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    ADRA Case Study ENA Madagascar

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    ADRA Case Study ENA Madagascar

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    ADRA_Case_Study_ENA_Madagascar

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    6 views2 pages

    ADRA Case Study ENA Madagascar

    Uploaded by

    kithchetrashch

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    © All Rights Reserved
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    of 2

    ADRA MADAGASCAR

    Implementing the Essential Nutrition Action Framework 2009-2014

    1. Background
    The Strengthening and Accessing Livelihood Opportunities for Household Impact (SALOHI) Program was
    implemented in partnership with Catholic Relief Services (CRS),
    Cooperative for Assistance and Relief Everywhere, Inc. (CARE), and Land
    O'Lakes International Development Division (LOL). The goal of this five-
    year food aid program (July 2009 – June 2014) is to reduce food insecurity
    and vulnerability through three integrated Strategic Objectives: improve
    health and nutritional status of children under five; improve livelihoods of
    food-insecure households; and increase community resilience to shocks.
    Four cross-cutting themes reinforce these three objectives: gender,
    environment, good governance and sustainability. The SALOHI program
    originally targeted seven regions, 21 districts, 120 communes and 544
    fokontany (an administrative unit composed of one or more communities)
    for a total of 630,000 beneficiaries in five geographical zones and seven
    regions. The primary target area for ADRA was Amoron’i Mania and
    Vatovavy Fitovinany covering the districts of Ambositra, Fandriana,
    Manandrina, Mananjary, Nosy Varika which cover 38 Communes and 234
    Fokontany.

    2. Nutrition Context
    Globally, Madagascar has the 15th highest stunting rate at 50 percent and up to 25 percent of the national
    population is undernourished. Nearly five percent of children under five suffer annually from severe
    wasting or severe acute malnutrition (SAM), which is a principal cause of child mortality in Madagascar.
    There are also relatively high rates of anemia among both women (35 percent) and children (50 percent).1
    The 2009 DHS showed that 27 percent of women of child-bearing age suffer from under-nutrition.
    ADRA’s Local Determinants of Malnutrition (LDM) study indicated that children who were perceived as
    small at birth by their mothers were six times more likely to be malnourished; 24 percent of babies under
    six months of age are already stunted (USAID-FSCF, 2013). Additionally, the median duration of exclusive
    breastfeeding is only three months for girls and two months for boys; only 29.8 percent for four- and five-
    month olds continue to be exclusively breastfed. The impact of this is that approximately 20 percent of
    babies under six months of age are already stunted and that boy children have higher malnutrition rates.
    Only 12.3 percent of children 6 – 23 months of age receive the minimum acceptable diet.2

    3. ENA Strategy
    Promoting ENA was the responsibility of several groups: SALOHI field agents; the community volunteers
    for each sector and committee members; and local leaders and authorities in SALOHI communities.
    SALOHI emphasized: breastfeeding (immediate breastfeeding within one hour of birth and exclusive

    1
    (UNICEF, Global Nutrition Report, 2013; CFSVA+N, 2011).
    2
    (USAID, FSCF, 2013; DHS, 2009)
    breastfeeding for children 0-6 months); complementary feeding for children 6-23 months with continued
    breastfeeding; appropriate nutritional care for sick or severely malnourished children; and prevention of
    micronutrient deficiencies and anemia. The ENA were utilized through several different platforms
    including: training and support of Community Health Volunteers (CHVs) in ENA; counseling mothers
    during Growth Monitoring and Promotion (GMP) sessions; PD/Hearth where deviant mothers, “Model
    Mothers” were chosen to work with CHVs to promote ENA to caretakers of moderately malnourished
    children; and support groups for pregnant and lactating women (SAMBAIKA). These support groups,
    composed of pregnant, lactating women and Model Mothers, used participatory capacity building
    techniques to promote healthy pregnancies, reduce low birth weights, and ensure that children had an
    excellent start in life.

    4. Successes
    During Qualitative Study Focus Group Discussions (FGDs) and Key
    Informant Interviews (KIIs), women routinely discussed the importance of
    immediate breastfeeding (IBF), exclusive breastfeeding (EBF), and an
    adequate and diverse diet for young children starting at six months of age.
    They recited recipes, knew which foods were high in micronutrients such as
    Vitamin A and iron, and described the positive physical changes they had
    seen in their children as a result of the SALOHI program. Quantitative
    examples include: exclusive breastfeeding (EBF) increased from 26% in the
    baseline to 75% at the time of the final evaluation. Women whose children
    participated in GMP said they received advice on hand washing with soap
    (67%), complimentary feeding (66%), food conservation and processing
    (54%), conservation and treatment of drinking water (46%) and care of the
    sick child (40%), as well malaria prevention (31%) and foods rich in iron and vitamin A (24%). Stunting
    decreased from 41 % to 36 % and underweight decreased from 34% to 26%.

    5. Challenges
    Mothers did not always produce the necessary ingredients suggested in the recipes or have the money to
    buy them to practice some of the essential nutrition actions for complementary feeding. Another major
    challenge was the CHV motivation including capacity of the
    individual and the system, motivation and incentivization. As a
    solution to this challenge, this activity was decentralization to
    the hamlet level so parents and children didn’t have to travel so
    far to participate in nutrition activities. Although the national
    standard is to have at least two CHVs per Fokontany, the
    SALOHI program trained up to 10 CHVs per Fokontany, to
    facilitate access to essential services in nutrition in remote
    locations, and in widely dispersed communities.

    Another challenge worth noting is the gender disparity noted most frequently was the lack of special
    consideration for pregnant/lactating women due to their status, and particularly their nutritional
    requirements. The second disparity was the lack of interest on the part of men in the health of their
    children and wives. As a solution to this challenge, SALOHI trained both men and women CHVs, to
    facilitate communication with both parents.

    For more details contact: Laura Brye ADRA International [email protected]

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