Myanmar Sustain : a 'Nutrition- Sensitive' Food

MYANMAR

SUSTAIN : A ‘NUTRITION- SENSITIVE’ FOOD SECURITY INTERVENTION In response to the 2010 devastating earthquake, Action Contre la Faim implemented a range of emergency activities, in Port-au-Prince and Gonaïves, including a pilot Fresh Food Vouchers (FFV) project to complement other food assistance and nutrition interventions. Building on lessons learnt, the pilot was then adapted and replicated in Gonaïves and again in Port au Prince in 2011 in the frame of a safety net approach. The latter programme aims at restoring food security for vulnerable households and to improve their nutritional situation. By providing food vouchers giving access to fresh food and staple food through the local market, ACF intends to support the local economy, to strengthen WKHEHQHÀFLDULHV·UHVLOLHQFHDQGWRLPSURYHWKHKRXVHKROGV· DFFHVVWRDGLYHUVLÀHGGLHW

Naypyidaw

Humanitarian context

Background Although Myanmar is considered The percentage of children a food-surplus country with high underweight remains high, with agriculture potential and an prominent disparities between states abundance of natural resources, it is (see the table below). 7KHRIÀFLDO one of the poorest countries in Asia data related to chronic and acute and ranks 132 on the 2010 HDI1 malnutrition indicate that 41% FODVVLÀFDWLRQ RIFKLOGUHQXQGHUÀYH\HDUVDUH

Chronic food and nutrition insecurity chronically undernourished while 11% suffer from acute malnutrition.3 is the consequence of a number of situations: unfavourable economic The release of the Multiple Indicators policies, rural underdevelopment, Cluster Survey (MICS) carried out in vagaries of weather, and the 20094 provided further data for marginalisation of some sectors of DQDO\VLV6SHFLÀFDOO\SRRUDFFHVVWR the population. As a consequence, food with the increased price of food the ability for many households to commodities, a lack of land access, DFFHVVVXIÀFLHQWOHYHOVRIIRRGDV effects of climate change and the well as basic services such as clean lack of basic knowledge on Infant and water, health and education has Young Child Feeding (IYCF) practices been affected and is particularly resulted in protracted high rates of pronounced on the borders and undernutrition. among ethnic minorities.

Assessment Percentage of underweight in 2005 The last 2011 WFP VAM surveys & 2010 estimated that 45% and 33% of households are severely and State/Union 2005 2010 moderately food insecure, respectively, Ayeyarwaddy 36.2% 33.4% in the Northern Rakhine State (NRS). In the Shan State and in the dry Rakhine 60.5% 52.8% © ACF - Myanmar, Courtesy Victor Kiaya zone, almost half of the population Shan (N) 26.5% 17.2% was considered food insecure (18% 1Human Development Index Sagaing 28.5% 33.4% 2The UNDP released in 2011 a partial Millennium severely food insecure and 24% Development Goal (MDG) report, based on the 2009- moderately food insecure). Although Yangon 27% 27.3% 2010 Integrated Household Living Conditions Assessment modest improvements have been in Myanmar (IHLCA). 3According to WHO Crisis classification, Global Acute made, the country is far from reaching Malnutrition (GAM) between 10% and 14% are serious. the MGD-1 of halving extreme 4UNICEF, Myanmar Ministry of Health, Ministry of National Planning and Economic Development, 2 poverty and hunger by 2015. Myanmar Multiple Indicator Cluster Survey, 2009-2010,

issued in October 2011

3 Programme overview and rationale

ACF has started a 40 month “nutrition The action will be implemented by a sensitive” food security programme consortium which includes Action Contre (SUSTAIN 5) in 2012 in order to la Faim (ACF), Groupe de Recherche ÀJKWDJDLQVWWKHXQGHUO\LQJFDXVHV et d’Echanges Technologiques (GRET), of undernutrition. The programme is and Welthungerhilfe (WHH). The LPSOHPHQWHGLQÀYHDJURHFRORJLFDOO\ consortium will pilot and adapt three and culturally distinct regions innovative approaches which integrate of Myanmar: Northern Rakhine essential activities to promote nutrition State (Maungdaw and Buthidaung awareness, IYCF6 and care practices Townships), Northern Shan State as well as practical components (Lashio, Namtu and Theinni Townships), such as the production of diverse, Ayeyarwaddy Region (Bogalay nutrient dense food, the production Township), Sagaing Division (Monywa of complementary foods for children Township) and in the Yangon Division. under two, and a range of ‘nutrition-

sensitive’ livelihoods. The objective of this programme is: To improve the nutritional status of By increasing availability of and vulnerable populations access to nutritious food through their own production, the collection of wild Through foods or ability to purchase, targeted EHQHÀFLDULHVZLOOLPSURYHWKHLUIRRG A sustainable increased nutrient intake.

consumption of micronutrient-rich 7KLVLQWHUYHQWLRQEHQHÀWVIURPWKH foods/products, and enhanced cumulative experience in the country practices of optimal nutrition and and the expertise in food security and care. nutrition of each partner.

The SUSTAIN project involves applying a “nutrition lens” at each step of the project cycle and an extensive “do no harm approach”. The action aims to tackle undernutrition from different angles, and to establish actionable linkages and levers between agriculture, food security, nutrition and health sectors (see the UNICEF Conceptual Framework on Malnutrition).

5Sustainable Approaches for Improved Nutrition. 6Infant and young child feeding

4 © ACF - Myanmar, Courtesy Victor Kiaya

Implementation

Initial surveys - What barriers are there on food

The MAIN, LANN and Nutridev consumption? innovative approaches Intervention details will be determined after the completion of The comprehensive baseline survey The Maximising Impact on Nutrition a comprehensive baseline survey will help to better understand (MAIN) approach developed by and additional informative survey to food consumption patterns, dietary ACF , consists in the application of gain in-depth understanding on the intake and micronutrient adequacy, a ‘nutrition lens’ at each step of the following topics: seasonality, nutrition needs of the SURMHFWF\FOH$&)ZLOOÀHOGWHVWWKH $JURELRGLYHUVLW\LQYHQWRU\ group at risk, gender considerations, MAIN approach in the context of DQGIHHGLQJKDELWVLQWKHÀYHDUHDV the NRS. - What wild/indigenous food (plants and animals) is available? of intervention. This will allow for data The Nutridev programme has - To what extent are wild food comparisons from one agro-ecological been implemented since 1994 by considered? and cultural area to another and serve the GRET and the IRD (Institut de as a common pre-survey to monitor &URSVDQGIRRGQXWULWLRQDOFRQWHQWV Recherche pour le Développement) the intervention’s progress. The design - What nutrients are available in and will develop and promote of the methodology and related tools which food? qualitative and affordable as well as the roll out of the baseline - How to improve crop’s nutrient complementary food for children survey will be done in collaboration content? 6-23 months in the market in between all three agencies. Sagaing and Yangon divisions . )RRGFRQVXPSWLRQSDWWHUQVGLHWDU\ The Behaviour Change Strategy intake/micronutrient adequacy: The Linking Agriculture, Natural (BCS) targeting mothers, caregivers, - What do household members eat? Resource Management and Nutrition family members including children, Do they eat together? (LANN) community-driven approach decision makers and community agents - What is considered a good meal? In aims at changing community are central to strategies aimed at which season? and household preferences and improving nutrition and care of infants - How is the food prepared and practices for improved nutrition. It and young children and women of preserved? What is eaten together? does so by strengthening the social childbearing age. BCS is a much - Costs vs. income and overall mobilization patterns and capacities longer-term strategy that seeks to household expenditures? and may lead to platforms for change deep-rooted behaviours future service providers and market &DUHJLYHQWRFKLOGUHQ and requires time and a thorough access. WHH implements it in - How are children fed? How long are knowledge of the context, beliefs, the Northern Shan State and the they exclusively breastfed? norms and traditions. - Is their food complemented? Ayeyarwaddy Delta.

+RXVHKROGPHPEHUVUROHVUHJDUGLQJ food/Gender considerations: - Who is involved in food production (and how)? - Who is involved in selecting the food to be eaten? - Who is involved in food purchases?

5 © ACF - Myanmar, Courtesy Victor Kiaya

Formative research7 will be conducted forced migration, households with Nutrition-sensitiveness to gain insight into the barriers and limited access to income, and those opportunities to change behaviour FKURQLFDOO\IRRGLQVHFXUH7KHWZRÀUVW Food Security, Nutrition and DQGWRGHÀQHDQDSSURSULDWH%&6 approaches integrate vital activities Health interventions have for the It is crucial to have a thorough on nutrition education, child health and most part been implemented as understanding of why people behave practical components such as healthy individual approaches with limited cooking or production of diverse and consideration in how they overlap. the way they do and what they are willing to change. healthy food into the participatory The combination of the three learning experience. %HQHÀFLDU\VHOHFWLRQDQGWDUJHWLQJ approaches in Myanmar is

The Nutridev approach focuses on XQSUHFHGHQWHGDQGUHTXLUHVÀHOG ACF focuses on areas with high rates pregnant and lactating women, testing and adaptation to the local of undernutrition and within these children under two years old and their needs and culture to generate areas will target 5,300 households mothers because they are the most evidence and lessons learnt. (26,500 individuals) from vulnerable vulnerable to malnutrition. It aims at FRPPXQLWLHVSD\LQJVSHFLÀFDWWHQWLRQ :RUNLQJLQÀYHFXOWXUDOO\DVZHOO improving the availability of low cost to women of reproductive age, as agro-ecologically distinct areas and qualitative complementary food pregnant and/or lactating women, (e.g. rural/urban, upland/marine) for children under two and raises and children under two years of age. increases the chances of replication awareness on IYCF and care practices. DQGVFDOLQJXSRILGHQWLÀHGEHVW In this programme, ACF, the GRET Relatives (caregivers, mother-in- practices. and WHH have developed three law, and decision-makers within the complementary approaches (refer to household) of the mother will also Each approach includes a pilot box page 5) which involve: be targeted to ensure sustainable phase with a limited number of EHQHÀFLDULHVDQGDFWLYLWLHVUHJXODU - 1,000 households for the ‘MAIN behavioral change. external inputs and expertise, a approach’ (ACF) %HQHÀFLDULHVZLOOEHLGHQWLÀHG robust component of Behaviour - 1,900 households for the ‘LANN through participative consultations Change Strategy (BCS) to suit the approach’ (WHH) with communities and according cultural context and well-tailored to standard targeting procedures. - 2,400 households for the ‘Nutridev Monitoring & Evaluation (M&E) A range of stakeholders (e.g. systems. programme’ (GRET) community health workers, nutrition The targeted groups include volunteers, women, nurses, trained This is also the opportunity to vulnerable communities from different and traditional birth attendants etc.) develop new collaboration and ethnic groups (Shan, Lahu, Palaung, ZLOODOVREHQHÀWIURPWKHLQWHUYHQWLRQ partnerships with stakeholders. Rohingya, Rakhine). These are farmers through capacity building. with no or restricted land access, 7KHÀQDOEHQHÀFLDULHVVHOHFWHG former poppy producers, victims of will broadly cover the different 7 Formative research consists of assessing the communities and the next generation, behaviours, attitudes and practices of a community, private actors involved in infant and understanding the target group’s perspective, which influence their behaviours, and determines the feeding, health, nutrition and food best ways to reach them. Several formative research security stakeholders as well as the methods may be used to develop BCS including barrier analysis, trials of improved practices, positive deviance, whole Myanmar population. focus groups, in-depth interviews, supporting groups for accompanying the change, reinforcing the positive practices, and finding coping strategies. 6 Contact details and further reading Victor Kiaya, Food Security and Livelihoods Advisor, ACF France [email protected]

Key activities Pathways through which the intervention is expected to affect nutritional status of children All the activities integrate a “nutrition- lens” approach. Cash or Education in in-kind IGA/ ) R U W L À H G S U R G X F W V Programme Agricultural inputs nutrition and health Activities include the implementation Livelihoods (children aged 6 to inputs 23 months) (Women control) and roll out of trainings following (women control) comprehensive baseline surveys; ACTIVITIES healthy gardens coupled with Programme Household income Household food Women Knowledge and outputs Income Generating Activities (IGA), (women control) production (women time awareness demonstration plots with bio- control) RESULTS IRUWLÀHGFURSVDQGWKHSURGXFWLRQ and promotion of high quality and Household food security diet quality/ Feeding and care affordable food for children between quantity practices

6-23 months. Extra attention is given SPECIFIC to results and outcome dissemination, OBJECTIVES achieved through publications, Food and nutrient S h o r t - t e r m participation in forums, workshops and intake Health impact production of a movie. The intervention O V E R A L L includes a wide range of participants OBJECTIVE from food security, nutrition and health Child nutrition Long-term sectors and is built on the local and impact traditional knowledge.

The community key stakeholders will receive training and Information, Education and Communication (IEC) Particular added-value of the of agricultural biodiversity to SUSTAIN programme sustainably increase the productivity materials to foster the uptake of positive and optimal nutrition, care The SUSTAIN intervention aims at of small-scale farmers and and hygiene behaviours. The design promoting gender equality and increase their resilience to climate of the complementary product and women’s empowerment, as women change and shocks. It provides the the following stages will be carefully have a key role as the gatekeeper opportunity to develop links with implemented in collaboration with of household food security, health local private companies (i.e. Gold local production companies. and nutrition . This includes support Power) and research institutes to women groups by giving and/or universities (e.g Mahidol them access to inputs, childcare, University). Lastly, the action targets ÀQDQFLDOVHUYLFHVH[WHQVLRQ members of marginalized ethnic services, technology, markets and groups. employment. Environmental concerns are addressed with the promotion

This document is part of a set of case studies on ACF Food Security and Livelihoods interventions which aim to reduce and/or prevent undernutrition. It has been developed by the ACF “Aligning Food Security and Livelihoods with Nutrition” Working Group, with the support of Elodie Ho in collaboration with ACF project managers. The layout was done by Verena Pandini. The aim of the “Aligning Food Security and Livelihoods with Nutrition” Working Group is to promote and scale up nutrition sensitive Food Security and Livelihoods interventions, within ACF as well as partner organizations. The Working Group promotes these interventions by gathering lessons, building evidence, developing tools and guidance and building capacity.

For more information on the “Aligning” approach, please refer to the ACF manual: 0D[LPLVLQJWKHQXWULWLRQDOLPSDFWRI)RRG6HFXULW\DQG/LYHOLKRRGVLQWHUYHQWLRQV$PDQXDOIRUÀHOGZRUNHUV http://www.actioncontrelafaim.org/fr/content/maximising