Multi-sector programming at the sub-national level: A case study of Chipinge and Chiredzi Districts, Zimbabwe a k e h c a M a d n e t a T / P F W Multi-sector programming at the sub-national level: A case study of Chipinge and Chiredzi Districts, Zimbabwe Authors Report prepared for Emergency Nutrition Network (ENN) by John Borton with input from Natalie Sessions, Carmel Dolan and Jeremy Shoham. Acknowledgements Acronyms In-country ANC Antenatal Care DFNSC District Food and Nutrition Security Committee Our thanks go to: Dr George Kembo (SUN DLLC District Literacy and Learning Coordinator Focal Point and Director, Food and Nutrition ENN Emergency Nutrition Network Council (FNC)); Siboniso Chigova (Nutrition ESAP Economic Structural Adjustment Programme Officer, FNC); Tatenda Mudiwa (Principal ESAR East and Southern African Region Officer, FNC); and Miriam Banda (Multisectoral EU European Union Co-ordination Manager, FNC), whose support FAO Food and Agriculture Organization was essential to the success of this work. FNC Food and Nutrition Council Thanks also to Nester Gumbo (Chair, National FNSC Food and Nutrition Security Committee Food and Nutrition Security Committee FNSCs Food and Nutrition Security Committees (FNSC) and Chief Agricultural Extension GNI Gross National Income Specialist, Ministry of Lands, Agriculture and IPC Integrated Food Security Phase Classification Rural Resettlement); Yvonne Mavhunga MCBM Multi-Sectoral Community Based Model (Deputy Director – Programmes, FNC) and MoH Ministry of Health Kudzai Mukudoka (Nutrition Officer – Stunting NGO Non-governmental Organisation Reduction, United Nations Children’s Fund) for NRTM Near-real-time monitoring their helpful insights. ODK Open Data Kit OPC Office of the President and Cabinet PMR Programme Monitoring and Response SUN Scaling Up Nutrition SUNRAP Scaling Up Nutrition Research and Academia Platform TAN Technical Assistance for Nutrition UNICEF United Nations Children’s Fund VHWs Village Health Workers WASH Water, Sanitation and Hygiene WFP World Food Programme WHO World Health Organization ZCSOSUNA Zimbabwe Civil Society Organisation for Scaling Up Nutrition Alliance Zim Asset Zimbabwe Agenda for Sustainable Socio- Economic Transformation Multi-sector programming at the sub-national level: A case study of Chipinge and Chiredzi Districts, Zimbabwe Contents Executive Summary 1 Section 1: Setting the scene 3 Introduction 3 The national level 4 Chipinge and Chiredzi Districts 5 Methodology for this study 6 Section 2: The National Food and Nutrition Security Policy 7 Section 3: The Multi-Sectoral Community-Based Model (MCBM) 9 and its operation in Chipinge and Chiredzi Districts Piloting the MCBM in the four pilot districts 10 Inter-district learning 11 Functionality assessment 11 Identification of drivers of stunting 12 Section 4: Analysis and findings on the operation of the MCBM 13 in the two districts Multi-sector working 13 Views of the committees on the achievements and impact of the MCBM 14 The introduction of the mentorship approach in the MCBM 15 The introduction of model wards and model villages in the MCBM 15 The role of the chiefs and traditional leaders 16 The operation of the near-real-time monitoring system (NRTM) 17 Logistical and economic challenges 18 Challenges stemming from cultural and religious beliefs and practices 19 The role of VHWs and volunteer VHWs in the MCBM 19 The impact of Cyclone Idai 20 Section 5: Conclusions 21 Annex 1. List of interviewees and those consulted 23 Annex 2. Questions used in group discussions at field level 25 Annex 3. NRTM data-collection tools for pregnant women and 26 children under two years of age a k e h c a M a d n e t a T / Executive summary P F W Children attending school in Zvishavane, Zimbabwe, benefit from the home grown school feeding programme imbabwe is currently ranked 107 of 119 • The explicit involvement of local chiefs and headmen, countries on the Global Hunger Index 2018, given their significant role in influencing local practices; with 38% of the population defined as • An explicit commitment to building capacities at chronically food-insecure. However, trends for district, ward and village levels; Zchild malnutrition have seen substantial declines in • Achieving greater efficiencies in the delivery of gov- stunting (from 33.8% in 2010 to 26.2% in 2018 1) and ernment services at district, ward and village levels; underweight (from 10% in 2010 to 8.8% in 2018), • Leveraging additional resources through the although wasting has risen marginally (from 2.1% in involvement of donor and non-governmental 2010 to 2.5% in 2018). The country has a long history organisation (NGO) partners; of multi-sector nutrition programming, with the Food • Strengthening of monitoring and feedback and Nutrition Council (FNC) established in 2001 as a mechanisms at the different levels. multi-stakeholder platform to convene cross-sector actions and provide leadership to stakeholders with Between April and September 2019, Emergency academics, donors and non-governmental partners. In Nutrition Network (ENN) conducted field visits to 2012, the FNC led the development of the Food and understand and document the MCBM approach. Key Nutrition Security Policy for Zimbabwe, with an informant interviews were conducted in Harare as well accompanying Implementation Plan/Matrix. As part of as Chipinge and Chiredzi, two districts that were part of this policy, a multi-sector approach to reducing the pilot districts in the MCBM model. Fifteen national- stunting was developed two years later; the ‘Multi- level interviews were conducted with stakeholders from Sectoral Community Based Model for addressing the FNC, the ministries responsible for agriculture and food and nutrition insecurity for Stunting Reduction’ health, the United Nations Children’s Fund (UNICEF), (commonly referred to as ‘MCBM’). Four pilot districts the Food and Agriculture Organization of the United were selected for the programme on the basis of their Nations (FAO), and donor partners. At a sub-national stunting rates, poverty levels and other indicators. level, interviews were conducted with a chief, and five focus-group discussions were held with members of Key elements in the design of the MCBM pilot include: Food and Nutrition Security Committees (FNSCs) at • Participatory planning at the community level to district, ward and village levels (40 people). Meetings identify and address the specific causes of stunting were also held with members of local community in each community; gardens and health clubs (approximately 50 people). • Targeting of nutritionally at-risk households (vulnerable pre-pregnant, pregnant and lactating The findings noted a number of important successes women, children under two years of age and of the model thus far. First, it has enabled and adolescent girls) with nutrition-specific and nutrition- enhanced multi-sector ways of working, with joint sensitive programmes to improve maternal and child planning and implementation being seen . There nutrition and reduce household food insecurity; was broad agreement that the MCBM significantly • Developing community-based processes aimed at increased the level of joint planning and practical empowering adolescent girls, pre-pregnant and pregnant women and mothers; 1 2010 and 2018 National Nutrition Survey. 1 Multi-sector programming at the sub-national level: A case study of Chipinge and Chiredzi Districts, Zimbabwe collaboration between different government ministries. an important role to play in changing behaviours The MCBM’s requirement for district, ward and village and practices . On the basis of the two district visits, FNSCs to undertake joint assessments, identify and it is clear that chiefs and traditional leaders are indeed agree on local needs and priorities, then collaborate playing a key role in influencing behaviours and on addressing those priorities was seen as central to practices that contribute to stunting. After identifying the increased collaboration. Wards develop their own their role at sub-national level, chiefs from the four action plans based on the agreed needs, which can pilot districts were sensitised during the initial stages then be used to hold wards and sectors accountable. of MCBM on stunting and its causes, and briefed on Critically, a number of behaviour changes have taken the overall MCBM initiative. place since the programme began, such as dairy farmers retaining some milk for their own consumption The operation of a near-real-time monitoring rather than selling it all, and the encouragement of system (NRTM) proved valuable and was seen as a community gardens. While some of the changes may vital part of the MCBM approach as it provided well have occurred in the absence of the MCBM, there districts and wards with data to help set priorities and was a widely shared sense that it had contributed action plans, revise priorities where necessary, and positively to the changes by focusing attention on indicate progress. The feedback provided to the stunting and the many different factors contributing to communities by the NRTM was seen by many in the it. By bringing the different ministries together at two districts as integral to the success of the MCBM. district, ward and village levels to focus on stunting However, certain challenges remain. For example, since reduction, and by helping to conscientise and mobilise the external funding for the NRTM ended around mid- communities to focus on stunting reduction, the 2017, it has encountered a number of challenges and its MCBM contributed significantly to the positive effectiveness and coverage has declined. Some at the changes in behaviours. Second, the MCBM enabled national level regard the NRTM as not having functioned the introduction of the mentorship approach , which properly for the last two years. In Ward 22 in Chiredzi, has helped to improve the quality of stunting- for instance, the tablet device was sent to Harare for reduction efforts. The approach involves members of updating in February 2019, and it had not been returned the District FNSC mentoring one or two wards. The seven months later (although the ward was informed of system is generally regarded as a positive innovation the reasons for the delay.