Improving nutrition for caregivers and

children in difficult circumstances :

Promising strategies, Southern Africa:

Fadzai Mukonoweshuro

GRM International

Children and HIV: Family Support

July 16th and 17th 2010

Vienna, Austria

Acknowledgements

PRP

UN and Partners Alliance

Introduction

• The nutrition challenge in the context of HIV

and AIDS in southern Africa

• Promising livelihood actions with nutrition

outcomes for carers and children in difficult

circumstances

• Lessons : • case studies undertaken by the UN partners in

Southern Africa

• PRP programme in Zimbabwe

Background

• Complex food insecurity situation and rising incidence of malnutrition in Southern Africa

• Malnutrition is particularly acute among children living with HIV and infants

• Challenges in meeting food security, care practices and health services – although ART is becoming more and more available

• 17 Million children orphaned by AIDS

• OVC living with carers most elderly

• Extended families care for more than 90% of all double orphans and single orphans not living with the surviving parent in sub-Saharan

Nutrition situation in Southern Africa • Zimbabwe - prevalence of stunting is highest

among maternal orphans (CNMSS, 2008)

• Malawi – 48 % U5 suffering from moderate and severe stunting (The State of the World’s Children

2007 )

• Humanitarian concerns e.g. Cholera outbreak -

• Skipped-generation household (SGHs) –grandparents (65+) care for roughly 60% of all orphans in Zimbabwe (UNICEF, 2007

• Burden of care on women and children

Snap shot of Nutritional Status among children

in Zimbabwe – Boys/Girls

37.9

32.5

13.1

10.5

2.91.9

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Male Female Male Female Male Female

Stunting Underweight Wasting

MIMS, 2009

Determinants of Nutrition status

Background

Characteristics

Background

Characteristics

Health Services

and environment

Caring Practices

Food security Dietary Intake Dietary Intake

Disease

So……..

• Income poverty contributing to food

insecurity, inadequate care and unhealthy

household environment – need for

sustainable economic livelihood strategies

• But….. Not everything necessary for adequate

nutrition can be bought – health, gender

equity, clean water

Promising livelihood strategies:

Review of experience

UN and Partners Alliance

Malawi � Community Based Organisations -

Tawonga (10 Villages ), Chitundu (9 Villages ) and Good News (36 Villages) - Total of 6000 vulnerable children

� Main objective- strengthen livelihood strategies with nutrition outcomes for carers and vulnerable children

� Community initiated and managed

Agro-based

• Communal gardens – food diversity

• Staple food production for consumption and

income-generation

• Small stock for asset accumulation and

income generation – Guinea fowls, K100,000

per year from about 2,000 eggs from ten fowls

(each hen lays about 250-300 eggs per year)

• Agricultural skills for teenage children

Off-farm

• Development of artisanal skills - tailoring

• Communal maize mill

• Village loans

Health and sanitation

• Provision of basic medicines to OVC

• Provision of potable water and sanitation facilities.

Effectiveness

• 3 meals provided to children on a daily basis-

• Increased food production – able to buy farm

implements from village loans

• Predictable access to food and nutrition

security for children throughout the year

Food item Qty/child/yr

(Kg)

Unit cost

(K/Kg)

Cost/child/y

r (K)

Maize 112 40 4,480

Vegetables 29.2 70 2,044

Meat 29.2 500 14,600

Beans 29.2 200 5,840

Others (sugar, salt, tea,

cooking oil, etc)

5,000

Total annual food cost 31,964

(US$228.31)

The annual cost of feeding a child at Good News

UN and Partners Alliance - Programme of

Support – Zimbabwe

409,926 beneficiaries (by February 2010 )

Two key interventions focusing on nutrition

1. Supplementary feeding:

� children did not complain of hunger (67.7%)

� Improved health status (30.9%).

2. Nutrition gardens:

� increased food access and health status;

� beneficiaries reported children could buy text books and pens (17.4%),

� increased number of meals (21.7%)

� Improved quality of meals (13%).

Nutrition gardens low on contribution to

dietary diversity for targeted children but

contributed to other household requirements

PRP – Zimbabwe

Household food security and nutrition enhanced through sustainable and improved productivity and income generation

•Nationwide - urban & rural •Target includes Carers and children in difficult circumstances

• Reaches 2 million Zimbabweans (20% of the population)

PRP II: The Approach

Instrument Social

protection Livelihoods

promotion

Food and

nutrition

Security

Cash transfers High Medium High

Food vouchers Medium Low Medium

Targeted inputs Medium High Medium

Nutrition gardens (W) High Medium High

Conservation farming Low High High

Small livestock (W) Medium High Medium

Watsan (W) Low Medium Medium

Home-based care (W)

High Low Medium

VS&L (W) Medium Medium Low

New crops Low Medium Medium

Agri Training Low High High

Conservation Agriculture-availability

Garden support-Increase availability of diverse vegetable

Small Livestock support- Increase availability and access

Cash Transfers and ISALs-Increased access to food 75% of ISAL Increased # of meals

Food Vouchers-increase access to food

WASH- availability of clean and safe water and dignified sanitation

Conservation agriculture Increased Yields- increase food

availability

Yield data (kg/ha) from ICRISAT panel study data : (All Natural Regions including high yielding areas)

Comparisons of

CA versus non CA

Season CA Non CA

2007 1,590 765

2008 1,114 407

2009 1,546 970

2010 1,209 658

Natural Region Yield in Kg/HA

0

5

10

15

20

25

30

35

40

45

Food Education Human

health

Livestock Housing Farming Clothing Ceremony

Perc

enta

ge o

f fa

rmers

Cattle Goats

0

10

20

30

40

50

60

70

Live

stoc

k

Rem

ittan

ces

Veg

etab

les

Cro

p fa

rmin

gC

asual l

abor

Man

ufact

urin

g

Fores

t pro

ducts

Form

al em

ploym

ent

Alc

ohol

bre

win

gR

etail

shop

Ven

ding

Fish s

ales

Gol

d min

ing

Cro

ss b

order

trad

eFai

th h

ealin

gTra

nspor

t

Perc

en

tag

e o

f fa

rmers

Rank 1 Rank 2 Rank 3

Food Access: Livestock as important source of cash income – most households are net buyers of food

Use of transfer by type of

spending

Assets Household Items IGAs

Livestock

Goats: Meat, milk,

cheese, income,

Chicken: Meat, eggs,

income

Staple: 50% spent

Cereal

Non Staple:

Cooking oil

Sugar

Salt,

Vegetables,

Meat

Kapenta fish

Other

Grinding mill

Transport to health facility

Blankets

Petty trade

Projects such as

sewing

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

S1 S2 S3 S1 S2 S3

V.Poor Poor

se

as

on

al

inc

om

eother income cash transfer

Gweru Urban, Income, Season 1, 2 & 3

$0

$50

$100

$150

$200

$250

$300

$350

$400

S1 S2 S3 S1 S2 S3

V.Poor Poor

se

as

on

al

ex

pe

ns

es

social services

productive inputs

hh items

non-staple food

staple food

What is the cash transfer for? Is it

sufficient?: AAID and JI-Gweru Urban

Gweru Urban Expenses, Season 1, 2 & 3

Spending on social services about equals the cash transfer.

Graduated packages – whole community

benefits

Poorest / non-viable -Child headed

-Elder headed + orphans

-Chronically ill / disabled headed

-High dependency ratios

Poor / viable -Land

- HH economically active members

Community benefits

Cash transfers

Nutrition gardens

Small livestock

Agricultural inputs

Agricultural inputs &

training

Conservation farming

Small livestock

Nutrition gardens

VS&L

Water & sanitation

Small dams & irrigation

Market invigoration

Agri training

Health clubs

Lessons

increased food production can improve income,

which, in turn, can improve consumption

patterns. The evidence shows that this is more

likely to occur under the following conditions:

· The incremental income is earned or controlled

by women

· The stream of income is regular or frequent,

even if the absolute amounts are small

· Training in health and nutrition is provided

Lessons

• Framework for promoting livelihoods - NPAs

• Community initiated intervention more

successful – ISALS, Village savings

• Health clubs approach – promising

• Chronically ill disappearing – able bodied

carers

Thank you