Save the Children in partnership with SNV

Projet USAID Nutrition et Hygiène à Cooperative Agreement No. AID-688-A-13-00004

Quarterly Report January 1, 2015– March 31, 2015

Contact Information for this report: Maurice Gerald Zafimanjaka, MSc, MPH Project Director, Projet USAID Nutrition et Hygiène Email: [email protected]

1 Contents

Acronyms ...... 3

Introduction...... 4 Context and Project Objectives: ...... 4

Planned activities for the reporting period (Y2Q2): ...... 4 Achievements during Y2 Q2: ...... 6

Success Story ...... 19

Challenges and Constraints ...... 20 Lessons Learned ...... 21

Gender Integration Achievements ...... 21 Major Activities Planned for Year 2, Quarter 3 (Y2Q3) ...... 22

Future Events Planned during the First Quarter of FY2 ...... 23 Indicator Reporting Table ...... 24

Environmental compliance ...... 26

Conclusions...... 26 Annexes ...... 26

2 Acronyms ASC Agent de Santé Communautaire AEA Agriculture Extension Agents ASACO Associations de Santé Communautaire ASDAP L’Association pour le Soutien du Développement des Activités de Population ATPC Assainissement Total Piloté par la Communauté or CLTS BDS Business Development Services CAP Community Action Plans CLAN Community Leaders for Action on Nutrition CLTS Community Led Total Sanitation or ATPC CM Community Mobilization CMAM Community-Based Management of Acute Malnutrition CSCOM Centre de Santé Communautaire DRA Direction Régionale de la Santé DRACPN Direction Régionale de l’assainissement et du Contrôle des Pollutions et des Nuisances ENA Essential Nutrition Actions FARN Foyer d ’Apprentissage et de Réhabilitation Nutritionnelle FFMSy Family Farming Management Systems FFS Farm Field Schools FSL Food Security and Livelihoods GOM Government of HKI Helen Keller International ICRISAT International Crops Research Institute for the Semi-Arid Tropics IER Rural Economy Institute IPC Interpersonal Communication IYCF Infant and Young Child Feeding MAM Moderate Acute Malnutrition MLA Maman Leader Animatrice MUAC Mid-Upper Arm Circumference NG Neighborhood Groups OD Open Defecation OHADA Organisation pour l’Harmonisation du Droit des Affaires en Afrique OTP Outpatient Therapeutic Feeding Program PLW Pregnant and Lactating Women RUTF Ready-to-Use Therapeutic Foods SACCN Senior Advisors for Client Counseling and Negotiation SAM Severe Acute Malnutrition SBC Social and Behavior Change SBCC Social and Behavior Change Communication SIS Système d'Information Sanitaire SFP Supplementary Feeding Program SOW Scope of Work TA Technical Assistance TOR Terms of Reference USG United States Government VCA Value Chain Analysis WASH Water Sanitation and Hygiene

3 Introduction Projet USAID Nutrition et Hygiene is in its second year of implementation and the reporting period, with January 1 through March 31, 2015 signaling the completion of its sixth quarter of implementation. The project is actively present in six health districts, in 46 of health facilities, and in 232 out of 251 full package communities.

Context and Project Objectives: Save the Children leads the implementation of the Projet USAID Nutrition et Hygiene or Nutrition and Hygiene Project (the Project), implemented in partnership with SNV. The project’s goal is to improve the nutritional status of pregnant and lactating women and children under two years of age in six health districts (, Nièna, Sikasso, , Kignan, and ) of . Sikasso Region is considered to be Mali’s breadbasket, agriculturally productive and a trade center, and is also one of the most densely regions of Mali and host to high rates of malnutrition .

The project’s three strategic objectives are: - SO1: To increase the adoption of optimal behaviors to supports nutrition, health, hygiene and sanitation - SO2: To increase the production and accessibility of nutrient-rich foods - SO3: To improve the delivery of nutrition services to address acute malnutrition

The project’s approach is grounded in community mobilization and social and behavior change. It works through community structures to facilitate change and promote specific behaviors, engaging community members in Community Led Total Sanitation, committees for action on nutrition, Farmer Field Schools (FFS), and Family Farmer Management Systems (FFMSy). The project also supports the Malian Ministry of Health and ASACO in addressing acute malnutrition through CMAM and encouraging interpersonal communication (IPC) through client- patient exchanges as a means of instigating the adoption of recommended behaviors. Over the course of the five year the project will reach at least 13,000 pregnant and lactating women (PLW) and 53,000 children under 2 years of age in six health districts in the Sikasso Region with the totality of its interventions.

Planned activities for the reporting period (Y2Q2):

Cross-cutting activities:

- Conduct workshop to share the results of the formative research; - SBC strategy development using the results of formative research/ baseline study;

SO1: To increase the adoption of optimal behaviors to support nutrition, health, sanitation and hygiene

IR1.1 Households and caregivers have adopted recommended behaviors to support health and nutrition - Conduct barrier analysis - Develop SBCC materials - Develop facilitation curricula - Training of SBC agents on facilitation curricula - Organize and orient community coordination committees - Facilitate development of community action plans

4 - Mentor implementation of community action plans - Facilitate the organization of action groups for nutrition (CLAN, Care Groups, JFAN) - Flipchart production and multiplication - Orient/train action groups for nutrition - Train mother leader animators on lessons - Monitor action groups for nutrition

IR1.2 Households and communities undertake actions to support optimal hygiene and sanitation - Pre-trigger communities in CLTS - Trigger communities in CLTS - Post-trigger monitoring - Joint evaluation of triggered villages for eventual certification - WASH committee members sensitize households on WASH - Identify private sector collaborators (sanplat producers, etc.)

SO2: To increase production and accessibility of nutrient -rich foods

- Disseminate results of value chain analysis study for cowpeas, groundnut, and soya crops

IR 2.1: Producer groups are strengthened - Contract Local Capacities Builders (LCB) - Organize livelihood producer groups - Organize meetings between female producers and land owners to facilitate women’s access to land - Identify land for gardening - Conduct a feasibility study on the installation of a micro-irrigation system - Install micro-irrigation equipment and fencing for gardens - ToT of AEAs on micro-irrigation techniques - Train peer farmers on micro-irrigation techniques - Train extension agents and animators (peer farmers) on the maintenance of micro-irrigation systems

IR 2.2: Improved farm management techniques adopted - Train extension agents in FFMSy (CEF) - Identify and orient animators (peer farmers) on CEF - Train extension agents on improved agriculture techniques - Identify farmer field schools (FFS)

IR 2.3: Smallholder access to agricultural inputs improved - Facilitate access to agricultural inputs - Evaluate the needs and launch request of logistics for agricultural inputs - Identify, select and contract microfinance institutions - Identify and establish a committee for revolving funds - Train extension agents on revolving fund management - Facilitate smallholders in their development of credit applications

IR 2.4: Linkages between producers, processors, and markets improved - Conduct market study on nutrient-rich flours and fortified complementary foods. - Identify and contract Business Development Service Providers (BDS) - Identify potential processors - Liaise with National and Regional DN (to endorse select nutrient-rich flour or complementary foods)

5 SO 3: To improve the delivery of nutrition services to address acute malnutrition

IR 3.1: Management structure capacity to support CMAM is improved - Facilitate procurement of materials for CMAM - Distribute inventoried materials - Regional and district-level assessment and training on commodity management and pipeline

IR 3.2: Health workers have heightened capacity in the management of acute malnutrition - Assess and document capacity of human resources by health facility - Facilitate district-level monitoring of CSCOM and CMAM services - Train Relais Communautaire (RECO) volunteers on role-specific CMAM services - Mass-screening and referral exercise

IR 3.3 Health workers have heightened capacity to counsel and negotiate with clients - Observe and interview 40 SACCN candidates - Select 20 SACCN - Select 20 SACCN - Conduct orientation meeting for 20 SACCN

Achievements during Y2 Q2:

Activities not specific to SO/IR

Formative Research The draft of formative research report was submitted and comments were provided by the project team. The result restitution workshop was scheduled for the following quarter, Y2Q3, or April 15, 2015 in Sikasso.

SBC Strategy Development: Conduct a workshop to develop SBC strategy The project conducted a participatory workshop to support the development of the SBC strategy September 30 - October 2, 2014 with the support of a consultant who acted as the facilitator and technical advisors from Save the Children US, Adriane Seibert and Natalie Roschnik. Under the leadership of SC/US Nutrition Advisor, the SBC strategy is under development. SBC messaging platform using cascade communication was adopted. In full package area of intervention, women of reproductive age (WRA) will be organized into neighborhood groups of 10-15 that identify from their members, mothers leaders to be targeted by the project. Mother leaders will be organized into care groups and receive monthly informal nutrition and hygiene education from project staff (SBC agents). The project will also reach the husbands/fathers, mothers-in-laws, and community leaders as they play a significant role in influencing IYCF and other key behaviors.

Conduct barrier analysis: The project planned conduct barrier analysis for approximately six additional sub-behaviors during Y2. The staff will be trained on barrier analysis methodology when a SBC Advisor has been identified to operationalize the SBC strategy.

6

Develop SBCC materials: The project has selected specific counseling cards validated by the Malian Ministry of Health as the job aid used to introduce key concepts regarding Community Action Cycle: exclusive breastfeeding, optimal complementary feeding, and hygiene in the interim. The - Community awareness of malnutrition and hygiene and procurement process was launched and potable water access as community issues worthy to be materials will be available during Y2Q3. The addressed collectively; project will develop additional materials that will - Community mobilization for a community health and be aligned with the fully elaborated SBC strategy. nutrition assessment including pre-triggering stage of CLTS;

- Develop facilitation curricula: Community Action Planning (CAP) engaging community actors (frontline workers, Mother leaders, Facilitation curricula were developed in Y2Q2 to community leaders, woman farmer groups, etc.) help field agents when training mother leaders in - CAP Implementation through local actors: nutrition using MoH counseling cards: topics and contents and WASH SBCC messaging, growing and utilization were developed and session plan being finalized. of nutrient-rich foods, WASH infrastructures improvement through triggering stage of CLTS and Training of SBC agents on facilitation curricula: WASH marketing, community based nutritional The project will train SBC agents in facilitation screening and referrals to health and nutrition services curricula during the next quarter using - Community coordination, partnership negotiation, counseling cards as the basis. monitoring and evaluation, including post-triggering

stage of CLTS, through Community Coordination Full package intervention (all strategic Committee. objectives) will be implemented by the project - Community Action Plan Review team in 251 communities within fifteen (15) health areas (CSCOM). The project’s approach to community mobilization (community action cycle) will be adopted in these 251 communities.

During the community assessment, community representatives analyze the root causes of malnutrition in their communities using the UNICEF nutrition framework and also discuss healthy growth and development. Mains causes/problems in terms of nutritious food access and consumption care for children and women at home, water and sanitation and access to health and nutrition care are identified analyzed and prioritized. Community representatives elaborate community action plans that engage community actors to implement their own activities in at least the three subcomponents covered by the three project strategic objectives: adoption recommended nutrition and WASH behaviors by caregivers, families and communities (SO1), access to and utilization of locally produced nutrient-rich foods (SO2), and access to and utilization of improved WASH infrastructures and to quality health and nutrition services (SO3). It is noticed that the SO1 is crosscutting to SO2 and SO3.

SO1: To increase the adoption of optimal behaviors to support nutrition, health, sanitation and hygiene

IR1.1 Households and caregivers have adopted recommended behaviors to support health and nutrition

Facilitate development of community action plans: Over the course of the five years of the project, community mobilization and social behavior change activities will be implemented in 251 communities. These communities will be oriented to nutrition and the healthy growth and development of children and will prompted to conduct community nutrition assessments and elaborate action plans to improve nutrition status of their constituencies. Through this process, community leaders are mobilized and sensitized on nutrition issues and identify small doable actions that can be adopted. Project field staff supported the 64 communities from Y1 trough a community nutrition assessment and action planning.

7 During Y2Q2, 135 new communities initiated community nutrition assessment during Y2Q1. 165 new community action plans (CAP) were elaborated by community representatives themselves facilitated by project staff. This process allows the mobilization and sensitization (malnutrition and key IYCF behaviors) of 4,086 (2,084 males; 2,002 females) community leaders. Exclusive breastfeeding as included as a topic in these sensitization sessions.

Mapping exercise with Gondaga Community Mapping exercise with Diérebougou Community (-Sikasso), Jan 29, 2015 (Niamala-Bougouni), Jan 29, 2015

Cumulatively, 156/187 and 168/211 communities respectively initiated nutrition assessments and elaborated CAP during Y2.

USG indicator: In Y2Q2, 2,002 women reached with messages on exclusive breastfeeding. Cumulatively over the course of the project, 2,239 women reached with messages on exclusive breastfeeding.

Organize and orient community coordination committees: Community coordination committees (CCC) are implemented in each community to reinforce community mobilization process and coordinate CAP implementation. CCCs are oriented on their roles and responsibilities by project SBC agents. SBC Agents supported the 64 pilot communities from Y1, to have their CCCs to coordinate and monitor the implementation of their community action plans.

During Y2Q2, 102 community coordination committees (CCC) were organized and 908 people (486 males; 422 females) members of the CCC were oriented. Exclusive breastfeeding was globally communicated to these CCC members.

Cumulatively, 166 out of 251 communities have their CCC in place. 1,477 people (804 males; 673 females) members of the CCC were oriented.

USG indicator: - In Y2Q2, 422 women reached with education on exclusive breastfeeding - In total 691 women reached with education on exclusive breastfeeding.

Facilitate the organization of action groups for nutrition:

The project supports communities to mobilize community action groups and individuals to plan and implement actions as prioritized in the CAPs.

In Y2Q2, Women of reproductive age (WRA) were organized into 841 neighborhood groups (NG) in 129 communities in Y2Q1. Each NG elected a mother leader animatrice (MLA). In total, 841 MLA were identified.

8 1,089 mother in-laws and 1,326 husbands were identified in respectively 144 and 137 communities respectively to support WRA to adopt IYCF and hygiene practices at family level after they receive messaging from MLA.

Cumulatively, 1,181 NG with 1,181 MLAs within 129 communities were put in place from October 2014 to March 31, 2015.

Flipchart production and multiplication: Based on the project’s decision to adopt as alternate materials the MoH counseling cards in December, the project launched the procurement process to acquire 4,210 flipcharts that will be distributed as job aids to approximately 3,650 MLA of 251 communities, 502 relais communautaires, 30 ASCs from 15 CSCOM, and health agents. These flipcharts will be available during Y2Q3.

Orient/train action groups for nutrition: Project staff orients/trains theses community groups and individuals on their respective roles and responsibilities and IYCF practices (including exclusive breastfeeding) and hygiene practices to conduct actions for nutrition targeting WRA as primary caregivers and other population groups.

In Y2Q2, 841 MLA, 1,089 mother in-laws and 1,326 husbands received orientation about their roles and responsibilities as well as general information on key IYCF practices including exclusive breastfeeding. 1,930 women (841 MLA and 1089 mother in-laws) received general information about exclusive breastfeeding. They will be trained and receive job aids in late Y2Q2 or the beginning of Y2Q3.

Cumulatively, 1,181 MLA, 1,436 mother in-laws, and 1,538 husbands received orientation and general information about IYCF practices, including exclusive breastfeeding during Y2.

Naminasso CCC Elaborating Community Action Plan Training of N’Galamatiébougou Ad Hoc Committee in Community (Fama, Sikasso), January 29, 2015 Assessment ( A/C, Sikasso), March 9, 2015 (Fama, Sikasso), January 29, 2015.tion Plan

USG indicator: - In Y2Q2, 841 MLA; 1,089 mother in-laws) women reached with education on exclusive breastfeeding - In total 2,617 (1,181 MLA; 1,436 mother in-laws) women reached with education on exclusive breastfeeding

MLA (Care group) regular training: This activity was not yet conducted in Y2Q2. Training curricula based on MoH flipchart are under development for field SBC Agents who will be trained in Y2Q3 and then in turn, train MLA in their project areas.

Monitor action groups for nutrition: Based on initial orientation on their roles and responsibilities and general information on IYCF practices, 139 MLAs from 25 communities communicated core messages on exclusive breastfeeding and child nutrition to WRA in

9 Y2Q2. 1,647 WRA were reached by MLA during this quarter. Cumulatively, 1,647 WRA were reached by 139 MLA though IYCF practice messaging, including exclusive breastfeeding.

USG indicator: In total, 1,647 women (WRA) reached with messages on exclusive breastfeeding.

IR1.2 Households and communities undertake actions to support optimal hygiene and sanitation

Orient/train action groups for WASH activities: One hundred thirty three (133) WASH committees composed by 762 members (370 males; 392 females) from 133 communities were organized and oriented/trained on their roles and responsibilities and recommended hygiene practices. These committees which are linked the CCCs will be in charge of WASH activity implementation in the CAP, particularly sensitization and CLTS implementation.

Cumulatively, 838 WASH committee members (428 males; 410 females) from 145 WASH committees were oriented in Y2.

Maintenance of the Well Surroundings and Hand Washing Stations in Guérékélé Village (Niamala-Bougouni), February 2015

Community Cleaning for Healthy Environment in Kolayerebougou Community Cleaning for Healthy Environment in Béréla Village Village, (-Sikasso), March 10, 2015. (Niamala-Bougouni), February 12, 2015.

USG indicator: -762 people (370 males and 392 females) trained in child health and nutrition through USG supported programs in Y2Q2 10 -In total, 838 people (428 males; 410 females) trained in child health and nutrition in Y2.

Pre-trigger communities in CLTS: Though the community nutrition assessment, basic data are collected on populations and WASH infrastructures for the 251 communities. This process nurtures the CLTS pre-triggering stage.

In Y2Q2, thirty-seven (37) new communities were assessed for CLTS and a new list of 30 villages was validated during a workshop with DRACPN for CLTS triggering stage.

In total, 63 communities were assessed and 107 (78 assessed from Y1) communities were approved by DRACPN to be triggered.

Trigger communities in CLTS: Sixty-two (62) communities were triggered in Y2Q2. During the triggering process, 331 triggering agents (233 males; 98 females) were trained on ATPC and hygiene to mobilize communities. Of these triggering agents, 186 (124 males; 62 females) were community leaders. Approximately 5,000 community members were sensitized on hygiene and sanitation through CLTS triggering. At the end of the CLTS triggering stage, the 62 communities developed 62 WASH action plans to be implemented and monitored during post-triggering stage.

In total, 92 out of 107 communities approved to be triggered in Y2 were triggered. 510 people were trained (359 males; 151 females) trained on hygiene practices of whom 276 community leaders (184 males; 92 females). The fifteen (15) remaining communities will be triggered in April 2015.

Community Mapping Involving Children CLTS triggering stage, Environnemental Walk for Identification of Open Defecation Spots in Kaboila (Kaboïla-Sikasso), January 22, 2015. in Kaboila Village (Kaboïla-Sikasso) with Mr. Seydou Bouaré, Radio Animator in Charge of Media, January 22, 2015

USG indicator: - In Y2Q2, 331 people (233 males; 98 females) trained in child health and nutrition through USG supported. - In Y2, 510 people (359 males and 151 females) people were trained.

- Post-trigger monitoring During post-triggering stage, communities implement their WASH action plans and receive door-to-door hygiene practice messaging from WASH committees.

Post-trigger monitoring sessions are conducted at three/four levels. At community level, WASH committees, supported by field agents, conduct weekly monitoring sessions which are combined with WASH door-to-door sensitization. At municipality level, CSCOM and municipality hygiene agents, supported by the project conduct monitoring sessions at least once a month at selected communities to involve and make them aware of their responsibilities in WASH CLTS process. The cercle level and eventually regional level are also involved are supported by the project at least once during post-triggering stage to monitor CAP progress at community level.

11 4,633 households were sensitized on WASH practices within fifty seven (57) communities, particularly on latrine and hand washing station use and critical moments for hand washing) during the reporting .

In total, households were sensitized on WASH practices in Y2.

USG indicator: 11,134 people (5 425males and 5 709 females) gaining access to an improved sanitation facility in USG supported programs

Mass communication during special events: The project supported the Region and Regional Directorate of Women, Children and Family Promotion to organize the celebration ceremony of the International Women in Sikasso. Messages about safe disposal of child feces and pregnant and lactating women feeding using locally affordable aliments were communicated. Additionally, the project supported the CCC in 40 communities to celebrate the event with the same messages as well.

Women International Day Celebration organized by Kouroumasso Mother Leaders during the Women International Day Celebration CCC, Kouroumasso (Fama, Sikasso) organized by Siramana CCC, Siramana (Fama, Sikasso)

SO2: Increase production and accessibility of nutrient-rich foods

Value Chain Analysis (VCA): An expert in VCA was recruited by SNV in December to conduct VCA of three main value chains (cowpea, soya, groundnuts). Final result dissemination was held during Y2Q2 with partners.

Partner Representatives Discussion Value Chain Results During the Partner Representatives During Value Chain Result Restitution Restitution Workshop, March 5, 2015 Workshop, March 5, 2015 12 The VCA results assist the project in achieving a better understanding of actor relationships, techniques used by each groups of actors, costs and created value at each steps of the value chains. This information could be used by the project to develop interventions that facilitate access to low cost techniques that can be used by large numbers of women and can serve the promotion of production, processing and marketing of flours made of the promoted crops (cowpeas, soya, and groundnuts).

IR 2.1: Producer groups are strengthened Contract Local Capacities Builders (LCB): The two local implementing partners (FAAMUYASO and YIRIWASIRA) strengthening producer groups and contracted in June 2014 have been evaluated in December. Their contracts were renewed for one year in Y2Q2.

Identify and organize livelihood producer groups: No additional producer group was formalized in Y2Q2. This activity was put on standby waiting for the adoption of OHADA (Organisation pour l’Harmonisation du Droit des Affaires en Afrique) text that will govern cooperatives. In Y2 Q1, LCBs identified 12 livelihood producer groups. Five (05) of them were organized and formalized.

Identify garden spaces: Sixteen (16) additional garden spaces were pre-identified in Y2Q2 for micro-irrigation bringing the number up to 29 pre-identified garden spaces cumulatively. The micro-irrigation expert validated fifteen (15) sites after a feasibility study. Each site measures approximately 0.5 hectare involving 10 women.

Conduct a feasibility study on the installation of a micro-irrigation system: Final report of feasibility study was validated in Y2Q2. The feasibility study shows the implementation of micro- irrigation is too expensive for project. In addition, USAID informed the project that agriculture water infrastructures including micro-irrigation and borehole are not allowable for this project funding.

Micro-Irrigation Feasibility Study Results Restitution to Sikasso Partners, February 27, 2015.

Install micro-irrigation equipment and fencing for gardens: To comply with USAID recommendation, the project will cease activities related to the installation of micro- irrigation system. To improve water access for gardens, the project team is mobilizing some communities to invest in infrastructure with the project will only support farmer groups by providing materials to fence gardening spaces. One contact was conducted to Cereal Value Chain project implemented by ACDI/VOCA to explore how the project can use some established gardening by the closed IICEM project. These options are under further assessment. In addition, the project team will identify and work with women’s group already practicing gardening provided that irrigation mechanisms are already available.

13 IR 2.2: Improved farm management techniques adopted

Train extension agents in FFMSy (CEF) Eight (08) extension agents (7males; 1 female) received three-day training for trainer session in FFMSy in Y2Q2.

Identify and orient animators (peer farmers) in FFMSy CEF One hundred twenty (120) new peer farmers (116 males; 4 females) were identified and received a four-day training session in FFMSy in March 2015. They will start supporting approximately 1,200 women from Y2Q3. During this reporting period, 746 women continued to receive technical peer supports from 80 peer farmers the project trained in Y1.

Anna Sidibé, Peer Farmer from Diekabougou (Sido, Bougouni) Training Participant’s Photo: Peer Farmers, Extension Agents, the Restituting to Large Group during FFMSy Training Project Agro-nutritionist during FFMSy Training (, Bougouni), March 12-15 2015. (Koumantou, Bougouni), March 12-15 2015.

Train extension agents on improved agriculture techniques Eight (08) extension agents (7males; 1 female) received five-day training for trainer session in improved agriculture techniques (integrated soil fertility management) in Y2Q2.

Post-harvest storage and conservation technique diffusion: During Y2Q1, six (06) agriculture extension agents (AEAs) and two (02) representatives of these two local partners were trained in post-harvest storage and conservation techniques during a 5-day session in collaboration with the Regional Directorate of Agriculture (DRA). These AEAs trained 80 peer farmers in post-harvest techniques who provided technical assistance to 746 female beneficiaries within 400 households.

Identify farmer field schools (FFS): FFS will be identified early in Y2Q3 and launched during the incoming agricultural season from July 2015.

IR 2.3: Smallholder access to agricultural inputs improved

This result depends on the contract SNV is negotiating with microfinance institution (MFI). Actually, women have limited access to agriculture inputs (seeds, hoes, bio-fertilizers, etc.). Having access to credits allows them to purchase agriculture inputs and grow nutrient-rich foods. SNV negotiated with Soro Yirisso during the first semester of Y2. This negotiation did not get through. SNV is negotiating with another MFI in place of Soro Yirisso.

While access to credits is very relevant to improve woman access to agricultural inputs, it looks like contracting with formal MFI is too expensive, time consuming. In addition, MFI are already present to many of the project area of intervention but too much oriented to cash crops ensuring quick and sure profit to them and cannot be accessible for the most vulnerable people like women who will grow new nutrient-rich foods such as soya that may not that profitable in the short-term. The project will look for alternate microfinance mechanism like auto- 14 generated savings and loans or village savings and loans association (VSLA) that is more adapted and accessible to the target population and their activities. Moreover, this will support cooking demonstration of the locally produced food that may require women buy cooking utensils and ingredients like oil. A pilot VSLA for women was successfully tested by the project in Siramana village.

IR 2.4: Linkages between producers, processors, and markets improved

Conduct market study on nutrient-rich flours and fortified complementary foods. This activity was delayed by the value chain analysis. As some nutrient-rich flours made of local products are available in Sikasso market, the project proposes not to pursue this activity.

Identify and contract Business Development Service Providers (BDS) This activity was delayed by the value chain analysis and the market study and the marketing research. As some nutrient-rich flours made of local products are available in Sikasso market, the project will not continue to implement this activity.

Liaise with National and Regional DN (to endorse select nutrient-rich flour or complementary foods) Projet USAID Nutrition et Hygiene will not continue with this activity as it is time consuming and duplicative. The project will actively promote the utilization of locally available flours and continue to promote diversified diets for children and women using locally available foods.

SO3: Improve the delivery of nutrition services to address acute malnutrition The Project is strengthening the health system not only to provide high quality CMAM service delivery to treat acute malnutrition cases but also systematically integrate nutritional counseling to accompanying caregivers of malnourished children admitted to CMAM program so that there are limited relapse.

In this way, CMAM project staff will build the capacity of management structure (DRS, health districts, and ASACO) as well as stakeholders so that there is no shortage of CMAM inputs; timely and accurate reporting system is in place, and data used to inform decision-making. Health care providers (CSRéf, CSCom and ASC) will be supported through SACCN to systematically provide accurate effective IYCF messages to accompanying caregivers.

IR 3.1: Management structure capacity to support CMAM is improved

Regional and district-level assessment and training on commodity management and pipeline These activities were not realized. An assessment will be conducted in Y2Q3. Scopes of work and training session plans for commodity supply chain management and management information system and data utilization trainings will be developed in Y2Q2. Training of 18 health agents at district level will be conducted by the end of Y2Q3.

CMAM project agent supported health district and CSCoM during monthly meeting of health districts where CMAM program progress is discussed. These meeting did not allow in-depth data analysis and utilization for decision making, especially in terms of CMAM input supply chain and program performance indicators. Data use capacity of health districts should be reinforced.

15 IR 3.2: Health workers have heightened capacity in the management of acute malnutrition Assess and document capacity of human resources by health facility: During this year of implementation, the project will work with additional 39 CSCoM bringing the total number of the supported 85 CSCom by the end of Y2. Twenty (20) new health facilities (CSCOM) were assessed in terms of human capacities to deliver CMAM services in Y2Q2.

Facilitate district-level monitoring of CSCOM and CMAM services: In Y2Q2, one (01) joint supervision session was conducted by health district and project staff in three (03) health district of Sikasso. Eleven (11) health agents (8 males; 3 females) at CSCOM were supervised in three (03) health areas. In total, fifty-nine (59) health agents at CSCOMs received joint supervision.

During the reporting period, one hundred one (101) joint supervision sessions were conducted by CSCOM and field agents within five (05) health districts. These sessions allowed providing technical supports to 340 health agents (144 males; 196 females). In addition, 126 Ministry of Health student/residence interns (97 males; 29 females) were supervised during these joint supervisions. In total, 536 CSCOM health agents (226 males; 310 females) received technical supervision through 195 joint supervision sessions conducted by health district and project staff in Y2.

Sixty-seven (67) joint supervision sessions were conducted by CSCOM and project field agents allowing technical assistance to 75 ASCs (9 males; 66 females) and 112 relais communautaires (95 males; 17 females). In total, 99 ASCs and 163 relais communautaires received joint supervision by CSCOM and project staff in Y2.

Mr. Amara Coulibaly, Health Assistant at N’Kourala Mr. Amara Coulibaly, Health Assistant at N’Kourala CSCOM CSCOM Conducting a Group Discussion with accompanying Testing the Appetite of a child diagnosed with severe acute caregivers of acutely malnourished children admitted to malnutrition (Sikasso), February 24, 2015 CMAM program (Sikasso), February 24, 2015.

USG indicator: 46 out of Y2 targeted 85 of health facilities with established capacity to manage acute malnutrition

Train ASCs volunteers on role-specific CMAM services: No new trainings were scheduled for Y2Q2. In total, two (02) 3-day training sessions were organized to train 179 ASC (36 males; 143 females) in CMAM and IYCF so that they can manage moderate acute malnutrition cases and actively promote IYCF practices (including exclusive breastfeeding) through counseling and negotiation with caregivers to promote recovery and prevent relapse.

USG indicators: - In total, 179 ASC (36 males; 143 females) people trained in child health and nutrition through USG supported

16 programs - In total, 143 women (ASCs) reached with education on exclusive breastfeeding

Train relais communautaires on role-specific CMAM services: No new training was scheduled for Y2Q2. In total, fifteen (15) 3-day training sessions were organized to train 444 relais communautaires (332 men; 112 women) were trained during three days on their role-specific CMAM service delivery in Y2.

Traditional Birth Attendant Conducting Recipe Demonstration at A Child Eating Enriched Porridge after Recipe Demonstration in Pimperna CSCOM (Sikasso), March 3, 2015 Pimperna (Sikasso), March 3, 2015

Active case finding/screening and referral exercise: Sixty-Nine (69) communities of 19 CSCOM reported to have conducted community-based nutritional screening in Y2Q2. 15,200 children aged of 6 – 59 months (7,291 boys; 7,909 girls) and 3,568 WRA were screened. The screening allowed for the identification of 1,009 (436 boys; 573 girls) suspected cases of moderate acute malnutrition and 436 children (195 boys; 241 girls) suspected cases of severe acute malnutrition. Seventy-six (76) moderate cases were detected among pregnant and lactating women (PLW). They were referred to ASCs and CSCOM for further assessment and treatment. There are two key challenges: i) low motivation of relais communautaires in some villages, particularly in area where the project does not have community anchor; ii) and shortage of inputs to treat these cases at the facility level.

Recovery rates were 72% and 83% for respectively severe and moderate acute malnutrition. The recovery rate is lower than those of Y2Q1 for the severe cases. The main reason was the shortage of both systematic and nutritional treatment at CSCOM. To address these challenges, the project is developing partnership with community actors in area where it does not have community presence to encourage relais communautaires. In full package area of intervention, the project encourages relais to be active through a performance plan of intervention and render them accountable to their communities through CCC. In addition, the project advocates for a better coordination under their leadership of DRS, health districts during periodic meetings. The project also approached UNICEF and WFP individually for the same purpose.

In total, 21,661 children aged of 6-59 months and 3,792 PLW were screened in Y2.

USG indicator: - In Y2Q2, 15,200 (7,291 boys; 909 girls) children under age of five were reached in USG supported area. - In total, 21,661 (10,390 boys; 11,271 girls1) children under age of five were reached in USG supported area

17 1 Estimates based on Y2Q2 ratio boys and girls for Y2Q1.

Coordination with ASDAP The Project collaborates and coordinates with the similar Nutrition and Hygiene USAID funded Project DAMU WASA implemented by ASDAP. For a better coordination of the complementarity between ASDAP and SC in Sikasso when implementing the two Projet USAID Nutrition et Hygiène, a draft of MoU was discussed at Sikasso level and submitted in December 2014 to ASDAP in Bamako for discussion and final approval. The MoU intends to define roles and responsibilities of each project in health area where they are both present. DAMU WASA is expected to support community based screening, referral and home visit follow-ups while the project implemented by SC is heightening capacity of facility health agents in management of malnutrition cases. ASDAP has yet to provide comments yet allowing both projects to finalize the MoU.

IR 3.3 Health workers have heightened capacity to counsel and negotiate with clients Selection of 20 Senior Advisors for Counseling and Change Negotiation After a buy-in meeting with the health district of Bougouni, local health authorities (medical chief officer, nutrition focal point, CSCOM technical directors) committed to reinforcing counseling and behavior change negotiation to caregivers at relevant points of contact with caregivers. Twenty SACCN candidates were selected in Y2Q2. A joint team is in place to select and orient 10 SACCN among the forty proposed candidates. The selection process will be conducted in Sikasso health district in Y2Q3 as well.

18 Success Story

With support from her family, Oumou Coulibaly a woman in the Projet USAID Nutrition et Hygiene intervention zone gave nothing but breast milk to her son Baba during his first six months of his life, a practice called exclusive breastfeeding (EBF) and he is healthy and growing well.

One of the main causes of malnutrition in Sikasso is poor infant and young child feeding (IYCF) and caring practices. For instance, only 35% of children under 6 months of age are exclusively breastfed (baseline survey, 2014). The project works to improve community perceptions of EBF and positions others in the community (husbands, mothers-in-laws) to help women address barriers to EBF.

After receiving information from the community mobilization process supported by the Projet USAID Nutrition and Hygiène, relayed by community leaders, Mr. Sangaré, Oumou Coulibaly, his co-wife Fatoumata Dao, and his mother Bintou Konate (Ma) were persuaded to exclusive breastfeed Baba, their second child unlike Adama, their first child was. They discussed together the best ways to support Oumou Coulibalyas a family. Ma has never tried to provide decoction to Baba. Fatoumata took on some of Oumou’s chores which allowed Oumou more time for breastfeeding. Mr. Sangare encouraged Oumou to breastfeed on demand. Oumou felt that she produced sufficient amounts of breastmilk because she breastfed Baba for longer periods of time and breastfed him on demand day and night.

The family is very happy because they have observed the difference between their two children with regards to their healthy growth and development. Oumou remarked that “My baby grows his teeth and nobody noticed because he did not have any problem during this critical period as Ba did.” Other women in Kodialanida envy Baba due to his health and nutrition status.

Oumou Colibaly, 28years-old, Holding her Son Baba (four months- Oumou Coulibaly Breastfeeding Baba, in Kodialanida, old), in Kodialanida, (Pimperna, Sikasso), December 2014. (Pimperna, Sikasso)

Success story prepared by Fatoumata Samaké, SBC Assistant, Projet USAID Nutrition et Hygiène, in Pimperna. E-mail: [email protected]. Telephone numbers: +223 66 81 51 86 or +223 74 04 95 36

19 Challenges and Constraints

Challenges and constraints Actions

The SBC strategy development is a complex The process was initiated in Sept-October 2014 through endeavor. distance and in-country support from SC/US Nutrition Advisor. The project anticipates hiring a short-term SBC Advisor to finalize the strategy and operationalize the strategy. While the project intends to utilize sanitation Four staff from the project visited Mopti to have a or pro-poor WASH marketing to ensure learning exchange visit with USAID WASH Plus project households have access to sanplats and other implemented by CARE International in November 2015. materials and products, there is not enough This exchange visit provided staff with an opportunity to experience in this domain in the Sikasso region learn more about the CLTS approach and CARE’s or nationally, although some sporadic experiences. However, technical assistance is still initiatives are implemented by some NGOs. needed for pro-poor WASH marketing. The project has requested STTA from SC/US to support the project team in WASH marketing and is liaising with the SSGI project which has a similar approach. Some delays were noticed in agriculture The consortium works together to address these component. They can be explained by challenges and is modifying project activity plans to administrative issues within implementing account for these delays. partner and working environment in the sector (availability of qualified partners/services providers such as expertise in value chain analysis, micro-irrigation for gardening, microfinance institution). The success of CMAM program is very much The project will bring stakeholders (DRS, health districts, dependent on the availability of inputs UNICEF and WFP) together more frequently to identify (pharmaceuticals and RUTF). There are means of establishing a more coordinated and stable recurrent shortage and erratic supplies of RUTF supply mechanism. It will continue to advocate to this in in the region with the problem being rooted in the coming months. poor commodity management and low levels of accountability. Regional authorities are not in the habit of The project encourages DRS to convene regular coordinating interventions implemented by meetings of partners to discuss and address partners within their circumscription areas at programmatic issues in nutrition interventions, scale. They typically liaise with partners one on particularly in CMAM program. one, on a case by case basis. This affects not The project approached key partners including UNICEF only the program coordination as a whole but and WFP to initiate and join discussions on partnership also the use of unique standard for all partners and coordination. for the same types of activities. In WASH sector, SC project meet together and harmonize as much as possible terms of collaboration with the DRACPN. Regardless, in the Bougouni intervention zone, some actors do not have a similar approach to development interventions.

20 Lessons Learned

Developing a SBC strategy is a complex and time consuming endeavor that requires full-time support. The project is using Mo counseling cards to promote priority behaviors included in the strategy but will also hire or contract a SBC Advisor to finalize the SBC strategy and operationalize it through project activities.

The community mobilization approach is time-intensive but a very effective approach to mobilize communities, encourage ownership and accountability, and prompt communities to mobilize resources to implement their own action plans through CCC. To better fulfill their roles and responsibilities, CCC members need technical supports in terms of organizational development and role specific capabilities. The project will reinforce community and individual empowerment.

Frontline community workers (ASCs and relais communautaires) report low motivation, especially in communities where the project does not have community anchor. The project will raise the issues with CCC, ASACO and local health authorities to improve motivation of community workers, particularly relais communautaires. In addition, it will reinforce partnership with other community actors (ASDAP and others). Close supervisions post training will be proposed as effective ways to motivate frontline workers. ,

Partners should harmonize as much as possible their approach and terms of partnership when supporting local government, communities, and their representatives (administrative and logistics supports, etc.). The latter prioritize partners that meet their personal interests. The project started to build coalition SC- implemented WASH projects to harmonize partnership to DRACPN. The Project will build a coalition with other partners to support the regional and district programs of the government. This coalition will define and advocate for more or less harmonized ways of working with the local authorities.

Gender Integration Achievements The project staff promotes woman participation at all levels of decision making and acting. Women are represented in almost all decision making processes (CCC, WASH committees, mother leaders, etc.). It was challenging to have women in agriculture sector. However, the project team made a particular effort to have women. Currently, there are one woman among the eight extension agents, and 4 out of 200 peer farmers.

Field Monitoring and supervision visits Have any program monitoring visits/supervisions been made during the fourth quarter?

No/Not Applicable Please Yes If yes, list below: Officers regularly do field monitoring and supervision alone or with local authority’s representatives.

Publications/Reports Did your organization support the production of publications, reports, guidelines or assessments during the fourth quarter?

No/Not Applicable Yes If yes, please list below:

21 Technical Assistance and Visitors Did your organization utilize short-term TA during the fourth quarter?

No/Not Applicable Yes If yes, please list below:

Name Arrival Departure Organization Type of TA provided Adriane Seibert, 24.01.15 30.01.15 Save the Provided technical assistance during SBC Nutrition Children US strategy development workshop. Advisor Ana Caceres 15.03.14 21.03.15 Save the Provided technical assistance during budget Silva, Awards Children US realignment exercises. Manager

Travel and Visits Did your organization support international travel during the fourth quarter?

No/Not Applicable Yes

Major Activities Planned for Year 2, Quarter 3 (Y2Q3)

Cross-cutting activities:

- Formative research finding dissemination; - Finalize the first version of the SBC strategy; - Develop SBCC materials; - Develop facilitation curricula; - Organize and orient community coordination committees (CCC); - Facilitate development of community action plans; - Mentor implementation of community action plans;

SO1: To increase the adoption of optimal behaviors to support nutrition, health, sanitation and hygiene

IR1.1 Households and caregivers have adopted recommended behaviors to support health and nutrition - Facilitate the organization of action groups for nutrition; - Flipchart production and multiplication; - Training of SBC agents on facilitation curricula; - Orient/train action groups for nutrition; - Train mother leader animators on lessons; - Monitor action groups for nutrition.

IR1.2 Households and communities undertake actions to support optimal hygiene and sanitation - Trigger communities in CLTS (15 remaining villages); - Post-trigger monitoring; - Joint evaluation for ODF certification;

22 - WASH committee members sensitize households on WASH; - Identify private sector collaborators;

SO2: To increase production and accessibility of nutrient-rich foods

IR 2.1: Producer groups are strengthened

- Assist with the organization and training of producer groups - Supporting woman groups practicing gardening; - Mobilize villages to rehabilitate/existing water sources for gardening;

IR 2.2: Improved farm management techniques adopted - Conduct FFS activities; - Equip field schools with necessary materials;

IR 2.3: Smallholder access to agricultural inputs improved - Support women producers to have access to agriculture inputs - Support the development of local alternative to access to micro-credits to some producers

IR 2.4: Linkages between producers, processors, and markets improved

SO 3: To improve the delivery of nutrition services to address acute malnutrition

IR 3.1: Management structure capacity to support CMAM is improved - Training of management structure in commodity and information management and decision making; - Monthly meeting at regional and District level to analyze reported data and make decisions; - Facilitate district-level monitoring of CSCOM and CMAM;

IR 3.2: Health workers have heightened capacity in the management of acute malnutrition - Train health facility staff on select CMAM actions; - Train ASC/ Relais communautaires volunteers on role-specific CMAM services - Provide regular technical supports to health agents, ASC and Relais communautaires. - Facilitate CSCOM-level monitoring of ASC and Relais communautaires; - Support CSCOM and CCC to organize active community-based screening and referrals - Mass-screening and referral exercise in collaboration with MCSP.

IR 3.3 Health workers have heightened capacity to counsel and negotiate with clients - Select 20 SACCN; - Conduct orientation meeting for 20 SACCN; - Conduct counseling training for SACCN; - Facilitate SACCN monitoring visits.

Future Events Planned during the First Quarter of FY2

- Comité régional d'orientation, de coordination et d'évaluation des programmes socio-sanitaires (CROCEPS) workshop will be organized in Sikasso (April 2015). The project will be represented during the workshop. - A mass screening exercise will be jointly organized by the MoH and supported by different project implemented by Save the Children (USAID MCSP, Projet USAID Nutrition and Hygiene).

23 Indicator Reporting Table

Target Achievement Comment (please explain why you are above or below target by 10%

MATERNAL AND CHILD HEALTH 1 Number of households with 1,302 1,878 During Y2Q2, 1,878 out of observed 3,876 soap and water at a hand households in 57 CLTS triggered villages washing station used by (communes de , Kapala, Kaboila, family members in USG Finkolo AC, N’Kourala, , supported programs et Tiemala-Banimonotie) had soap and water at a hand washing station. NB: Data were collected during monthly monitoring. The project did not cumulate the number with the Y2Q1 figures to avoid double counting.

2 Number of women reached ND 7,431 Field agents systematically provide with education on exclusive information about exclusive breastfeeding breastfeeding during each meeting with community groups: Contact Total reach Community Mobilization 2,239 Community Coordination Committee 673 Mother Leaders Animatrices 1,181 Mother-in-laws 1,436 Women of Reproductive Age 1,647 Agent de Santé Communautaire 143 Relais Communautaires 112 Total 7,431

3 Number of individuals ND 1,348 Trainings were provided during i) CLTS trained to implement triggering stage to triggering agents, ii) and improved sanitation methods WASH committee orientation to their members Trained individuals Males Females Totals Triggering agents 428 410 838 WASH committee members 359 151 510 Total 787 561 1,348 Number of Men ND 787 Number of Women ND 561 NUTRITION 4 Number of people trained in 825 1,133 During Y2, the project trained 1,133 people : child health and nutrition 179 ASC (36 males; 143females), through USG supported programs

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444 relais communautaires (332 males; 112females), ont été formés Durant cette période. 510 peoples (359 males; 151 females) CLTS. The difference was due to i) 92/105 villages were triggered and 179 ASC unplanned for Y2Q1trained. Number of Men ND 727 Number of Women ND 406

5 Number of health facilities 66 46 The 20 health facilities scheduled for Y2Q1- with established capacity to Q2 were not supported yet. The 46 were manage acute under supported from Y1. A total of 39 additional nutrition CSCOM is planned for the whole Y2. Numerator 66 46 Denominator 85 85

6 Number of children under ND 21,661 21,661 children were planned to be reached five reached by USG- Y2 and they will be phased on quarterly supported nutrition programs basis

Number of boys ND 10,390 Ratio boys/girls from Y2Q2 achievement Number of Girls ND 11,271 were used to disaggregate by sex for Y2Q1. Sex was not distinguished by some relais communautaires.

WASH 7 Number of communities 0 0 92 out of 105 communities were triggered certified as “open defecation during Y2 up to March 31st, 2015. free” (ODF) as a result of USG Certification are expected to start from May assistance 2015

8 Number of people gaining ND 16 710 16,710 people out of 24,969 inhabitants are access to an improved gaining access to an improved drinking drinking water source water source within the 4,633 observed households. NB: Data were collected during monthly monitoring. The project did not cumulate the number with the Y2Q1 figures to avoid double counting. Number of Men ND 8,103 8,103 out of 11, 983 males inhabitants within the 4,633 observed households. Number of Women ND 8,607 8,607out of 12, 986 males inhabitants within the4,633 observed households.

9 Number of people gaining ND 11,134 11,134 people out of 24,969 inhabitants access to an improved within the 4,633 observed households. NB: sanitation facility Data were collected during monthly monitoring. The project did not cumulate the number with the Y2Q1 figures to avoid double counting. Number of Men ND 5,425 5,425 out of 11,983 male inhabitants within the 4,633 observed households.

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Number of Women ND 5,709 5,709 out of 12,986 female inhabitants within the 4,633 observed households.

Environmental compliance The project took all measures to monitor its environmental compliance during the reporting period and can attest that project staff, partners, and beneficiaries were compliant. The project team promoted environment-friendly agricultural techniques to women farmers. All accompanied woman farmers used organic manure and compost as fertilizers when growing cowpeas, groundnuts and soya. They did not use chemicals nor genetically modified organisms. For conservation techniques, the project promoted the use of ash or bio-conservator like Neem (Azadirachta indica).

Conclusions The project has set in place all of the critical components for successful delivery at project and community-levels and will intensify implementation through a defined SBC strategy over the coming year. It must accelerate SO2 implementation.

Annexes Q2 Report on Progress (Excel file) EMMP (Excel file)

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