Concern Worldwide and
Scottish Government funding
support of nutrition
Nov 2010
Murakaza Neza! Céad míle Fáilte! Welcome! ...
Rwanda: Key Poverty Indicators
• The most densely populated country
in Africa : 395 people / sq km
• Total population: ove...
• 37% of the population are living in extreme
poverty
• More than one-third of the population is
unable to obtain the mini...
Concern Rwanda in 2010
Primary Health Care
Nutrition
Primary Education
Livelihood Security
HIV & AIDS
Health Programme
• Covers 6 districts (20% of districts nationally)
• Goal: to reduce child mortality reaching over
300,00...
Why is a nutrition component
necessary?
• Under nutrition a significant public
health problem contributing to high
infant,...
CMAM definition
“The CMAM programme treats severe and
moderate malnutrition in children using
the CTC model to treat SAM, ...
Key CMAM activities
• Case identification and referral
• Rehabilitation of MAM cases using
community-based nutrition appro...
Integration process
• Nutrition component fully integrated into
health programme in 2009, using Scottish
Government fundin...
How was CMAM integration done?
• Close working relationship with MoH
• Advocacy with MoH technical working group to
includ...
Nutrition beneficiaries with
their goats
Impact of CMAM
• Successful advocacy, informed by the positive
impact of the programme has resulted in the
inclusion of th...
• 2,209 CHWs trained in, identfiiciation, referral treatment of
acute malnutrition
• 263 community kitchens and 143 PD/Hea...
Beneficiary case study 1: CTC
Mother Immaculee (34) with youngest
child, Valentine (9 months) at CTC in
Gikore Health Cent...
Beneficiary case study 2:
kitchen gardens
Kitchen gardens
and community
kitchens/PD Hearth
groups improve the
motivation o...
The Future
• Implement the Community Based Management
of Malnutrition strategy and contribute to district
plans
• Emphasiz...
NIDOS 10th Anniversary - Concern Worldwide present their child nutrition project in Rwanda
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NIDOS 10th Anniversary - Concern Worldwide present their child nutrition project in Rwanda

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  • (0-14 years: 42.1%)
    38.4% of GDP in 2007.
    (FAO consider 0.9 minimum to feed a household)
    of 2,500 kcal per adult per day and go hungry. (EICV II, 2006)
  • December 2007 to Feb 2008 a qualitative assessment was carried out looking at prevention behaviours; illness classification; home care and care seeking practices among communitites.
    The result was elaboration of a behaviour change strategy with key messages on the uptake of recommended behaviours one of which was hand washing
    Transmitted community and household education; community leaders
    Southern Province – Gisagara and Nyaruguru
    Using the care group model mobilised community leaders and community volunteers to visit households and encourage people to designate handwashing stations.
    The stations are made of local inexpensive material – 5 litre gerry cans, rope, sticks.
    Mothers sensitised on the key times to wash their hands with soap. – before eating/before feeding the child/after defecating; before preparing food; after cleaning the child.
    Today 2,478 hand washing stations are installed in the two care group sites of Gisagara – 70% of targeted households
    In Nyaruguru 917 stations are installed – 21% of target households
  • NIDOS 10th Anniversary - Concern Worldwide present their child nutrition project in Rwanda

    1. 1. Concern Worldwide and Scottish Government funding support of nutrition Nov 2010 Murakaza Neza! Céad míle Fáilte! Welcome! Bien venue!
    2. 2. Rwanda: Key Poverty Indicators • The most densely populated country in Africa : 395 people / sq km • Total population: over 9 million • Agriculture is the main occupation of 80% of adults
    3. 3. • 37% of the population are living in extreme poverty • More than one-third of the population is unable to obtain the minimum food requirement
    4. 4. Concern Rwanda in 2010
    5. 5. Primary Health Care
    6. 6. Nutrition
    7. 7. Primary Education
    8. 8. Livelihood Security
    9. 9. HIV & AIDS
    10. 10. Health Programme • Covers 6 districts (20% of districts nationally) • Goal: to reduce child mortality reaching over 300,000 children under 5 using CHWs • Malnutrition is known to be a contributing factor in over 35% of all child deaths
    11. 11. Why is a nutrition component necessary? • Under nutrition a significant public health problem contributing to high infant, child and maternal mortality • 50% of children are stunted, one in five are underweight, and 4% are wasted • Access to services to address acute malnutrition was poor and MoH recognised the need for assistance to implement a nutrition component into the existed health programme
    12. 12. CMAM definition “The CMAM programme treats severe and moderate malnutrition in children using the CTC model to treat SAM, and utilises the two models of Community Kitchens and PD/Hearth models to treat MAM, all integrated into a community based approach”
    13. 13. Key CMAM activities • Case identification and referral • Rehabilitation of MAM cases using community-based nutrition approaches • Small livelihood support for beneficiaries • Rehabilitation of SAM cases at OTP sites
    14. 14. Integration process • Nutrition component fully integrated into health programme in 2009, using Scottish Government funding • Process included national level advocacy on policy • Government of Rwanda have made it part of their health service nationwide
    15. 15. How was CMAM integration done? • Close working relationship with MoH • Advocacy with MoH technical working group to include CMAM in national protocol • Training of CHWs on screening with MUAC and referral for malnutrition • Scale up from 2 health centres in one district to 43 health facilities across the six districts • Community Kitchens and sensitization on prevention • Supervision and follow up of management at health centre level
    16. 16. Nutrition beneficiaries with their goats
    17. 17. Impact of CMAM • Successful advocacy, informed by the positive impact of the programme has resulted in the inclusion of the community management approach in the Rwandan national guidelines for treatment of acute malnutrition • 43 health facilities have been supported to provide services for the management of severe acute malnutrition in 6 districts • 2, 321 children have been admitted to the SAM programme since January 2009
    18. 18. • 2,209 CHWs trained in, identfiiciation, referral treatment of acute malnutrition • 263 community kitchens and 143 PD/Hearth sites have been opened since the beginning of the programme • 3,818 moderately malnourished children have been treated at community kitchens and PD/hearth sites since January 2009
    19. 19. Beneficiary case study 1: CTC Mother Immaculee (34) with youngest child, Valentine (9 months) at CTC in Gikore Health Centre
    20. 20. Beneficiary case study 2: kitchen gardens Kitchen gardens and community kitchens/PD Hearth groups improve the motivation of model parents and sustainability Callixte & his wife Beatrice & 2 of their 3 children at a community kitchen garden
    21. 21. The Future • Implement the Community Based Management of Malnutrition strategy and contribute to district plans • Emphasize prevention messages in particular, positive practices for infant and young child feeding • Focus on providing livelihoods support to CMAM beneficiaries • Greater integration across programmes with Livelihoods, Education, HIV and AIDS

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