregnantwomenareparticularlyvulnerabletoanemiadueto increased requirements for ironand folicacid.According toRDHS (2010),17percentofwomenaged15-49yearswerefoundtobeanemic,buttheoverallprevalenceofanemiahasdecreasedby8percentsinceRDHS2005.Maternalunderweightstatuscontributestopoormaternalhealthandbirthoutcomes.
3.9.DisabilityMainstreamingGuidelines(2014)
Rwanda has endorsed many legal instruments, 13 ministerial orders, Sector policy andstrategicplanstoconsiderthatalltypesofdisabilities,includingphysical,intellectual,visualandhearingimpairmentsareconsideredineveryareaoflife.Intermsofinternationallegalandpolicyframeworks,UNCRPDwasratifiedandEasternAfricanDisabilitypolicyendorsed.Domestication of these and political intent framed with: Rwandan constitution, law ondisability,Ministerialorders,EDPRSI,II,policyframeworksandMinistrysectorstrategicplans.IntheEDPRSIIdocument,disabilityisconsideredasacrosscuttingissuetotakeintoaccountinallpragmaticareas,anditismentionedthat“Rwandadoesnotintendtoleaveanyofitscitizensbehindinthedevelopment.Assuch,specificstepswillbetakentoensurethatpeoplewithdisabilities(PWDs)andotherdisadvantagedgroupsareabletocontributeactivelytothecounty’sdevelopmentandtobenefitfromit.”Theguidelinesconstituteasastepforwardforvariousactors,as itproposespracticalstepsofmainstreamingdisability invariousareasoflifemainlyineducationandhealthwithemphasisonearlychildhooddevelopment.(NationalCouncilofPersonswithDisabilities,Kigali,May2014).
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4. SITUATIONAL ANALYSIS AND PROBLEM STATEMENT
4.1.Stunting
Stunting is a complex form ofmalnutrition. Although therewas a remarkable progress inreducingstunting(from44percentin2010to38percentin2015accordingtoDHS),Rwandaaimstoreduceitto15%by2024.Stuntingisknowntocompromiseoptimalbraindevelopmentandhasadirectimpactonachild’sdevelopment.
Stuntingcanbecausedfirstbynutritionalfactors,includingmother’snutritionstatus(oftenresulting inchildrenbeingbornwitha low-birthweight), lackofappropriatebreastfeedingandpooryoung-childfeedingpractices.ThebreastfeedingrateishighinRwanda(99percentamongchildrenduringtheirfirstyearoflife),butonly56percentofchildrenaged6-8monthsreceivecomplementaryfoods.Thispartlyexplainsthehighrateofstuntingandofanemia(37percent)amongchildrenaged6-59months.Alongsidenutrition,hygieneiscriticalinpreventinginfectiousdiseasesthatexacerbatestunting.Stuntingislinkedtofrequentepisodesofdiarrheaamongchildrenunderfiveyears,whoseprevalenceisRwandais12percent.Childreninruralareasaremoreaffectedbydiarrhea (13percent in ruralareas, compared to10percent inurbanareas).Oncethechildgetsinfectiousdisease,itisimportanttoseekhealthcarebeforethechildhealthisfurtherundermined.However,theDHSshowsthatoutofthe19percentofchildrenwhohadfever,only62percentofparents/caregiverssoughtadviceortreatmentfromcommunity health workers or health providers.
Inthefollowingsection,furtherdetailsofthedatarelatedtoECD,health,nutritionandWASHwillbepresentedtounpackthedeterminantsofstunting.
4.2.Rwanda-EarlyChildrenDevelopment(ECD)figures
4.2.1 Child development
Overall,63percentofchildrenaged36-59monthsaredevelopmentallyontrackinliteracy-numeracy,physical, social-emotional,and learningdomains.Urbanchildrenaremore likelythan rural children to be developmentally on track (67 percent versus 62 percent). Beingdevelopmentallyontrackispositivelyassociatedwithmothers’education(59percentamongchildrenwhosemothers have no education compared to 69 percent among thosewhosemothershavereachedsecondaryeducationorhigher).Thereisalsoadisparityaccordingtofamily income-levelwith67-68percentof children founddevelopmentallyon trackamongtheuppertwowealthquintilesandonly59-63percentamongthelowestthreequintiles.Keyfactorshinderingthechilddevelopmentaredescribedbelow.4.2.2.Earlychildhoodeducationandorganizedcare
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AlthoughRwandahasahighrateofprimaryschoolattendance,veryfewchildrenbelowtheageofsixyearshaveanopportunityforearlylearning.Only13percentofchildrenaged36-59monthsattendanorganizedECDprogram;childrenlivinginurbanareasaremuchmorelikelytoattendthanchildrenlivinginruralareas(37percentand9percent,respectively).
Significantcorrelationsareobservedbymothers’educationandhouseholdwealthquintile.Only 4 percent of children whose mothers have no education attend an ECD program,comparedwith49percentofchildrenwhosemothershaveasecondaryeducationorhigher.TheKnowledge,AttitudeandPractices(KAP)surveylookedintothereasonsfornotbringingchildrentoorganizedcarefacilities.Forthemajoritywhodonottaketheirchildrentoorganizedchildcarecenters,themainreasonsprovidedareprotectionforthechildren,becauseparentsfeel they are too young tobeout of the family setting (16%), a preference for having thechildren at home (12%) or fear that children might get sick (5%). Some parents also felt that thechildcarecentersareexpensive(14%),whileothersdidnotknowwherethecenterswerelocated (14%).
The main problem hindering access to organized care is the supply issue - availability ofsafe andnurturing space for children.With the aimof increasing thequantity andqualityofservices,MIGEPROFismappingallECDinterventionsacrossthecountry.TheinformationgeneratedwillprovideaninsightonthescopeandreachofRwanda’sECDservicesandtheactors/stakeholdersinvolved.Itwillalsogiveinformationonthequalityofservicescurrentlyprovided and highlight any gaps in service-provision. The mapping will help to improveequitablescale-upofECDservices,startingfromareaswiththehighestneed.Youngchildrenspendthemajorityoftheirtimeathomesothehomeenvironmentmatters.Accesstobooksandotherlearning-playmaterialsisverylow:only1percentofchildrenhadoneormorechild-friendlybook,and30percentofchildrenhadaccesstoplaymaterials.
4.2.3.Childrenwithdisabilities
According toRwanda’s2012Census, therewere15,831childrenaged3-6withdisabilities.However, according to the 2014 Education Statistical Yearbook, only 1,387 children withdisabilitieswereattendingpre-primaryschool.Thismeansonly9percentofthesechildrenareattendingpre-primaryschool,whichissignificantlylowerthanthenationalaverageof13percent.Thisgapindicatesthatmanychildrenwithdisabilitiesarestayingathomewithoutaccesstoorganizedcare.Effortsarethereforeneededtosupportchildrenwithdisabilitiesandtheirfamiliesbyremovingphysicalandsocialbarrierswhileincreasinginnovativeandinclusivecare knowledge amongst parents and caregivers.
4.2.4.Adultinvolvementinearlylearningandstimulation
Age-appropriate,responsivecareandstimulationsupportstherapidbraindevelopmentthatoccursinthefirstthreeyearsoflife.However,theRwandaDHSreportedthatonly49percentofyoungchildrenengagedwithanadulthouseholdmember infourormoreactivitiesthatpromotelearningandschoolreadinessduringthethreedaysbeforethesurvey.Amongthose
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children,only3percentengagedinfourormorelearningactivitieswiththeirbiologicalfathers,and12percentwiththeirmothers,indicatingverylowparentalengagement,especiallywithfathers.Parent-childinteractionincreaseswithincreasingwealthquintileandtheeducation-level of parents, especially mothers. The KAP Survey indicated that parents do not haveaccurateknowledgeofwhenchildrenstarthearing,seeingandlearning.Also,parentsdonotfullyunderstandwhatspecificformsofinteractionhelpinthedevelopmentoftheirchildrenatdifferentstagesofearlychildhood.
4.2.5. Role of Father
TheKAPsurveylookedintoattitudestowardsfatherhood.Theopinionsofcaregivers,inrelationtotheimportanceofthefather’sroleinthedevelopmentoftheirchild,wereinvestigatedindepth.Thefindingsshowthatthemostimportantroleofthefatherwithregardtochildrenaged0-2yearsisseenas‘showingloveandaffectiontothechildandplayingwithhim/her(92percent). This is closely followedby ‘providing forday-to-daynecessities’ (91percent).Forchildrenaged2-6years,however, themost importantroleof the father is foundtobe‘discipliningthechild’(91percent),closelyfollowedby‘providingthethingsthe child needs’ (89 percent). The breadwinning role is seen as being of central importance, and the roleof fathers is also particularly highlighted in relation to discipline. Key informant interviewswith fathers indicatedthatsocialnorms ingenderroleshaveanegative impactonfathers’participationinparenting. 4.2.6. Adequate care for young children to protect from harm
The Rwanda DHSmeasured the incidence of children under five left alone or with otherchildren.Childrenleftaloneareexposedtomanyrisksincludingaccidents,abuseandneglect.Thirty-fivepercentof childrenunderfive yearswere left aloneor left in the careof otherchildrenbelow10yearsduringtheweekprecedingtheinterview.Withregardstodiscipline,nearlyhalfofthoseinterviewedfortheKAPsurveyexpressedabeliefthatchildrenneedtobephysicallypunishedtogrowupwell.Ontheotherhand,50percentagreedwiththestatementthat ‘beating children may negatively affect self-confidence, including encouraging them to beat others’.Tounderstandtheseseeminglycontradictingviews,attitudestowardsdisciplinewereexploredinfocusgroupdiscussions.Parentsandcaregiversarenotinfavorofphysicalpunishmentand themajority showedpreference for talking tochildrenandadvising themontherightthingtodo.Thisopinionissharedbymaleandfemalecaregivers,aswellasbycommunityhealthworkers.AtthesametimetheKAPassessmentfindsthepracticeofphysicalmethodsofdiscipliningchildrentobecommon.Sixty-threepercentofcaregiversslaptheirchildrenaged4-6,forexample.Itisalsoevidentfromthefindingsthatpunishmentbecomesmoreabusiveaschildrengrow.
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4.3.AdultHealthandNutrition
4.3.1. Antenatal, Postnatal, and Delivery Care Services
Antenatal(ANC),postnatal(PNC),anddeliverycare(DC)servicesinRwandaarecloselylinkedtomaternal,child,andreproductivehealthoutcomes,whichmaketheserelevanttothiscurrentstrategy.Accordingtothe2015RDHS,99%ofwomenwithalivebirthsince2010receivedatleastoneantenatalcareservicefromaskilledhealthprovider,and44%ofwomenattendedthe recommended fourANCvisits during their pregnancy (RDHS2015). ThepercentageofwomenattendingfourANCvisitshasincreased9%since2010(35%).OtherkeyfindingsfromRDHS2014-2015include:91%oflivebirthssince2009-2010weredeliveredinahealthfacility;91%of livebirthswereassistedbyaskilledhealthprovider;and43%ofwomenwhogavebirthin2012or2013receivedapostnatalcarecheckupinthefirsttwodaysafterdelivery.ThestudyalsorevealedsomechallengesinANCandPNC,notablythatonly19%ofnewbornsin2012and2013receivedapostnatalcheckupwithinthefirsttwodaysafterbirth.Amongthesenewbornswhoreceivedpostnatalcheckups,nearlyallreceivedcarefromskilledpersonnel.Additionally,accesstohealthcarecontinuestobeabarrierformostRwandanwomen:59%reportedatleastoneprobleminaccessinghealthcare(RDHS2015).Themainbarriertoaccesswasfoundtobefinancial,althoughdistancetoahealthcarefacility,andsafety issueswerefrequentlycitedbywomenasseriousfactorsinthemaccessinghealthcare.Generally,thesebarriersareheightenedamongwomenlivinginruralareas.
4.3.2. Maternal Micronutrient Intake:
Adequatemicronutrient intake by pregnant women has important health implications forbothwomenandtheirchildren.Breastfeedingprovideschildrenwithcriticalmicronutrients,especiallyvitaminA.Ironsupplementationofwomenduringpregnancyprotectsthemotherandinfantfromanemia,whichisknowntoincreasetherisksofprematuredeliveryandlow-birthweight(Allen,2000).AnemiaprevalenceamongRwandanwomenisrelativelylow(19%)andincludesalmostnocasesofsevereanemia(DHS2015).Nevertheless,it isimportanttoensurepregnantwomenarereceivingmicronutrients,sothemothersandtheirchildrendonotbecomeanemic.Acommonapproachtoimprovingmicronutrientintakeamongmothersin Rwanda is to provide them with iron and folic acid supplements during pregnancy and vitaminA inthepostpartumperiod.RDHS2014-2015foundthat49%ofwomenwhogavebirthbetween2009-2010receivedvitaminAsupplements(RDHS2015).Approximately80%ofwomenreportedtakingironsupplementsduringpregnancy,althoughmostofthesecases(68%) took supplements for 60 days or less.
4.3.3. Overweight and underweight:
AccordingtoDHS2015,theproportionofoverweightwomenstandsat17%and4%ofwomenare considered to be obese. The proportion of overweight or obese women is positivelycorrelated towomen’s age, increasing from14%amongwomen age 15-19 to 26%among
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womenage30-39beforedecliningto23%amongwomenage40-49.Urbanwomenaretwiceaslikelytobeoverweightorobese(37%)asruralwomen(17%).6%ofmenareoverweightandlessthan1%areobese.Generally,obesityinwomenismorethanninetimeshigherthanmen. Overall 13% ofmen age 15-49 are underweight and about twice the percentage ofunderweight women (7%).
4.4.ChildHealthandNutrition
While overall nutrition outcomes in Rwanda have improved in the past decade, chronicmalnutritionamongchildrencontinuestobeapublichealthconcernthatwarrants furtherintervention.AccordingtoRDHS2015,theprevalenceofchronicmalnutrition(stunting)amongchildren under 5 has steadily improved – falling from a prevalence of 51% in 2005 to 44% in 2010,andto38%in2015(RDHS2015).StuntingisalsohigheramongruralhouseholdsandintheWesternProvince(45%)(RDHS2015).Acutemalnutrition(wasting)hasdeclinedfrom5%to 2%overthesameperiod,andtheproportionofchildrenunder5whoareunderweighthasdecreasedfrom18%in2005to9%in2014-15(RDHS2015).
These improvements may be partly attributable to Rwanda’s National Plan to Eliminate Malnutritionwhich,since2009,hasincludedactivenutritionscreeningofchildrenbycommunityhealthworkers(CHWs).Childrenwhoaredeterminedtobeatriskofacutemalnutritionarereferredtoahealthfacility forappropriatetreatmentusingtherapeuticmilks,ready-to-usetherapeutic food, anda corn-soyblend.Otherapproacheshavebeen initiated, includinganational infant and young child feeding program, community-based nutrition programs,behaviorchangecommunicationefforts includingmassmedia,andhome food fortificationusing micronutrient powders.
AlthoughmuchlesssignificantthanwastingorstuntinginRwanda,thenumbersofoverweightandobesechildrenisincreasingamongchildrenunder5yearsofage.Overall,8%ofchildrenunder5areoverweightorobese(weight-for-heightmorethan+2SD)(RDHS2015).Thereisasignificantdifferenceinprevalenceofbeingoverweight/obesebyareaofresidence:11%inurbanareasand7%inruralareas(RDHS2015).Thus,thereremainsaneedformoreintensiveandcomprehensiveinterventionsacrossmanysectors.
4.4.1. Initiation of Breastfeeding
TheWorldHealthOrganization(WHO)recommendstheprovisionofthemother’sbreastmilktoinfantswithinonehourofbirth(WHO,2016).Thefirstbreastmilkproducedbythemothercontainscolostrum,which ishighlynutritiousandhasantibodiesthatprotectthenewbornfromdiseases.Earlyinitiationofbreastfeedingalsofostersbondingbetweenthemotherandchild.InRwanda,81%ofchildrenarebreastfedwithinonehourofbirth,a10%increasefrom2010figures(RDHS2015).Ninety-six-percentofchildrenarebreastfedwithinonedayofbirth,andapproximately5%ofchildrenreceiveaprelacteal feed,which issomethingotherthanbreastmilkduringthefirstthreedaysoflife.
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4.4.2. Exclusive Breastfeeding and Complementary Feeding
Exclusivebreastfeedingduring thefirst sixmonths iswidelypracticed inRwanda–87%ofchildrenareexclusivelybreastfedfortheirfirst6monthsoflife(RDHS2015).However,thereisstillaneedtoconveytheimportanceofexclusivebreastfeedingfortheentirefirst6months:94%ofinfantsaged0-1monthwereexclusivelybreastfed,butthisfiguredropsto90%amongthoseaged2-3monthsand81%amongthoseaged4-5months(RDHS2015).After6months,breastmilkaloneisnolongersufficienttomaintainachild’soptimalgrowth.Forthisreason,UNICEFandWHOrecommend the introductionof solid food to infantsatapproximately6monthsofage(PAHO/WHO,2003).After6months,addingcomplementaryfoods,includingproteinandvegetables,toachild’sdietensuresthechildisreceivingallheorsheneedstogrow properly.
AccordingtoRDFS, thestuntingrate increasesaround6months,aftertheweaningperiod,andRwandaneedstosignificantlyimproveinthisarea.RDHS2015showsthatonly17%ofbreastfeeding children aged6-23months consumemeatorfish; 4%of children aged6-23monthsconsumeeggsinadditiontobreastfeeding;andonly1%ofchildreninthisagegroupconsumed cheese, yogurt, or other dairy products in the 24 hours preceding the survey.Overall,itwasfoundthat89%ofchildrenaged6-23monthsconsumedsolidorsemisolidfoodduringthedayornightprecedingthesurvey.Most“solidorsemisolidfood”referstofruit,vegetables,andlegumes.Furthermore,CFSVA2015indicatedthatforchildrenaged6to23months, themostcommonfood itemsconsumedbychildren in thisagegroupcomefromthefollowingfoodgroups:grains,rootsandtubers;vitaminArichfruitsandvegetables;andlegumesandnuts.About32percentofchildrenarereachingtheminimummealfrequency(For breastfed children, twice for 6–8-months old and three times for 9–23 months. For non-breastfed children, four times for 6– 23-months old)while29percentareobtainingminimumdietary diversity (four or more food items out of seven food groups).
4.4.3. Infant and Young Child Feeding Practices WHOandUNICEFrecommendthefollowinginfantandyoungchildfeedingpractices(IYCF):early initiationofbreastfeedingwithin1hourofbirth;exclusivebreastfeeding for thefirst6monthsoflife;andintroductionofnutritionally-adequateandsafecomplementary(solid)foodsat6months togetherwith continuedbreastfeedingup to2 yearsof ageorbeyond.Introducing solid and semisolid foods at 6 months is known as complementary feeding and is a time when a sharp increase in stunting and underweight is seen (RDHS 2015).Childrenwhocontinueexclusivebreastfeedinglongerthan6monthsandthosewhoarefedinadequate amounts of food or a lack of variety of foods are at the highest risk for developing malnutrition.ChallengesregardingIYCFpracticesinRwandashowthatonly18%ofchildrenaged 6-23months are currently fed in accordance to all 3 recommended practices (RDHS2015).TheMinimalAcceptableDiet(MAD),acompositeofbothMinimumMealFrequency
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andMinimal Dietary Diversity shows that overall, in children 6-23months, a gain of only1% improvement in this indicatorwas seen over a 5-year period of time from 2010-2015(RwandaStakeholder&ActionMapping2015).Adherencetoappropriate feedingpracticesarelinkedtoindicatorsofgeography—childreninurbanhouseholdsaremorelikelytobefedinaccordancewiththerecommendedIYCFpractices—andhouseholdincomeandeducationlevelarefactorsassociatedwithpracticingtheIYCFrecommendations.IYCFhasmademanypositivecontributionstowarddecreasingmalnutrition,anditneedstocontinuetoimprove,particularlyattimesofcomplementaryfeeding,whentheincreaseinratesofmalnutritioncanbeseen.
4.4.4. Diarrheal Disease and Treatment of Diarrhea
Diarrheal diseases constitute one of the main causes of death among young children indevelopingcountriesastheyareassociatedwithdehydrationandmalnutrition.Tocombattheeffectsofdehydration,WHOrecommendstheuseoforalrehydrationtherapy(ORT),whichincludesapreparedsolutionoforalrehydrationsalts(ORS)madefrompacketsorasolutionprepared at homeusing cleanwater, sugar, and salt (recommended homefluids, or RHF).According toRDHS2015, theprevalenceofdiarrhea is especiallyhighamongchildrenage12-23monthsand6-11months(22%and18%,respectively).Diarrheaprevalencevariesbyprovince,fromalowof8percentinCityofKigalitoahighof15percentinWest.RegardingtreatmentofDiarrhea,RDHS2015showedthat44percentofchildrenwithdiarrheaseektheadvice or treatment from a health facility or provider.
4.4.5. Feeding Practices during Diarrhea
Tominimizetheadverseconsequencesofdiarrheaforthechild’snutritionalstatus,mothersandcaregiversareencouragedtocontinuefeedingchildrennormallywhentheysufferfromdiarrhealillnessesandtoincreasethefluidsthatchildrenreceive.Thesepracticeshelpalsotoreducetheriskofdehydrationamongdiarrheicchildren.Accordingto(RDHS2015),only20percentofchildrenwithdiarrheaweregivenORTorincreasedfluidsandalsogiventhesame,more,orslightlylesstoeatthanusual.
4.4.6. Vaccinations and Micronutrient Intake
Accordingtothe2014/15DHS93%ofchildrenreceivedall8basicvaccinations,upfrom75%in2005.ThisincludesvaccineagainstRotavirus,whichisthemostcommoncauseofdiarrhealdisease among infants and young children.Inaddition,86%receivedavitaminAsupplement,80%receiveddewormingmedicationinthe6monthspriortothesurveyandalmost100%percent(99.7%)livedinahouseholdwithiodizedsalts.InaKAPsurveydonebyUNICEFin2012itwasfoundthat78%hadknowledgeaboutvaccinatingachildagainstapreventablediseaseand38%hadknowledgeaboutVitaminAsupplements.FromthisitwasinferredthatalthoughpeoplemaynotknowthefullimportanceofvaccinationsandVitaminAsupplementstheyvaccinatedtheirchildrenandgavethemVitaminAsupplements,anexampleofapositivehealthy social norm.
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4.5.Water,SanitationandHygiene(WASH)
4.5.1. Household Drinking Water
Currently,73%ofRwandanhouseholdshaveaccesstoan“improved”sourceofdrinkingwater(RDHS,2015),withprotectedsprings(32%)andpublictaps(27%)arethemostcommonsourcesof improved drinking water. The remaining (27%) households reported using unimprovedsourcesofwater,andonly10%ofhouseholdsinRwandahaverunningwaterintheirhome(RDH 2015). Fourteen percent of households reported using an unprotected spring as their primarywatersource.Bynothavingaccesstoorusingimprovedwatersources,householdsare at a higher risk of contracting diarrhea and other waterborne diseases compared topeopleusinganimprovedsourceortreatingtheirwaterbeforeconsumption.Further,thoseusingan improvedsourcemaystillbedrinkingcontaminatedwater,althoughdataonfecalcontaminationinwaterisunknownforruralareasinRwanda.Diarrhealdiseasesarelinkedtomalnutrition,especially inchildrenunder5yearsold. Ifahousehold isunabletosecurewater from an improved source, then treatment prior to consumption is recommended.Further,RDHS2015highlightedthatchildren inhouseholdswithsharedandnon-improvedtoiletfacilitiesaremorelikelytohavehaddiarrheathanthosewholiveinhouseholdswithimproved,notsharedtoilets.
There is anapparent associationbetweendiarrheaprevalenceandhouseholdwealth. Theprevalencevariesfromahighof15percentamongchildreninthelowestquintiletoalowof8percentamongchildreninthehighestquintile. InRwanda,44percentofhouseholdsuseanappropriatetreatmentmethodpriortodrinking,whiletheremaining56%do not take any measuretotreattheirwaterpriortodrinking(RDHS,2015p.21).Themostcommonmethodtotreatwaterpriortodrinkingisboiling(38%),followedbyaddingbleach/chlorinetountreatedwater(5%).Usingceramic/sandoranotherfiltertodistilluntreatedwaterwasalsoreportedasatreatmentmethodby4%oftheRDHSstudypopulation.Theissueofsecuringsafedrinkingwateralsoappearstobeinfluencedbygeography.Mosturbanhouseholds(91%)werefoundtohaveaccesstosafedrinkingwater,whileaccesstosafedrinkingwaterisconsiderablylessamong rural households (69%). It is not surprising then that Rwandans living in rural areas aremorelikelytodrinkuntreatedwater(60%)thantheirurbancounterparts(33%).Securingaccesstosafedrinkingwateriscriticaltoimprovingthehealthandwell-beingofallRwandans.
4.5.2. Household Sanitation Facilities and Practices
Asecuresanitationfacility(e.g.acoveredtoilet)inthehouseholdisvitaltoreducetheriskofexposuretodangerouspathogensanddiseases.Diarrhealdiseasesarethedeadliestandmostcommontypesofillnesswhicharecausedbyalackofadequatesanitationfacilities(Duncanet.al.,2010).Approximately10%oftheglobaldiseaseburdenhasbeenattributedtoalackofadequatesanitationfacilities,resultinginover2milliondeathsperyearglobally(Prüss-ÜstünAet.al.,2008).HouseholdaccesstoadequatesanitationfacilitiescontinuestobeanareainneedofimprovementinRwanda.RDHS2015foundthat54percentofhouseholdsnationally
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haveaccesstoanimproved,unsharedtoiletfacility.Fifty-sevenpercentofhouseholdsinruralareasreportedaccess,comparedto42%accessibilityinurbanareas(RDHS2015,p.21).
AlmostallhouseholdsinRwanda(99%)lacktoiletsthatflushtoapipedsewersystem.Twenty-sevenpercentofruralhouseholdsand11%ofurbanhouseholdsreportedusingapitlatrinewithoutaslaboran“openpit”(RDHS2015,p.22).Improvingaccesstoadequatesanitationfacilities is important intheefforttoreducetheimpactofdiarrhealdiseaseinthecountry.Promotionofroutinehandwashinginthehomeisrecommendedwidelybytheglobalhealthcommunity,asproperandroutinehandwashinghelpsdeterdeadlybacteria.Indeed,practicingrecommendedhandwashingreducestheriskofcontractingdiarrhealdiseases(UNICEF,2016).AccordingtoRDHS2015,thisisanotherareainneedofconsiderableimprovement:only12%ofhouseholdsnationallyhadaplaceforhandwashing.Amongthose,lessthanhalf(37%)hadwaterandsoapinthehouse.Surveyfindingsagainrevealanurban/ruraldisparityinaccesstosanitationfacilities–20%ofurbanhouseholdsdedicatedaspaceforhandwashing,comparedto 10% of households in rural areas. Pregnant women and children under 5 years old are especiallyvulnerabletosufferfromdiarrhealdiseases.
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5. PRIORITY BEHAVIOR TO ADDRESSBased on the data and findings above, the followingmeasures should be given priority incommunicationactivities.
5.1.Keynegativebehaviorsandbehaviorstopromote
Key negative behaviors /Barriers Behavior to promote
Early childhood education and organized care
Limited access to adequate programs and facilities that benefit early stimulation and learning
- Increase awareness of the government officials and local leaders on the importance of budgeting to increase the number of ECD centers and community based ECD that meets the minimum standard.
- Involve religious leaders, civil society organizations, community-based organizations, and private sector in scaling up the number of community-based ECD facilities.
- Engage media to promote educational programs for young children and parents.1
Adult involvement in early learning and stimulation
- Insufficient awareness around ECD, particularly among parents and caregivers.
- Parent and caregivers lacks knowledge on child development and age-appropriate methods of stimulation to help child development.
- Misunderstanding that children’s growth between 0-6 years is mainly about the physical development. There is limited understanding of “brain development” in Rwandan context that makes children smarter.2
- Limited male engagement. Conventional gender role is translated into the social norm against fathers’ involvement in child care practices.
- Poor couple communication in household decision-making, which involves cultural and social, gender norms and misconceptions
- Increase awareness among parents and community about the benefit of ECD, including importance of early stimulation and brain development.
- Educate parents on age-appropriate stimulation according to the stages of child development. This includes promoting low-cost home activities such as storytelling, singing and playing with household objects.
- Encourage private sector, local cooperatives and community members to produce affordable toys for children.
- Promote communication between the couples in the household decision-making. Promote gender equality in the child care practices. Knowledge and practice should be shared by both fathers and mothers.
- Promote the nurturing role of fathers, which would require social change for the community to embrace equal participation of both mothers and fathers in childcare.
1. A first attempt has been spearheaded by MIGEPROF and the Rwanda Broadcasting Agency with UNICEF support in the form of a week-ly show called Itetero, which brings age-appropriate stimulation to children and educates parents on parenting skills.
2. Qualitative findings from a field survey confirmed during the ECD technical working group.
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Adequate care for young children to protect from harm
- Insufficient awareness about the risk of leaving child home alone or in the care of another child.
- Lack of alternative service/care when parents need to go to work and leave the child.
- Corporal punishment is common.
- Raise awareness among parents on the importance of child safety and protection from harm.
- Promote services such as mobile crèche and community-based solutions such as community-based ECD and home-based ECD to provide alternative child care.
- Promote positive parenting skills and address the social norms around corporal punishment.
- Children with disabilities and children with special needs (including those with HIV) face stigma and discrimination and experience social exclusion.
- Raise awareness in the community about disabilities and social inclusion (psychological and social barrier).
- Promote removal of physical barriers to increase access to social services and social activities.
- Promote disability mainstreaming in every activity.
- Advocate for the inclusion of early detection of disabilities as part of pediatric check-up.
Stunting
Adult nutrition
- Women of reproductive age, including pregnant and lactating women and adolescent girls, are not getting minimum meal frequency and dietary diversity.
- There is misconception about food taboos (e.g. girls and pregnant women should not eat eggs, vegetables are for poor people).
- Increased consumption of energy-dense foods high in saturated fats and sugars, and reduced physical activity which cause overweight and obesity.
- Increase awareness that women of reproductive age, particularly pregnant and lactating women should eat meals four times each day that contain foods from at least four food groups out of seven food groups (demand).
- Address taboos related to food and promote correct knowledge.
- Address food insecurity and rising price of nutritious food (access and resilience).
- Promote reduced consumption of energy-dense food high in saturated fats and sugars, and increase physical activities among those who are obese.
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Infant and Young Child Nutrition
- Poor infant and young child feeding practices. Minimum dietary diversity and frequency is not met, adequate amount of food and consistency are not met, and responsive feeding is not practiced;
- Non-exclusive breastfeeding (giving water with sugar to the newly born baby and water or other liquids/foods to infants under six months.)
- Delayed initiation and diluted complementary feeding to young children starting from 6 months.
- Poor hygiene and sanitation practices such as poor handwashing practices at critical times; feeding the child without washing hands with soap; drinking unsafe water and storage; not using an improved latrine and poor disposal of children’s feces; unclean household environment.
- Poor food safety practices, such as not washing food before eating, which causes infection from a foodborne illness.
- Not continuing feeding during diarrheal disease among young children.
- Limited capacity of getting food among poor families
- Issue of pregnancy and birth spacing which as one of the causes of children malnutrition
- Promote good infant and young child feeding practices with a focus on quality of food as opposed to only the quantity of food; address resource allocation and prioritize nutritious food for children.
- Promote optimal breastfeeding and early initiation of breastfeeding (within 30 min after delivery) and emphasis on colostrum.
- Encourage adequate and timely complementary feeding to young children between 6 and 23 months.
- Educate about minimum meal frequency3; Minimum dietary diversity4; adequate amount of food and consistency, active/responsive feeding, exclusive breastfeeding (not giving any other foods or liquids to infants besides breastmilk in the first 6 months of life).
- Promote hand-washing with soap and water at four critical times5; always treating water prior to drinking, use an improved latrine and properly dispose children’s feces.
- Promote continued feeding and Oral Rehydration Treatment (ORT) during diarrheal disease among young children.
- Advocate for construction and maintenance of latrines which can be cleaned.
- Advocate for poor families to have income generated activities
- Promote family planning among Rwandan families
- Lack of appropriate knowledge on responsive child feeding
- Not feeding children who are sick
- Raise awareness to parents and caregivers to responsive child feeding practices
- Education on feeding children even when they are sick
3. Minimum meal frequency for breastfed children: twice for 6–8 months old and three times for 9–23 months; For non-breastfed children: four times for 6–23 months old.
4. Minimum dietary diversity means consumption of four or more food items out of seven food groups.
5. Critical times of handwashing are: after defecating; after cleaning a child who has defecated; before preparing meals/touching food; before eating; before feeding a child.
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Health Seeking behavior
- Poor attendance of growth monitoring and promotion sessions.
- Mothers and caregivers of children under 5 are not properly giving micronutrient powders to their children.
- Poor completion of full ANC/PNC visits.
- Delayed health seeking behaviors when the child is ill.
- Promote regular attendance to the monthly growth monitoring and promotion sessions to assess the growth of the child.
- Educate mothers and caregivers of children under 5 about the importance of complying with the instruction on how to give micronutrient powders to eligible children.
- Promote full attendance at ANC/PNC.
- Promote early care seeking in case of diarrhea, fever and respiratory infection from a health facility.
5.2.Priorityareasforcommunication
• Infant and young child feeding (IYCF):Minimummeal frequency (i.e. for breastfedchildren:twicefor6–8monthsoldandthreetimesfor9–23months;Fornon-breastfedchildren:fourtimesfor6–23monthsold);Minimumdietarydiversity(consumptionof four or more food items out of seven food groups); adequate amount of food and consistency,active/responsivefeeding.Emphasisshouldbeputontimelyintroductionofnutritiousandfrequentcomplementaryfeedingatsixmonthsofagewithoutdelay.
• Effortsareneededtopreventsicknessbypromotinghandwashingwithsoap (afterdefecating;aftercleaningachildwhohasdefecated;beforepreparingmeals/touchingfood;beforeeating;beforefeedingachild),cleanhomeenvironment(constructandmaintainlatrineswhichcanbecleanedandcovertheholetoreducetheincidenceofdiarrhealdiseasestransmittedviaflies),safehandlingandstorageoffoodandwater,andimmunization.
• Early care-seeking behaviorswhen a child is sick (diarrhea, fever, acute respiratoryinfection)andcontinuedfeedingwithORTduringdiarrhea.
• Adolescent girls, women of reproductive age, particularly pregnant and lactatingwomen,eatmealsfourtimeseachdaythatcontainfoodsfromatleastfourfooditemsoutofsevenfoodgroups.Whenpregnant,attendANCandPNCandtakeiron+folicacidsupplementation.
• Familycarepractices:monthlygrowthmonitoringtocheckwhetherthechildisgrowingwell;Ongera/shishakibondomicronutrientpowder.
• To ensure equity, communication efforts should ensure reaching parents with lowsocio-economic status and low levels of education, and children with disabilities/special needs.
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• Parentsshouldbetaughtabouttheimportanceofearlylearningandearlystimulationthatchildgrowthisnotonlyphysical,butalsobraindevelopment“togrowsmarter”.Parentaleducationshouldemphasizeresponsivecaregiving,includingadequatecareofchildren,methodofstimulationperdevelopmentstage,protectionandadequatenutrition.
• Accesstoactivitiesandprogramsthatbenefitearlystimulationand learningshouldbepromoted.Thisincludesi)promotinglow-costhomeactivitiessuchasstorytelling,singingandplayingwithhouseholdobjects.Theprivatesector,localcooperativesandcommunitymembersshouldbeencouragedtoproduceaffordabletoysforchildren;ii)promotingmediaprogramsforyoungchildrenandparents.AfirstattempthasbeenspearheadedbyMIGEPROFandtheRwandaBroadcastingAgency inaweeklyshowcalled Itetero, which brings age-appropriate stimulation to children and educatesparentsonparentingskills.Sucheffortsshouldbeamplified,andmoreeffortsshouldbemade to increase listenership; iii) promoting community-based ECD care,whichincludesexpandedpartnershipwiththereligiousnetworksothatECDservicescanbeofferedatchurchesandmosques.
• Maleengagementandhouseholddecisionmaking:There isaneed topromote thenurturingroleoffathersandcouplecommunicationforjointdecisionmaking,whichwouldrequiresocialchangeforthecommunitytoembraceequalparticipationofbothmothersandfathersinchildcare.Thisissueofgenderequalityislinkedtothewidergenderagendathataffectschildren–thatsharedresponsibilitybetweenparentswilllead tomutual respectandunderstanding, andmore cohesion in the family.Whenparents demonstrate gender equality at home, children will be liberated from thenarrowdefinitionoftraditionalgenderviewsandfeelmoreempoweredtoparticipateinsocietyandexploretheirfullpotential.
• The promotion of positive disciplining needs to be approached from social normperspective.Wheretheindividualpreferenceof“Idonotreallyenjoyhittingmychild”is over-ridden by the perceived social norm that it is parental responsibility to usephysicaldisciplinetomaintainthesocialorder,communicationeffortsshouldtakeatwo-trackapproach.Itisnecessarytofostersocialchangeinthecommunitywhileatthesametime informingparentsabout theharmfuleffectsof corporalpunishmentandteachingnon-violentdisciplineskillstopromoteindividualchange.
• Improveaccesstonutritiousfoodandmitigatetheimpactofclimatechangeonfoodinsecurity in terms of social protection measures while building resilience in thecommunities.
Whencreatingmessages topromotebehaviors like thosecitedabove,attentionshouldbegiventothespecificbarriers(forexample:genderdynamicssuchaslimitedaccesstoorcontroloverhouseholdresources;culturalnormsandsocialbeliefs,limitedskillsandknowledgeonhealth, etc.) that areholdingpeopleback fromadopting thepromotedbehavior. It is alsoimportanttoconsidertheneedsofchildrenwithdisabilitiesandchildrenwithspecialneeds.
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6. NATIONAL SBCC STRATEGY COMMUNICATION FRAMEWORK
6.1.Vision
AllchildreninRwandagrowtotheirfullpotentialandcontributetothedevelopmentofthecountry as a result of appropriate childcare practices in the family, equal access to socialservicesandsupportivecommunity.
Guiding principles
• SocialchangeshouldbenurturedtomakeECD,NutritionandWASHservicesapartofnationalculture.Progressonchildren’sholisticdevelopmentwillrequirecollaborationamongmulti-sectoralstakeholders(genderandfamilypromotion,WASH,health,socialprotection,childprotectionandeducation)forequalaccesstoqualitysocialservices,and leveraging partnerships (government, CSOs, academia, the private sector, andcommunity and religious leaders) to create anenabling environment. CollaborationbetweenministrieswillbecoordinatedasstipulatedintheECDpolicy.
• Specialfocusshouldbeplacedonbuildingtheself-confidenceofparentsorcaregiversandchildren,especiallyfordisadvantagedpersons,suchaspersonswithadisability,parents with low educational background, the poorest households and people inremote areas. The approach will be guided by the identification of what works inRwanda,basedonscientificevidenceanddocumentedgoodpractice.
• It is necessary to invest in capacity-building of various actors at different levels –household,community,serviceprovidersandgovernment.
• The communication mix will be carefully designed to engage communities andindividualsthroughmedia,socialmobilizationandinterpersonalcommunication.
• While communication often targets parents, efforts will be made to communicatedirectly to young children to form positive attitudes and behavior by using age-appropriatemessagesthroughchild-friendlymethods.
6.2.Theoreticalframework
Individualchildcarepracticeisdeeplyconnectedtosocialnorms,includinggenderroles,andtheavailabilityofsocialservicesforyoungchildrenandtheirfamilies.ThissectiondescribesandrecommendsthreetheoreticalmodelstoallstakeholderstoimprovetheECD,nutritionandWASHbestpractices.
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The socio-ecological model:DevelopedbyBronfenbrenner,socio-ecologicalmodel looksatanindividual’sdevelopmentwithinthecontextofthesystemofrelationshipsthatformhisorherenvironment.Thetheorydefinescomplex‘layers’ofenvironment,eachhavinganeffectonanindividual’sdevelopment.Thistheoryemphasizesthat,toaffectanindividual’sattitudesandbehavior,itisnecessarytoaddressthecommunityandsocialsystemsthatinfluencetheirchoices.Behavior-changemessagingtoindividualsneedstobecoupledwithcommunicationinterventionstoaddressenablingsocialnormsoncarepractices.
Figure: Visual Depiction of Ecologic Model. Source – U.S. Center for Disease Control and Prevention
SBCC strategy Theory of Change based on the socio-ecological model
ChildrenofECDagespendthemajorityoftimeathomesotheirfamily’sabilitytocareforchildren is themost important factor. Theabilityof family canbeenhancedby supportivesocialnormsandforumsinthecommunity,aswellasaccesstoqualitysocialservices,whichinturn,needstobesupportedbythenationalandlocalauthorityallocatingadequateresources.TheTheoryofChangecanthereforebesummarizedasfollows:
• IfthepolicymakersmakeECD,NutritionandWASHrelatedfamily-friendlypolicies,andnationalandlocalauthoritiesallocateadequateresourcestosupportsocialservices,communityinitiativeandfamilieswithyoungchildren;and
• If the social services (ECD, health, nutrition, WASH, child protection and socialprotection)tofamilieswithyoungchildrenprovideequalaccessandquality;and
• IfthecommunitiesandotherpartnersunderstandtheimportanceofECD,Nutritionand WASH Services and hold supported social values and norms; and
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• IfthefamiliesunderstandtheirrolesandskillsforparentingandadoptECD,NutritionandWASHgoodpractices;and
• If the children receive age-appropriate communication and interaction with familymembers;
• Thenchildrenwillachieveoptimaldevelopment.
Community Health Club (CHC) Approach
TheCHCapproachisbasedonthefamiliarPHASTmethodologyandappealstoaninnateneedforhealthknowledge,whichisthenreinforcedbypeerpressuretoconformtocommunallyacceptedstandardsofhealthandhygiene,andtherebycreatinga“CultureofHealth.” TheCHCApproachaddressesawiderangeofpreventablediseaseswithinaholisticframeworkofdevelopmentthatunderstandshealthpromotionasanentrypointintoalong-termprocessoftransformationofsocialnormsandvaluesthatultimatelyleadstopovertyreductionoutcomes.
ThestrengthoftheCHCapproachisnotonlyitsabilitytoengenderhealthandhygienebehaviorchangebutitisalsoabletoquantifybehaviorchangeusingcommunitymonitoringtoolsasanintegral part of the process of change. Each CHC is charged with monitoring the changes within initsownvillagemembership(usuallyconsistingofbetween50and150households).
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Theseobservations,knownasa“householdinventory”areconductedonaregularbasisandthe information is then entered into an exercise book, thus enabling eachCHC to identifyexactlywhentheagreedbehaviorandlifestylechangeshavebeenmadeandhousetohousevisitsamongCHCmembersisreinforcedtostrengthentheselectedtargetpractice.
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7. NATIONAL SBCC AUDIENCE ANALYSIS
Although the audience is all Rwandan, there are a number of key priority audiences. Thissectionhighlightskeycharacteristicsofthekeyaudiences.
7.1. Primary Audience:
Adolescent girls, pregnant women, lactating mothers / caregivers of children from zero to 6 years with emphasis on children under 2 years:
Mothersarenotonlybeneficiaries,butalsohaveprimaryresponsibilityforday-to-daychildcare.Manymothersofsmallchildren,whetherurbanorrural,havelowlevelsofformaleducationand income, and limitedaccess tohealth informationand services.Attimesmothersmaybelievethattheyhavelittleabilitytochangepracticesordonothavethecommunitysupporttonegotiate improvedpracticeswiththeirhusbandsand/ormothers-in-law.Mothersoftenaccesshealthandnutritioninformationthroughtheirreligiouscommunities,theirhusbands,peers,mothers-in-law,professionalhealthworkersaswellastheCHWs.
Fathers:
Theywerealso identifiedamong theprimaryaudience, togetherwithmothersof childrenfrom0to6yearswithemphasisonchildrenunder2,astheyexerciseinfluenceonthemothers’practices.Womenoftenaskmenforadvice,permission,ormoneyforhealth-relatedmattersasmenhaveextensivefinancialpowersandareoftenthekeydecisionmakersonhealthissues.
Girls and Boys aged 12-18:
They are found in primary school aswell as at the lower secondary education level. Theyareimportantmembersofsocietyastheygetreadytofulfilltheirroleasgoodcitizensandasfutureparents.Itisimportanttoequipthemwithinformationonreproductive,maternalandchildhealthandnutritionaswellastheirresponsibilityasfutureparents.Iftargetedwithempoweringinterventions,adolescentgirlsandboyscanchangetheirbehaviorandprotecttheirownhealthandthatoftheireventualchildren,aswellasserveasmodelstoimprovedhealthybehaviorsamongtheothermembersoftheirhouseholds.
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7.2. Secondary Audience
Health care providers:
Healthcareproviders includingdistricthospitalandhealthcentersstaffwhoaretrained incharge of ECD, Nutrition andWASH activities. This National Integrated SBCC Strategy willenablethemtocoordinateandimplementECD,NutritionandWASHbehaviorcommunicationactivitieseffectivelyatcommunityandhousehold levelsaimingat improving the individualbehaviors.TheSBCCimplementationplanwillbeelaboratedandintegratedineachdistricthospitalandhealthcenteractivitiesplanandbemonitoredincollaborationwithDistrictSBCCTaskforceunderDPEM.
Community Volunteers:
CommunityvolunteersincludingCommunityHealthWorkers(CHWs),ECDCaregivers,Inshutiz’Umuryango (Friendsof theFamily),MamansLumières/Parents Lumières (ModelParents),Farmer Promoters (FP) and Field Agents (FA) are trained community facilitators and recognized bytheGovernmentofRwandathroughdifferentlineministriestosensitizethecommunityonECD,Nutrition,WASH,agricultureandeconomic-relatedactivities.Livingwithincommunities,thosefacilitatorswillactasbehaviorchangechampionstoeducateandchannel integratedECD,nutritionandWASHmessagewithinthecommunity.
Grandparents and parents-in-law:
Theseareolderfamilymembers,usuallylivingwithintheextendedfamily.Theyareinfluentialandasourceofinformationonmaternalandchildcarepractices,oftenbasedontheirownexperience.Youngparentsusuallyrefertotheirgrandparentsandparents-in-lawforadvice,which they trust and follow.
7.3.Tertiaryaudience:
Community leaders, religious leaders, youth leaders, youth club members, women’s group leaders and leaders of civil society organizations, opinions leaders and decision makers:
Thesegroups arehighly influential, respectedand trustedentities in the community. Theyrepresent an extremely important channel for providing information and motivatingadolescents and parents within their community. ThisNationalIntegratedECD,NutritionandWASH SBCC Strategy willbringtogetherthesedifferententities,workingatthecommunity-level in a strategic communication planning process to identify issues, raise awareness ofprimary and secondary audience and support other community behavior change activitiesaimedatimprovinghouseholdECD,nutritionandWASHbehaviors.
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8. COMMUNICATION OBJECTIVES Themainfocusofinterventionscanbesummarizedasfollowsaccordingtothetargetaudience:
Audience 1: Children
Output 1:Childrenhaveincreasedexposuretoearlystimulationbytheirfamilies,including accesstoage-appropriatemediaprograms,books,andplayandlearningmaterials.
Communication objective 1.1: Children receive age-appropriate communication (e.g.mediaprograms,books,playandlearningmaterials).
Communication objective 1.2:Childrenreceivepreventiveandcurativecareintermsofhealth,nutritionandWASHservicestoavoidrecurringinfections.
Communication objective 1.3: Children start eating nutrition-rich and balancedcomplementaryfoodfromsixmonthofage.
Audience 2: Parents with children 0-6 years old / adolescent girls and boys
Output 2: Parents provide responsive care to young children.
Communication objective 2.1: Parents understand the importance of ECD, especiallyresponsivecareofyoungchildren(talking,interacting,readingandplaying)
Communication objective 2.2:Bothfathersandmothersparticipateequallyinchildcareandstimulation.
Communication objective 2.3:Parentspracticeappropriatehealth,nutritionandWASHpracticesforthemselvesandfortheirchildren.
Audience 3: Community
Output 3:CommunitiesadoptsupportivesocialnormsforECDandtakeownershipof ECD initiatives.
Communication objective 3.1:Communitiesunderstandthe importanceofECDand itspositiveimpactonthecommunity.
Communication objective 3.2: Communities demand basic social services for youngchildren(aminimumpackageofhealth,nutrition,WASH,childprotection,socialprotectionandECDservices), includingtheiraccessibility tochildrenwithdisabilities,andsupportcommunity-basedECDinitiatives.
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Communication objective 3.3:Communitiesembracefatherswhoparticipateincareofyoung children.
Communication objective 3.4: Communities discuss their own issues related to youngchildren and families in local forums.
Audience 4: Social service providers
Output 4: Service providers (health professionals, Community HealthWorkers, Inshutiz’Umuryango, socialprotection)provideadequate services toyoungchildrenand theirfamilies.
Communication objective 4.1: Frontlineworkers acquire interpersonal communicationskillstoensuresocialinclusionandtoworkwithparentsinthebestinterestsofthechild.
Communication objective 4.2: Frontline workers feel their work is important and valued bythecommunity.
Communication objective 4.3:Qualityserviceprovidersaremotivatedandremainintheirjobs.
Communication objective 4.4: There isanestablished linkageat the local levelamongdifferentareasofsocial serviceschildrenand familiescanbenefit fromreferralsacrosssectors.
Audience5:Localauthorities
Output 5:Localauthoritiesprovideadequate leadershiptoscaleupECDinitiativesand basicsocialservices.
Communication objective 5.1:LocalauthoritiesknowthekeyaspectsoftheECDpolicy,understandtheimportanceofECD,andtheirECD-relatedrolesandresponsibilities
Communication objective 5.2:ECDishighonthelocalagenda(atdistrict,sector,cellandvillagelevels,respectively)andisincludedindistrictplansandbudgets
Communication objective 5.3:Localauthoritiesandcommunityleaderssupportscale-upofECDandstrengthenthelinkagesbetweenECDandothersocialservices.
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9. ANALYSIS OF RELEVANT COMMUNICATION CHANNELS:
Mass media
TelevisionandothermediacanincreasehomeaccesstoECD,NutritionandWASHprogrammingaimedateitherchildrenorparents.Forexample,localversionsoftheeducationaltelevisionprogram Sesame Street reach children inover150 countries.Ameta-analysis representingmorethan10,000childrenfrom15countriesfoundsignificantbenefitsfromwatchingSesame Streetinliteracyandnumeracy,healthandsafety,andsocialreasoningandattitudestowardothers.TheRwandaDHS2014-2015showedthatradioisthemostwidespreadandfrequentlyusedcommunicationchannelinRwanda–morethanhalfthepopulation(55percent)ownaradio.Radioprogramsarealsolistenedtoviamobilephones,whichareownedby60percentofthepopulation.Onaverage,79percentofmenand62percentofwomenlistentoradioatleastonceaweek.Accesstotelevisionisstilllimited(10percent)but29percentofmenand16percentofwomensaytheywatchTVatleastonceaweek.This indicateshighlevelofcommunalTVviewing,whichwouldbeexpectedtorisesharplywiththecountry’srapidelectrification. Overseen by MIGEPROF, the Rwanda Broadcasting Agency launched its first home-grownchildren’sprogramcalledIteteroinOctober2015.Thisweekly30-minuteprogramisairedonRadioRwandatwiceaweekandaimstostimulateyoungchildrenaged0-6yearsandtoguidetheir familieson issues related toparenting. Itetero combinesdifferent creative segmentsincludingmusic, drama, storytelling and expert interviews reflecting the local context andculture.ThecontentisdevelopedbyagroupoftechnicalstakeholdersfromvarioussectorswhoformtheContentAdvisoryGroup(CAG)onECD.Thereisascopeforfurtherexpansionofchildren’smediaprogramsonbothradioandTV.
Community forums
Rwandahasseveralnationwideforumsthatareimportantatthecommunitylevel.
Umugoroba w’Ababyeyi (Parents’ evening) isavillagegatheringthatbringstogetherparents(bothmenandwomen).Youngwomenandmenwhodonothavechildrenaresometimesinvitedtojointhegathering,andchildrenmayoccasionallyparticipateiftherearesubjectsthatconcernthem.Accordingtoitsstrategydocument,Umugoroba w’Ababyeyi aims to provide a platformwhereparentscandiscussandaddresstheirsocio-economicconcernsforsustainabledevelopment. It has seen success stories in resolving family issues, improving health andnutrition, and reducing the poverty gap and violence in the family. Village Committees oftheNationalWomen’sCouncil(NWC)incollaborationwiththeVillageExecutiveCommitteesare responsible for overseeingUmugoroba w’Ababyeyi’s activities. The National Women’sCouncil highlights achievements of Umugoroba w’Ababyeyiinitsquarterlyreportsubmittedto MIGEPROF.
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National Children’s Forum
Thiswasestablishedtoprovidechildrenwithaplatformtoexpresstheiropinionsandbeheardonmattersconcerningtheirlife,familyandcountry.TheForumservesasthenationalvoiceforchildrenandachannelwherechildrencanexpresstheirviewsonnationalissuesandsuggesthowthesecanberesolvedbygovernmentswithchildren’sparticipation.These forumsarealso structures where children learn leadership and socialization skills from an early age.Children’sForumcommitteesareelectedbychildrenforthree-yearterms.Thecommitteesareformedatvillage,cell,sectoranddistrictlevel,andtheirresponsibilitiesincludeleadingregularChildren’sForummeetingsandprovidingviewsonthewelfareandrightsofchildren.Otherfunctionsincludetakingpartinthedecisionsthataffectchildren,denouncingproblemsaffecting children in the community and disseminating the resolutions of Annual NationalChildrenSummits.Establishedin2004,theannualNationalChildrenSummitbringstogetherchild delegates from all administrative sectors across the country. The Children’s Summitprovideschildrenwithaspecialopportunitytoexpresstheirviewsandwishesaboutbuildingthenation.Childrenalsoparticipateinunderstandingandproposingwhatisdoneorplannedforthemintermsofnationalpoliciesandprograms.Theydiscusstheirrights,thecountry’seconomicandsocialdevelopment,andtheirroleinsuchconcerns. Youth-friendly Centers
Healtheducationisprovidedtoyoungpeopleatyouthresourcecenters,whichofferyoungpeopletheopportunitytoparticipateinsports,culturaldance,andotherfunactivities.Thischannel offers an opportunity for discussion between boys, girls, and their parents abouthealthybehaviorsbasedoninformedchoices.ThisnationalintegratedstrategywillcollaboratewithNationalYouthCouncilandusethischanneltotargetyouthatcenterswithappropriatemessagesfocusingontheroleofyouthinimprovingECD,nutritionandWASHbehaviors.
Umuganda (Community work)
ThewordUmugandacanbetranslatedas‘comingtogetherincommonpurposetoachieveanoutcome’. In traditional Rwandan culture,members of the communitywould call upontheirfamily,friendsandneighborstohelpthemcompleteadifficulttask.AspartofeffortstoreconstructRwandaandnurtureasharednationalidentity,thegovernmentdrewontraditionalpracticestoenrichandadaptdevelopmentprogramstothecountry’sneedsandcontext.Theresultisasetofhome-grownsolutions−culturallyownedpracticestranslatedintosustainabledevelopmentprograms.OneofthesesolutionsisUmuganda.ModerndayUmugandacanbedescribedasacommunity-serviceday (umunsiw’umuganda).Onthe lastSaturdayofeachmonth,Rwandansaged18-65cometogetherforthreehoursinthemorningtodoavarietyofpublicworks.Thisoftenincludesinfrastructuredevelopmentandenvironmentalprotection.Participation inUmuganda is usually supervisedby amanagerorUmudugudu chairpersonwhooversees theeffectiveness andefficiencyof communityparticipation.While themainpurposeistoundertakecommunitywork,italsoservesasaforumforleadersateachlevelof government (fromvillageup to national level) to inform citizens about important news
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andannouncements.Communitymembersarealsoabletodiscussanyproblemstheyorthecommunityarefacingandproposejointsolutions.Thistimeisalsousedforevaluatingwhattheyhaveachievedandforplanningactivitiesforthefollowingmonth’sUmugandasession.
Growth Monitoring and Promotion session (GMP)
Growthmonitoringistheregularmeasurementofachild’ssizetomonitorhisgrowth.Itreferstoregularlyweighingachild(frombirththroughthefirsttwo,threeorfiveyearsoflife)andrecordingtheweightonagrowthchart.Becauseweighingandchartingalonecannotimprovegrowth,promotionalactivitiesarealsoneeded.TheseincludenutritioneducationandSBCCactionstoimprovechildgrowthandpreventallformsofmalnutrition.ThisactivitytakesplacemonthlyinallvillagesofRwandaandisledbyhealthserviceprovidersincludingCommunityvolunteers in collaboration with local leaders. This national strategy will use this channelto increaseawarenessandeducatemothers, caregiversandhusband/fathersofunderfivechildrenaroundECDservices,nutritionandWASHbestpractices.
Inshuti z’Umuryango (Friends of Families)
Enshrined inRwandan society is thebelief that childrenbelongnotonly to thebiologicalparentsbutalsototheextendedfamilyandcommunityatlarge.Thispromotesthepositivevalueof‘treatingeverychildasyourown’.Withthisinmind,twopersons(onemanandonewoman)wereselectedineveryvillagetopreventandrespondtoviolence,abuse,exploitation,neglect,abandonmentandotherchild-protection risks in their locality.This informal cadreestablishedin2015bytheNCCisanintegralpartofthechildprotectionsysteminRwandaandworkstogetherwithprofessionalsocialworkersandpsychologistsatdistrictlevel.Theirmain responsibilities are to conduct home visits, identify any cause for concern regardingchild protection,make referrals to professionals and other service-providers, and sensitizehouseholdsonpositiveparentingandchild-friendlypractices.Theyreporttolocalauthoritiesand professional socialworkers and psychologist in districts, andworkwith other sectors,including community health workers and ECD caregivers, to ensure children and familiesreceiveholisticservices.
Itorero (National Itorero Commission)
ThisisaRwandanciviceducationinstitutionwhichaimstoteachallRwandesetokeeptheirculturethroughitsdifferentvaluessuchasnationalunity,socialsolidarity,patriotism,integrity,bravery, tolerance, the dos and don’ts of society, etc. Through this instrument, Rwandansarealso informedofgovernmentpoliciesandprograms,whichstrengthensownershipandpromotesthepopulation’sroleinimplementingthesesocial-economicdevelopmentprograms.Civiceducationisorganizedbythe‘Itorerory’igihugu’institutionundertheNationalItoreroCommission.
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Religious denominations
The majorityof Rwandans are religious.According to the2012 census, 44percentof theresidentpopulationof the countryareCatholics, followedbyProtestants (38percent) andAdventists(12percent).Muslimsrepresent2percentofresidentpopulation,andmorethanhalfofthemliveinurbanareas.Religiousleaders,althoughindependentfromgovernment,play an important role in forming and guiding social norms and individual behavior. Theyalsoserveasan importantsourceof information,especiallyfortheruralpopulationwherecommunicationchannelsarelimited.AtanadvocacymeetinginDecember2015,theleadersof the Catholic, Protestant andMuslim denominations expressed commitment to supportstuntingreductionandECD.UnderMIGEPROF’sguidance,asermonguideonECDforChristianandMuslimisbeingdeveloped.TheaimistostrengthenthecapacityofallreligiousleaderstodisseminateECDmessages,andtocorrectmisconceptionsaboutwhatthereligiousscripturessayaboutgenderroles.
Information Communication and Technologies (ICT) Recenttechnologicaladvanceshaveenabledthedevelopmentofnew,excitingapproachestocommunication,especiallyforurbanpopulationwithstableaccesstoelectricity.Thisstrategywill build on the advantages and benefits of using appropriate technology to reach targetaudiences.Themobilephonesareusedinhealthcommunication,particularlythroughshortmessageservice(SMS),aninexpensivewayofobtainingandsharinginformationandgettingfeedback.Similarly,ICTplatformsusingvoicemessagesorcall-inservicescancreateinteractiveopportunities where beneficiaries can use their own simplemobile phones to proactivelyretrieveinformationacrossarangeoftopicsinlocallanguage-anytime,anywhere,andfreeofcharge.Thisinteractiveformofmessagingallowsindividualstomakedecisionsregardingthechoiceonbehaviortopicsandcontents.Thecall-inservicescancoverabroadrangeoftopicareasincludinggender,health,agriculture,andmicro-finance.Inaseriesof“listen,thenchoose”steps,callerscanusetheirphonestoselectfromamonghundredsofrecordedvoicemessages.ThisnationalstrategywillencouragetheuseofsuchtechnologyfocusedchannelstoenhanceknowledgeandpromoteoptimumECD,NutritionandWASHrelatedmessages
Private sector
The private sector in Rwanda is growing rapidly. Domestic and foreign investments aredrivingthecountry’seconomy.Theprivatesectoremploysmanypeople,andtheworkforceis mostly young people and young parents who need to receive messages around ECD. In some instances, the busy schedules and work environment in the private sector do notallowtheseyoungparentsandcaregiverstoattendothercommunitygatheringandeventswhereECDsensitizationisdone.Private-sectorplatformscanthereforeserveasthechannelsof communication to disseminate messages to workers and stakeholders. Well-tailoredcommunicationmaterialssuchasoutreachinbusinessareas,communicationmaterialsandinterpersonalcommunicationcanallbeusedtoreachparentsandcaregiversworkingintheprivatesector.MIGEPROF,inpartnershipwithUNICEF, isexpandingitspartnershipwiththe
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privatesectortoadvancechildrenrights,byobservingtheChildRightsandBusinessPrinciples(CRBP). Capacity-building interventionswill be carriedout to raise awarenessof theCRBP,targetingbusiness sectorswhich affect the lives ofwomen and children, including the teasector,theICTsector,andleisureandtourism.Corporationswillbetechnicallysupportedtoimprovetheirpoliciesandproceduresandtomaketheirworkingenvironmentsmorechild-friendly.
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10. NATIONAL SBCC STRATEGY IMPLEMENTATION ARRANGEMENTS
ThischapteroutlineshowtheSBCCstrategywillberolledout. Italsocovers therolesandresponsibilities of implementing partners and community-based organizations. Finally,the chapter spells out how the strategy should be coordinated and suggests monitoringmechanisms.
10.1.CoordinationandCollaborationmechanism
The National Early Childhood Development Program (NECDP) will lead and oversee theimplementationoftheSBCCstrategyinclosecollaborationwithRwandaHealthCommunicationCenter(RHCC)atalllevels.TheSBCCactivitieswillbeinsertedintotheannualactionplansoflineministriesandpartnersaswellasrelevantnationaltechnicalworkinggroups.EverylineministryandimplementingpartnerwillrefertothisSBCCstrategywhendevelopingactivities.
All communication materials related to the implementation of ECD, nutrition and WASHactivitieswillbereviewedandvalidatedbytheNationalHealthPromotionTechnicalWorkingGroup.
10.2.Rolesandresponsibilities
10.2.1 Social Cluster Ministries and Rwandan Parliamentarians Network on Population and Development (RPRPD)
TostrengthentheconsistencyandefficiencyofSBCCactionsundertakenbymanysectorsandpartners,theNationalSBCCStrategywillbecoordinatedfrom,atminimum,atcentral,districtlevelandsectorlevels.TheSocialClusterMinistrieswillcontributetostrengthexistingrelatedpoliciesandstrategies,advocacyforSBCCimplementation,mobilizeresources,andsupportlocalgovernmentsinimplementingthisSBCCStrategy.
The Rwandan Parliamentarians Network on Population and Development (RPRPD) willcontributeinadvocacyandcommunityengagementrelatedactivitiesforbetterimplementationofSBCCactivities.
10.2.2. National Early Childhood Development Program (NECDP)
TheNationalEarlyChildhoodDevelopmentProgram(NECDP)wasestablished inDecember2017as per thePrimeMinisterial Instructionpublished in theNationalGazetteno.03/003 24/12/2017. The NECDP is an autonomous agency both administratively and financiallyreportingtotheMinistryofGenderandFamilyPromotion.Withthedecreethat institutedNECDP,theprogramreceivedthegeneralmissiontocoordinateandimplementallinterventions
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thatsupportadequateearlychildhooddevelopmentforchildrenfromtheirconceptiontosixyears of age as outlined in the Early Childhood Development Policy.
TheGovernmentcommissionedtheNationalECDProgram(NECDP)withtheoverallgoalofreducingstuntingthroughECD.NECDPisalsomandatedtocoordinateallprogramsrelatedtoECDandnutritiontoattainthedesiredchilddevelopmentoutcomesonthepremisethatprogram integration is critical for holistic child growth and development. A child needs toreceive comprehensivequality early stimulationand learning, health, nutrition,WASHandprotectionservicestogrowanddeveloptofullpotential.NECDPenvisagetoincreasechildren(0-6years)accesstoECDservicesfromthecurrent13%to45%by2024.Similarly,itintendstoreducestuntingfrom38%to19%duringthesameperiod.
TheNECDPisthereforetaskedtocarryouttheresponsibilitiescitedbelow:
In close collaboration and coordination of all sectors playing a role in Early ChildhoodDevelopment,specificallyNECDPisresponsiblefor:
• Increasingchildren’spreparednesstotheprimaryschoolenvironment;
• Promotingoptimalchilddevelopment;
• Enhancingpositiveparentingandcommunityparticipationinchildprotection;
• Reducingmalnutritionandstuntedgrowthamongyoungchildren;
• Eliminatingphysical,moral,andpsychologicalabuseofyoungchildren;
• Enhancing equal access to early childhood development services for children with disabilitiesandspecialneeds.
TheNECDPwilloverseetheoverallcoordinationand implementationofthisNationalSBCCStrategy including but not limited to organizing quarterly meeting of all related technicalgroupsincludingHealthPromotionTWGtomonitortheprogressonregularbasis.AstrongcoordinationandmonitoringmechanismensureseffectiveandcomplementarypackagingofinterventionssothatECD,NutritionandWASHrelatedsocialservicesandmessagescanbedeliveredseamlesslywithoutduplicatingefforts.
10.2.3. The Rwanda Health Communication Centre (RHCC)
RHCCisthecommunicationarmoftheentirehealthsector.Itisresponsibleforthecoordinationofhealthpromotioninterventions,handlesmediaandpublicrelationsthesector.RHCCwillchairNationalHealthPromotionTechnicalWorkingGroupactivitiestoensureallcommunicationstoolsrelatedtotheimplementationofSBCCStrategyarereviewedandapproved.Thisincludescoordination,monitoringandreportingofSBCCactivitiestoNECDPcoordinationonquarterlybasis.TheNationalHealthPromotionTWGmembersincludeallsocialclustersministriesand
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implementingpartnersandco-chairedbyUNICEF.
10.2.4. Technical Working Groups (TWGs)
All technical working groups operating in areas of ECD, Nutrition an WASH will have arepresentativewithinNationalHealthPromotionTWGtoensurethatallrelatedcommunicationtoolsaresubmittedforreviewandvalidationbythesaidteam.ThetechnicalworkinggroupsincludeECD,FoodandNutrition,WaterandSanitationandAgricultureSectorTWGs.
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11. MONITORING AND EVALUATION FRAMEWORK
This National Integrated ECD, Nutrition andWASH SBCC Strategy represents national-levelguidelinesforallECD,NutritionandWASHstakeholdersandwillmonitorregularlytheirECD&SBCCimplementationplans.DifferentindicatorswillbeusedbasedonspecificECD&SBCCrelatedprogramandactivities.
EvaluationofthisstrategywillconsidermeasuringECD,NutritionandWASHrelatedindicatorsatvariouslevelsincludinginputs,outputs,andprocess,outcomeandimpactindicators.Moreformative research will be undertaken periodically to monitor the changes in knowledge,attitudes, beliefs, self-efficacy and perceived risks which will contribute to the process ofadaptingmessages,communicationmaterialsandsomebehaviorchangeactions.Thissectionwilldefinehowthemonitoringandevaluationwillbedoneandatwhatfrequenciesdatawillbecollected.
ItalsohighlightstheprogramleveloroutcomeindicatorsthatareexpectedtobemeasuredatmidtermandendlineofagivenECD,nutritionandWASHrelatedSBCCinterventions.
Objectives of M&E plan:
TheobjectivesoftheM&Eplansinclude:
- TooutlinekeyECD,NutritionandWASHindicatorsforimplementingthiscommunicationstrategyatalllevelsbehaviorchangecommunicationmonitoringandevaluation
- Toguidethemonitoringofplannedstrategyactivities,measureexpectedoutcomesandimpacts
- Document challenges /generate evidence on key ECD, nutrition and WASH relatedpracticestoinformsubsequentbehaviorchangeplanning,implementationandstrategicdecisions.
Monitoring the behavior change interventions or routine tracking: This is done throughrecordkeeping,periodicreviewofimplementationreports(e.g.supervisor’sreport,meetingand training reports).
Thiswillhelptogeneratedataonoutputindicators(e.g.:messagedeliveredandreachedtotheaudience,materialsdisseminated,andchannelsused)overaplannedtime.ItwillassesstheextenttowhichtheimplementationofplannedactivitiesisconsistentwiththeM&Eplansand to determine which areas require more focus.
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Formative or qualitative research:Thisisakeysteptocreateprogrammaterials,toolsandapproachesthatareculturallyappropriatetothelocalcontext.Qualitativemethodscollectdatatoanswerquestionssuchas“why?”and“how?”Althoughthisapproachprovidesrichanddetailed information, it isnotmeant togeneralize toanentirepopulationor intendedaudience.
The National ECD, Nutrition and WASH SBCC Strategy recommends undertaking regularformativeresearchtoidentifyandtrackemergingchanges,currentlevelofknowledge,beliefsandattitudes,impactofchannelsthroughwhichmessagesweredeliveredandtocustomizecontents and approaches accordingly.
Indicators for evaluating Integrated EDC nutrition and WASH impacts:By improvingtheECD,NutritionandWASHbehaviors,thisNational Integratedstrategywillassist Rwandan Government effort to promote optimal Early Childhood Development anddeclinethestuntingamongchildrenunder5andcreatingpositiveoutcomeswhicharereflectedintheFourthHealthSectorStrategicPlan(2018–2024)andthroughstrategyimplementationplans,thisstrategywillmonitortheseindicatorsreflectedinRwandaDHS2015andHSSPIV(2018-2024).
AdditionaltothekeyindicatorsdefinedinM&Eplan,anygovernmentorcivilsocietyorganizationsconductingcommunication,advocacyandsocialmobilizationactivitiesforECD,NutritionandWASHinRwandaareencouragedtousetheaboveoutputandoutcomeindicatorstomeasureprogressandresults.UsingthesameindicatorswillallowharmonizedcumulativereportingacrossawiderangeofECD,NutritionandWASHpartnersandstakeholders.Theresultsshouldbe sharedwith National NECD Program as a platform for knowledgemanagement. Theseindicators include: Outcome indicators
- Prevalenceofstuntingamongchildren(0–59months)
- Prevalence of underweight children (0–59 months)
- Prevalenceofwasting(Ht/Wt)
Indicators to measure implementation progress, communication and advocacy activities:
- #ofdistrictswithECDincorporatedintotheirplansandbudgets
- #offamilies/parentsreachedwithcommunicationmessagesonresponsivecaregiving/positiveparenting.
- #ofchildrenreachedwithchild-friendlymassmediaprograms(radio,TV).
- #oflocalauthoritiesreachedwithawareness-raisingmessagesonECD
- #ofcommunication/advocacyeventsorganizedatdifferentlevels(national,district,
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sector,community)
- #offrontlineworkerstrainedoninter-personalcommunicationskills.
- # of children reached with growth monitoring
- # of ECD service providers / caregivers trained.
- #ofparentsreachedwithparentingeducation.
- # of parents reached with integrated messages.
- #ofIntegratedECD,NutritionandWASHmessagesdeveloped,communicationmaterialsproducedanddistributed
- #ofsensitizationmeetingorganizedwithlocalleaders
- #ofECD&NutritionandWASHradiomaterialsproduced.
12. CONCLUSIONThe implementation of this National Integrated ECD, Nutrition and WASH SBCC StrategywillbeledbyNationalECDProgramwiththesupportfromlineministries,centralandlocalgovernment,andnon-governmentalagencies,includinglocalandinternationalorganizations,U.N.agencies,developmentpartners,privatesector,andotherhealthsector implementingpartners. Collaborationamongall stakeholders is key for successful implementationof theNationalIntegratedECD,NutritionandWASHSBCCStrategyactivitiesatthenational,district,and community levels.
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ED A
CTI
VIT
IES
SNA
ctiv
itie
sTi
mef
ram
ePr
opos
ed
Budg
etRe
spon
sibl
eSo
urce
of F
unds
2018
2019
2020
2021
2022
2023
2024
I.W
orks
hops
N
atio
nal W
orks
hops
1.1
Diss
emin
atio
n W
orks
hop
for
Inte
grat
ed S
BCC
Str
ateg
y
3,15
0,00
0N
ECD
P N
ECD
P , U
NIC
EF,
RBC
and
CRS
1.2
Cond
uct W
orks
hop
with
M
edia
Ow
ners
and
Edi
tors
on
pro
gram
min
g ab
out
Inte
grat
ed E
CD
, Nut
ritio
n an
d W
ASH
bah
avio
r ch
ange
rela
ted
serv
ices
and
ap
pror
iate
age
or/
and
child
fr
iend
ly m
edia
62
,300
,000
NEC
DP
NEC
DP
, UN
ICEF
, RB
C
1.3
Cond
uct W
orks
hop
for
targ
et a
rtist
s on
Chi
ld
frie
ndly
com
posit
ion
45
,000
,000
NEC
DP
UN
ICEF
1.4
Cond
uct a
Wor
ksho
p to
revi
ew a
nd a
dapt
IEC
m
ater
ials
and
mes
sage
80
,000
,000
NEC
DP
NEC
DP
, UN
ICEF
, RB
C
AN
NEX
1: S
BCC
inte
grat
ed Im
plem
enta
tion
pla
n
52
D
istr
ict W
orks
hops
1.5
Cas
cade
d D
issem
inat
ion
Wor
ksho
ps fo
r Int
egra
ted
SBCC
Str
ateg
y at
Dist
rict
leve
l
24
,950
,000
NEC
DP
NEC
DP
, UN
ICEF
, RB
C
II.Co
mm
unit
y M
obili
zati
on
2.1
Aw
ards
of c
ham
pion
s /co
mm
unity
vol
unte
ers
to
prom
ote
Soci
al b
ahav
ior
chan
ge c
omm
unic
atio
n EC
D, N
utrit
ion
and
WA
SH
(EC
D, N
utrit
ion
and
WA
SH
Serv
ices
pro
vide
rs, I
ZU,
CH
W, M
odel
Par
ents
, Art
ists,
Jour
nalis
t etc
10
5,00
0,00
0N
ECD
P N
ECD
P , U
NIC
EF,
RBC
2.2
Cond
uct c
omm
unity
m
obili
zatio
n th
roug
h Pa
rent
foru
ms,C
omm
unity
W
ork/
Um
ugan
da, I
ntek
o z’A
batu
rage
, Ito
rero
ry
’Um
udug
udu;
Com
mun
ity
Dra
ma,
Cin
e M
obile
, IC
T Pl
atfo
rms,
Relig
ious
For
ums,
Spor
t eve
nts,V
illag
e co
okin
g de
mon
stra
tion
sess
ions
.
42
1,00
0,00
0N
ECD
P N
ECD
P, RB
C,
UN
ICEF
,
53
2.3
Cond
uct I
nter
pers
onal
Co
mm
unic
atio
n th
roug
h H
ome
Visi
ts th
roug
h co
mm
unity
vol
unte
ers
10
5,00
0,00
0 N
ECD
P an
d RB
CN
ECD
P, RB
C,
UN
ICEF
,CRS
III.
Aw
aren
ess C
ampa
igns
3.1
Day
of A
fric
an C
hild
(DA
C) /
SBC
rela
ted
inte
rven
tions
90
,000
,000
NEC
DP
NEC
DP,R
BC,
UN
ICEF
, NCC
and
N
WC
3.2
Fam
ily C
ampa
igns
/SBC
re
late
d in
terv
entio
ns
15,0
00,0
00N
ECD
P an
d M
INA
GRI
NEC
DP,M
INA
GRI
, W
FP,FA
O
3.3
Han
d W
ashi
ng a
nd
Toile
t Day
/SBC
rela
ted
inte
rven
tions
80
,000
,000
NEC
DP
NEC
DP,U
NIC
EF
3.4
Inte
rnat
iona
l Day
of P
erso
ns
with
Disa
bilit
ies
50
,000
,000
NEC
DP
3.5
Wor
ld B
reas
feed
ing
Wee
k /
SBC
rela
ted
inte
rven
tions
10
5,00
0,00
0N
ECD
P, RB
CN
ECD
P ,U
NIC
EF
3.6
Wor
ld F
ood
Day
/SBC
re
late
d in
terv
entio
ns
50,0
00,0
00
NEC
DP
,MIN
AG
RI,FA
O,
WFP
3.7
MC
H w
eek
/ SBC
rela
ted
inte
rven
tions
15
0,00
0,00
0 N
ECD
PN
ECD
P,UN
ICEF
, RB
C, C
RS
3.8
Day
of A
fric
an C
hild
(DA
C) /
SBC
rela
ted
inte
rven
tions
9
0,00
0,00
0 N
ECD
PN
ECD
P, RB
C,
UN
ICEF
, NCC
and
N
WC
54
IV.
Prod
ucti
on o
f med
ia a
nd
IEC
Mat
eria
ls
4.1
Prod
uce
and
broa
dcas
t m
edia
adv
erts
(Rad
io a
nd
TV sp
ots )
55
0,00
0,00
0N
ECD
PN
ECD
P,UN
ICEF
,R
BC,C
RS
4.2
Prod
uce
and
broa
dcas
t Ra
dio
and
TV P
rogr
ams
( Rad
io a
nd T
V T
alk
show
s; Pr
e re
cord
ed
mag
azin
es ,
Aud
io V
isual
D
ocum
enta
ries,
Chi
ld
frie
ndly
Dra
ma
(e.g
: Ite
tero
an
d D
J men
tions
)
12
5,00
0,00
0N
ECD
PN
ECD
P,UN
ICEF
,R
BC,C
RS
4.3
Prod
uce
and
publ
ish
artic
les a
nd su
plim
ents
in
new
pape
rs a
nd w
eb b
ased
m
edia
incl
udin
g W
eb B
anne
r
92
,000
,000
NEC
DP
NEC
DP,U
NIC
EF
,RBC
4.4
Test
and
dist
ribut
e th
e ex
istin
g IE
C m
ater
ials
and
m
essa
ges (
broc
hure
s ,fly
ers,
bann
ers ,
book
lets
etc
)
2,
400,
000,
000
NEC
DP
NEC
DP
,RBC
,UN
ICEF
V.Tr
aini
ngs
5.1
Cond
uct T
oT fo
r EC
D,
Nut
ritio
n an
d W
ASH
se
rvic
e pr
ovid
ers o
n re
vise
d,
adap
ted
and
prod
uced
IEC
m
ater
ials
and
mes
sage
s
2
4,60
0,00
0 N
ECD
PN
ECD
P, U
NIC
EF,
Oth
er P
artn
ers
55
5.2
Cond
uct c
asca
ded
Trai
ning
fo
r Com
mun
ity v
olun
teer
s on
on
revi
sed,
ada
pted
and
pr
oduc
ed IE
C m
ater
ials
12
0,00
0,00
0 N
ECD
PN
ECD
P, U
NIC
EF,
Oth
er P
artn
ers
5.3
Cond
uct t
rain
ings
with
Jo
urna
lists
on
repo
rtin
g ab
out I
nteg
rate
d EC
D,
Nut
ritio
n an
d W
ASH
ba
havi
or c
hang
e re
late
d se
rvic
es
44
,250
,000
NEC
DP
NEC
DP,
UN
ICEF
, O
ther
Par
tner
s
VI.
Tech
nica
l and
fina
ncia
l Su
ppor
t
6.1
Crea
te a
nd su
ppor
t med
ia
netw
orks
to p
rom
ote
ECD
,Nut
ritio
n an
d W
ASH
be
havi
or c
hang
e re
late
d ac
tiviti
es
12
5,00
0,00
0N
ECD
PN
ECD
P ,
UN
ICEF
,RBC
6.2
Supp
ort c
hild
frie
ndly
art
s pr
oduc
tion
22
5,00
0,00
0N
ECD
PN
ECD
P ,
UN
ICEF
,RBC
VII.
Adv
ocac
y m
eeti
ngs
7.1
Adv
ocac
y m
eetin
gs w
ith
stak
ehol
ders
on
effec
tive
serv
ice
prov
ision
of
inte
grat
ed E
CD
, Nut
ritio
n an
d W
ASH
1
2,60
0,00
0 N
ECD
PN
ECD
P, U
NIC
EF,
CRS
, Oth
er
Part
ners
acc
ordi
ng
to th
eir D
istric
t of
Inte
rven
tion
56
7.2
Cas
cade
d ad
voca
cy
mee
tings
with
com
mun
ity
lead
ers o
n eff
ectiv
e se
rvic
e pr
ovisi
on o
f int
egra
ted
ECD
,N
utrit
ion
and
WA
SH
14
4,00
0,00
0 N
ECD
PN
ECD
P, U
NIC
EF,
CRS
, Oth
er
Part
ners
acc
ordi
ng
to th
eir D
istric
t of
Inte
rven
tion
VIII
.M
&E
8.1
Evid
ence
bas
ed K
now
ledg
e sh
arin
g w
ithin
the
com
mun
ity
68
,000
,000
NEC
DP
NEC
DP
,UN
ICEF
RB
C
8.2
Cond
uct f
orm
ativ
e re
sear
ch
on E
CD
,Nut
ritio
n an
d W
ASH
bah
avio
rs a
nd re
view
th
is SB
CC st
rate
gy (2
022)
14
0,00
0,00
0N
ECD
PN
ECD
P ,U
NIC
EF
,RBC
8.3
Surv
eys (
KA
P, M
id T
erm
an
d En
dlin
e Ev
alua
tions
) on
SBC
C a
ctiv
ities
on
ECD
, N
utrit
ion
and
WA
SH
21
0,00
0,00
0N
ECD
PN
ECD
P ,U
NIC
EF
,RBC
Tota
l5,
756,
850,
000
57
AN
NEX
2: S
BCC
M&
E fr
amew
ork
A
udie
nces
/Ta
rget
Com
mun
icat
ion
Obj
ecti
ves
Eval
uati
on
indi
cato
rsBa
selin
eTa
rget
s/m
ilest
ones
Dat
a so
urce
Freq
uenc
y D
ata
colle
ctio
n Re
spon
sibl
e
Y1Y2
Y3Y4
Y5Y6
Out
com
e: E
nhan
ced
opti
mal
Ear
ly c
hild
dev
elop
men
t, c
hild
ren’
s pre
pare
dnes
s to
the
prim
ary
scho
ol e
nvir
onm
ent,
pos
itiv
e pa
rent
ing
and
com
mun
ity
part
icip
atio
n in
chi
ld p
rote
ctio
n an
d re
duce
d m
alnu
trit
ion
and
stun
ted
grow
th a
mon
g yo
ung
child
ren.
Stra
tegi
c ou
tput
s 1:
Child
ren
have
incr
ease
d ex
posu
re to
ear
ly st
imul
atio
n by
thei
r fam
ilies
, inc
ludi
ng a
cces
s to
age-
appr
opri
ate
med
ia p
rogr
amm
es, b
ooks
, and
pla
y an
d le
arni
ng m
ater
ials
.
Chi
ldre
n (0
-6
year
s old
) Co
mm
unic
atio
n ob
ject
ive
1: B
y 20
24, a
50%
in
crea
se in
the
prop
ortio
n of
chi
ldre
n lis
teni
ng to
age
-ap
prop
riate
and
in
clus
ive
med
ia
prog
ram
mes
.
% o
f chi
ldre
n ag
ed to
0-6
ye
ars l
isten
ing
to
age-
appr
opria
te
med
ia
prog
ram
mes
.
Nee
d ba
selin
e in
form
atio
n5%
of c
hild
ren
aged
to 0
-6
year
s list
enin
g to
ag
e-ap
prop
riate
m
edia
pr
ogra
mm
es
5% o
f chi
ldre
n ag
ed to
0-6
ye
ars l
isten
ing
to
age-
appr
opria
te
med
ia
prog
ram
mes
10%
of c
hild
ren
aged
to 0
-6
year
s list
enin
g to
ag
e-ap
prop
riate
m
edia
pr
ogra
mm
es
10%
of c
hild
ren
aged
to 0
-6
year
s list
enin
g to
ag
e-ap
prop
riate
m
edia
pr
ogra
mm
es
10%
of c
hild
ren
aged
to 0
-6
year
s list
enin
g to
ag
e-ap
prop
riate
m
edia
pr
ogra
mm
es
10%
of c
hild
ren
aged
to 0
-6
year
s list
enin
g to
ag
e-ap
prop
riate
m
edia
pr
ogra
mm
es
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Qua
rter
ly
NEC
DP:
Con
duct
A
dvoc
acy
RHCC
: des
ign
med
ia p
rogr
ams
HM
C: C
hann
eliz
e m
edia
pro
gram
s
Chi
ldre
n (0
-6
year
s old
)Co
mm
unic
atio
n ob
ject
ive
2:
By 2
024,
a
50%
incr
ease
in
pro
port
ion
of c
hild
ren
play
ing
with
ag
e-ap
prop
riate
bo
oks,
and
incl
usiv
e pl
ay
and
lear
ning
m
ater
ials.
% o
f chi
ldre
n ag
ed to
0-6
ye
ars c
hild
ren
play
ing
with
ag
e-ap
prop
riate
bo
oks,
and
play
an
d le
arni
ng
mat
eria
ls
30 %
of c
hild
ren
unde
r 5 a
ges
have
acc
ess t
o to
ys a
nd p
lay-
thin
gs a
nd o
nly
1
% o
f chi
ldre
n un
der 5
age
s w
ith a
cces
s to
child
ren’
s boo
ks
(RD
HS
2015
)
8 %
of c
hild
ren
unde
r 5 a
ges h
ave
acce
ss to
toys
an
d pl
ay-t
hing
s
1
% o
f chi
ldre
n un
der 5
age
s w
ith a
cces
s to
child
ren’
s boo
ks
8 %
of c
hild
ren
unde
r 5 a
ges h
ave
acce
ss to
toys
an
d pl
ay-t
hing
s
1
% o
f chi
ldre
n un
der 5
age
s w
ith a
cces
s to
child
ren’
s boo
ks
8 %
of c
hild
ren
unde
r 5 a
ges h
ave
acce
ss to
toys
an
d pl
ay-t
hing
s
1
% o
f chi
ldre
n un
der 5
age
s w
ith a
cces
s to
child
ren’
s boo
ks
8% o
f chi
ldre
n un
der 5
age
s hav
e ac
cess
to to
ys
and
play
-thi
ngs
1 %
of c
hild
ren
unde
r 5 a
ges
with
acc
ess t
o ch
ildre
n’s b
ooks
8% o
f chi
ldre
n un
der 5
age
s hav
e ac
cess
to to
ys
and
play
-thi
ngs
1 %
of c
hild
ren
unde
r 5 a
ges
with
acc
ess t
o ch
ildre
n’s b
ooks
10 %
of c
hild
ren
unde
r 5 a
ges h
ave
acce
ss to
toys
an
d pl
ay-t
hing
s
1
% o
f chi
ldre
n un
der 5
age
s w
ith a
cces
s to
child
ren’
s boo
ks
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Ann
ually
N
ECD
P:
Adv
ocac
y
RSA
U: R
wan
da
Soci
ety
of
Aut
hors
Fa
cilit
ate
the
publ
icat
ion
of
age-
appr
opria
te
book
s, R
AC
: Rw
anda
A
rts C
ounc
il
outp
uts 2
: Pa
rent
s’ re
spon
sive
car
e to
you
ng c
hild
ren
prov
ided
Pare
nts w
ith
child
ren
0-6
year
s ol
d / a
dole
scen
t gi
rls a
nd b
oys
Com
mun
icat
ion
obje
ctiv
e 1:
By
2024
, a 5
0%
incr
ease
in th
e pr
opor
tion
of P
aren
ts
unde
rsta
ndin
g th
e im
port
ance
of
EC
D, e
spec
ially
re
spon
sive
care
of
you
ng c
hild
ren
incl
udin
g PW
Ds (
talk
ing,
in
tera
ctin
g,
read
ing
and
play
ing)
% o
f par
ents
with
ch
ildre
n 0-
6 ye
ars
old
/ ado
lesc
ent
girls
and
boy
s w
ith in
crea
sed
know
ledg
e of
the
impo
rtan
ce o
f EC
D, e
spec
ially
re
spon
sive
care
of y
oung
ch
ildre
n (t
alki
ng,
inte
ract
ing,
re
adin
g an
d pl
ayin
g)
13%
of
child
ren
age
36-5
9 m
onth
s at
tend
ing
an
orga
nize
d ea
rly
child
hood
ed
ucat
ion
prog
ram
(RD
HS
2015
)
5 %
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s w
ith in
crea
sed
know
ledg
e of
the
impo
rtan
ce o
f EC
D, e
spec
ially
re
spon
sive
care
of y
oung
ch
ildre
n (t
alki
ng,
inte
ract
ing,
re
adin
g an
d pl
ayin
g)
5 %
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s w
ith in
crea
sed
know
ledg
e of
the
impo
rtan
ce o
f EC
D, e
spec
ially
re
spon
sive
care
of y
oung
ch
ildre
n (t
alki
ng,
inte
ract
ing,
re
adin
g an
d pl
ayin
g)
10 %
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s w
ith in
crea
sed
know
ledg
e of
the
impo
rtan
ce o
f EC
D, e
spec
ially
re
spon
sive
care
of y
oung
ch
ildre
n (t
alki
ng,
inte
ract
ing,
re
adin
g an
d pl
ayin
g)
10 %
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s w
ith in
crea
sed
know
ledg
e of
the
impo
rtan
ce o
f EC
D, e
spec
ially
re
spon
sive
care
of y
oung
ch
ildre
n (t
alki
ng,
inte
ract
ing,
re
adin
g an
d pl
ayin
g)
10%
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s w
ith in
crea
sed
know
ledg
e of
the
impo
rtan
ce o
f EC
D, e
spec
ially
re
spon
sive
care
of y
oung
ch
ildre
n (t
alki
ng,
inte
ract
ing,
re
adin
g an
d pl
ayin
g)
10 %
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s w
ith in
crea
sed
know
ledg
e of
the
impo
rtan
ce o
f EC
D, e
spec
ially
re
spon
sive
care
of y
oung
ch
ildre
n (t
alki
ng,
inte
ract
ing,
re
adin
g an
d pl
ayin
g)
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Ann
ual
NEC
DP:
Pro
vide
ke
y m
essa
ges
NCP
D: P
rovi
de
key
mes
sage
s ap
prop
riate
to
PWD
s. N
WC
, NCC
, M
IGEP
ROF,
M
INA
LOC
, Loc
al
Aut
hori
ties
, ch
urch
le
ader
s,et
c.
D
issem
inat
e ke
y m
essa
ges
58
Pare
nts w
ith
child
ren
0-6
year
s ol
d / a
dole
scen
t gi
rls a
nd b
oys
Com
mun
icat
ion
obje
ctiv
e 2:
By
202
4, a
50%
in
crea
se in
the
prop
ortio
n of
bo
th fa
ther
s an
d m
othe
rs
part
icip
ate
equa
lly in
ch
ild c
are
and
stim
ulat
ion.
% o
f bot
h fa
ther
s an
d m
othe
rs w
ith
child
ren
0-6
year
s ol
d / a
dole
scen
t gi
rls a
nd b
oys
part
icip
atin
g eq
ually
in
child
car
e an
d st
imul
atio
n
Base
line
Dat
a:
(RD
HS
2015
): 35
% o
f chi
ldre
n un
der 5
yea
rs
wer
e le
ft a
lone
or
in th
e ca
re o
f ot
her c
hild
ren
5 %
of b
oth
fath
ers a
nd
mot
hers
with
ch
ildre
n 0-
6 ye
ars
old
/ ado
lesc
ent
girls
and
boy
s pa
rtic
ipat
ing
equa
lly in
ch
ild c
are
and
stim
ulat
ion
5 %
of b
oth
fath
ers a
nd
mot
hers
with
ch
ildre
n 0-
6 ye
ars
old
/ ado
lesc
ent
girls
and
boy
s pa
rtic
ipat
ing
equa
lly in
ch
ild c
are
and
stim
ulat
ion
10 %
of b
oth
fath
ers a
nd
mot
hers
with
ch
ildre
n 0-
6 ye
ars
old
/ ado
lesc
ent
girls
and
boy
s pa
rtic
ipat
ing
equa
lly in
ch
ild c
are
and
stim
ulat
ion
10 %
of b
oth
fath
ers a
nd
mot
hers
with
ch
ildre
n 0-
6 ye
ars
old
/ ado
lesc
ent
girls
and
boy
s pa
rtic
ipat
ing
equa
lly in
ch
ild c
are
and
stim
ulat
ion
10 %
of b
oth
fath
ers a
nd
mot
hers
with
ch
ildre
n 0-
6 ye
ars
old
/ ado
lesc
ent
girls
and
boy
s pa
rtic
ipat
ing
equa
lly in
ch
ild c
are
and
stim
ulat
ion
10 %
of b
oth
fath
ers a
nd
mot
hers
with
ch
ildre
n 0-
6 ye
ars
old
/ ado
lesc
ent
girls
and
boy
s pa
rtic
ipat
ing
equa
lly in
ch
ild c
are
and
stim
ulat
ion
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Ann
ually
NEC
DP:
Pro
vide
ke
y m
essa
ges.
NW
C, N
CC,
MIG
EPRO
F,
MIN
ALO
C, L
ocal
A
utho
riti
es,
chur
ch
lead
ers,
etc
:
Diss
emin
ate
key
mes
sage
s G
MO
: Mon
itor
gend
er e
qual
ity
Pare
nts w
ith
child
ren
0-6
year
s ol
d / a
dole
scen
t gi
rls a
nd b
oys
Com
mun
icat
ion
obje
ctiv
e 3:
By
202
4, a
50%
in
crea
se in
the
prop
ortio
n of
par
ents
pr
actic
ing
posit
ive
pare
ntin
g sk
ills,
incl
udin
g po
sitiv
e di
scip
linar
y m
easu
res.
% o
f par
ents
with
ch
ildre
n 0-
6 ye
ars
old
/ ado
lesc
ent
girls
and
boy
s pr
actic
ing
posit
ive
pare
ntin
g sk
ills,
incl
udin
g po
sitiv
e di
scip
linar
y m
easu
res
Base
line
Dat
a:
(RD
HS
2015
): 49
% o
f chi
ldre
n en
gage
d w
ith a
n ad
ult h
ouse
hold
m
embe
r in
four
or
mor
e ac
tiviti
es
that
pro
mot
e le
arni
ng a
nd
scho
ol re
adin
ess
5 %
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s pr
actic
ing
posit
ive
pare
ntin
g sk
ills,
incl
udin
g po
sitiv
e di
scip
linar
y m
easu
res
5 %
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s pr
actic
ing
posit
ive
pare
ntin
g sk
ills,
incl
udin
g po
sitiv
e di
scip
linar
y m
easu
res
10 %
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s pr
actic
ing
posit
ive
pare
ntin
g sk
ills,
incl
udin
g po
sitiv
e di
scip
linar
y m
easu
res
10 %
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s pr
actic
ing
posit
ive
pare
ntin
g sk
ills,
incl
udin
g po
sitiv
e di
scip
linar
y m
easu
res
10%
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s pr
actic
ing
posit
ive
pare
ntin
g sk
ills,
incl
udin
g po
sitiv
e di
scip
linar
y m
easu
res
10 %
of p
aren
ts
with
chi
ldre
n 0-
6 ye
ars o
ld
/ ado
lesc
ent
girls
and
boy
s pr
actic
ing
posit
ive
pare
ntin
g sk
ills,
incl
udin
g po
sitiv
e di
scip
linar
y m
easu
res
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Ann
ually
NEC
DP:
NCP
D: P
rovi
de
key
mes
sage
s ap
prop
riate
to
PWD
s. N
WC
, NCC
, M
IGEP
ROF,
M
INA
LOC
, Loc
al
Aut
hori
ties
, ch
urch
le
ader
s etc
:
Diss
emin
ate
key
mes
sage
s
Stra
tegi
c ou
tput
s 3: P
aren
ts p
ract
ice
appr
opria
te h
ealth
, nut
ritio
n an
d W
ASH
pra
ctic
es
Mat
erna
l Nut
ritio
n - I
ncre
ase
inta
ke o
f nut
rient
-ric
h fo
ods b
y pr
egna
nt a
nd la
ctat
ing
wom
en
Preg
nant
wom
en
Com
mun
icat
ion
obje
ctiv
e 1:
By
20
24, a
50%
in
crea
se in
the
prop
ortio
n of
pr
egna
nt w
omen
ea
ting
daily
an
ext
ra m
eal
or sn
ack
that
co
ntai
n fo
od ri
ch
in e
nerg
y, vi
tam
in
A o
r iro
n
% o
f pre
gnan
t w
omen
eat
ing
daily
an
extr
a m
eal o
r sna
ck
that
con
tain
food
ric
h in
ene
rgy,
vita
min
A o
r iro
n
Dat
a ga
ps:
need
bas
elin
e in
form
atio
n
5 %
of p
regn
ant
wom
en e
atin
g da
ily a
n ex
tra
mea
l or s
nack
th
at c
onta
in fo
od
rich
in e
nerg
y, vi
tam
in A
or i
ron
5 %
of p
regn
ant
wom
en e
atin
g da
ily a
n ex
tra
mea
l or s
nack
th
at c
onta
in fo
od
rich
in e
nerg
y, vi
tam
in A
or i
ron
10%
of p
regn
ant
wom
en e
atin
g da
ily a
n ex
tra
mea
l or s
nack
th
at c
onta
in fo
od
rich
in e
nerg
y, vi
tam
in A
or i
ron
10%
of p
regn
ant
wom
en e
atin
g da
ily a
n ex
tra
mea
l or s
nack
th
at c
onta
in fo
od
rich
in e
nerg
y, vi
tam
in A
or i
ron
10%
of p
regn
ant
wom
en e
atin
g da
ily a
n ex
tra
mea
l or s
nack
th
at c
onta
in fo
od
rich
in e
nerg
y, vi
tam
in A
or i
ron
10%
of p
regn
ant
wom
en e
atin
g da
ily a
n ex
tra
mea
l or s
nack
th
at c
onta
in fo
od
rich
in e
nerg
y, vi
tam
in A
or i
ron
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Ann
ually
NEC
DP:
Pro
vide
ke
y m
essa
ges
MoH
: Dev
elop
gu
idel
ines
RB
C:
part
icip
ate
in
impl
emen
tatio
n LO
DA
: Dist
ribut
e ex
tra
mea
l to
Ubu
dehe
1&
2 R
AB:
Fac
ilita
te to
pr
oduc
e ex
tra-
food
. CH
Ws:
cond
uct
sens
itiza
tion
of
extr
a m
eal t
o be
nefic
iarie
s
59
Lact
atin
g M
othe
rsCo
mm
unic
atio
n ob
ject
ive
2:
By
2024
, a 5
0%
incr
ease
in th
e pr
opor
tion
of
lact
atin
g w
omen
ea
ting
daily
tw
o ex
tra
mea
ls or
snac
ks th
at
cont
ain
food
rich
in
ene
rgy,
vita
min
A
or i
ron
% o
f lac
tatin
g w
omen
eat
ing
daily
two
extr
a m
eals
or sn
acks
th
at c
onta
in fo
od
rich
in e
nerg
y, vi
tam
in A
or i
ron
Dat
a ga
ps:
need
bas
elin
e in
form
atio
n
5 %
of l
acta
ting
wom
en e
atin
g da
ily tw
o ex
tra
mea
ls or
snac
ks
that
con
tain
food
ric
h in
ene
rgy,
vita
min
A o
r iro
n
5 %
of l
acta
ting
wom
en e
atin
g da
ily tw
o ex
tra
mea
ls or
snac
ks
that
con
tain
food
ric
h in
ene
rgy,
vita
min
A o
r iro
n
10 %
of l
acta
ting
wom
en e
atin
g da
ily tw
o ex
tra
mea
ls or
snac
ks
that
con
tain
food
ric
h in
ene
rgy,
vita
min
A o
r iro
n
10 %
of l
acta
ting
wom
en e
atin
g da
ily tw
o ex
tra
mea
ls or
snac
ks
that
con
tain
food
ric
h in
ene
rgy,
vita
min
A o
r iro
n
10 %
of l
acta
ting
wom
en e
atin
g da
ily tw
o ex
tra
mea
ls or
snac
ks
that
con
tain
food
ric
h in
ene
rgy,
vita
min
A o
r iro
n
10 %
of l
acta
ting
wom
en e
atin
g da
ily tw
o ex
tra
mea
ls or
snac
ks
that
con
tain
food
ric
h in
ene
rgy,
vita
min
A o
r iro
n
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Ann
ually
NEC
DP:
Pro
vide
ke
y m
essa
ges
MoH
: Dev
elop
gu
idel
ines
RB
C:
part
icip
ate
in
impl
emen
tatio
n LO
DA
: Dist
ribut
e ex
tra
mea
l to
Ubu
dehe
1&
2 R
AB:
Fac
ilita
te to
pr
oduc
e ex
tra-
food
. CH
Ws:
con
duct
se
nsiti
zatio
n of
ex
tra
mea
l to
bene
ficia
ries
Impr
ove
Infa
nt a
nd Y
oung
Chi
ldre
n N
utri
tion
(IYC
N)
Chi
ldre
n (0
-6
mon
ths)
Com
mun
icat
ion
obje
ctiv
e 1:
By
2024
, a 1
0%
incr
ease
in th
e pr
opor
tion
of
child
ren
unde
r 6
excl
usiv
ely
brea
stfe
ed fo
r the
fir
st 6
mon
th
% o
f inf
ants
un
der 6
mon
ths
of a
ge w
ho
are
excl
usiv
ely
brea
stfe
d (r
ecei
ving
bre
ast
milk
, and
not
re
ceiv
ing
any
othe
r flui
ds o
r fo
ods,
with
the
exce
ptio
n of
or
al re
hydr
atio
n so
lutio
n,
vita
min
s, m
iner
al
supp
lem
ents
and
m
edic
ines
)
Base
line
Dat
a:
(RD
HS
2015
): 87
% o
f chi
ldre
n un
der 6
mon
ths
are
excl
usiv
ely
brea
stfe
d
2 %
of i
nfan
ts
unde
r 6 m
onth
s of
age
who
ar
e ex
clus
ivel
y br
east
fed
1% o
f inf
ants
un
der 6
mon
ths
of a
ge w
ho
are
excl
usiv
ely
brea
stfe
d
1% o
f inf
ants
un
der 6
mon
ths
of a
ge w
ho
are
excl
usiv
ely
brea
stfe
d
2% o
f inf
ants
un
der 6
mon
ths
of a
ge w
ho
are
excl
usiv
ely
brea
stfe
d
2 %
of i
nfan
ts
unde
r 6 m
onth
s of
age
who
ar
e ex
clus
ivel
y br
east
fed
2 %
of i
nfan
ts
unde
r 6 m
onth
s of
age
who
ar
e ex
clus
ivel
y br
east
fed
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Ann
ually
NEC
DP:
1.
Cond
uct
awar
enes
s ca
mpa
ign
2.
Prov
ide
key
mes
sage
s M
oH: D
evel
op
guid
elin
es
RBC
: pa
rtic
ipat
e in
im
plem
enta
tion
LOD
A: D
istrib
ute
extr
a m
eal t
o U
bude
he 1
&2
RA
B: F
acili
tate
to
prod
uce
extr
a-fo
od.
CHW
s: c
ondu
ct
sens
itiza
tion
of
extr
a m
eal t
o be
nefic
iarie
s N
WC
, NCC
, M
IGEP
ROF,
M
INA
LOC
, Loc
al
Aut
hori
ties
, ch
urch
lead
ers,
Diss
emin
ate
key
60
Chi
ldre
n (6
-23
mon
ths)
Co
mm
unic
atio
n ob
ject
ive
2: B
y 20
24, a
50%
in
crea
se in
the
prop
ortio
n of
ch
ildre
n ag
ed
6-23
mon
ths f
ed
in a
ccor
danc
e to
all
3 (h
ealt
h,
nutr
itio
n an
d W
ASH
) re
com
men
ded
prac
tices
%
of c
hild
ren
aged
6-2
3 m
onth
s fed
in
acco
rdan
ce to
all
3 re
com
men
ded
prac
tices
Base
line
Dat
a:
(RD
HS
2015
): 18
% o
f chi
ldre
n ag
ed 6
-23
mon
ths a
re
curr
ently
fed
in
acco
rdan
ce to
all
3 re
com
men
ded
prac
tices
10%
of
chi
ldre
n ag
ed 6
-23
mon
ths f
ed in
ac
cord
ance
to a
ll 3
reco
mm
ende
d pr
actic
es
10%
of
chi
ldre
n ag
ed 6
-23
mon
ths f
ed in
ac
cord
ance
to a
ll 3
reco
mm
ende
d pr
actic
es
10%
of
chi
ldre
n ag
ed 6
-23
mon
ths f
ed in
ac
cord
ance
to a
ll 3
reco
mm
ende
d pr
actic
es
10%
of
chi
ldre
n ag
ed 6
-23
mon
ths f
ed in
ac
cord
ance
to a
ll 3
reco
mm
ende
d pr
actic
es
10%
of
chi
ldre
n ag
ed 6
-23
mon
ths f
ed in
ac
cord
ance
to a
ll 3
reco
mm
ende
d pr
actic
es
10%
of
chi
ldre
n ag
ed 6
-23
mon
ths f
ed in
ac
cord
ance
to a
ll 3
reco
mm
ende
d pr
actic
es
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Ann
ually
NEC
DP:
1.
Cond
uct
awar
enes
s ca
mpa
ign
2.
Pro
vide
key
m
essa
ges
MoH
: Dev
elop
gu
idel
ines
RB
C:
part
icip
ate
in
impl
emen
tatio
n LO
DA
: Dist
ribut
e ex
tra
mea
l to
Ubu
dehe
1&
2 R
AB:
Fac
ilita
te to
pr
oduc
e ex
tra-
food
. CH
Ws:
cond
uct
sens
itiza
tion
of
extr
a m
eal t
o …
N
WC
, NCC
, M
IGEP
ROF,
M
INA
LOC
, Loc
al
Aut
hori
ties
, ch
urch
le
ader
s etc
Diss
emin
ate
key
mes
sage
s
61
Impr
ove
Wat
er, H
ygie
ne a
nd S
anit
atio
n pr
acti
ces
- H
and
Was
hing
at a
ll Cr
itic
al ti
mes
wit
h a
soap
, dis
pose
s all
fece
s inc
lude
d ch
ildre
n’s i
n a
safe
; hyg
ieni
c la
trin
e; D
rink
alw
ays p
rope
rly
trea
ted
wat
er;
Mot
her /
Car
egiv
er
of c
hild
ren/
te
ache
rs (0
-59
mon
ths)
Com
mun
icat
ion
obje
ctiv
e 1:
By
2024
, a 5
0%
incr
ease
in th
e pr
opor
tion
of m
othe
rs o
r ca
regi
vers
of
child
ren
0-59
m
onth
s was
h th
eir h
ands
and
ch
ildre
n’s h
ands
w
ith so
ap a
t all
criti
cal t
imes
% o
f mot
hers
/ca
regi
vers
was
h th
eir h
ands
with
so
ap a
t crit
ical
tim
es
need
bas
elin
e in
form
atio
n5
% o
f mot
hers
/ca
regi
vers
was
h th
eir h
ands
with
so
ap a
t crit
ical
tim
es
5 %
of m
othe
rs/
care
give
rs w
ash
thei
r han
ds w
ith
soap
at c
ritic
al
times
10 %
of m
othe
rs/
care
give
rs w
ash
thei
r han
ds w
ith
soap
at c
ritic
al
times
10 %
of m
othe
rs/
care
give
rs w
ash
thei
r han
ds w
ith
soap
at c
ritic
al
times
10 %
of m
othe
rs/
care
give
rs w
ash
thei
r han
ds w
ith
soap
at c
ritic
al
times
10 %
of m
othe
rs/
care
give
rs w
ash
thei
r han
ds w
ith
soap
at c
ritic
al
times
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Ann
ually
NEC
DP:
1.
Cond
uct
awar
enes
s ca
mpa
ign
2. P
rovi
de k
ey
mes
sage
s W
ASA
C: P
rovi
de
trea
ted
wat
er
MIN
EDU
C:
Mon
itor W
ASH
gu
idel
ines
im
plem
enta
tion
at S
choo
ls D
istr
icts
: 1.
Con
duct
ad
voca
cy to
W
ASC
to su
pply
sa
fe d
rinki
ng
wat
er
2. T
o en
sure
the
new
and
exi
stin
g Sc
hool
s hav
e w
ater
har
vest
s. CH
Ws:
con
duct
se
nsiti
zatio
n fo
r ap
prop
riate
han
d w
ash.
62
Mot
her /
Car
egiv
er
of c
hild
ren/
te
ache
rs (0
-59
mon
ths)
Com
mun
icat
ion
obje
ctiv
e 2:
By
2024
, a 5
0%
incr
ease
in th
e pr
opor
tion
of m
othe
rs o
r ca
regi
vers
of
child
ren
0-59
m
onth
s disp
ose
of fe
ces,
incl
udin
g ch
ildre
n’s,
in
latr
ines
with
co
ver
% o
f mot
hers
/ca
regi
vers
of
child
ren
0-59
m
onth
s disp
ose
of fe
ces,
incl
udin
g ch
ildre
n’s,
in
latr
ines
with
co
ver
need
bas
elin
e in
form
atio
n5%
of m
othe
rs
/car
egiv
ers o
f ch
ildre
n 0-
59
mon
ths d
ispos
e of
fece
s, in
clud
ing
child
ren’
s, in
la
trin
es w
ith
cove
r
5% o
f mot
hers
/c
areg
iver
s of
child
ren
0-59
m
onth
s disp
ose
of fe
ces,
incl
udin
g ch
ildre
n’s,
in
latr
ines
with
co
ver
10 %
of m
othe
rs
/car
egiv
ers o
f ch
ildre
n 0-
59
mon
ths d
ispos
e of
fece
s, in
clud
ing
child
ren’
s, in
la
trin
es w
ith
cove
r
10%
of m
othe
rs
/car
egiv
ers o
f ch
ildre
n 0-
59
mon
ths d
ispos
e of
fece
s, in
clud
ing
child
ren’
s, in
la
trin
es w
ith
cove
r
10 %
of m
othe
rs
/car
egiv
ers o
f ch
ildre
n 0-
59
mon
ths d
ispos
e of
fece
s, in
clud
ing
child
ren’
s, in
la
trin
es w
ith
cove
r
10%
of m
othe
rs
/car
egiv
ers o
f ch
ildre
n 0-
59
mon
ths d
ispos
e of
fece
s, in
clud
ing
child
ren’
s, in
la
trin
es w
ith
cove
r
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Ann
ually
NEC
DP:
1.
Cond
uct
awar
enes
s ca
mpa
ign
2. P
rovi
de k
ey
mes
sage
s W
ASA
C: P
rovi
de
trea
ted
wat
er
MIN
EDU
C:
Mon
itor W
ASH
gu
idel
ines
im
plem
enta
tion
at S
choo
ls D
istr
icts
: 1.
Con
duct
ad
voca
cy to
W
ASC
to su
pply
sa
fe w
ater
for
latr
ines
use
. 2.
To
ensu
re th
e ne
w a
nd e
xist
ing
Scho
ols h
ave
appr
opria
te
latr
ines
CH
Ws:
con
duct
se
nsiti
zatio
n fo
r ap
prop
riate
han
d w
ash.
63
Mot
her /
Car
egiv
er
of c
hild
ren/
te
ache
rs (0
-59
mon
ths)
Com
mun
icat
ion
obje
ctiv
e 2:
By
202
4, a
50%
in
crea
se in
the
prop
ortio
n of
mot
hers
or
care
give
rs o
f ch
ildre
n 0-
59
mon
ths
% o
f mot
hers
/ca
regi
vers
of
child
ren
0-59
m
onth
s tre
atin
g dr
inki
ng-
wat
er w
ith
reco
mm
ende
d m
etho
ds
Base
line
Dat
a:
(RD
HS
2015
) : 4
4 %
of
hous
ehol
ds u
se
an a
ppro
pria
te
trea
tmen
t m
etho
d pr
ior t
o dr
inki
ng
5%
of m
othe
rs
/car
egiv
ers o
f ch
ildre
n 0-
59
mon
ths t
reat
ing
drin
king
-w
ater
with
re
com
men
ded
met
hods
5 %
of m
othe
rs
/car
egiv
ers o
f ch
ildre
n 0-
59
mon
ths t
reat
ing
drin
king
-w
ater
with
re
com
men
ded
met
hods
5%
of m
othe
rs
/car
egiv
ers o
f ch
ildre
n 0-
59
mon
ths t
reat
ing
drin
king
-w
ater
with
re
com
men
ded
met
hods
5%
of m
othe
rs
/car
egiv
ers o
f ch
ildre
n 0-
59
mon
ths t
reat
ing
drin
king
-w
ater
with
re
com
men
ded
met
hods
5 %
of m
othe
rs
/car
egiv
ers o
f ch
ildre
n 0-
59
mon
ths t
reat
ing
drin
king
-w
ater
with
re
com
men
ded
met
hods
5%
of m
othe
rs
/car
egiv
ers o
f ch
ildre
n 0-
59
mon
ths t
reat
ing
drin
king
-w
ater
with
re
com
men
ded
met
hods
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Ann
ually
NEC
DP:
1.
Cond
uct
awar
enes
s ca
mpa
ign
2. P
rovi
de k
ey
mes
sage
s W
ASA
C: P
rovi
de
trea
ted
wat
er
MIN
EDU
C:
Mon
itor W
ASH
gu
idel
ines
im
plem
enta
tion
at S
choo
ls D
istr
icts
: 1.
Con
duct
ad
voca
cy to
W
ASC
to su
pply
sa
fe w
ater
for
latr
ines
use
. 2.
To
ensu
re th
e ne
w a
nd e
xist
ing
Scho
ols h
ave
appr
opria
te
latr
ines
CH
Ws:
con
duct
se
nsiti
zatio
n fo
r ap
prop
riate
han
d w
ash.
Impr
ove
Hea
lth
Seek
ing
beha
vior
at c
omm
unit
y le
vel
Preg
nant
wom
enBy
202
4, a
50%
in
crea
se in
the
prop
ortio
n of
wom
en
atte
nded
the
reco
mm
ende
d fo
ur A
NC
visi
ts
durin
g th
eir
preg
nanc
y
% o
f pre
gnan
t w
omen
who
at
tend
the
four
-re
com
men
ded
ante
nat
al c
are
visit
s
Base
line
Dat
a:
(RD
HS
2015
) :
44%
of w
omen
at
tend
ed th
e re
com
men
ded
four
AN
C v
isits
du
ring
thei
r pr
egna
ncy
5% o
f pre
gnan
t w
omen
who
at
tend
the
four
-re
com
men
ded
ante
nat
al c
are
visit
s
5% o
f pre
gnan
t w
omen
who
at
tend
the
four
-re
com
men
ded
ante
nat
al c
are
visit
s
5% o
f pre
gnan
t w
omen
who
at
tend
the
four
-re
com
men
ded
ante
nat
al c
are
visit
s
5% o
f pre
gnan
t w
omen
who
at
tend
the
four
-re
com
men
ded
ante
nat
al c
are
visit
s
5% o
f pre
gnan
t w
omen
who
at
tend
the
four
-re
com
men
ded
ante
nat
al c
are
visit
s
5% o
f pre
gnan
t w
omen
who
at
tend
the
four
-re
com
men
ded
ante
nat
al c
are
visit
s
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Qua
rter
lyN
ECD
P: 1
. Co
nduc
t aw
aren
ess
cam
paig
n
2.
Pro
vide
key
m
essa
ges
RBC
: Rei
nfor
ce
heal
th fa
cilit
ies
leve
ls CH
Ws:
con
duct
se
nsiti
zatio
n fo
r A
NC
N
WC
, M
IGEP
ROF
Chu
rch
lead
ers,
U
MU
GO
ROBA
W
’ABA
BYEY
I: co
nduc
t m
obili
zatio
n an
d di
ssem
inat
e ke
y m
essa
ges o
n A
NC
64
Mot
her o
f new
bo
rn in
fant
By 2
024,
a 5
0%
incr
ease
in th
e pr
opor
tion
of
mot
her o
f new
bo
rn in
fant
re
port
ing
to
heal
th fa
cilit
ies t
o se
ek p
rofe
ssio
nal
care
% o
f mot
her o
f ne
w b
orn
infa
nt
repo
rtin
g to
he
alth
faci
litie
s to
seek
pro
fess
iona
l ca
re
Base
line
Dat
a:
(RD
HS
2015
): 43
% w
omen
w
ho g
ave
birt
h in
the
two
year
s pr
eced
ing
the
surv
ey re
ceiv
ed
a po
stna
tal c
are
chec
kup
in th
e fir
st tw
o da
ys
afte
r del
iver
y.
5 %
of m
othe
r of
new
bor
n in
fant
re
port
ing
to
heal
th fa
cilit
ies t
o se
ek p
rofe
ssio
nal
care
5% o
f mot
her o
f ne
w b
orn
infa
nt
repo
rtin
g to
he
alth
faci
litie
s to
seek
pro
fess
iona
l ca
re
10 %
of m
othe
r of
new
bor
n in
fant
re
port
ing
to
heal
th fa
cilit
ies t
o se
ek p
rofe
ssio
nal
care
10 %
of m
othe
r of
new
bor
n in
fant
re
port
ing
to
heal
th fa
cilit
ies t
o se
ek p
rofe
ssio
nal
care
10%
of m
othe
r of
new
bor
n in
fant
re
port
ing
to
heal
th fa
cilit
ies t
o se
ek p
rofe
ssio
nal
care
10 %
of m
othe
r of
new
bor
n in
fant
re
port
ing
to
heal
th fa
cilit
ies t
o se
ek p
rofe
ssio
nal
care
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Qua
rter
lyN
ECD
P: 1
. Co
nduc
t aw
aren
ess
cam
paig
n
2.
Pro
vide
key
m
essa
ges
RBC
: Rei
nfor
ce
heal
th fa
cilit
ies
leve
ls C
HW
s: co
nduc
t se
nsiti
zatio
n fo
r A
NC
N
WC
, C
hurc
h le
ader
s, U
MU
GO
ROBA
W
’ABA
BYEY
I: co
nduc
t m
obili
zatio
n an
d di
ssem
inat
e ke
y m
essa
ges o
n A
NC
Mot
her o
f new
bo
rn in
fant
sBy
202
4, a
1 %
in
crea
se in
the
prop
ortio
n of
fu
lly im
mun
ized
ch
ildre
n at
age
on
e ye
ar p
er
pres
crib
ed b
y he
alth
car
e pr
ovid
ers
% o
f ful
ly
imm
uniz
ed
child
ren
at a
ge
one
year
per
pr
escr
ibed
by
heal
th c
are
prov
ider
s
Base
line
Dat
a:
(RD
HS
2015
) :
99%
of c
hild
ren
age
12-2
3 m
onth
s ha
ve re
ceiv
ed a
ll ba
sic v
acci
nes (
10
0 %
of f
ully
im
mun
ized
ch
ildre
n at
age
on
e ye
ar p
er
pres
crib
ed b
y he
alth
car
e pr
ovid
ers
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Qua
rter
lyN
ECD
P: 1
. Co
nduc
t aw
aren
ess
cam
paig
n
2.
Pro
vide
key
m
essa
ges
RBC
: Rei
nfor
ce
heal
th fa
cilit
ies
leve
ls CH
Ws:
con
duct
se
nsiti
zatio
n fo
r A
NC
N
WC
, C
hurc
h le
ader
s,
UM
UG
ORO
BA
W’A
BABY
EYI:
cond
uct
mob
iliza
tion
and
diss
emin
ate
key
mes
sage
s on
AN
C
65
Mot
her o
f U5
child
/ C
areg
iver
s te
ache
rs/ a
nd
ECD
s ser
vice
s pr
ovid
ers
By 2
024,
a 1
0 %
incr
ease
in
the
prop
ortio
n of
Mot
her /
Hus
band
of
child
ren
unde
r fiv
e at
tend
ing
regu
lar g
row
th
mon
itorin
g an
d pr
omot
ion
sess
ions
(GM
P
% o
f Mot
her /
Hus
band
of
child
ren
unde
r fiv
e at
tend
ing
regu
lar g
row
th
mon
itorin
g an
d pr
omot
ion
sess
ions
(GM
P)
need
bas
elin
e in
form
atio
n 1
% o
f Mot
her
/Hus
band
of
child
ren
unde
r fiv
e at
tend
ing
regu
lar g
row
th
mon
itorin
g an
d pr
omot
ion
sess
ions
(GM
P)
1 %
of M
othe
r /H
usba
nd o
f ch
ildre
n un
der
five
atte
ndin
g re
gula
r gro
wth
m
onito
ring
and
prom
otio
n se
ssio
ns (G
MP)
2 %
of M
othe
r /H
usba
nd o
f ch
ildre
n un
der
five
atte
ndin
g re
gula
r gro
wth
m
onito
ring
and
prom
otio
n se
ssio
ns (G
MP)
2 %
of M
othe
r /H
usba
nd o
f ch
ildre
n un
der
five
atte
ndin
g re
gula
r gro
wth
m
onito
ring
and
prom
otio
n se
ssio
ns (G
MP)
2 %
of M
othe
r /H
usba
nd o
f ch
ildre
n un
der
five
atte
ndin
g re
gula
r gro
wth
m
onito
ring
and
prom
otio
n se
ssio
ns (G
MP)
2 %
of M
othe
r /H
usba
nd o
f ch
ildre
n un
der
five
atte
ndin
g re
gula
r gro
wth
m
onito
ring
and
prom
otio
n se
ssio
ns (G
MP)
RDH
S Re
port
s, K
AP
surv
eys,
Prog
ram
ba
selin
es, F
GD
s, N
ECD
P Re
port
s
Mon
thly
NEC
DP:
1.
Cond
uct
awar
enes
s ca
mpa
ign
2. P
rovi
de k
ey
mes
sage
s RB
C: R
einf
orce
he
alth
faci
litie
s le
vels
CHW
s: c
ondu
ct
sens
itiza
tion
for
AN
C
NW
C,
Chu
rch
lead
ers,
U
MU
GO
ROBA
W
’ABA
BYEY
I:
co
nduc
t m
obili
zatio
n an
d di
ssem
inat
e ke
y m
essa
ges o
n A
NC
66
AN
NEX
3: M
essa
ges f
or S
BCC
Inki
ngi y
’Imbo
neza
mik
urire
: 1.
Ubu
zim
a n’
Imiri
re
Imite
rere
y’ik
ibaz
o (N
egat
ive
baha
vior
)Im
pam
vu z
ibite
raIm
yitw
arire
yifu
zwa
(Des
ired
beha
vior
)A
bo u
butu
mw
a bu
gene
we
Ubu
ryo
bw’ih
erer
ekan
yabu
tum
wa
bush
obok
aU
butu
mw
a bw
’inge
nzi
1. K
utita
ku
kam
aro
k’im
irire
myi
za
y’U
mw
ana
mu
min
si 10
00 y
a m
bere
y’
ubuz
ima
bwe,
bitu
ma
aban
a ba
daku
ra n
eza
mu
giha
gara
ro n
o m
u bw
enge
bik
anon
gera
impf
u z’a
bana
bat
o Ba
mw
e m
u ba
byey
i nt
ibon
sa
aban
a ku
isah
a ya
mbe
re b
akiv
uka
Bam
we
mu
baby
eyi b
avan
gira
ab
ana
amas
here
ka n
’ibin
di m
u m
ezi
6 ya
mbe
re
Nyu
ma
y’am
ezi 6
, bam
we
mu
baby
eyi
baha
aba
na b
abo
ifash
aber
e
arik
o ba
kayi
baha
idah
agije
kan
di
itagi
zwe
n’in
dyo
yuzu
ye, b
igat
uma
bagw
ingi
ra c
yang
wa
baka
rwar
a bw
aki
• Ubu
men
yi b
uke
ku m
irire
m
yiza
y’u
mw
ana
mut
o
• Kut
amen
ya a
kam
aro
k’im
irire
mu
min
si 10
00 y
a m
bere
y’U
mw
ana
• A
baga
bo b
atita
bira
in
yigi
sho
zijy
anye
n’
imbo
neza
mik
urire
y’ab
ana
bato
• K
uba
mu
igen
amig
ambi
ry
’inze
go z
imw
e na
zi
mw
e ha
taba
mo
ibik
orw
a bi
shyi
giki
ra
imbo
neza
mik
urire
y’ab
ana
bato
nko
mu
mih
igo
• A
baby
eyi n
tibaz
i aka
mar
o ko
gus
hyira
um
wan
a ku
iber
e ak
ivuk
a • A
baby
eyi n
tibaz
i aka
mar
o ko
nsa
gusa
mu
mez
i at
anda
tu y
a m
bere
• A
baby
eyi n
tibaz
i aka
mar
o k’
ifash
aber
e
• Aba
byey
i bum
va k
o gu
ha
umw
ana
iber
e bi
hagi
je
• Har
i aba
byey
i bab
ura
ifash
aber
e ku
bera
ubu
kene
• H
ari a
bata
zi g
uteg
ura
neza
ifa
shab
ere
igiz
we
n’in
dyo
yuzu
ye
• Har
i aba
tazi
igih
e n’
insh
uro
umw
ana
akw
iriye
guh
abw
a am
afun
guro
• Ubu
fata
nye
bw’ab
agiz
e um
urya
ngo
kwita
ku
buzi
ma
n’im
irire
by’
umw
ana
mu
gihe
cy’
imin
si 10
00 y
a m
bere
y’
ubuz
ima
• A
bayo
bozi
mu
nzeg
o zo
se: K
ugira
uru
hare
mu
guka
ngur
ira a
bo b
ayob
oye
kwita
ku
mbo
neza
mik
urire
y’
aban
a ba
to, k
u bu
zim
a n
o ku
miri
re m
yiza
mu
gihe
cy
’imin
si 10
00 y
a m
bere
y’
ubuz
ima
bw’u
mw
ana
• Kon
sa u
mw
ana
ku is
aha
ya
mbe
re a
kim
ara
kuvu
ka
• Kon
sa u
mw
ana
igih
e cy
’amez
i 6 n
ta k
indi
ava
ngiw
e • G
uha
umw
ana
imfa
shab
ere
igiz
we
ni’in
dyo
yuzu
ye i
gizw
e n’
ibiry
o bi
tand
ukan
ye b
yuzu
zany
a m
u nt
unga
mub
iri k
uva
agiz
e am
ezi a
tand
atu
Aba
byey
i bom
bi
n’ab
andi
bar
era
aban
a.
• Aba
yobo
zi m
u nz
ego
zita
nduk
anye
• I
nzeg
o za
Let
a • A
mad
ini
• Aba
jyan
ama
b’ub
uzim
a • I
nshu
ti z’u
mur
yang
o • A
bajy
anam
a b’
ubuh
inzi
A
bafa
sham
yum
vire
• Ibi
gani
ro n
’abag
ize
umur
yang
o (H
ome
Visi
ts)
• Ubu
jyan
ama
buko
zwe
n’ab
ajya
nam
a b’
ubuz
ima
(Cou
nsel
ing
Talk
s by
CH
Ws)
• U
butu
mw
a bu
tanz
we
n’In
shut
i z’
Um
urya
ngo
• U
butu
mw
a bu
nyuz
e m
u m
asib
o,
inga
mba
n’an
di m
ahur
iro a
tegu
rwa
n’Ito
rero
ry’Ig
ihug
u • U
mug
orob
a w
’abab
yeyi
(Eve
ning
Pa
rent
s For
um)
• Ish
uri m
bone
zam
irire
ry
’um
udug
udu
(Vill
age
Nut
ritio
n Sc
hool
)
• Im
irim
a sh
uri (
Farm
er F
ield
Le
arni
ng S
choo
l)
• Aho
bap
imira
aba
na ib
iro m
u m
udug
udu
(Gro
wth
Mon
itorin
g Pr
omot
ion)
• A
mat
sinda
yo
kubi
tsa
no
kugu
rizan
ya/I
bim
ina
(Sav
ing
and
Inte
rnal
Len
ding
Com
mun
ities
) • K
alab
u z’
isuku
n’is
ukur
a (C
omm
unity
Hea
lth C
lub
sess
ions
)
• Ibi
gani
ro b
itang
irwa
kwa
mug
anga
(IE
C se
ssio
ns)
• Ibi
tabo
n’iz
indi
nya
ndik
o (P
rinte
d m
ater
ials)
1. K
wita
ku
miri
re m
yiza
y’
Um
wan
a w
awe
mu
min
si 10
00
ya m
bere
y’u
buzi
ma
bwe,
ni
inge
nzi k
u m
ikur
ire, h
aba
mu
giha
gara
ro, m
u bw
enge
no
mu
mba
mut
ima.
Fat
a in
dyo
yuzu
ye
kand
i iha
gije
mu
gihe
utw
ite n
o m
u gi
he w
onsa
. Shy
ira u
mw
ana
ku ib
ere
mu
isaha
ya
mbe
re
akiv
uka,
ons
a um
wan
a nt
a ki
ndi u
muv
angi
ye h
abe
n’am
azi
mu
mez
i 6 y
a m
bere
, m
uhe
ifash
aber
e ig
izw
e n’
indy
o yu
zuye
ku
va k
u m
ezi 6
avu
tse
kuge
za
kuri
24, b
izam
urin
da k
ugw
ingi
ra
akur
e ne
za a
fite
ubuz
ima
bwiz
a,
azig
irire
aka
mar
o, a
kagi
rire
umur
yang
o n’
igih
ugu
mur
i ru
sang
e.
2. O
nsa
umw
ana
ku is
aha
ya m
bere
aki
mar
a ku
vuka
ku
ko b
imuf
asha
kug
uman
a ub
ushy
uhe,
guh
umek
a ne
za,
bika
nam
uha
ubud
ahan
garw
a bw
’ um
ubiri
67
• Ibi
nyam
akur
u by
andi
ka
(New
spap
ers)
• I
ngo
mbo
neza
mik
urire
/Am
arer
ero
(EC
D c
ente
rs)
• I
nam
a za
VU
P (V
UP
Mee
tings
) • I
biga
niro
kur
i Rad
iyo
na T
V (R
adio
ta
lk sh
ow T
V)
• Sin
ema
zo h
anze
(Cin
e m
obile
s)
• Ibi
gani
ro m
bwirw
aruh
ame
na z
a vi
dew
o bi
kore
we
hanz
e (R
oad
show
s an
d m
obile
vid
eo sh
ows)
, • U
mug
anda
(Com
mun
ity w
ork)
• I
ntek
o z
’abat
urag
e (C
omm
unity
M
eetin
g)
• Ubu
tum
wa
buta
ngw
a n’
abas
hinz
we
irang
amim
erer
e (C
ivil
stat
us a
nd n
otar
y offi
cers
) • A
mat
orer
o/in
seng
ero
n’im
isigi
ti (c
hurc
h an
d m
osqu
e)
• Am
ashu
ri: A
ho a
bany
eshu
ri ba
tera
niye
(Stu
dent
s’ as
sem
blie
s)
Ibig
aniro
mpa
ka (d
ebat
es in
…)
• Am
akor
aniro
y’u
ruby
iruko
(You
th
corn
ers)
• I
kina
mic
o (D
ram
a), I
miv
ugo
(poe
m),
Ubu
tum
wa
buny
ujijw
e m
u nd
irim
bo (
song
for c
omm
unity
ou
trea
ch),
• U
butu
mw
a bu
nyuj
ijwe
ku m
buga
nk
oran
yam
baga
na
Inte
rinet
e (B
CC
ICT)
3. O
nsa
umw
ana
igih
e cy
’amez
i 6
ya m
bere
nta
kin
di u
muv
angi
ye
habe
n’am
azi k
uko
bim
urin
da
indw
ara
zita
nduk
anye
har
imo
im
pisw
i, um
uson
ga n
’imiri
re
mib
i. K
uva
ku m
ezi 6
kug
ezak
m
yaka
2, k
omez
a w
onse
kan
di
uhe
umw
ana
imfa
shab
ere
igiz
we
ni’in
dyo
yuzu
ye i
gizw
e n’
ibyu
baka
um
ubiri
, ibi
tera
im
bara
ga n
’ibiri
nda
indw
ara.
4.
Ni i
nshi
ngan
o z’u
mug
abo
mu
kwita
ku
miri
re n
’ubu
zim
a bw
’um
wan
a w
e m
u m
insi
1000
ya
mbe
re y
’ubu
zim
a bw
e. F
asha
um
ugor
e w
awe
gufa
ta in
dyo
yuzu
ye k
andi
ihag
ije m
u gi
he
atw
ite n
o m
u gi
he y
onsa
.; guh
yira
um
wan
a ku
iber
e m
u isa
ha y
a m
bere
aki
vuka
, ku
mw
onsa
nta
ki
ndi a
muv
angi
ye h
abe
n’am
azi
mu
mez
i 6 y
a m
bere
, ku
muh
a ifa
shab
ere
igiz
we
n’in
dyo
yuzu
ye
kuva
ku
mez
i 6 a
vuts
e ku
geza
ku
ri 24
, biz
amur
inda
kug
win
gira
ak
ure
neza
afit
e ub
uzim
a bw
iza,
az
igiri
re a
kam
aro,
aka
girir
e um
urya
ngo
n’ig
ihug
u m
uri
rusa
nge.
68
• Ubu
kang
uram
baga
bw
ose
buga
mije
kw
ita k
u bu
zim
a bw
’aban
a ba
to (I
cyum
wer
u cy
ahar
iwe
ubuz
ima
bw’u
mub
yeyi
n’u
mw
ana
(MC
H c
ampa
ign)
, Icy
umw
eru
cy’u
mur
yang
o (F
amily
cam
paig
n)…
• U
buvu
gizi
mu
nam
a na
bafa
taya
biko
rwa
(adv
ocac
y Pa
rtne
rshi
p m
eetin
gs)
• Ubu
kang
uram
baga
n’in
ama
kuri
seriv
isi z
ikom
atan
yije
z’
imbo
neza
ikur
ire y
’aban
a ba
to
(cam
paig
n an
d m
eetin
gs o
n in
tegr
ated
EC
D se
rvic
es)
5. N
i ins
hing
ano
z’aba
yobo
zi
mu
nzeg
o zi
tand
ukan
ye;
aban
yam
adin
i, ab
ajya
nam
a b’
ubuz
ima,
insh
uti z
’um
urya
ngo,
ab
ajya
nam
a b’
ubuh
inzi
, n’
abaf
asha
myu
mvi
re m
u kw
ita
ku m
irire
myi
za n
’ubu
zim
a bw
’aban
a. K
angu
rira
umub
yeyi
ut
wite
n’u
won
sa g
ufat
a in
dyo
yuzu
ye k
andi
ihag
ije ;
guhy
ira
umw
ana
ku ib
ere
mu
isaha
ya
mbe
re a
kivu
ka,
kum
won
sa n
ta
kind
i am
uvan
giye
hab
e n’
amaz
i m
u m
ezi 6
ya
mbe
re ,
kum
uha
ifash
aber
e ig
izw
e n’
indy
o yu
zuye
ku
va k
u m
ezi 6
avu
tse
kuge
za
kuri
24, b
izam
urin
da k
ugw
ingi
ra
akur
e ne
za a
fite
ubuz
ima
bwiz
a,
azig
irire
aka
mar
o, a
kagi
rire
umur
yang
o n’
igih
ugu
mur
i ru
sang
e.
69
2. K
utita
bira
gup
imish
a ab
ana
mu
rweg
o rw
o gu
kurik
irana
no
gute
za
imbe
re im
ikur
ire y
abo
• Kut
amen
ya n
o ku
daha
ag
aciro
ikur
ikira
na im
ikur
ire
y’um
wan
a • U
bum
enyi
buc
ye k
u ka
mar
o ko
kw
ita k
u m
wan
a m
u gi
he
cy’im
insi
1000
ya
mbe
re
y’ub
uzim
a bw
e
• Kut
amen
ya u
ko b
agom
ba
kubi
taho
• G
upim
isha
ibiro
, ub
ureb
ure,
… k
u gi
he k
ugira
ha
kurik
iranw
e im
ikur
ire
y’ab
ana
• Kw
ita k
u m
irire
y’u
mw
ana
mut
o m
u gi
he c
y’im
insi
1000
ya
mbe
re y
’ubu
zim
a bw
e
• Aba
byey
i bom
bi
n’ab
andi
bar
era
aban
a.
• Aba
yobo
zi m
u nz
ego
zita
nduk
anye
; • I
nzeg
o za
Let
a • A
mad
ini
• Aba
jyan
ama
b’ub
uzim
a • I
nshu
ti z’u
mur
yang
o • A
bajy
anam
a b’
ubuh
inzi
, A
bafa
sham
yum
vire
1. M
ubye
yi, k
urik
irana
imik
urire
y’
umw
ana
waw
e um
upim
isha
ibiro
n’u
muz
engu
ruko
w’ik
izig
ira
cy’u
kubo
ko k
u ba
jyan
ama
b’ub
uzim
a n’
ubur
ebur
e .k
u ki
go n
dera
buzi
ma
kugi
ra n
go
ugirw
e in
ama,
biz
atum
a m
u gi
he
agar
agay
eho
ikib
azo
cy’im
irire
m
ibi,
yita
bwah
o n’
abaj
yana
ma
b’ub
uzim
a cy
angw
a n’
ibig
o nd
erab
uzim
a.
2. M
ubye
yi, g
ana
urug
o m
bone
zam
ikur
ire r
ukw
eger
eye
cyan
gwa
ikig
o nd
erab
uzim
a,
kugi
ra n
go u
habw
e in
yigi
sho
ku m
irire
n’im
ikur
ire ib
oney
e y’
umw
ana
waw
e
3. H
ari a
baby
eyi b
atita
bira
kw
ipim
isha
no k
wisu
zum
isha
kwa
mug
anga
igih
e ba
twite
na
nyum
a yo
kub
yara
• Ubu
men
yi b
uke
ku k
amar
o ko
kw
ipim
isha
igih
e um
ugor
e at
wite
• Kw
itabi
ra k
wip
imish
a no
kw
isuzu
mish
a kw
a m
ugan
ga
igih
e um
ugor
e at
wite
nib
ura
insh
uro
enye
zag
enw
e
• Aba
gore
bat
wite
n’
abag
abo
babo
• A
bajy
anam
a b’
ubuz
ima
• Aba
yobo
zi b
’inze
go
z’ib
anze
, abo
mu
miry
ango
itar
i iya
Let
a • A
bajy
anam
a b’
ubuz
ima,
Insh
uti
z’um
urya
ngo
...
Mub
yeyi
, igi
he u
twite
itab
ire
kwip
imish
a in
da in
shur
o en
ye z
agen
we,
biz
aguf
asha
gu
kurik
irana
imik
urire
myi
za
y’um
wan
a ur
i mu
nda
no
kwita
ku
buzi
ma
bwaw
e n’
ubw
’um
wan
a ut
wite
; igi
he
cyo
kuby
ara
niki
gera
, uby
arire
kw
a m
ugan
ga k
uko
biza
gufa
sha
kuby
ara
neza
kan
di u
byar
e m
wan
a m
uzim
a
70
4. H
ari a
baby
eyi b
atita
bira
gu
king
iza
aban
a in
king
o zo
se• U
bum
enyi
buk
e bw
’abab
yeyi
ku
kam
aro
ko
guki
ngiz
a ab
ana
inki
ngo
zose
• Kw
itabi
ra g
ukin
giza
um
wan
a uk
o in
king
o zo
se
ziku
rikira
na
• Aba
gore
bat
wite
n’
abag
abo
babo
• A
bajy
anam
a b’
ubuz
ima
• Aba
yobo
zi b
’inze
go
z’ib
anze
, abo
mu
miry
ango
itar
i iya
Let
a • A
bajy
anam
a b’
ubuz
ima,
Insh
uti
z’um
urya
ngo
…
Mub
yeyi
, kin
giza
um
wan
a w
awe
inki
ngo
zose
uko
zi
tega
nyijw
e, b
izam
urin
da
indw
ara
ziza
haza
aba
na c
yane
cy
ane
ko n
’iyo
indw
ara
zije
zi
tam
ugira
ho u
buka
na n
k’ub
wo
zigi
ra k
’uda
king
iye.
Gan
a ik
igo
nder
abuz
ima
kikw
eger
eye
ahat
angi
rwa
inki
ngo
zirim
o ur
w’im
basa
, ise
ru, a
kani
ga,
igitu
ntu,
aga
kweg
a, u
mw
ijim
a w
o m
u bw
oko
bwa
B nd
etse
n’
umus
onga
.
5. H
ari a
baby
eyi b
atita
bira
ku
bone
za u
ruby
aro
• Ubu
men
yi b
uke
bw’ab
abye
yi k
uri g
ahun
da y
o ku
bone
za u
ruby
aro
• Uru
hare
ruto
rw’ab
agab
o bu
mva
ari
uruh
are
rw’ab
agor
e gu
sa
• Im
yem
erer
e ish
ingi
ye k
u m
adin
i • I
myu
mvi
re is
hing
iye
ku
muc
o w
o ku
byar
a ab
ana
bens
hi
Kwita
bira
kub
onez
a ur
ubya
ro
ku b
uryo
bub
erey
e bu
ri w
ese
kand
i yih
itiye
mo
• Aba
gore
bat
wite
n’
abag
abo
babo
• A
bajy
anam
a b’
ubuz
ima
• Aba
yobo
zi b
’inze
go
z’ib
anze
, abo
mu
miry
ango
itar
i iya
Let
a • A
bajy
anam
a b’
ubuz
ima,
Insh
uti
z’um
urya
ngo
…
1. K
ubon
eza
urub
yaro
biri
nda
imfu
z’ab
abye
yi, k
ugw
ingi
ra
kw’ab
ana
n’ub
uken
e m
u m
iryan
go. M
ubye
yi, i
tabi
re
gahu
nda
yo k
ubon
eza
urub
yaro
ku
ko b
itum
a ub
ona
umw
anya
uh
agije
wo
kons
a no
kw
ita
ku m
wan
a uk
iri m
uto
cyan
e cy
ane
mu
min
si 10
00 y
a m
bere
y’
ubuz
ima
bwe.
Ubu
ryo
bwo
kubo
neza
uru
byar
o bu
bone
ka
ku b
ajya
nam
a b’
ubuz
ima
mu
mud
ugud
u, k
u ki
go n
dera
buzi
ma
cyan
gwa
ku k
igo
cyun
gani
ra ik
igo
nder
abuz
ima
(pos
te d
e sa
nte)
no
ku b
itaro
. Aba
kozi
bab
ihug
ukiw
e ba
zagu
ha ib
isoba
nuro
bih
agije
ku
gira
ngo
wifa
tire
icye
mez
o un
ihiti
rem
o ub
uryo
buk
unog
eye.
71
2. K
ubon
eza
urub
yaro
ni
insh
inga
no y
’um
ugor
e n’
umug
abo.
Mug
abo,
fash
a um
ugor
e w
awe
kwita
bira
ga
hund
a yo
kub
onez
a ur
ubya
ro
kuko
bitu
ma
abon
a um
wan
ya
uhag
ije w
o ko
nsa
no k
wita
ku
mw
ana
ukiri
mut
o cy
ane
cyan
e m
u m
insi
1000
ya
mbe
re
y’ub
uzim
a bw
e. H
erek
eza
umug
ore
waw
e k
u ba
jyan
ama
b’ub
uzim
a m
u m
udug
uidu
, ku
kigo
nde
rabu
zim
a no
mu
bita
ro
ahat
angi
rwa
seriv
isi z
o ku
bone
za
urub
yaro
. Aba
kozi
bab
ihug
ukiy
e ba
zaba
ha ib
isoba
nuro
bih
agije
ku
gira
ngo
mw
ifatir
e ic
yem
ezo
mw
umvi
kane
uza
bone
za
urub
yaro
mur
i mw
e n’
ubur
yo
bum
unog
eye.
Inki
ngi y
’Imbo
neza
mik
urire
: 2.
Am
azi m
eza,
isuk
u n’
isuku
ra6.
Isuk
u nk
e ku
ri ba
mw
e m
u ba
byey
i n’ab
andi
bar
era
aban
a,
umuc
o w
o gu
kara
ba in
toki
ha
kore
shej
we
amaz
i mez
a n’
isabu
ne u
kiri
hasi,
isuk
u nk
e y’
ibiry
o, in
go z
idafi
te u
bwih
erer
o n’
ingo
zifi
te u
bwih
erer
ero
butu
juje
ib
yang
ombw
a
• Har
i aba
ntu
bagi
fite
umuc
o m
ubi w
o ku
tita
ku
isuku
y’u
mub
iri, i
biko
resh
o n’
ahad
ukik
ije…
• U
bum
enyi
buk
e no
kut
ita
ku k
amar
o ko
guk
arab
a in
toki
uko
bik
wiy
e • U
bum
enyi
buk
e no
kut
agira
um
uco
w’is
uku
mu
gute
gura
ib
iribw
a • U
bum
enyi
buk
e ku
kam
aro
ko k
ugira
no
guko
resh
a ub
wih
erer
o bw
ujuj
e ib
yang
ombw
a
• Isu
ku ig
ihe
cyos
e ku
mub
iri,
ku b
ikoe
sho,
n’ah
andi
hak
ikije
ab
antu
• U
muc
o w
o gu
kara
ba in
toki
ne
za m
u bi
he b
yage
nwe
• Gut
egur
ana
amaf
ungu
ro
isuku
ihag
ije
• Kug
ira u
bwih
erer
o bu
fite
isuku
,bw
ujuj
e ib
yang
ombw
a ka
ndi b
ukor
eshw
a ne
za k
u ng
o n’
ahan
di h
ahur
ira a
bant
u be
nshi
Abo
ubu
tum
wa
buge
new
e:
• Aba
byey
i bom
bi
n’ab
andi
bar
era
aban
a • A
bana
• I
nzeg
o za
Let
a • A
mad
ini
• Aba
jyan
a b’
ubuz
ima
• Ins
huti
z’um
urya
ngo
1. Is
uku
ni is
oko
y’ub
uzim
a.
Um
wan
da n
i iso
ko y
’indw
ara
nyin
shi h
arim
o: in
zoka
zo
mu
nda,
mu
bwon
ko n
’izo
mu
miy
obor
o y’
amar
aso;
kol
era;
im
pisw
i; sh
ishik
ara;
am
avun
ja;
n’iz
indi
nyi
nshi
. Izi
ndw
ara
zose
zi
kaba
ziz
ahaz
a uz
irway
e, z
igat
era
kugw
ingi
ra k
’um
wan
a n’
imiri
re
mib
i mur
i rus
ange
, zik
aba
zam
uhita
na c
yang
wa
zika
mut
era
ubum
uga.
72
2. G
ira u
muc
o w
’isuk
u un
ywa
amaz
i asu
kuye
, uka
raba
in
toki
uko
resh
eje
amaz
i mez
a n’
isabu
ne m
bere
yo
gute
gura
am
afun
guro
, ugi
ye g
ufun
gura
, ug
iye
kons
a cy
angw
a ku
gabu
rira
umw
ana
n’ig
ihe
cyos
e uv
uye
mu
bwih
erer
ero.
kan
di u
gire
isuk
u ku
bi
kore
sho
byos
e by
o m
u ru
go.
3. G
ira u
bwih
erer
o bu
suku
ye
kugi
ra n
go w
irind
e in
zoka
zo
mu
nda
n’iz
indi
ndw
ara
zose
zi
kom
oka
ku m
wan
da n
k’in
zoka
zo
mu
nda,
mu
bwon
ko n
’izo
mu
miy
obor
o y’
amar
aso;
kol
era;
im
pisw
i; sh
ishik
ara;
am
avun
ja;
n’iz
indi
nyi
nshi
. 4.
Gira
isuk
u ku
mub
iri
wiy
uhag
ira u
mub
iri w
ose
buri
mun
si uk
ores
heje
am
azi m
eza
n’isa
bune
, kan
di u
gire
n’is
uku
ku m
yam
baro
no
ku b
uriri
; w
ite k
u isu
ku y
’aho
utuy
e n’
aho
ugen
da k
andi
wiri
nde
kura
rana
n’
amat
ungo
, biz
atum
a w
irind
a ka
ndi u
rinde
n’ab
awe
indw
ara
zose
zik
omok
a ku
mw
anda
nk
’inzo
ka z
o m
u nd
a, m
u bw
onko
n’iz
o m
u m
iyob
oro
y’am
aras
o; k
oler
a; im
pisw
i; sh
ishik
ara;
am
avun
ja; n
’izin
di
nyin
shi.
73
Inki
ngi y
’Imbo
neza
mik
urire
: 3.
Kur
enge
ra u
mw
ana
7. H
ari a
bana
bat
o ba
giko
rerw
a ih
ohot
erw
a ha
rimo
n’iri
shin
giye
ku
gits
ina,
irib
abaz
a um
ubiri
, iri
baba
za u
mut
ima,
kut
itabw
aho,
gu
shak
irwah
o in
yung
u,
guko
resh
wa
imiri
mo
itajy
anye
n’
imya
ka y
abo
…
• Im
yum
vire
ya
bam
we
itaki
jyan
ye n
’igih
e m
u bi
jyan
ye
no k
urin
da u
mw
ana,
• A
bana
bas
igirw
a a
band
i ba
ntu
baba
rera
arik
o ba
taba
fitiy
e ur
ukun
do
cyan
gwa
bada
shob
oye
• I
mw
e m
u m
iryan
go ih
oran
a am
akim
bira
ne m
u ng
o
• Kur
eres
ha a
bana
aba
ntu
bize
we
bana
bifit
iye
ubum
enyi
• K
uran
dura
um
uco
mub
i wo
guho
hote
ra a
bana
bat
o •
Kuba
hiriz
a ub
uren
ganz
ira
bw’ab
ana
bato
• K
urw
anya
am
akim
bira
ne
mu
miry
ango
hag
amijw
e in
yung
u z’a
bana
bat
o
Abo
ubu
tum
wa
buge
new
e:
• Aba
byey
i bom
bi
• Aba
ndi b
arer
a ab
ana
• Aba
yobo
zi m
u nz
ego
zita
nduk
anye
• I
nzeg
o za
Let
a • A
bafa
sham
yum
vire
(c
are
give
rs)
1. M
ubye
yi,
ita k
u m
utek
ano
w’ab
ana
baw
e ub
aher
ekez
a ig
ihe
bagi
ye k
u ish
uri n
’igih
e ba
tash
ye,
biza
barin
de k
ugira
impa
nuka
, gu
huta
zwa
cyan
gwa
guko
rerw
a ih
ohot
erw
a iry
o ar
i ryo
ryos
e ha
rimo
n’ih
ohot
erw
a ris
hing
iye
ku g
itsin
a.
2. M
ubye
yi, i
hutir
e kw
andi
kish
a ab
ana
mu
bita
bo
by’ir
anga
mim
erer
e m
u gi
he
kita
renz
e im
insi
30 n
k’uk
o bi
tega
nyw
a n’
itege
ko k
ugira
ngo
bi
bafa
she
kubo
na u
bure
ngan
zira
bw
abo
imbe
re y
’amat
egek
o ka
ndi b
ifash
e ig
ihug
u m
u ig
enam
igam
bi
3. M
ubye
yi, m
utur
anyi
, muy
oboz
i na
we
mur
ezi,
ihut
ire g
utan
ga
amak
uru
ku g
ihe
ku n
zego
z’u
mut
ekan
o n’
iz’u
buyo
bozi
ig
ihe
umen
ye k
o um
wan
a ya
huye
n’
ihoh
oter
wa
iryo
ari r
yo ry
ose
8. H
ari a
baby
eyi b
atan
diki
sha
aban
a ba
bo m
u gi
he c
yage
nwe
mu
bita
bo b
y’ira
ngam
imer
ere
• K
utam
enya
am
ateg
eko
n’am
abw
iriza
age
nga
irang
amim
erer
e ku
ri ba
mw
e m
u ba
byey
i • K
udah
a ag
aciro
aka
mar
o ko
kw
andi
kish
a ab
ana
mu
bita
bo
by’ir
anga
mim
erer
e
• Kw
andi
kish
a ab
ana
mu
irang
amim
erer
e ba
kivu
ka m
u gi
he c
y’im
insi
30
9. H
arac
yaga
raga
ra ik
ibaz
o cy
’aban
a ba
to b
ajya
ku
ishur
i ba
dafit
e um
untu
muk
uru
ubah
erek
eje
• Ubu
rang
are
bw’ab
abye
yi n
o ku
tita
ku m
utek
ano
w’ab
ana
babo
Aba
byey
i bak
wiy
e gu
here
keza
ab
ana
babo
igih
e ba
giye
ku
ishu
ri ka
ndi b
akaj
ya
kuba
kura
yo ig
ihe
cyo
guta
ha
74
Inki
ngi y
’Imbo
neza
mik
urir
e:
4. U
bure
re b
ubon
eye
10. A
baby
eyi b
ensh
i b’ab
agab
o nt
ibat
etes
ha a
bago
re b
abo
batw
ite
cyan
gwa
ngo
bite
ku
buzi
ma
bw’ab
ana
babo
bak
iri m
u nd
a
• Um
uco
wa
kera
utu
ma
abag
abo
bada
tete
sha
abag
ore
babo
• U
bum
enyi
bud
ahag
ije k
u bu
ryo
n’ak
amar
o ko
kw
ita k
u m
wan
a uk
iri m
u nd
a • I
myu
mvi
re y
’uko
um
ugab
o ut
etes
ha u
mug
ore
yitw
a in
ganz
wa
Aba
gabo
bak
wiy
e kw
ita k
u ba
gore
bab
o n’
igih
e ba
twite
, ku
byin
irira
no
kurir
imbi
ra
inda
no
guku
rikira
na
imik
urire
yay
o
• A
baby
eyi b
ombi
• A
band
i bar
era
aban
a • I
nzeg
o za
Let
a,
Aba
nyam
adin
i • A
bafa
sham
yum
vire
(c
are
give
rs)
1. M
ugab
o, G
ira u
ruha
re m
u m
ikur
ire n
’ubu
rere
bub
oney
e bw
’aban
a ba
we.
Irin
de
guho
hote
ra, g
utot
eza
cyan
gwa
gufa
ta n
abi u
mub
yeyi
utw
ite
kuko
big
ira in
garu
ka m
bi k
u bu
zim
a bw
’um
wan
a ak
iri m
u nd
a ya
nyi
na n
’igih
e cy
e ki
zaza
. 2.
Mug
abo,
ita
ku b
uzim
a bw
’um
ugor
e w
awe
igih
e ba
twite
, um
wita
ho, u
mut
etes
ha. T
angi
ra
kuga
niriz
a um
wan
a w
awe
akiri
m
u nd
a ku
gira
ngo
uta
ngire
gu
kang
ura
ubw
onko
bw
e ha
kiri
kare
bity
o az
akur
ane
uruk
undo
. 3.
Bab
yeyi
, mug
aniri
ze a
bana
ba
kiri
bato
, mub
akin
ishe
uduk
ino
duta
nduk
anye
bity
o bi
tum
e ub
won
ko b
wab
o bu
kang
uka
kare
bi
zaba
fash
a ku
baka
n’im
iban
ire
myi
za n
’aban
di.
3. B
abye
yi, m
wiri
nde
guku
bita
um
wan
a cy
angw
a ku
muh
a ib
ihan
o bi
baba
za u
mub
iri
n’im
bam
utim
a ze
, ahu
bwo
mum
ugan
irize
, mum
ukos
oran
e ur
ukun
do.
4. B
abye
yi n
amw
e ba
rezi
, m
ujye
muc
ira a
bana
imig
ani,
mub
ariri
mbi
re, m
ubas
omer
e ud
ukur
u …
kug
ira n
go
muk
angu
re u
bwon
ko b
wab
o ha
kiri
kare
, am
aran
gam
utim
a n’
imib
anire
myi
za n
’aban
di
11. H
ari a
baby
eyi b
atag
aniri
za
aban
a ba
bo b
akiri
bat
o
• Im
yum
vire
idah
a ag
aciro
ib
iteke
rezo
by’
aban
a • I
myu
mvi
re it
uma
abag
abo
baha
rira
abag
ore
babo
ub
urer
e bw
’aban
a bo
nyin
e • I
myu
mvi
re y
’abag
abo
yum
va k
o gu
hahi
ra u
rugo
bi
hagi
je
• Aba
byey
i bom
bi b
akw
iye
kugi
ra u
mw
anya
wo
kuga
nira
n’
aban
a ba
bo b
ato
• Aba
byey
i bom
bi b
akw
iye
guki
nish
a ab
ana
babo
ud
ukin
o tu
jyan
ye n
’imya
ka
yabo
kan
di b
akab
acira
im
igan
i, in
dirim
bo,
kuba
som
era
uduk
uru
…
kugi
ra n
go b
akan
gure
ub
won
ko b
wab
o ka
re
12. H
ari a
baby
eyi b
agita
nga
ibih
ano
biba
baza
um
ubiri
n’im
bam
utim
a by
’aban
a ba
to
• Kw
ibw
ira (i
myu
mvi
re)
ko ig
itsur
e gi
kabi
je a
ri cy
o ki
goro
ra u
mw
ana
• Ubu
men
yi b
uke
ku n
garu
ka
ibih
ano
bibi
big
ira k
u ba
na
bato
• Kur
era
no g
uhan
a ha
dako
resh
ejw
e ib
ihan
o bi
baba
za u
mub
iri n
’um
utim
a by
’um
wan
a (in
koni
, ibi
tuts
i,...)
75
Inki
ngi y
’Imbo
neza
mik
urir
e:
5. G
uteg
urira
um
wan
a kw
iga
amas
huri
aban
za
13. S
eriv
isi m
bone
zam
ikur
ire
ziki
ri nk
e ug
erer
anyi
je n
’um
ubar
e w
’aban
a ba
zike
neye
• Aba
fata
nyab
ikor
wa
baki
ri ba
ke m
u gu
tang
a se
rivisi
z’
imbo
neza
mik
urire
y’ab
ana
bato
•
Aba
byey
i bad
afite
ub
umen
yi k
u ka
mar
o k’
ingo
m
bone
zam
ikur
ire y
’aban
a ba
to
• Aba
fata
nyab
ikor
wa
bata
nduk
anye
ba
kwiy
e kw
injir
a m
uri
gahu
nda
ikom
atan
yije
y’
imbo
neza
mik
urire
y’ab
ana
bato
• A
baby
eyi b
akw
iye
kujy
ana
aban
a ba
bo b
ato
mu
ngo
mbo
neza
mik
urire
• Aba
byey
i bom
bi
• Aba
ndi b
arer
a ab
ana
• Aba
yobo
zi m
u nz
ego
zita
nduk
anye
• A
biko
rera
• A
bany
amad
ini
• Im
iryan
go it
ari i
ya
Leta
1. B
abye
yi, m
wish
yire
ha
mw
e m
ushy
ireho
Ing
o M
bone
zam
ikur
ire z
’Aba
na B
ato
(EC
D) k
u rw
ego
rw’u
mud
ugud
u bi
zaba
fash
a kw
ita k
u m
ikur
ire
n’ub
urer
e bw
’aban
a ba
nyu
no k
urw
anya
igw
ingi
ra ry
abo
n’ub
uize
rere
zi. M
wib
umbi
re m
u m
atsin
da y
’ingo
ziri
hag
ati y
a 10
na
15, m
ugen
e ur
ugo
aban
a ba
nyu
bari
mun
si y’
imya
ka 6
ba
zajy
a ba
hurir
amo
mu
mas
aha
mw
agiy
e m
u m
irim
o, m
aze
muj
ye ib
ihe
byo
kure
ra a
bo b
ana.
M
usho
bora
kan
di g
ukor
ana
n’ab
ayob
ozi b
anyu
n’ab
andi
ba
fata
nyab
ikor
wa
mu
gush
aka
ibyu
mba
byo
se m
u m
udug
udu;
nk
’ibyu
mba
by’
inam
a, in
seng
ero
cyan
gwa
ibin
di b
yum
ba
by’ab
anya
mad
ini,
ndet
se
n’ a
mas
huri
atag
ikor
eshw
a,
byas
anw
a bi
gako
resh
wa
mur
i ga
hund
a m
bone
zam
ikur
ire
y’ab
ana
bato
. 2.
Bas
hora
mar
i nam
we
biko
rera
, ni
mus
hore
imar
i mu
mik
urire
m
yiza
y’ab
ana
bato
mus
hyira
ho
ingo
mbo
neza
mik
urire
n’
amas
huri
y’in
shuk
e cy
ane
cyan
e ah
o bi
tari,
bity
o m
ugire
ur
uhar
e m
u gu
tegu
ra a
bana
ba
to g
utan
gira
nez
a am
ashu
ri ab
anza
; bi
zatu
ma
biga
nez
a,
muz
aba
mut
anze
um
usan
zu m
u ku
baka
igih
ugu
kita
rang
wam
o ig
win
gira
.
14. H
arac
yari
aban
a ba
daha
bwa
amah
irwe
yo k
wig
a am
ashu
ri y’
insh
uke
cyan
gwa
mu
ngo
mbo
neza
mik
urire
y’ab
ana
bato
• Aka
men
yero
gas
hing
iye
ku m
yum
vire
y’u
ko a
bana
ba
tang
ira k
wig
a (k
uva
mu
rugo
) bafi
te im
yaka
7
• Gut
angi
za a
bana
kw
iga
mu
mas
huri
y’in
shuk
e no
kub
ajya
na m
u ng
o m
bone
zam
ikur
ire h
akiri
kar
e
15. I
nyin
shi m
u ng
o m
bone
zam
ikur
ire n
’Am
ashu
ri y’
insh
uke
men
shi n
tiyak
ira a
bana
ba
ri m
u ns
i y’im
yaka
itat
u
• Am
ikor
o m
ake
n’U
bush
oboz
i bw
’ingo
m
bone
zam
ikur
ire n
tibut
uma
bash
obor
a kw
akira
abo
ban
a
Kong
era
amas
huri
y’in
shuk
e n’
ingo
mbo
neza
mik
urire
y’
aban
a ba
to h
irya
no h
ino
mu
gihu
gu
16. A
bana
bafi
te u
bum
uga
n’ab
aken
eye
kwita
bwah
o by
’um
wih
arik
o nt
ibita
bwah
o uk
o bi
kwiy
e
Um
uco
wo
guhe
za n
’akat
o bi
kore
rwa
aban
a ba
fite
ubum
uga
n’ib
ibaz
o by
ihar
iye
hari
aho
biki
ri
Ubu
rezi
n’u
bure
re b
udah
eza
aban
a ba
fite
ubum
uga
n’ab
afite
ibib
azo
byih
ariy
e
76
3. B
abye
yi, b
arez
i nam
we
bayo
bozi
, mur
i gah
unda
zi
shin
giye
kur
i ser
ivisi
zos
e z’
imbo
neza
mik
urire
, muz
irika
ne
ubur
ezi b
udah
eza
aban
a ba
fite
ubum
uga
n’ab
aken
eye
ubuf
asha
bw
ihar
iye;
biz
abaf
asha
guk
urira
m
u bu
zim
a b
uzira
aka
to.
77
78