"A Harvest of Nutrition Results in Thies"
An hour’s drive out of Dakar, Senegal, across a semiarid terrain brought us to Thies -the place we visited on March 24, 2010, as part of the third day of the AfCoP annual meeting. Under a huge shade tree in the hot afternoon sun, a local community gathered. A woman lead soloist brought us into song and dance as we approached. With a huge smile and a spell-binding voice, she sings and talks with her hands outstretched towards us – a call that binds us with the mothers. We are open to learning.
A young mother begins to breastfeed her baby. This is not indecent exposure. This is a process to teach other mothers how to properly take care of their babies. Nursing mothers actually form a group very similar to a Community of Practitioners (CoP) on health and nutrition. It is a safe space for the young mothers to learn and share best practices in a highly inclusive and participatory manner. There are discussions about what works and why – what doesn’t work and why. Myths about practices are discussed, dissected and discarded. A community nurse shares facts, shows pictures and demonstrates good nursing practices. The mothers are asked to apply the knowledge instantly and, through trials and errors, the right practices are learned. Songs with compelling lyrics are taught instantaneously by the lead soloist to help the group remember the practices to follow. This method of knowledge sharing and adaptive learning is saving lives and improving livelihoods. Most of the activities run in this community are voluntary; no one asks for pay.
This group of mothers is a response to unusually high rate of infant mortality in the area. It exists as part of the Senegalese Nutrition Enhancement Program, a nationwide instrument that aims to contribute to reaching the Millennium Development Goals through improving the nutritional status and growth of children under the age of two. In Thies, this national program is implemented in over twenty health centers by a local branch of Child Fund. The focus on learning from other mothers is only one of the many components of the program. It also measures outcomes on a monthly basis– including babies’ weight and height – which is a unique process in West Africa. In other communities benefitting from this project, village grandmothers come together on a regular basis to discuss nutrition issues facing the village, debate the pros and cons of different methods, and then share best practices with the younger women of the village. In every aspect of the program, there is an incredible focus on community-driven development.
To reduce infant mortality, adequate nutrition, particularly breast milk, which provides babies with both the nourishment and the antibodies to fight infectious diseases, is very important. Infant mortality refers to deaths of children under the age of one year. It is measured by the infant mortality rate, which is the total number of deaths of children under the age of one year for every 1,000 live births. A large portion of infant mortality in Thies is due to infectious (such as pneumonia, tetanus, and malaria), communicable diseases, lack of clean water, insanitary surroundings, inadequate food and shelter, and lack of access to health care services.
Overall, income and education, both at the societal and individual levels, are also closely associated with infant mortality in these communities. While the relationship between infant mortality and level of socioeconomic development is not perfect, the infant mortality rate is commonly used more than any other measure as a general indicator of socioeconomic wellbeing and of general medical and public health conditions in a country. At the individual level, mothers (and fathers) with higher income and education are more likely to possess knowledge of sanitary behaviors and the money for adequate food, as well as to take their babies to a health service if needed. Especially important in the latter regard is oral rehydration therapy, which is effective in saving babies from dying from the dehydration that accompanies diarrhea. It is estimated that more than 90% of deaths every year could be prevented by breast-feeding.
The issue of HIV-infected mothers breast-feeding has become controversial. Breast-feeding protects the child against the infectious diseases that take the lives of millions of infants every year, but the child could end up with HIV from the mother. There is policy debate globally about the best course of action, but for the time being for mothers of Thies, the debate is closed. For HIV positive mothers, the Government policy is to not breast feed.
In Thies, infant mortality has fallen, and child survival rates are high. Diseases like diarrhea, malaria, and malnutrition related diseases have reduced drastically. The strong partnership between Child Fund and the Senegalese government ensures gains made by communities are not lost. Mechanisms and policies discussions to lock the gains are at an advanced stage.
This site visit was a wonderful reminder for AfCoP members about what Managing for Development Results is all about: improving the lives of beneficiaries. Charts on the walls of the project’s health clinics indicated significant results and progress. Most importantly the healthy looking mothers and babies helped us understand the success of this program. We were especially impressed which the pervasive focus on participatory processes and community involvement. The site visit was an inspiring experience which energized Annual Meeting participants to push the AfCoP forward to achieve greater results and impact in all of our countries.
Dr. Rosa Muraguri-Mwololo is a member of the AfCoP Core Management Team. She is a Results-Based Management expert and presently the Program Review Committee Secretary at UN-Habitat in Nairobi.
A young mother begins to breastfeed her baby. This is not indecent exposure. This is a process to teach other mothers how to properly take care of their babies. Nursing mothers actually form a group very similar to a Community of Practitioners (CoP) on health and nutrition. It is a safe space for the young mothers to learn and share best practices in a highly inclusive and participatory manner. There are discussions about what works and why – what doesn’t work and why. Myths about practices are discussed, dissected and discarded. A community nurse shares facts, shows pictures and demonstrates good nursing practices. The mothers are asked to apply the knowledge instantly and, through trials and errors, the right practices are learned. Songs with compelling lyrics are taught instantaneously by the lead soloist to help the group remember the practices to follow. This method of knowledge sharing and adaptive learning is saving lives and improving livelihoods. Most of the activities run in this community are voluntary; no one asks for pay.
This group of mothers is a response to unusually high rate of infant mortality in the area. It exists as part of the Senegalese Nutrition Enhancement Program, a nationwide instrument that aims to contribute to reaching the Millennium Development Goals through improving the nutritional status and growth of children under the age of two. In Thies, this national program is implemented in over twenty health centers by a local branch of Child Fund. The focus on learning from other mothers is only one of the many components of the program. It also measures outcomes on a monthly basis– including babies’ weight and height – which is a unique process in West Africa. In other communities benefitting from this project, village grandmothers come together on a regular basis to discuss nutrition issues facing the village, debate the pros and cons of different methods, and then share best practices with the younger women of the village. In every aspect of the program, there is an incredible focus on community-driven development.
To reduce infant mortality, adequate nutrition, particularly breast milk, which provides babies with both the nourishment and the antibodies to fight infectious diseases, is very important. Infant mortality refers to deaths of children under the age of one year. It is measured by the infant mortality rate, which is the total number of deaths of children under the age of one year for every 1,000 live births. A large portion of infant mortality in Thies is due to infectious (such as pneumonia, tetanus, and malaria), communicable diseases, lack of clean water, insanitary surroundings, inadequate food and shelter, and lack of access to health care services.
Overall, income and education, both at the societal and individual levels, are also closely associated with infant mortality in these communities. While the relationship between infant mortality and level of socioeconomic development is not perfect, the infant mortality rate is commonly used more than any other measure as a general indicator of socioeconomic wellbeing and of general medical and public health conditions in a country. At the individual level, mothers (and fathers) with higher income and education are more likely to possess knowledge of sanitary behaviors and the money for adequate food, as well as to take their babies to a health service if needed. Especially important in the latter regard is oral rehydration therapy, which is effective in saving babies from dying from the dehydration that accompanies diarrhea. It is estimated that more than 90% of deaths every year could be prevented by breast-feeding.
The issue of HIV-infected mothers breast-feeding has become controversial. Breast-feeding protects the child against the infectious diseases that take the lives of millions of infants every year, but the child could end up with HIV from the mother. There is policy debate globally about the best course of action, but for the time being for mothers of Thies, the debate is closed. For HIV positive mothers, the Government policy is to not breast feed.
In Thies, infant mortality has fallen, and child survival rates are high. Diseases like diarrhea, malaria, and malnutrition related diseases have reduced drastically. The strong partnership between Child Fund and the Senegalese government ensures gains made by communities are not lost. Mechanisms and policies discussions to lock the gains are at an advanced stage.
This site visit was a wonderful reminder for AfCoP members about what Managing for Development Results is all about: improving the lives of beneficiaries. Charts on the walls of the project’s health clinics indicated significant results and progress. Most importantly the healthy looking mothers and babies helped us understand the success of this program. We were especially impressed which the pervasive focus on participatory processes and community involvement. The site visit was an inspiring experience which energized Annual Meeting participants to push the AfCoP forward to achieve greater results and impact in all of our countries.
Dr. Rosa Muraguri-Mwololo is a member of the AfCoP Core Management Team. She is a Results-Based Management expert and presently the Program Review Committee Secretary at UN-Habitat in Nairobi.
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Comment
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Comment by Dr. Rosa Muraguri-Mwololo on May 28, 2010 at 9:50am -
Dear Nuha and Bimerew- excuse my silence sometimes my nearly all my hours belong to others. I love what i see in your rejoinder to my story. stories about how new knowledge &siklls, new attitudes and new behaviour are transforming and sustaining life.
When people change the way they think- the change the way they do things. Attitudes are often not informed by facts but by beliefs which cannot be backed by data evidence- but they still make people act in self-destructing ways. The best thing about evdence based management is that we are getting better at making social change an experimental science. People listen to facts better than they listen to opinions and perspectives. Change that is measurable and observable will transform behavior of people more rapidly than
than change that is speculative. Lets keep the measuring and the telling and communities will tranform. Lets keep the balancing act of pursueing results in our complex environments and among the many conflicting interests and priorities of our partners.
My warm regards-
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Comment by Bimerew Alemu on May 15, 2010 at 6:21am -
Dear colleagues
Warm Greetings from Addis Ababa
Thank you Dr. Rosa Muraguri-Mwololo for your recollection of Thies in Senegal. I am also an eye witness that the health personnel and the community in Thies area work hand and gloves, well coordinated in serving the community.
Related to child and mothers program let me also briefly share what is being implemented in my home land. Ethiopia has implemented the Enhanced Outreach Strategy which reaches most under-5 children in the country, and provides them with Vitamin A supplementation twice a year. Vitamin A provision every six months is known to reduce child mortality from all causes by as much as 23 percent. A new Health Extension Program with community Health Extension Workers (HEWs) was introduced in 2003, but most scaling up occurred after 2005. HEWs are now in most rural communities in the country, and their main focus is on preventable basic diseases with a strong impact on child and maternal health. The national target for 2008/09 was to deploy a total of 30,786 HEWs. A total of 5622 HEWs have been trained and deployed in 2008/09. Together with the 24, 571 HEWs deployed prior to 2008/09, the total number of HEWs deployed so far has reached 30,193 accounting for 98.07% of the total national requirement of 30,786 HEWs. Additional 600 HEWs are currently under training, raising the overall planned target for HSDP-III (2005/06 to 2010) to 30,786. Notice that the total number of rural kebeles (lower tiers of administration) implementing the HEP is 16,731, while the number of rural kebeles with two HEWs is 15,022.
Actually reliable data on child and maternal mortality are collected only once every five years as part of the Demographic and Health Survey (DHS). The last DHS was conducted in 2005, and the next one will be conducted in 2010. The results from the 2010 DHS will confirm whether Ethiopia is on the way to achieving the child mortality MDGs or not. For the health MDGs to all be achieved, it is clear that the very encouraging steps already taken will have to be reinforced by new ones, facilitated by scaled up levels of funding.
It is from this angle that recently our Ministry of Health began a new program to reinforce the existing activities. The officially launched a UNFPA-funded programme is "No Woman Should Die Giving Birth". The programme is one new component in the comprehensive programme where 30,786 health extension workers (HEWs) are educated and where the construction of health centers will soon reach the aim of one health centre to 25,000 citizens. The Global Fund and the heavy investment of the Ethiopian government attributed to this achievement.
Let all Africans join hands and combat all sorts of diseases and ensure maternal and child health is a human right.
Best regards
BIMEREW ALEMU
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Comment by Nuha on May 15, 2010 at 3:18am -
Thank you very much dear Dr. Muraguri for giving us full image about your visit to Thies. I got really impressed about the local community being voluntary active in development issues without expecting returns. From my experience, introducing issues of the reproductive health was very tough in the traditional communities, but now, local traditions and gatherings functions at the local levels are the main targets for distribution of the key messages on health in general, but at the same time the community used this opportunity to show the change in perception towards better practices.
In Sudan- as it is in other countries- the child health and maternal mortality are main concerns for the development. We realized that some interventions- especially on health as sensitive topic sometimes- could not be successful without stronger commitment from the community, despite the support provided by local and international organizations. The traditional community and religious leaders were trained and mobilized to fight female genital cutting/ mutilation (FGC/M) in some areas in Sudan. When the local community adopted the eradication campaign, they didn’t need to have a special forum or even a budget to start discussing or providing information to fight the FGC/M practice. The religious leaders transmit the message in the churches and mosques, the women were talking about it whenever they have social gathering, and the youth peer educators were voluntarily providing information when they meet in the playgrounds, schools and whenever they meet informally.
In my organization, we provide capacity development activities to women CBOs and NGOs. Our support to them includes some opportunities for economic development. I have an experience with one of our partners who planned to establish women sewing center for income generation. In the planning stage, they conducted an assessment for community needs. I was stunned when the women from the community requested reproductive health services and literacy classes to accompany the economic development intervention. They noticed the high number of child births and illiterate mothers. They could draw an association between the family’s economical situation, child births and the knowledge about the reproductive health at the household level. This has led them to discover that there is high level of illiteracy among the families. And now they are planning a program that gives the women in the area a professional training to improve their economic status, but at the same time they used the opportunity to inject doses of literacy classes and sessions on family planning, gender and development, as well as HIV/AIDS. They expect to graduate women leaders.
I think what you said was quite true; some communities were really able to implement Management for Development Result approach. In some cases they were not fully oriented about the approach, but it still they are successful in bringing it clear through their activities
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