Learning by Doing Together: Mainstreaming Nutrition in Mozambican Rural Development Programs
Learning by doing together
The case of nutrition integration in the IFAD portfolio in Mozambique
This post presents the experiences of the International Fund for Agricultural Development (IFAD) in supporting the implementation of Mozambican government projects, which have applied knowledge and communication management tools to integrate nutrition into their interventions.
The pathway from August 2014 to July 2017 included working meetings, supervision missions, field visits, training, studies, exchange of experiences, teamwork, evaluations, negotiations and agreements. Each step involved a range of actors, such as IFAD professionals and partners, government and community representatives, managers and technicians of various projects, consultants and members of rural and fishing communities in Mozambique.
The most alarming nutrition issue in the country is the prevalence of chronic malnutrition, which affects 43 percent of children under five years and irreversibly impairs their brain development capacity. Immediate causes include inadequate diet and recurrent illnesses caused by poor access to nutritious food diversity, inadequate maternal care and loss of nutrients caused by diarrhea and other illnesses due to incorrect water and sanitation practices and services.
IFAD seeks to contribute to the reduction of chronic undernutrition in Mozambique through the promotion of diet diversification, which involves the production, processing, storage, access, preparation, sharing and consumption of balanced nutritious foods.
In parallel to IFAD's adoption of nutrition as a corporate priority, the portfolio of projects in Mozambique evolved from a pilot project of donation to five projects, out of six financed in the country, with a commitment to contribute to improving the nutritional status of the vulnerable population, such as women of reproductive age and children up to two years of age.
IFAD's first nutrition intervention in Mozambique began in 2012 and was limited to the CHAPANI project, which covered six districts in the Nampula province and aimed to raise awareness among the fishing population about HIV/AIDS prevention and the importance of a balanced diet.
The European Union initiative to accelerate the reduction of hunger in Mozambique (MDG1c) provided additional funds for three IFAD-supported projects in 2013, increasing resources for activities already ongoing and bringing a nutrition education component for two of them.
Thus, the Rural Markets and Artisanal Fisheries projects, after four and two years of implementation respectively, have committed to promote nutrition education among the beneficiaries. The activities started late, because of the delay in signing the financing and also due to the teams’ lack of experience in the nutrition issue.
Incorporating nutrition into ongoing projects was not easy. It was necessary to understand the nutrition problems in the country, which was achieved by the IFAD nutrition facilitator’s participation in three  nutrition working groups. Technical support missions, meetings and workshops were held to sensitize the projects’ participants to the nutrition issues and to give the teams some support to get started in intervening.
The intervention in the Rural Markets Programme began in five districts of Cabo Delgado in October 2014 and in the Artisanal Fisheries Project in five districts of Zambezia in July 2016. The planned activities were similar to those of CHAPANI — social mobilization in the communities to promote a balanced diet — but the demonstrations of cooking and vegetable gardens were improved with techniques of conservation and food processing.
The government and IFAD joint supervision missions to the Rural Markets Programme revealed the need to integrate nutrition activities into all rural market activities. After that, a nutrition workshop was organized to review basic nutrition concepts and identify the entry-points in several program interventions, such as the development of farmers and rural traders organizations, functional literacy or the savings and credit groups.
The exchange visit between the projects was fundamental to ensure experience-sharing between actors involved in the same issue and promote methodological innovations. Practices of interpersonal and collective communication were debated and improved.
The external evaluation and the systematization of the CHAPANI pilot experience allowed for broadening the analysis of this intervention, dialoguing with other actors and specialists in the field, and identifying good practices and lessons learned.
In order to register and share this learning, a video and success stories from the field were created. These products were utilized, among other opportunities, at the CHAPANI closing workshop.
Today, nutritional education in both projects includes interpersonal awareness sessions in the community and in schools, messages in community radio programs, vegetable-garden demonstrations and cooking classes for production, preparation, processing and preservation of food with good hygiene practices. The intervention aims to improve knowledge on diverse diets; increase the availability of fruits, vegetables, local foods and animal products of high nutritional value; and improve practices on food preparation, conservation and processing.
Following a lesson learned in CHAPANI — the lack of a monitoring system capable of detecting the improvement of the diet among the beneficiaries after three years of awareness interventions — a study of the minimum diet diversity for women of reproductive age and for young children was conducted as a measure of the rural and fishing communities diet quality. The study allowed for defining the diet situation severity, establishing the starting point for the outcome indicators, setting goals and guiding the operational and technical support needed during the implementation of activities.
In parallel with the incorporation of nutrition into fisheries and rural markets projects, the inclusion of nutrition training modules for agricultural extension workers and farmers was approved, with the use of methodologies such as training of trainers, farm field schools and sensitization of teachers and students at schools and practical demonstrations. This intervention has already benefited 15 districts in the country.
Two other IFAD co-funded projects, using a value chain approach (red meats, horticulture, cassava and aquaculture), even without specific budgets for nutrition, have already started activities that contribute to the improvement of nutrition, such as encouraging the creation of vegetable gardens in the multifunctional holes in the scope of the red meat chain, or in the production of tilapia for the consumption and sale of fish in inland areas.
All the knowledge gained on this path was used to review the rationale of the interventions in each project and used during the negotiations to increase funds and expand nutrition activities in the IFAD's project portfolio.
Additional EU funds were approved in April 2016 to extend the coverage of nutrition activities to more fishing communities in 5 provinces. Additional IFAD funds were committed in December 2017 to mainstream nutrition in rural market interventions, not only extending the coverage but improving the approach applied. Currently, fisheries and market projects promote nutritional education for 21,000 women and children in agricultural and fishing communities in 35 districts of six provinces of the country.
There are several challenges in implementing nutrition-sensitive activities, including the invisibility of the problem of chronic undernutrition and the limited availability of financial resources and experienced nutrition professionals in the country, which has been overcome by the partnership among IFAD, EU and the Government of Mozambique, dedication of nutrition focal points, a gradual capacity building process of involved actors from different sectors and punctual and long-term support from experts.
Scaling up has also required IFAD's increased quality and time of technical support in implementing these interventions. IFAD's support has been strengthened by employing professional nutrition consultants to provide technical assistance to project managers, focal points and service providers responsible for nutrition intervention. The IFAD facilitator in Mozambique has also received financial support to participate in external professional training on the subject.
In 2017, several workshops were held together with the three service providers responsible for implementing nutrition education in the fisheries project. The objective was to understand the theory of change of this nutrition intervention, to harmonize the approach and the activities among service providers, as well as to strengthen the capacity development of the Mozambican professionals. These workshops with fisheries project was concomitant with the long term technical assistance by a nutrition expert to the rural market programme, bringing an opportunity to harmonize interventions between the two projects.
In order to enhance learning and knowledge sharing, a Community of Nutrition Practice was set up, consisting of nutrition focal points from the five IFAD co-funded projects. The community meets regularly to ensure learning, the systematic exchange of experience between projects and to carry out joint activities.
In addition to the Community of Practice, IFAD facilitated the insertion of project nutrition focal points in different fora at all levels, such as the provincial working groups for the implementation of the government’s multisectoral plan for chronic undernutrition. This ensured the labeling of projects in economic and social plans as a contribution of different sectors to the fight against chronic malnutrition in Mozambique.
To increase the use of evidence, partnership funds were made available to the government through the Technical Secretariat for Food and Nutrition Security (SETSAN) for the study of the Cost of Hunger in Mozambique, a multi-actor initiative, which identified the country's annual economic loss of 1.6 billion USD from chronic and acute malnutrition.
Advocacy: The government and its partners have chosen various tools to prioritize interventions that can reduce the cause of this cost of hunger. One of them, the Fill the Nutrient Gap approach, is a methodology to identify the most effective and efficient interventions to reduce hunger and malnutrition. This latter study will be of particular importance for the elaboration of the Strategic Opportunities Programme for IFAD's engagement with Mozambique (2018-2022).
Improving the intervention strategy: Considering the approval of additional funds and the extension of the rural markets programme, the nutrition intervention will make use of savings and credit groups, support to rural traders and functional literacy, in order to guarantee nutrition is embedded in the whole programme, in addition to increasing nutrition coverage for ten new districts.
The process of insertion of nutrition into the projects brought positive results, such as the following: (i) it increased the capacity of different professionals in a new area of action - nutrition, (ii) it facilitated the exchange of experiences between professionals from different sectors and institutions, (iii) it promoted the use of new methodologies and approaches validated internationally, (iv) it contributed to the improvement of the nutrition intervention logic in the different IFAD projects, (v) it raised the quality of the intervention through the use of evidence as indicators, (vi) it allowed IFAD to materialize a corporate priority, (vii) it improved IFAD's visibility vis-à-vis other partners and institutions, as well as (viii) ensured a larger scale of its nutrition interventions in the country, and therefore (ix) increased the possibility of institutionalizing nutrition in different government sectors such as Rural Development, Agriculture and Fisheries .
The use of knowledge management tools and the sharing of experiences through communication products are the main factors in achieving these results.
LESSONS LEARNED AND GOOD PRACTICES
Good Practices and Recommendations
Nutrition is a transversal issue, and therefore fighting chronic undernutrition demands multisectoral collaboration.
The multisectoral approach considers that each of the sectors could have a one-off contribution, which should be articulated with interventions of other actors. Agriculture, fisheries and rural development have much to contribute to the production, marketing and consumption of a nutrient-dense food.
Knowledge of the issue
Political decision makers, managers and practitioners still have limited understanding of nutrition-related problems, and misperceptions about how they can contribute to improve the nutritional status of vulnerable populations, being generally focused only on increasing food security.
It is important to continue advocacy to broaden the understanding of the potential contribution of each sector to the reduction of chronic malnutrition, and seek accountability of each sector as to its contribution. In the case of Mozambique, nutrition activities should be inserted into the social economic plans of each sector.
Mozambique still has a limited number of nutrition professionals or professionals sensitized to nutrition issues.
It is necessary to ensure the continuation of the training of extension workers and the active participation of nutrition focal points in the different institutions, since this facilitates the strengthening of local capacities, learning and continuity of activities after the end of the projects.
Projects that aim to contribute to nutrition should consider time, resources and technical assistance to strengthen the capacities of national professionals.
Mechanism for incorporating nutrition into projects
Late insertion of nutrition into ongoing projects is time-consuming, requires a lot of effort and has a greater risk of being implemented isolated from other project components.
Nutrition education should be complementary to other mechanisms that positively affect the nutritional status of the vulnerable population.
The introduction of nutrition into projects should take place primarily in the design of projects and programmes to identify activities that could have a positive impact on the health, nutrition and care of women of reproductive age, pregnant and lactating women, as well as children up to 2 years of age.
Nutrition education activities should be complementary to other activities along value chains that also contribute to improved nutrition, such as the production of nutrient-rich foods or the fortification of local foods.
The timid outcome of nutritional education interventions is the result of a restricted focus on passing information and increasing knowledge, among other factors.
Nutritional education should be carried out based on a participatory communication process for social and behavioral change that also promotes attitudes and practices for nutritional improvement.
The messages should also be directed to the opinion leaders of the communities, seeking their co-optation for the desired changes.
Learning about the area of intervention, the knowledge, the attitudes and the sociocultural barriers of the target population is a fundamental condition to ensure a good logistic plan, respect the local culture and achieve results.
Monitoring the intervention
The lack of an adequate monitoring system makes it difficult to assess results.
The baseline study on minimum diet diversity carried out in fisheries and markets projects showed the current situation and guided project activities to ensure greater consistency between objectives, expected results and operational aspects in the field.
Interventions should be planned on the basis of evidence.
Studies should be ensured at the beginning and at the end of the project, as it is essential to be able to assess the achievement of the intervention results.
Seasonality interferes with many indicators of food security, health and nutrition.
The recommendation is to consider seasonality while carrying out and interpreting the studies and while planning the activities.
Incorporating nutrition into the IFAD projects, whether through nutrition education components in artisanal fisheries projects, linkages in agricultural markets, or productive activities in value chains represents an increase in the commitment of new sectors, agriculture, fisheries and rural development to nutrition.
Interventions that contribute to nutritional improvement are diverse and complementary. All of them depend on a process of behavior change, which involves knowledge, attitudes and practices. The process of change thus requires a participatory communication process and a gradual, continuous and inclusive development of capacities. Our path has been built at every step, in order to ensure the involvement of different actors, through the exchange of theoretical and practical learning.
The use of knowledge management and communication tools for sharing experiences, learning, advocating for resources and improving results is the main contributing factor for achieving the incorporation of nutrition into projects carried out by IFAD, which today reaches 57 districts in the 11 provinces of Mozambique, directly benefitting 21,000 women.
In order to improve the effectiveness of nutrition interventions and their impact, IFAD should promote the development of more equitable and sustainable food systems that improve the nutritional status of vulnerable populations. These systems involve different axes of action: production, processing, storage, access, preparation, sharing and consumption of diverse and nutrient-dense food, which are expected to be achieved in the future through the active participation of communities in agroecological systems.
1 (i) Rome-Based Agencies Working Group (FAO, IFAD and WFP) under the Millennium Development Goal Programme 1c - Reducing Hunger in Mozambique - European Union initiative; (ii) United Nations Nutrition Group (UN Gang), involving UNICEF, WHO, UNFPA, FAO, WFP, IFAD and REACH; (iii) The Nutrition Partner Group (NPF), which involves all donors and NGOs working in nutrition in Mozambique.