- Feed the Future, the USG’s Global Hunger and Food Security Initiative, the major criteria for selection of target areas includes chronic undernutrition – here we can see stunting, wasting and underweight rates that remain some of the highest in the world and with little movement over the past few years.
While nationally rates remain high, there are certain areas that carry a larger number of stunted children. Zambezia and Nampula, two of the most populated areas were chosen as the target provinces for Feed the Future. In addition, work was done with the government and other donors (i.e. DANIDA, World Bank, others) so that other areas with high burden are also reached. For example, DANIDA is working more in Tete while others will focus efforts on Cabo Delgado. It is important to note that USAID/Mozambique was already investing in these regions through Food for Peace MYAP programs, integrated health/livelihoods bilaterals and clinical partners through PEPFAR funding. However, after some further investigation, we became aware that while the MYAPs and SCIP were heavily focused on community nutrition activities, links to facility based care for nutrition was still a work in progress.
The plan was to scale up nutrition assessment, counseling, and support in all regions. However, for the current phase of the roll-out, a focused scale-up of NACS—specifically the support portion—would only occur in a few provinces. HIV prevalence rate, and total population density—were, of course, significant considerations as the mission was developing their 2012 strategic plan. Maputo City, Maputo, and Gaza were the provinces chosen for scale up in the southern region.
However, regions in the North had not yet been chosen for focused-NACS scale-up. Zambezia and Nampula provinces were considered due to their very high population density. More importantly, they were considered due to the significant FtF activities and investments being made there.
So, this is not rocket science and should be the norm rather than the anomaly, however this example is really to emphasize that we could all do a better job of bringing our efforts together – and this is not only our partners, but us as donors as well. We all know that the multiple funding streams, difference in targeting approaches and timing do not always make this possible. Yet, there are possibilities and we should take advantage of them.
Some key considerations….Are there other recommendations that you would like to make to donors on this process in other countries? Are there more ideas of how we can generate dialogue on these types of issues in country?
Amie Heap & Jim Hazen
Mozambique Case StudyMaking Aid Work for NACS - A Study in Effective Integrated Programming Jim Hazen, USAID/GH/HIDN Amie Heap, USAID/GH/OHA
357, 922 children < 5 183, 026 children < 5 416, 737 children < 5138, 085
Prevalence of HIV by Sex and Province (15-49 years of age)
High population provinces HIV Prevalenceat ~ 3.7 million Cabo < 10 % Delgado 10.1 % to 15% Niassa 15.1% to 20% > 20% Nampula Tete Zambézia Sofala Manica Inhambane Gaza Maputo City Maputo
Possible Linkages Between the Health Facility And Community Community Referral for treatment of childhood illnesses referral to PRN Health Facility (CLC/CSC) Referral to community-based activities, follow-up (GoM / CP) Home Visits – Nutrition Group MCH/PMTCTVolunteers/APEs Improved quality (Mother’s/Father’ NACS pre-post natal (HBC/OVC) s Group) services-training and supervision GrowthWASH Activities Agriculture Monitoring Micronutrients Immunization Supplementation Deworming(Sanitation and Extensionistas / and (Farmers (Vitamin A, IFA, Treatment of Hygiene Associations / Promotion zinc) childhood Promotion) Value Chains) IllnessesLivelihood /FS Jr. Farmers Association / Value Chains
1. Expansion of PEPFAR Clinical partners NACS programs to FtF target areas 2. Strengthening of community/ facility links explicitly in Feed the Future and PEPFAR programming—specifically referral systemsOther potential areas of collaboration:• Joint SBCC strategy across HIV, nutrition and other health areas (i.e. hygiene, malaria)• Monitoring systems• Reporting• Joint supervision• Technical discussions amongst partners (i.e. complementary feeding, income generation opportunities, etc.)• Direct TA to the provincial level on nutrition under PEPFAR and FtF Initiatives.
Key ConsiderationsTo donors:•Nutrition is nutrition (bring different sectors together)•Inclusive design process lends to better chance of integratedprogram•The more you work together, often the more area you can cover(leveraging other resources)•Listen to partners, understand the gaps and identify practicalways to address themTo partners:•We do want comprehensive programs, but need to understandgaps – help us identify what can be done•Provide evidence, including potential positive/negativeconsequences of integrated/non-integrated platforms