Author: Chitekwe, S.
The Child Supplementary Feeding Programme was implemented in Bulilimamangwe, Umzingwane and Insiza districts of Matebeleland South Province from October 1999 to June 2000. The aim of the project was to reduce malnutrition among the under fives through target feeding. UNICEF, in collaboration with three NGOs -- ORAP, Red Cross and World Vision -- implemented Child Supplementary feeding in Insiza, Umzingwane and Bulilimamangwe districts. Key activities carried out during the reporting period included identification of the most food insecure wards in the district, pre-implementation training of Health Workers and Extension staff, social mobilisation, registration of children with moderate malnutrition, food distribution, regular monitoring and evaluation.
Purpose / Objective
The aim of the evaluation is to carry out the process and impact evaluation for Child Supplementary Feeding Program.
The evaluation used information collected from interviews with 17 Health Workers at Rural Health Centres, 5 Focus Group Discussions with 29 mothers and the results from 998 monitoring forms.
Key Findings and Conclusions
A total of 13,705 children under the age of five years in Bulilimamangwe, Umzingwane and Insiza were registered in the programme. The coverage of the programme among children under the age of five years in the three districts was 18%, 14%, and 3.7% respectively. Bulilimamangwe district had the highest coverage because it was more severely affected by drought. The programme was momentarily stopped in February and March 2000 because the districts were inaccessible due to flooding. The problem of access was followed by a shortage of diesel in the country. The project then resumed in April and ended in May 2000.
The result from the Focus Group Discussion with mothers indicates that the programme benefited children in these districts. Mothers reported that their children's weight improved, as shown by the Road to Health Card. Children were also reported to have started playing with other children as a result of improved health. Interviews with Health Workers revealed that attendance to health facilities improved significantly, since these facilities were used as food holding points. The results of this improved attendance were catch-up of children on immunizations and, for mothers, provision of family planning services.
Some mothers who were in the discussion indicated that targeted feeding caused conflicts with neighbors who did not receive supplements for their children. A few mothers still preferred target feeding because it helped underweight children to catch up in growth. Mothers with more than one child under five years were forced to share the food. It was difficult to explain to small children why they were not receiving supplements; other children left out within the family would think that the mother was favouring the other child. It was mentioned that this could be avoided if all under fives were given supplementary food.
Some mothers indicated their interest in training on nutritional enhancement of complementary foods. Evidence shows that there is a wide-spread poor practice within communities of using complementary foods that are poor in nutritional quality. This often results in growth faltering and subsequent stunting during the second year of life.
A total of 17 health workers from three districts were interviewed on their perception of targeted child supplementary feeding using SWOT analysis. The realisation by caregivers of the increase in weight of their children was highlighted as the strength of targeted feeding. Another strength was the use of dry rations, which prevented the stigma associated with having to queue up for wet rations. It was noted that CSFP provided an opportunity for integration with the provision of other nutritional and health services to both mother and child. The practice of some households to relying exclusively on CSFP was noted as a threat to targeted feeding. The threat is that the child would miss out on receiving nourishment from household foods and thus experience limited improvement in nutrition status. A noted weakness of target feeding is that children who are not in the programme may deteriorate in nutrition status.
One of the challenges of this evaluation was the lack of quantitative data to measure the impact. It was expected, from the onset of the study, that the evaluation would be based on monthly records of child weights. Unfortunately, the quality of the monthly records did not meet the required standard for baseline information or use in an evaluation. The ideal situation would have been to carry out a rapid nutrition assessment and then carry out another assessment to measure impact.
There is need to carry out a baseline survey before implementing CSFP to enable measurement of nutrition impact. A summative evaluation should then be carried out to measure impact of the intervention. Exclusive reliance on regular monitoring data may cause problems, especially when the quality and consistence of the records are poor.
Mothers need training on how to locally enhance the nutritional value of complementary foods. This could be implemented as an activity for the ongoing Community nutrition care projects.
Use of Rural Health Centers as food holding points should be encouraged because it provides an opportunity for children and their mothers to also receive treatment. This has been shown to improve both the immunization coverage as well as the provision of family planning services to mothers.
UNICEF could ensure that such Health facilities have an adequate supply of vitamin A capsules for children and iron/folate tablets for pregnant women.
There is need for integrating the training of caregiver on Early Childhood Development as part of the emergency response. It is challenging though to convince most donors that training of caregiver on childcare practices can be an activity worth undertaking during emergency situations.
PDF files require Acrobat Reader.
ECD - Health
Red Cross, World Vision, ORAP