Monitoring Tracks Many Levels of Change
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MONITORING TRACKS MANY LEVELS OF CHANGE n the village of Rukoro, situated in the district of At each session, infants and young children are IRubavu along the shores of Lake Kivu, volunteer weighed to check that they are growing properly, community health worker Esperance Mukarundo while their mothers are able to participate in a recalls how only a year earlier, 28 children were savings group. Many have used sums from the detected as acutely malnourished. Most had group to purchase small livestock, such as hens been in the ‘red’ category, indicating severe acute that provide eggs for protein in children’s diet. The malnutrition, which requires inpatient treatment goal eventually is for everyone in the group to be at the local health centre. Today, 8 children still able to purchase health insurance, so that they linger in the ‘yellow’ category, denoting moderate can access the full range of health services for acute malnutrition, which can mostly be treated themselves and their families. in families through improved feeding and care Mukarundo is highly motivated to lead the practices. But no child is in red. Mukarundo can fight against nutrition in her village. Part of this is foresee the day when even the yellow number because she is supported by a local committee to drops to zero. eliminate malnutrition, which involves a number She tracks progress closely. Though the of local officials active on agriculture, economic national standard is a monthly session, she development, health and other issues, including gathers all mothers in the community who have the village chief. Gone are the days when nutrition malnourished children for a ‘Child Growth’ session in the village was an issue mainly for community each week. Collectively, they learn and reinforce health workers. the knowledge Mukarundo has shared with them Equally important has been the introduction about how to feed their children a diverse diet of Rapid SMS, a system where community health of foods appropriate to their age, practice good workers use a mobile phone app to report a series hygiene and manage small kitchen gardens that of milestones essential to the health and nutrition provide nutritious vegetables. of young children. It is one part of a system for A nutritionist goes over a growth chart with a young woman carrying her daughter during a growth-monitoring session in Nyamagabe District. © UNICEF/UN016856/Noorani 1 monitoring progress in combatting malnutrition Speciose is a mother of three in Rukoro. For that also includes the DevInfo database, which her first pregnancy, before Rapid SMS was consolidates all indicators for the district plan to introduced, she remembers she never saw a eliminate malnutrition. community health worker. She gave birth at Tracking in Rapid SMS starts during home, as many women in the community have pregnancy and extends through age two, the traditionally done. But for her second pregnancy, so-called first 1,000 days of life. Data streams with Rapid SMS in place, the community directly to health centres as well as the national health worker came knocking on her door. She health system, under the name of each mother, received regular antenatal care and delivered at reducing the likelihood that individuals will the hospital, after which the community health be lost in more generic data collection, and worker visited again to advise her to breastfeed incentivizing community health workers to follow exclusively until six months and to introduce a up. If a mother misses a prenatal appointment, diverse diet of complementary foods after that for instance, and the community health worker point. Regular health screenings of her children, does not report that she has attended it, the including growth monitoring, have found that they system sends a message asking the health are well-nourished and thriving. worker to follow up. A BRIEF OVERVIEW OF THE NUTRITION SITUATION IN RWANDA: 18% 80% 54% of children 6-23 months receive of households are have improved sanitation a minimum acceptable diet (up food secure facilities (58% in 2010) from 1% since 2010) 38% 4% 37% of children younger than five of handwashing facilities with of children younger than five are stunted (down from 44% soap and water is available in 4% are suffering from anemia since 2010) of households (2% in 2010) (down from 38% in 2010) 87% 73% 2% of children 0-6 months are of households have of children younger than five exclusively breastfed access to an improved waterer are wasted (down from 3% source (75% in 2010) since 2010) Data sources: The RDHS 2014/15 and the CFSVA 2015. 2 WHAT IS BEING DONE BY UNICEF With support from the Dutch Distribution of micronutrient caregivers of young children to Government, SDC, the IKEA powders, Vitamin A and deworming increase access to financing and Foundation and USAID, UNICEF to improve the micronutrient status income generating activities is implementing a multisectoral of children and reduce anemia Support to coordination, package of nutrition-specific as well Support to the management monitoring and evaluation, learning as nutrition-sensitive interventions of severe acute malnutrition in and knowledge management at focusing on 19 out of 30 districts children, including screening, district and national levels through in the country. These interventions referral and treatment training in DevInfo to track district include: plans to eliminate malnutrition, Training of caregivers of young Support to monthly community support to learning visits between children in establishing kitchen growth monitoring and promotion districts and training in and support gardens and small livestock rearing sessions, including cooking to operational research to capture to supplement the family’s diet demonstrations, to teach caregivers lessons learned and best practices on how to prepare a diversified diet Establishment of community and identify drivers and barriers for from locally available ingredients saving and lending groups for effective nutrition interventions. BACKGROUND AND CONTEXT Rubavu is one of 18 districts where UNICEF and successful interventions as well as bottlenecks. six partners have backed a multisectoral approach UNICEF has supported districts in strengthening to nutrition. The programme operates under the monitoring of interventions included in the district aegis of the Government of Rwanda’s national plans using DevInfo, a a monitoring tool that nutrition programme, and through funding from the can bring together data from diverse sectors Government of the Netherlands, the United States and national systems, including nutrition, health Agency for International Development (USAID), and agriculture, and present them in visual the Swiss Development Cooperation (SDC) and compelling ways such as maps. These offer a the IKEA Foundation. The ACCESS Project is the dynamic visual measure of progress and gaps, partner in Rubavu district. including geographically across a district. DevInfo The multisectoral approach links the multiple is the only data system in Rwanda that combines issues critical to achieving sound nutrition all elements of the multisectoral approach to among children, such as child feeding and nutrition and is fully aligned with the district plans. care, hygiene, access to sufficient income and Each variable in each set of district data includes a agricultural practices that make a diverse diet baseline, regular updates and objectives. readily available. Districts selected for assistance UNICEF has also supported the Government include those with the highest rates of under-five in introducing RapidSMS in all 30 districts of stunting, poverty and food insecurity. Rwanda, including through the multisectoral Rwanda’s national plan to eliminate nutrition programme. This enables patient level malnutrition, given a national move towards more monitoring to complement the aggregated data decentralized provision of public services, prioritized produced by DevInfo. Evidence for improved the adoption of multisectoral district plans to nutrition programming is being generated through eliminate malnutrition. Under these, different evaluations of different programmes, including district actors plan and coordinate all activities one of the Dutch-funded nutrition programmes, required to reduce malnutrition, including by where results are expected in early 2017. The regularly monitoring and reviewing progress. national health management information system Monitoring is critical to track and manage the (HMIS) and SISCOM, a health financing database district plans and provides the evidence to identify are also used to monitor nutrition interventions. 3 LESSONS LEARNED AND RECOMMENDATIONS General considerations relating to monitoring for nutrition Representatives from various organizations and the district look at a map generated by DevInfo during a planning meeting in Gisagara District. © UNICEF/UN016888/Noorani Gaps remain in capacities to analyse data. While data on health, including nutrition, is regularly compiled at the village, cell, sector, district and national levels, abilities to apply it to guide the district plans to eliminate malnutrition have required strong support from partners. One has offered METHODOLOGY regular refresher training for district staff on the basics of how to present and analyse data, seeking As part of identifying some lessons to overcome the tendency to think that it is enough learned in Rwanda, UNICEF commissioned to simply compile numbers. five briefs on themes central to Meetings of committees at different