MALNUTRITION: Harvesting Momentum to Improve Nutrition in Zambia

Rakesh Katal of Concern tells how the program protects crops from natural disasters such as flooding and drought.


Zambia’s economy continues to show encouraging growth, which now stands at seven percent. And in the past year, Zambia’s agricultural sector produced a record food surplus, with a grain harvest of 2.8 million tons that literally overwhelmed storage capacity. This surplus was underpinned by subsidies for small-scale farmers, generous minimum price guarantees offered by the Zambia’s Food Reserve Agency and good rainfall in previous years. Nonetheless, the very poorest and most vulnerable families are still struggling to survive.
The terrain in remote areas of Zambia is rough; to reach communities you must cross rivers, wetlands and vast swathes of sandy territory. Concern is the only development organization working in some of these remote areas, such as districts in the Western Province.
These districts are characterized by poor infrastructure, few or no services, and high dependency on natural resources for livelihoods. The soil and forests are under tremendous pressure from very heavy use, as well as from droughts and flooding.
Reaching marginalized groups and implementing programs at the required scale to alleviate poverty is a challenge: our human and financial resources are stretched to capacity. But we have evidence of what works—and we know that adequate investment in interventions in nutrition, livelihoods, and agriculture would significantly reduce poverty and hunger.
Concern is showing farmers how to restore the soil and at the same time diversify their crops to provide better nutrition for their families and produce a surplus that they can sell in the marketplace. We work with communities to set up natural resource committees and natural resource “user groups,” whose initiatives—in conjunction with efforts by local state officials—include canal clearing to prevent flooding. We have also prioritized establishing disaster management committees in communities to protect against future damage from droughts and floods.
We face significant obstacles, but I see signs of progress and momentum every time I visit a farming village. I know that what we’re doing works when a farmer shows me how his harvest and income have improved, and when a person living with HIV is no longer isolated because she has access to support groups and a source of income to live a healthy and productive life. I have seen communities minimize their vulnerability to disasters, and begin to view themselves as participants in development, rather than as passive recipients.
As I prepare to attend the upcoming “1,000 Days to Scale Up Nutrition for Mothers & Children: Building Political Commitment” meeting in Washington, D.C., I am excited to join civil society leaders and government officials to rally greater investment to save lives. I welcome this opportunity to share experiences and ideas for supporting the SUN Roadmap.
I hope to act as a voice for people like Wamunyima Iluya, an extremely poor farmer in rural Senanga District. He shared his story of change with me, saying, “Before, we were farming according to tradition, but we have learned ways to improve harvests and make farming a more profitable business.”
Beyond the June 13th meeting, my team and I will continue to work at national level in Zambia, collaborating with Government agencies such as the Ministry of Agriculture and Cooperatives, the Ministry of Health, and the National Food and Nutrition Commission (NFNC). For instance, the NFNC is developing Zambia’s new Food and Nutrition Strategic Plan, a policy dialogue in which Concern actively participates.
These are exciting and encouraging times in Zambia in terms of nutrition. Under the Sixth National Development Plan, the Zambian Government aims to “improve the nutritional status of the Zambian population through the provision of quality nutrition services and increased availability, access and utilization of quality and safe foods.” Concern is committed to playing its part in making this aspiration become a reality.
In collaboration with local partners, the Government, and the International Food Policy Research Institute (IFPRI), Concern has launched the “Realigning Agriculture to Improve Nutrition (RAIN)” project, which targets women farmers and will help improve their nutritional status, as well as that of their families. The project is directly linked to the interventions outlined in the SUN Roadmap: working to prevent undernutrition and stunting by focusing on the critical 1,000 days from pregnancy to age two. We will share learning and evidence from this project on how best to link agriculture and nutrition with the international community.
My hope is that Concern’s programs contribute to efforts that make the growing international commitment to scale up nutrition a reality.
http://povertynewsblog.blogspot.com/search/label/Zambia

POVERTY: Analysis: Doubts over role of cash transfers in women's empowerment

6 May 2011 (IRIN) - Doubts are emerging over whether cash transfers, designed to strengthen local markets, also empower women and change gender roles in emergencies.
"Gender relations are quite complex and you cannot assume US$50 is going to change that," Sarah Bailey, research officer at the Humanitarian Policy Group, told IRIN. "You cannot assume targeting women necessarily leads to their empowerment or promotes gender equality."
According to a joint report by Oxfam Great Britain and Concern Worldwide on cash transfers and gender dynamics released on 6 May, most cash transfer programmes target women in the belief that communities will benefit and that men are irresponsible with money.
Cash-in-hand instead of goods-in-kind aid in an emergency became popular after the Indian Ocean tsunami in 2004.
While at first sceptical, donors and organizations now widely accept cash is a viable mechanism for relief if markets are intact and there is capacity to distribute money.
But while cash transfer policies tend to be gender-focused, such ideals remain largely unimplemented or lack a clear way to measure results, said Nupur Kukrety, social protection and food security adviser at Oxfam GB and also a member of the steering committee of the Cash Learning Partnership.

"Having policy is one thing; getting it implemented is another," she said.
Gabrielle Smith, social protection and safety nets adviser for Concern Worldwide, said remaining realistic about one's goals for cash transfers in an emergency environment was key.
Bailey concurred: "The objective is to provide critical assistance when people need it most, saving lives and livelihoods in the aftermath of disaster."

Gender analysis
Experts agree cash transfers in emergencies should at least aim to do no harm to women, making context-specific gender analysis just as essential to cash transfers as ensuring markets are working and prices are reasonable.
"Giving women cash in emergencies is an important step forward, but I would see empowerment as a process that goes far beyond this to tackle the multiple deprivations that women experience. This takes time so emergencies may not provide the conditions for empowering women in this broader sense," said Maxine Molyneux, gender expert and director of the Institute for the Study of the Americas at the University of London.
Molyneux cited research that shows women are often the most vulnerable when disaster strikes.
Assessments should be made both before and after a disaster, because often gender relations shift in an emergency, said Puspasari Indra, East Asia regional technical coordinator of emergency food security and livelihood for Oxfam GB in Indonesia.
"Gender analysis should be done based on a triangulation," Indra said. "You can do this quickly after the disaster by talking to local organizations and then to local men and women. It does not have to be perfect; it can improve."
Indra explained that gender analysis informed Oxfam's relief efforts after the earthquake in Western Sumatra in 2009, revealing an important nuance: women had money in their name, but they did not decide how to spend it.

Demonizing men
The report found many NGO programmes in Zimbabwe and Kenya targeted women, but did not actively involve men - a policy that can alienate or disempower men or negate feelings of responsibility.
Amina Abdulla, programme manager at Concern in Kenya, said men shied away from requesting assistance when food prices spiked in 2009 because their cash transfers targeted women, assuming men would not spend it wisely. However, the 10 percent of men who did receive cash in hand spent the money quite responsibly, contradicting stereotypes, she said.
Though Molyneux believes women should be the recipients of cash transfers, she said policies that failed to address gender inequalities could deepen gender divisions.
"Men are usually completely marginalized from the activities of the cash transfer programmes, which sends the message that they have no responsibility for care in the family," Molyneux said. "I would recommend men are integrated into these programmes and encouraged to think of their role in the family in more positive ways."
Kukrety added: "Empowerment is not just about handing over a resource to a man or a woman, it is much more than that. You can marry humanitarian response with long-term development and then you can change gender roles."
http://www.irinnews.org/report.aspx?reportid=92655

MALNUTRITION: Haiti: New premises to fight against malnutrition

18/04/2011

Like many other buildings of the Hospital of the State University of Haiti (HUEH), that of the paediatric service of the hospital was not spared by the January 2010 earthquake and the Nutritional Stabilization Unit (USN), a unit of the Service, which handles the management of children with severe acute malnutrition, was found devoid of premises.



"UNICEF (United Nations Children's Fund) had to accommodate the USN under tents to ensure the continuity of services for malnourished children," explains Marie-Claude Desilets, Nutrition Specialist of UNICEF But the tents, exposed to the weather, began to be worn. That is why UNICEF has decided to award an amount of 58,000 dollars for the construction of a semi-permanent structure that will be attached to the pediatrics premises. The USN has treated 319 children suffering from severe malnutrition, which represents about 22% of cases handled in 2010 for the whole country. And according to information provided by Mr. Mbakwa, Health and Nutrition Coordinator for Concern Worldwide Haiti, "from January to March 2011, 56 malnourished children were treated at the USN". Children may remain from 7 to 10 days, sometimes up to 15 days in USN, said Marie-Claude Désilets.
The new building will be equipped with two rooms. The largest will host twenty cradles [double the current capacity] as well as beds for parents. The second, smaller, serve as a playground for children. Also, this new structure will be equipped with toilets. The construction of the new premises of the USN was launched Thursday, March 24, 2011 and and work should be completed within one month. This project is implemented by the NGO Concern Worldwide, which, thanks to funding provided by UNICEF, put also available to the USN, eight members of its nursing staff. The international NGO also provides training for all medical personnel. This latest initiative is part of capacity building of the Ministry of Public Health and Population (MSPP).
UNICEF is working with Concern Worldwide Haiti in support of malnourished children in several other hospitals of the capital such as the Hospital La Paix in Delmas 33, the Hospital Eléazar Germain in Pétion-Ville, the Hospital Saint Damien in Tabarre, the Hospital des Petits Frères et Sœurs, the Health Center of Martissant, the Health Center of Bizoton and that of Delmas 75. ccording to Marie-Claude Désilets, UNICEF is currently studying the possibility of providing support to the MSPP for the establishment of Nutritional Stabilization Units in 10 departments.
http://www.haitilibre.com/en/news-2763-haiti-health-new-premises-to-fight-against-malnutrition.html

POVERTY: Poorest in Pakistan Journey Toward Recovery

For the next installment in our series of posts from Concern Worldwide, we havethis look at recovery efforts in Pakistan. Press Officer Joop Koopman takes a look at the destruction the Pakistan floods caused and how a sanitation program from Concern helps to improve lives.


By Joop Koopman, Press Officer, Concern Worldwide US

We are getting into the thick of our mission to report on Concern Worldwide’s emergency response to the Pakistan’s devastating floods. Susan Finucane, Program Officer, and I have flown to Karachi, provincial capital of Sindh, and have made our way by car to Thatta, the ancient center of Muslim learning, and more rural parts of Thatta district, where Concern is working in close partnership with local organizations.
This is our first look at the destruction left in the water’s wake. Thousands of villages in Sindh have been damaged, and the UN Office for the Coordination of Humanitarian Affairs (OCHA) estimates there are still up to 1 million homeless. Surveying the landscape, the statistics make sense. Highly vulnerable mud houses, characteristic of the extremely poor province, were literally washed away in heavy flooding. Meanwhile, stagnant water in large areas of the province increases the chance of waterborne diseases, a risk factor that will get worse once warmer temperatures return in the spring.
It is jarring to see sudden ‘lakes’ appear in the arid landscape, with half submerged telephone poles making it evident that these are still flooded areas. Roadside shrines and other simple structures clearly bear high-water marks—up to five feet and more. Workers are building new brick ramparts everywhere, as hoped-for protection against future flooding. Tent camps dot the higher grounds.
Our first stop is in the village of Mongo Jakhro, a small community of just 30 households less than a mile and-a-half from the Indus River. Most of the families fled without being able to take along any of their possessions and they returned here only in late October, after spending two months or more at a spontaneous settlement outside of Thatta. Working with a local partner, Concern came to the village shortly after the families’ return to distribute tarpaulins along with bamboo and rope frames. These crude but carefully constructed shelters are their homes for now.
“It is not easy living this way,” said Zeenat Khaskaili, who is 36 and a mother of five. “We are grateful for this shelter, which is much better than having to sleep in the open,” she adds. Her semi-collapsed mud home stands just behind the two tents the family was allotted.
Life is decidedly rough, as most family members have to sleep on the bare floor, their few possessions scattered about. The children are dirty and have nothing to do. A local school was washed away in the floods. There are no latrines as yet. Water and hygiene programs are the next step after the provision of shelter in the emergency effort. “We need a reliable supply of drinking water, mattresses and bedding, as well as kitchen utensils,” says Zeenat, adding that “a latrine is a priority.” A WASH (Water & Sanitation and Hygiene) program will be next for the village.
WASH programs can make an enormous difference in the lives of communities. The village of Aboro Jakhro is a case in point. This medium-sized village is home to 198 households. At the height of the flooding the community was submerged in five feet of water and residents had been forced to spend 50 days in a spontaneous settlement in the nearby town of Makli. But with the villagers’ eventual return came a transformation.
“We have learned how important it is to cut our nails, to wash our hair and wash our hands in order to stay healthy. We are wearing slippers now!” These were the excited exclamations of a group of animated women and girls gathered for one of the village hygiene refresher sessions. Compared to the dirt-strewn and chaotic environment of the previous village, Aboro Jakhro greets visitors with a positively bright, organized and clean-swept appearance.
“Before we never really thought much about hygiene,” says Nooran Merbahar, a 32-year-old mother of five, but “today we wash our hands before and after eating and after we visit the latrine.” Hygienic discipline is paying dividends: “…our children’s diseases have gone away,” says Nooran.
Concern has constructed 44 latrines—plumbing-included, a rarity in rural Sindh—across the village grounds, their temporary frames covered by bright-blue canvas. There are also three brand new hand pumps at strategic locations, each serving a cluster of homes. The old pumps had been destroyed or proved incapable of drawing up water from deep enough to avoid the flood-polluted ground waters.
Here, too, villagers are eager for a return to normalcy and especially an end to living in tents, but Concern’s WASH program is an important first step forward. Accountability is key—each program site is punctuated at regular intervals by posters listing numbers that villagers can call with questions or complaints. Local WASH committees—one for women, one for men—are being trained to keep things going even after Concern has pulled out. The process marks a transformation of the community’s way of life prior to the floods.
Ghulam Mustafa heartily agrees. This 46 year-old father of six heads the men’s WASH committee in the spontaneous settlement of Ed Gah. The camp is the temporary home of 128 families; it is perched on a hill overlooking a river and the almost completely submerged remains of their village beside it: “Many of the diseases we were struggling with have largely disappeared,” he says with a smile that demonstrates a leader’s pride.
“We had to follow women’s lead in paying more attention to what happens in our home,” he says, stressing that the well-being of the young is a top priority. “The “children are our future,” he insists, echoing the message conveyed at hygiene sessions—and to protect them from waterborne illnesses adults have to “keep our kitchens and clothes clean, cut our finger nails and our hair, and wash our hands all the time.”
The road to recovery for the very poorest people in Sindh will be a very long one. But their journey has begun in earnest.
http://povertynewsblog.blogspot.com/search/label/Pakistan

MALNUTRITION: People think malnutrition is normal

NIGER: A crisis, not (yet) a catastrophe MOGHEM, TAHOUA REGION,
13 August 2010 (IRIN) - Although Niger is facing a severe food crisis, early large-scale responses have so far helped prevent a rapid deterioration in the nutritional state of children. "We managed to avoid the worst until now," said the coordinator of Niger's early warning system, Harouna Hamani. "Even though the population is suffering and rates of malnutrition are very high, it could have been catastrophic without early interventions." Almost 17 percent of under-five children are malnourished [http://www.irinnews.org/Report.aspx?ReportId=89657] and nearly half of Niger's 15.2 million people are at risk of hunger after harvests failed in 2009, the government said. [http://www.irinnews.org/Report.aspx?ReportId=89598] Distributions of fortified flour, oil and sugar to children under two years old, backed by the UN and several NGOs, have been taking place since May in areas where rates of acute malnutrition are above the emergency threshold of 15 percent set by the World Health Organization (WHO). The supplementary rations are meant to prevent more children from becoming malnourished, said Rachid Boumnijel, Tahoua's food security manager for Irish NGO Concern in Tahoua region, central Niger.The NGO has also focused on strengthening the capacity of 10,000 families to cope with the crisis and feed their children by giving them cash and, in some cases, seeds, and on treating malnutrition. [http://www.irinnews.org/report.aspx?ReportId=89499] Since April, Concern's team of 330 volunteers has been dispatched to villages in Tahoua and Illela departments, in Tahoua region, to find children with signs of malnutrition and refer them to the nearest medical facility. "We started as soon as we saw that the situation was going to be difficult," said Boumnijel. "Our goal was to limit the number of cases of severely malnourished children, and we have been able to keep the situation under control." The organization has been supporting the treatment of acute malnutrition in several health centres, and a recent survey indicated that prevalence of this condition in the area Concern covers is now below WHO's emergency threshold. "The situation this year is much worse than in 2005, but the response is much better," said Eric-Alain Ategbo, nutrition manager at the UN Children's Fund (UNICEF). [http://www.irinnews.org/Report.aspx?ReportId=88958] "Since then, efforts have been made to increase the capacity of national structures. Now Niger is one of the countries on the continent with the highest number of facilities for the treatment of malnutrition." Clinics have treated nearly 150,000 severely malnourished children since the beginning of 2010, and 6,000 to 7,000 new cases are reported every week, according to the UN. Variable access and quality Yet this positive picture is not always consistent, nor is access to quality healthcare and assistance. Saratou Mahamadou had to walk for half a day with severely malnourished 16-month-old Rachida on her back to reach the health centre in Moghem village, in Tahoua region. "Only 44 percent of the population lives within a distance of 10 km or less from a health centre," said Adamou Oussemi, regional director of public health in Tahoua. [http://www.irinnews.org/Report.aspx?ReportId=89393] He noted that outreach efforts in districts not supported by an NGO were inadequate. "The number of cases increases when there is a partner [organization supporting the public structures], since an active identification [of malnourished children] takes place. Elsewhere, children may die at home - if they don't come to the hospital, we have no way of knowing." UNICEF's public health consultant in Tahoua, Pacifique Kitanina Fuoto, said more than a third of the region's health centres were not receiving such support and had limited capacity. [http://www.irinnews.org/report.aspx?ReportId=88541] Pockets of insecurity are also limiting the ability of NGOs to assess and respond to needs, said Modibo Traoré, head of the Office for the Coordination of Humanitarian Affairs in Niger. "Movements are limited in northern Tahoua, Tillaberi and Agadez regions. Areas may be left out, which has an impact on the quality of care offered." Underestimations by the government and the UN mean not all disadvantaged infants received supplementary rations, but the number of children has now been revised from half a million to more than 900,000, said UNICEF's Ategbo. In Bagga village, home to 5,000 people, only 100 of the many children in need of help received the ration. "In the end, we had to do a draw to select them," said its chief, Idrissa Dayabou. Difficult months ahead Tahoua Public Health director Oussemi warned that the situation could worsen, as malnutrition usually peaked in August and September, before the harvest. The start of the rainy season - when families begin planting - could lead to a deterioration of the nutritional state of children, because parents were likely to wait for longer before seeking medical care, said Manuel Lopez Iglesias, head of mission at Médecins Sans Frontières-Spain, which works in two departments in Tahoua. "People think malnutrition is normal and tend to wait until a child is really sick," he said. "We have to push people to go to health centres, especially when they are busy cultivating their fields."

MALNUTRITION: Cambodia, NGO CONCERN

After her husband’s death, Mrs. Sokhom was only able to earn $6 – $8 per month (26 cents per day): but it cost more than $15 per month to support her family. She tried to scrape together income by rice cultivation, growing vegetables and selling firewood that she had gathered, but it was not enough and she slipped further into debt as the months went on.
Mrs. Sokhom came to the point at which she could not provide enough food for her family, and she was forced to take three of her children out of school so they could help her earn extra income by herding livestock. In 2006, she decided to send two of her daughters to work in a clothes factory in Phnom Penh, but still found that she was unable to rise above the family debt.
In March 2007, Mrs. Sokhom was selected to participate in a Concern-supported livelihoods project. First, the program gave her training in rattan mat weaving, and later gave her skills and support to allow her to begin raising chickens. She received a grant of $50 to get started in this enterprise, and was able to earn $10 per month from selling chickens and vegetables. This in turn allowed her to save some money and reduce her debt.
http://blogs.concernusa.org/2010/04/30/cambodia-livelihoods/