Systematic stakeholder identification
and engagement to explore commitment
and capacity to address infant and
young child feeding practices in
Worcester, Breede Valley, Western Cape,
South Africa
LM du Plessis, MH McLachlan & SE Drimie
Su - Faculty of Medicine & Health Sciences
Department of Interdisciplinary Health Sciences
Division of Human Nutrition
Introduction
In 2007 the rector & vice-chancellor of SU, Prof
Russel H. Botman, articulated his vision of a
“pedagogy of hope” and a new positioning for
the university
Vision → “Overarching Strategic Plan” (OSP)
Included Food Security Initiative funded by SU
Council
Community-Based Nutrition Security Project
Division of Human Nutrition - CNSP
The Community Nutrition Security Project
(CNSP) baseline research investigated the food-
security situation in vulnerable communities in
the Breede Valley, Western Cape, South Africa
Target population: mothers and their young
children (0-36 months) – focus on the first 1000
days of life
-9 months
(conception)
0 months (birth)
6 months
12 months
24 months
The first 1000 days of life
The first 1000 days of life
The right nutrition during first 1,000 days of life
can have a huge impact on how a child grows,
learns and develops
It is one of the best investments we can make to
reach long term progress in health and
development around the world
In 1 000 days we can change the
future!
The right nutrition during 1 000 day window can:
save more than one million lives each year;
significantly reduce the human and economic burden
of diseases e.g. TB, malaria, diarrhoea & HIV/AIDS;
reduce the risk for developing various non-
communicable diseases such as diabetes, and other
chronic conditions later in life;
improve an individual’s educational achievement and
earning potential; and,
increase a country’s GDP by at least 2-3 percent
annually
http://www.thousanddays.org/about/
Stellenbosch University - CNSP
Selected findings
Nutritional assessments indicated, among
other, poor infant and young child feeding
(IYCF) practices and high levels of stunted
growth in young children
Infant & Young Child Feeding in
Worcester area
About 7 out of 10 babies are put to the breast
after birth
About 3 out of 10 babies are never breastfed
Around 9 out of 10 babies are not breastfed as
babies should be breastfed
Most drink or eat other milk and/or foods before
the age of 3 months (water, tea, juice, “meelbol”, pap, “behoedmiddel” etc)
Infant & Young Child Feeding in
Worcester area
3 in 10 are still breastfed at age 12-15 months
Most babies receive solids foods at age 6-8 months
BUT, only half of the babies received more than 4
different foods
grains (bread, cereal, pap)
legumes and nuts
dairy products (excluding breastfmilk – milk, yoghurt, cheese)
meat, fish, poultry and liver/organ meats
eggs
vitamin-A rich fruits and vegetables (sweet potato, carrots,
pumpkin, butternut, spinach, broccoli, apricot, peach, mango)
other fruits and vegetables
CNSP Phase 2
Applied a systematic approach to identify and
engage with many different stakeholders that
can impact IYCF practices at the district level
The research explores the perspectives,
commitment and capacity of key stakeholders,
the relationships among them and their relative
power and influence with regard to IYCF
(Acknowledgement: Engesveen 2008 & Kent 2000)
(Acknowledgement: Engesveen 2008 & Kent 2000)
(Acknowledgement: Engesveen 2008 & Kent 2000)
(Acknowledgement: Engesveen 2008 & Kent 2000)
CNSP Phase 2 - Methods
A strategically selected group identified key
stakeholders in IYCF
This was followed by individual in-depth
interviews with particular stakeholders
Findings from Interviews
Good understanding of the link between IYCF
and development
Appropriate practices – not well known
Factors influencing IYCF practices
poor knowledge
poverty & unemployment
misuse of social security grants
teenage pregnancies
child neglect
gangsterism, drug abuse, HIV
Complex
issue!
Findings from Interviews
Not everyone knew exactly why I wanted to talk
to them and referred to them as “stakeholders in
IYCF”
A lot of willingness to help in many different
ways at many different levels
Resources mentioned were humble
Some issues were out of the immediate scope of
the stakeholder, but could be identified as
another stakeholder’s area of focus
CNSP Phase 2 - Methods
Hereafter, stakeholders were engaged in a
workshop through a participatory research
method (“NetMap”) that defines relationships
among stakeholders as well as their priorities
and powers
Green line = Money/Funding
Blue line = Information/Advice
Red Line = Command/authority
Orange line = Advocacy
Findings from NetMap Workshop
Disjuncture between various government
sectors was highlighted as a contributing factor
to sub-optimal service delivery and poor
community response
Process revealed a significant flow of financial
support from National Treasury towards services
focused on young children
This allocation of funds corresponds with rigid
command/authority
Findings from NetMap Workshop
Local jobs are under pressure, because of
external issues and individual employer
responses to National Government policy
changes
Information flow on IYCF is sketchy and
advocacy on the topic almost non-existent
Findings from NetMap Workshop
Factors that impact IYCF at the district level are
very complicated
A range of issues are connected in a complex
network that transcends time and scale
Issues far away affect those close-by
Process highlighted some collective capacity
that could be unlocked to address IYCF
The community (mothers, fathers,
grandmothers, CBOs) is willing to engage
Findings from NetMap Workshop
The University can act as a partner for advocacy
and knowledge generation
The Business forum was also mentioned as a
medium for possible interventions
Liaison group consisting of Departments of
Health, Education, Social Services and
Community Development and Planning was
highlighted as a forum where joint solutions can
be developed
What has happened up to now?
Phase 1 - Baseline information
Phase 2 – Stakeholder engagement
Awareness
Advocacy
Dialogue
Reflection on current interventions / practices
Broad thinking of what can be done differently
What can be done together
What next?…Phase 3 – Interventions
Black et al 2013 – Lancet Series
Acknowledgements
CNSP team
Fieldworkers
Other colleagues
Family & Friends
Funding
SU Hope project
FIRRH
SURMEPI
Thank you!
Acknowledgement: Guiocommo Pirozzi, UNICEF