GCP/ZAM/059/BEL

Luapula Food Security, Nutrition Action and Communication Programme (LFSNAC)

Proceedings of the Evaluation Workshop

on

Trials on Improved Practices (TIPs)

For Improved Rainy Season

Infant and Child Feeding

23-25 March 2004

Samfya, Zambia

Prepared by

Charity Dirorimwe

Nutrition Education Consultant

Nutrition Programmes Service

Food and Nutrition Division

FAO, Rome

Contents

Page

I. Introduction 1

II. Objectives of Undertaking TIPs1

III. TIPs Evaluation Workshop1

IV. Workshop Proceedings3

V. Way Forward7

VI. Conclusion and Recommendations13

Annexes

Annex 1: List of Evaluation Workshop Participants15

Annex 2: Evaluation Workshop Programme16

Annex 3: Detailed District Presentations18

Annex 4: Modified Recipes27

Annex 5: Season-specific Dishes and Actionsto Recommend35

Annex 6: Proposed Workplan and Budget36

I. BACKGROUND

In September to November 2002, trials of improved practices (TIPs) were initiated in seven communities (two communities per district in Kawambwa and Mwense, and three communities in Nchlenge) These trials focused specifically on feeding small children aged 6-34 months, the age during which levels of malnutrition are highest. A second round of well-monitored child-feeding trials were conducted during the rainy season, a period when the community food reserves are at their lowest and agricultural labour demands are highest. For unforeseen reasons, the rainy season trials were initiated in late February-beginning of March instead of the planned January-February period, the peak of the lean season. The household food situation is not so critical during the late February-March period but is far from perfect. Hence trials were carried out using, among others, fish, fresh beans, groundnuts and fresh maize which are readily available at this time of the year.

II. OBJECTIVES OF UNDERTAKING TIPS

The objectives of undertaking the field trails were to:

  • Determine the practicability of some of the child feeding recommendations often disseminated;
  • Develop alternative nutritionally sound and season-specific child-feeding recommendations and recipes based on locally available foods;
  • Facilitate trial of the feeding recommendations by selected households with children aged 6-36 months;
  • Assess the acceptability of the different child-feeding options by households participating in the trails;
  • On the basis of comments from households participating in the trials, revise the feeding recommendations accordingly and come up with nutritionally sound recipes that mothers find feasible and acceptable; and
  • Recommend complementary actions for households that are unable to improve child-feeding practices without additional support.

The outcome of the dry and the rainy season trials will provide a basis for formulating season-specific recommendations for feeding small children.

III. TIPs Evaluation Workshop

3.1Workshop Objectives

From 23-25 March 2004, teams of district-level TIPs facilitators and monitors of the field trails participated in the TIPs evaluation workshop, organised in Samfya to:

  • Present and share lessons learnt during both the dry season and rainy season trials;
  • Come up with a set of season-specific child-feeding recommendations to be promoted at appropriate moments during the course of the year, depending on household food availability;
  • Discuss and recommend ways and means of promoting the improved child-feeding practices in the communities of the project districts;
  • On the basis of the lessons learnt during the field trials, discuss and recommend options for enhancing household food security during vulnerable periods, (i.e. those times when households are unable to practice the improved feeding options because of poor access to certain foods that are critical for dietary improvement), and develop an appropriate workplan for foe such food security enhancement initiatives;
  • Develop strategies for disseminating the season-specific child feeding recommendations and prepare a detailed workplan and budget for implementing these strategies; and
  • Develop procedures, workplan and budget for initiating TIPs for other nutritionally vulnerable household members, including the chronically ill.

3.2Workshop Participants

Workshop participants were drawn from Ministries of Health, Agriculture and Community Development Department, i.e.:

  • Health: District MCH co-ordinator or nutritionist;
  • Agriculture: Women and Youth Officer – WYPO or Agriculture Assistant; and
  • Community Development: Community Development Officer or Assistant.

A total of 12 participants were expected to attend, however, the MCH Co-ordinator, Kawambwa District, failed to attend, and there was no replacement from the health sector. A list of the workshop participants is provided in Annex 1.

3.3Workshop Methodology

Workshop methodologies included presentations of results of the trials, followed by plenary discussions to further refine the child-feeding options and working group sessions to elaborate the way forward.

3.4Expected Outputs

The expected outputs included:

  • A set of season-specific recommendations for improved child-feeding;
  • Recommendations on how to disseminate the improved child-feeding options;
  • Workplan and resources needed to implement the proposed actions;
  • Actions to bridge the gap in year-round availability of protein/vitamin and mineral-rich foods, such as fish, meat, poultry and eggs, vegetables and fruits;
  • identification of key players and resources to facilitate this process; and
  • Procedures and workplan for implementing TIPs for other nutritionally vulnerable member, including the chronically ill.

3.5Workshop Programme

Day 1 of the workshop programme aimed to:

  • Share experiences;
  • Refine recipes; and
  • Come up with season-specific child feeding recommendations.

Day 2 focused on:

  • Strategies for disseminating the season-specific child feeding recommendations;
  • Strategies of how to close the food access gap for those foods that are critical for households to prepare balanced meals, particularly for the small child; and
  • Procedures for TIPs for pregnant and lactating women and the chronically ill.

Day 3 was devoted to:

  • Synchronizing Day 1 and Day 2 outputs and sharing the participant's views on the way forward with project staff, i.e. the NTTOs for food security and institutions and participation as well as the project coordinator; and
  • Synchronizing the workplan proposed by the participants with planned food security and institutional capacity building activities in the current project workplan.

The Workshop Programme is provided in Annex 2.

IV.Summary of Workshop Proceedings

4.1Welcoming Remarks and Official Opening

In his welcoming remarks, Mr Kauseni, National Technical Training Officer-Nutrition Education and Communication (NTTO-NEC) welcomed the participants and thanked them for their dedication in facilitating rainy season TIPs, a task that was made difficult by the disruptive nature of the rains. He highlighted the persistently high levels of malnutrition in the province despite numerous efforts by government in collaboration with development partners. The levels of malnutrition were still unacceptably high and Luapula ranks bottom compared to other provinces. He urged the workshop to come up with plans to effectively reduce levels of malnutrition in the project districts.

The District Commissioner of Samfya officially opened the workshop. In his welcome address, he underlined the importance that government places on improving household food security and the nutritional wellbeing of the population. He expressed his gratitude towards the support that FAO is providing towards the reduction of hunger and poverty in the province and expressed his sincere hope that Samfya be considered as one of the project districts in the future. He thanked the workshop organizers for choosing Samfya as the workshop venue and wished the participants success in their deliberations.

4.2Participants’ Expectations

Participants were given VIPP cards on which to write down their expectations and these included:

  1. Sharing experiences on the outcome of the rainy season TIPs with other districts;
  2. Comparing field experiences in participating communities of different districts and discuss the way forward;
  3. Coming up with realistic recommendations based on the TIPs results;
  4. Resolving issues that may affect implementation of TIPs;
  5. How best to expand TIPs in the districts; and
  6. Learning more about the nutritional status in LuapulaProvince today.

4.3Group Norms

The participants came up with a set of group norms and these included:

  • Observance of time
  • Full participation in order to achieve goals
  • Controlled movements
  • Respecting other peoples’ opinions
  • Being brief and to the point
  • Speaking through the chair
  • No smoking
  • Being flexible
  • Accepting constructive criticisms
  • Being sober minded
  • Facilitators to observe time
  • Time keeper to be appointed

4.4Background to TIPs and the TIPs Evaluation Workshop

The presentation focused on the communities covered, lessons learnt and recommendations made during the 2002 dry season TIPs, i.e.: 7 communities, namely:

  • Mwense {Mumporokoso (CNPs[1]) and Nkomba (CNPs)}
  • Kawambwa {Chipepa (CNPs) and Koni (CNPs)}
  • Nchelenge {Kapambwe (CNPs), Nsemiwe (CNPs) and Seketeni (BFG[2])} were covered.

Lessons Learnt were summarised as follows:

  • Inclusion of vegetables was acceptable;
  • Inclusion of legumes was acceptable but most legumes finish in October/November and are not harvested until end of March-April.
  • Fish available during the rains but inclusion of fish in porridge was not acceptable

It was therefore recommended to defer the printing of recipe books but conduct rainy season TIPs with a view to explore acceptable ways of using fish in child feeding. Thereafter the recipe book that provides season-specific options can be printed.

Although the critical lean period was missed during the rainy season TIPS, undertaken in February-March 2004, the trials facilitated development of recipes that can be promoted during the pre-harvest period when foods such as, pumpkins/gourds; fresh groundnuts/beans; fresh maize; fresh and dry fish; avocado pears, etc.

4.5Summary of District Experiences

Details of the district presentations are presented in Annex 3. The presentations covered:

  • The organization of work;
  • A summary of the household assessments;
  • Recipes tried out and the reaction of mothers/caregivers;
  • Constraints encountered and how they were resolved; and
  • The way forward.

Nutrition-related problems identified during household assessments included:

  • Low daily meal frequency particularly during the late dry season and early rainy season;
  • Giving untreated water to new born babies especially in Chienge and introduction of water to the child within the first 2-3 weeks of life in the other districts
  • Poor quality of complementary feeds; and
  • Problems associated with feeding sick children.

Recipes that were promoted during the field trials by all the districts included porridges made from:

  • Cassava/maize flour + big fish + shredded vegetables + red palm oil
  • Cassava/maize flour + chisense (small fish) flour + shredded veg. + palm oil
  • Maize/rice flour + raw pounded g/nuts + shredded vegetables
  • Rice flour + roasted groundnuts + red palm oil + shredded vegetables
  • Rice flour + bean/bambara nuts flour + shredded vegetables + red palm oil

Additionally, some districts promoted weaning foods made from:

  • Sweet potato flour + roasted g/nuts
  • Rice and avocado mash
  • Pumpkin + avocado mash
  • Sweet potato-avocado mash
  • Fish soup with vegetables and soft nshima
  • Okra + groundnut relish
  • Imyungu (gourd) and avocado mash

In Nchelenge District, caregivers expressed concern over the time consuming nature of processing beans. An alternative option suggested by the nutrition consultant was to pound or grind the dried beans into flour and cook the cassava/maize and bean flour porridge for at least 30 minutes.

A food preparation demonstration of nutritionally sound dishes developed by some of the district teams was conducted during the workshop and this included:

  • Sweet potatoes and groundnuts with vegetables mash;
  • Fresh maize + fresh groundnuts + vegetables porridge;
  • Cassava flour + fresh groundnuts + vegetables porridge
  • Vegetables and chisense relish (to be eaten with soft nshima

Participants liked the taste of these dishes and the modified/new recipes and alternative processing methods are part of the recipes presented in Annex 4.

4.6Season-specific Recommendations

During plenary discussions, participants discussed the type of dishes and actions to recommend during the course of the year and the outcomes of these discussions are presented in Annex 5.

4.7Day 2 – Workshop Discussions

Day 2 was predominantly devoted to working group sessions. Three working group sessions were conducted on the following issues:

  • Disseminating child-feeding recommendations within communities that participated in TIPs. Participants were divided into 3 mixed groups to discuss:
  • How population coverage can be increased in terms of disseminating child feeding recommendations within the communities that participated in TIPs;
  • Activities to be undertaken;
  • Who will be responsible for what?
  • Timeframe during which the proposed expansion activities will take place;
  • Resources required and source; and
  • Risks/Key Issues.

Thereafter, participants formed working groups by district and discussed the expansion and dissemination of child-feeding recommendations to other areas and communities and the discussion focused on:

  • The activities to be undertaken;
  • Time frame for implementing the proposed activities;
  • Lead implementer and support agencies for the proposed activities;
  • Resources required and source;
  • Means of detecting behaviour change in communities trying out the improved child-feeding practices, i.e. extent of adoption of improved feeding practices; and
  • Risks and ways of minimizing the risks.

Furthermore, the participants discussed issues of:

  • Closing gaps in year-round availability of foods essential for preparing the improved child feeding recipes and the discussions focused on:
  • How to ensure year-round accessibility of protein-rich foods and vegetables by communities and vulnerable households in particular;
  • Activities to be undertaken;
  • Time frame for implementing the proposed activities;
  • Lead implementer and support agencies for the proposed activities
  • Resources required and source; and
  • Risks and ways of minimizing the risks.

Last but not least, a smaller group of participants from the health sector together with the workshop facilitators reviewed procedures for undertaking TIPs of feeding and caring of pregnant and lactating mothers and the chronically ill including people living with HIV/AIDS.

4.8Day 3 – Workshop Discussions

Part of Day 3 was devoted to reporting back to plenary the outcomes of the previous day’s working group session followed by discussions with the project staff. The National Project Coordinator, NTTO-Food Security and NTTO-Institutions/Participation participated in the last session of the workshop (morning of Day 3) to explore improved coordination and synchronization of the full range of project activities, particularly better integration between the nutrition, food security and institutions/participation components as part of the 2004 workplan.

The outcomes of Day 2 and Day 3 working sessions are presented below under "Expansion".

V. WAY FORWARD

Expansion in the application of the TIPs approach and lessons learnt so far will take four different forms, namely:

  • Expanding the coverage of households (HHs) within the 8 communities where TIPs on feeding small children has already been initiated;
  • Strengthening the household food security enhancement component of activities promoted through the CBGMPCs by strengthening collaboration at community level between the community nutrition promoters (CNPs) and the nearest camp officer and using community nutrition promoters' households as models for improved household food security (HFS) and nutrition in the communities;
  • Expanding the integrated HFS and nutrition improvement approach to other communities and depending on the current state, this may entail:

establishment of additional CBGMPCs in communities where these do not exist; or

training CNPs and breastfeeding group promoters (BFGPs) in the TIPs methodology and how to apply this in the context of nutrition promotion during counselling; and

  • Broadening the scope of TIPs to the development of improved feeding and caring practices of pregnant and lactating women and the chronically ill, including people living with HIV/AIDS (PLWHA) and integrate these into, among others, activities promoted through CBGMPCs.

5.1Existing Rural Health Facilities and CBGMP Centres by Project District

5.1.1Chienge and Nchelenge Districts

Chienge and Nchelenge Districts have very few CBGMPCs and all the trained CNPs were trained by FAO. Details of the health facilities, CBGMPCs, breastfeeding promotion groups and growth monitoring outreach posts are provided below.

Chienge District:

  • Communities (4) with trained CBGMP promoters are:
  • Puta CNPs
  • Kamansasa CNPs
  • Maoma CNPs- currently doing TIPs
  • Chilanga - currently doing TIPs

These centres are undertaking CBGM and nutrition promotional activities.

Active breastfeeding groups (4) are:

  • Mukunta
  • L/chomba
  • Chipungu
  • Kabole

They predominantly focus on breast feeding promotion.

Existing growth monitoring posts (i.e. outreach) are:

  • Puta H/centre (4 posts): Kalembwe, Abinala, Kamansasa, Kambwe
  • Chipungu RHC (5 posts): Lupiya, Funtu, Kazembe, Swali & Maoma
  • L/Chomba (3 pots): L/Chkwama, Kabendwe & Mkwela
  • Mukunta RHC (3 post): Kasote, Kalobwa & Makondo
  • Kabole RHC (4 posts): Kufulwe, Kabwe, Kapako, and Chikumbi
  • Sabula RHC (2 posts): Chlanga matako & Mipa East

They undertake growth monitoring in collaboration with the RHC staff responsible for the outreach programmes but are not trained in counseling.

RHC (2) Under Construction and Scheduled to Open in August 2004 are:

  • Kalembwe RHC; and
  • Mwabu RHC.

Nchelenge District

Communities with Community-Based Promoters Trained in CBGMP or Breast Feeding Promotion

Nchelenge has a total of 10 health facilities. Only 4 communities are served by trained CNPs:

  • Kabota,
  • Kashikishi,
  • Kambwali; and
  • Chibilikila.

However, all the 10 health facilities have trained breastfeeding promotion groups.

Two communities, namely, Kambwali and Chabilikila have CNPs trained in the TIPs methodology and these communities participated in the dry and wet season trials of improved infant feeding. However, only one breastfeeding group at Kambwali participated in the dry season TIPs but not in the rainy season TIPs.