CASE STUDY TEMPLATE What is a case study? A case study is an individual’s story. It tells the reader how Save the Children’s work has made a difference in the life of a child or his/her family.

1. Background: Please provide basic information about the interviewee(s). Name(s), gender, age: Mama Gabey Kassim is female aged 23 years Location – village/town, Gabey is a resident Meri location of wajir south district/province and constituency of wajir county. country: Keywords – themes: HOME FORTIFICATION

2. Summary: Please describe the interviewee’s day-to-day life and environment. Gabey lives in Meri location, she is a mother of five, four girls and one boy. She hails from a very poor family who don’t have enough resource to gratify their family sustainance.Gabey’s family come to settle Meri location the year 2007 when drought swept away their livestock. She is a petty trader and she sales mirra in the market of Meri where she generates their daily source of livelihood. Her husband does not work but he takes care of the children at home when the wife is away to the market selling mirra. Gabey and her family members live in a small make shift since they are poor and can’t afford to build permanent house.

3. The story: Interviewee’s story in his or her own words. Please use exact words with direct quotes. Gabey who is a mother of four girls and one boy, One of her children (Alinoor) was among the beneficiaries of HINI and was enrolled in OTP program where he stayed in the program for three months and he could not improve his nutritional status.Alinoor, the sole son of Gabey was discharged from the program when it was found that he is non respondent.Gabey says, “willkeyda wuxuu buskud qathanay muda sidaax bilood ah waxna wuu utari waay markass kadib waa lagabixi isagoon reysan wiili” .My son was in OTP program for a period of three months and he was discharged when it was found that he is a non-respondent and the plumpy nut did not help to improve his nutritional status”. One of the fine days Alinoor fall sick and started diahorring periodically and he was refered to Meri dispensary for treatment. “Alinoor’s mother said, Markii aan isbitalka tagaay daqtaarka canuugi buu ee daweey wuxuuna isoo siyaay bahal bodaar eeh oo nafaqaa ah, wuxuna idahay bahashan canugaa soodan casho sii maaliin daafna usii marrkas kadib na soo labo waayo waaxa laraba canuga innu qatoo lix bilood oo xiriir ah sifo nafaqathisa aay ukamilmato. ” She said when I reached the facility the nurse treated for me the child and she gave me micronutrient powders of which I was told it is an important nutrient and you should give to this child for a period of thirty days and you give on alternate days. I was also further advised to continue giving him for duration of six months so that the child gets enough minerals and vitamins in his body”. Mama Gabey started feeding Alinoor with the MNPs for duration of three months that is as from December 2014 to date and at the inception of the MNPs consumption he stopped the periodic diahorring and fed well. His mother says, “waaxan maleyna waax laisii inaay dawaoo tahay maarnaba uma maleysanin in aay tahaay nafaqaa maaxa yellay bahashan(MNPs) waxaay kujirtay warqaad yaar anigana maaleyneynin inn aytahay irsaqaat lakiin haado waxxan oogathi innay lamitahay caano geel maxa yeelay wuxuu buski taari waay ayaay tarti canuugina wuu igureystay anna faxad aad baan mujinaya” she said.(I thought what I was given was medicine and I never thought if it was nutritious food because the MNPs are in small sachets of which I don’t thinks it will be of any help to my child but I come to realise that those small powders are nutritious like camel milk and I ruptured with glee when my son get recovered in few days’ time sweating from the head to the ankle creating small streams.”) “ I attended several MNPs sensitization meetings held by save the children in conjunction with the Ministry of Health and I was equipped with the knowledge of home fortification.” She preached the gospel to her neighbours when she found that her child get recovered from the malnutrition. However, her neighbours were interested to know what she had given to her child since they knew the child had stunted growth and moon face. Neighbouring mothers used to visit her every morning to know the status of Alinoor since he was sick but finally he recovered after consuming several sachets of MNPs. According to Alinoor’s mother, he was a very playful baby before falling sick and after sickness his character turned into strange and he refuse to play with other kids but kept on weeping and spewing most of the time making her sleepless and sometimes suffers sleep walking. Due to the poverty situation of Alinoor’s family he was not refered to any other facilities for him to get further treatment since he was discharged as non- respondent from HINI program but he was only given MNPs to treat him as the last option. His mother says “cuunugeydi shubbank wuu goosti Markii uu cunay bahashi bodarka ee hayt caaloshi weyneet na waay kayaarati tintissina waay mathobatay Markii horna way cadeed.” (My son stopped diarhoearring when he has taken the MNPs, his belly pot reduced and his yellowish hair turned to black, looks smarter and reversed his playful character. ) Eventually she narrated for me a Somali fallacy story on TB treatment which has similarity with the MNPs treatment on her child. She said, “During the olden days having TB was nightmare and anybody who is infected with it was put into quarantine in the reserve area since there were no treatment available. However, once upon a time there was a man who was infected with TB and he was deserted into the reserve areas so that he does not infect the rest of the family members but lucky enough on raining the man followed behind a moving elephants and he started drinking water from the foot prints of the elephant where he immediately started vomiting excessively and got healed afterward. She said, from that moment the event become legend and drinking water from the elephant foot print become treatment for TB and everyone who has TB is told the same and my son’s treatment was just like that since he was given MNPs as last option treatment and he get recovered and I am doing the same to preach the gospel on how MNPs can instantly treat malnutrition and this left my neighbours wonders. “I will advise my neighbours, “niinki cafimaad raboow cunugisa hassiya MNPs” If you want health give your children to MNPs. SCI H&N nutrition promoter interviewing mama Gabey at her homestead.

Mama Gabey premixing MNPs with child’s food Gabey and her baby with euphoric mood while she is preparing to feed her baby with fortified food

Mama Gabey feeding he baby with fortified food. 4. Wider context 4.1 Program summary and background information. Micronutrient Powder (MNP) supplementation programme for children 6-23 months is implemented inWajir County - Wajir East and Wajir South Sub Counties Mandera County -Mandera West and Mandera Central Sub Counties Turkana County - Turkana South, Turkana Central, Loima, Kibish and Turkana North Sub Countie and the goal of contribute to a reduction in stunting associated with micronutrient deficiencies amongst children 6-23 months in Wajir, Mandera and Turkana Counties in Kenya through improving the quality of the diets for children 6-23 months. Multiple micronutrient powders (MNP) are innovation in home fortification addressing vitamin and mineral deficiencies. Micronutrient deficiencies is widespread in the industrialized nations, but even more so in the developing countries of the world including Kenya. It affects all age groups, with young children and women of reproductive age being at higher risk of developing micronutrient deficiencies. Iron deficiency is the most prevalent. It is estimated that just over 2 billion people in the globe are anaemic while just fewer than 2 billion have inadequate iodine nutrition. In addition to this, 254 million preschool-aged children are vitamin A deficient (WHO, 2006). Micronutrient deficiencies, based on the 1999 national micronutrient survey, are highly prevalent in Kenya especially among children under five years and women. The most common micronutrients deficiencies include vitamin A deficiency (VAD) among under-fives (84.4%), Iron deficiency anaemia (IDA) among 6-72 month olds (69%); pregnant women (55.1%), iodine deficiency (36.8%) and zinc deficiency among children under 5 years (51%) and 52% among mothers. The feeding practices among young children is poor in Kenya, nationally only 39 per cent of the children 6-23 months are fed in accordance with Infant and Young Child Practices. Improving nutritional status and reducing vitamin and mineral deficiencies are integral to achieving Kenya’s Vision 2030 and the Millennium Development Goals. The target group for micronutrient powder is infants and children aged 6-23 months. Save the children in conjunction with DoH and WFP have joined hands to implement home fortification program to treat young children from 6-23 months who are needs home fortification so that they don’t get mineral and vitamin deficiency in their bodies. The strategy is working well and more children are being registered in the entire wajir county so that every child can get the supplement. At the end of the program it is anticipated to reach 16508 children who are at the age of 6-23 months and create mass awareness to the communities to make sure program quality uptake and sustainability.

4.2 Follow-up: Is the individual in the beginning, middle or end of an activity/program with Save the Children?

Save the Children and the DOH still continue with programme implementation and follow ups in Meri location where Mama Gabey is one of the beneficiaries of micronutrient programme. She is playing a very crucial role in the community advocating for the consumption of the MNPs .she took voluntarily move and preached the gospel to the neighbours since she become role model to the society. She usually attends to MTMSGs sensitization meetings to give testimony on the importance of MNPs however, her presence in the village is an important aspect and there is high expectation that many will emulate.

4.3 Family, community leader, health worker, teacher, partner etc. quotes. Please ensure that you have the correct names, (job) title and organisation for each person quoted.

Gabey’s husband says, “There is serious drought biting this season and more children are prone to malnutrition since there is no milk available in the market but good luck we have these small powders and our children are like they are taking milk”. Community leaders say, “They had forbear about malnutrition due to prologue drought season but for now we have powders which are nutrient and most of our children are getting the supplement and home fortification is the order of the day”. “Waaxan kacabsi qaabni abbartaan deer in aay kenta nafaqaa daara caana laan awgeed laakin waxxan huubna innan haysana dawa nafaqaa daaro ka hoortagta”.He says we are extending our gratitude to Sci and DoH who have taken their time and resource to reach us at the grass root level with the aim of saving our children’s’ lives.

5.1 Overall impact: Please explain how Save the Children addressed the challenges/problem and describe the results. Malnutrition is a major challenge in Wajir community with poor access to nutrition services, poor feeding practices and lack of proper hygiene and sanitation. This poses a serious malnutrition aspect to the communities which resulted more epidemics. Save the children in partnership with DoH and other agencies have put in place several measures to intervene the situation by instituting HINI outreaches and capacity building the staffs of the existing facilities through OJTs supervision, sport checks and even employing some nutrion and medic personals and posting to the existing static facilities to scale up nutrition programmes. SCI in conjunction with the DoH have instituted other community structures to upscale health and nutrition program. These structures includes MTMSGs,CHATs,CUs and CHWs to make sure quality program implementation at the grass root level and also enhance behaviour change communication which will eventually accelerate program implantation and uptake. More than thousands of children and adult are enrolled in the HINI Program and they are undergoing treatment using therapeutic feeds while also getting health education on various aspects to curb underlying causes of malnutrition. SCI in conjunction with DoH initiated PD/Hearth methodology to capacity community members so that they can exploit the available resources and use to prevent and treat malnutrition. 5.3 Voice: Please describe if you have been able to advocate for better practices and policies or ensure children’s voices are heard.

SCI has been able to advocate for the children’s voice through the school health and nutrition clubs that exist in both primary and secondary schools in Wajir. Children in such clubs have been furnished with health education on good nutrition, bad nutrition, direct and indirect causes of malnutrition. They have also been empowered to know their environment, resources and how they can boost the utilization of their resources through community mapping and multi-risk calendars also called seasonal calendars. Besides, the health formation of health clubs students were also trained on school gardens so that they can use the greens in their schools and disseminate the information to the community members since children are agents of transformation or rather change. 5.4 Partnerships: Please describe if you have been able to cooperate with or build partnerships through this program. Partnership is strongly established between Save The Children, the DOH and other actors as Save the children does not conduct direct implementation of activities in Wajir county. Through written and signed Memorandum of understanding (MOU) and activity Terms of References (TORs), Save the children has been supporting partners such as the DOH, Department of Agriculture (DOA) and other local and international non-governmental organizations to achieve the goal of serving children and ensuring their rights to survival in Wajir county.

6. Child protection and consent issues 6.1 Please confirm that you have followed Save the Children child protection policies and have completed full consent forms for the child and/or family, and every individual you have quoted and photographed. Tick box to confirm: Yes

7. Case study reference information Interviewer: Abdi Mohamed Abey Photographer: Abdi Mohamed Abey Humanitarian response code (if applicable) Approved for use by: Approval for use is given by the Country Office. Date: 28/02/2015 Instructions for further use/further permissions required: When using this case study, please do not change any of what is written here.