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UNICEF GUINEA-BISSAU Review of Malnutrition Prevention and Management Project

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UNICEF GUINEA-BISSAU Review of Malnutrition Prevention and Management Project UNICEF GUINEA-BISSAU Review of Malnutrition Prevention and Management Project March 2018 Table of Contents Table of Figures ............................................................................................................................................................. 1 Executive Summary ....................................................................................................................................................... 2 Acknowledgements ....................................................................................................................................................... 4 Introduction ................................................................................................................................................................... 5 Objectives ...................................................................................................................................................................... 5 Key definitions ............................................................................................................................................................... 5 Background and Context ............................................................................................................................................... 6 Evaluation ...................................................................................................................................................................... 8 Challenges and Suggestions for the Future ................................................................................................................. 20 Bibliography ................................................................................................................................................................. 22 Appendix A: Human Interest Stories ........................................................................................................................... 23 Appendix B: Methodology ........................................................................................................................................... 25 Appendix C: Project Team ........................................................................................................................................... 27 Appendix D: Contact Details ........................................................................................................................................ 28 Table of Figures Figure 1: CRN Treatment outcomes (Bafata) ................................................................................................................. 8 Figure 2: CRN Treatment outcomes (Gabu) ................................................................................................................ 10 Figure 3: Percentage of patients tested for HIV .......................................................................................................... 11 Figure 4: Percentage of patients tested for HIV by type of treatment centre (Bafata) ............................................... 13 Figure 5: Percentage of patients tested for HIV by type of treatment centre (Gabu) ................................................. 13 Figure 6: Percentage of patients who test HIV-positive who are referred to a CTA (Bafata) ...................................... 14 Figure 7: Treatment outcomes of children who test HIV-positive (Bafata) ................................................................. 14 Figure 8: Treatment outcomes of children who test HIV-positive (All regions) .......................................................... 15 Figure 9: Percentage of parents of CRN patients who have heard of HIV tests (by region) ........................................ 16 Figure 10: Percentage of parents of CRN patients who have been tested for HIV (by region) ................................... 17 Figure 11: Water Source (%, by region) ....................................................................................................................... 17 Figure 12: Percentage who treat water (by region) .................................................................................................... 18 Figure 13: Type of water treatment (by region, multiple responses allowed) ............................................................ 18 BANDIM HEALTH PROJECT – REVIEW OF MALNUTRITION PREVENTION AND MANAGEMENT RESEARCH 1 Executive Summary Background In October 2014, UNICEF Guinea-Bissau launched an initiative for more effective prevention of chronic malnutrition and management of Severe Acute Malnutrition (SAM) in nutrition rehabilitation centres across the country. As part of efforts to shift towards integrated planning and monitoring through the creation of convergence and programmes linkages, Nutrition integrated HIV and WASH into its interventions in three nutrition rehabilitation centres managed by Caritas. Purpose To review the Malnutrition and Management project implemented at Nutritional Rehabilitation Centres (CRNs) and Casa das Mães in the regions of Gabú, Bafatá and Cacheu. Identified best practices Feedback from beneficiaries indicates that participation in the project has positively influenced their practices and behaviours, especially relating to WASH, Nutrition, and Breastfeeding practices, notably improving the health of children at the CRN. Both beneficiaries and Key Informants at the CRNs expressed project satisfaction. Specific identified best practices include: Overall • Programme effectiveness due to addressing of three intricately interrelated issues at the grassroots level in Guinea-Bissau: nutrition, hygiene and HIV/AIDS. Effective resource use due to complementarity and cross- fertilisation effects of interventions. • Community visits by animators and supervision allowing for follow-up of patients increased reach and effectiveness of the programme and was considered a best practice by CRN staff. • The multiplier effect of awareness raising and training of parents on best nutritional, health and hygiene practices as those directly involved transmitted knowledge onto their families and neighbours. Nutrition • Improvements in treatment outcomes at the CRN in Bafatá thanks to a combination of factors, including, good coordination between CRENI and CRENAG and better resourced and staffed CRNs, • Success in awareness-raising of nutritional practices thanks to better trained staff and the provision of graphic teaching materials (in Cacheu and Gabú). HIV/AIDS • Improvements in HIV testing and CTA referral rates in Bafatá thanks, at least partly, to better staff awareness and training and increased coordination between CRENI, CRENAG and CTA. • High levels of awareness of CRN patients regarding availability and importance of HIV testing in all three regions as a result of training of CRN staff WASH • Success in awareness-raising of water and sanitation practices thanks to better trained staff and the provision of graphic teaching materials (in Cacheu and Gabú). BANDIM HEALTH PROJECT – REVIEW OF MALNUTRITION PREVENTION AND MANAGEMENT RESEARCH 2 Identified challenges Overall Main overall challenges preventing the project from achieving its key objectives included: • Lack of coordination between centres in all three regions; insufficient financing for supervision field visits; inadequate training of all health professionals; • Inadequate and inconsistent data collection methods and serious ruptures to stocks of supplies. Nutrition • Fall in ongoing treatment and an increase in treatment abandonment at the CRN in Bafatá. The CRN have had to stop field visits due to financial constraints which may be impacting these results, there is a need for action to ensure patients finalise their treatment. • Worsening treatment outcomes at the CRN in Gabú, and a sharp rise in unconfirmed abandonment, again potentially due to lack of supervision visits. HIV/AIDS • Decrease in testing rates in Gabú, likely due to deficiencies in data collection and data sharing by the centre and the regional hospital. • Difficult to gauge success of HIV/AIDS awareness-raising as the topic remains a taboo subject when discussed in public. • As project was implemented via a catholic organisation (CRN Caritas) the use of preservatives to prevent HIV transmission was not being taught as a key awareness message in Cacheu. WASH • Respondents in Gabú and Cacheu are more likely to use methods that are not adequate to ensure water is safe for human consumption. • Severe constraints in access to water in parts of Cacheu. Sustainability • Lack of project awareness and training amongst health workers in hospitals, potentially due to the high rotation of staff in the Guinea-Bissau public health system. • Stop-start nature of donor funds impedes the on-going, prolonged efforts in raising-awareness that the project requires to achieve positive results and leads to waste, most notably of human capital. • MSF will exit Bafatá hospital, this may negatively impact the success in testing rates by the CRENI service. Key recommendations 1. Improve coordination and communication amongst the Centres within regions, and between UNICEF and the Centres. 2. Provide regular monitoring, supervision and support by UNICEF nutrition, HIV and WASH teams to the Centres. 3. Tackle treatment abandonment issues by providing financial means to allow regular field visits by the Centres to the Tabankas and invest in data collection methods. 4. Provide updated and regular training sessions to health
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