Concern Worldwide and Scottish Government funding

support of nutrition

Nov 2010

Murakaza Neza! Céad míle Fáilte! Welcome! Bien venue!

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

• 37% of the population are living in extreme poverty

• More than one-third of the population is unable to obtain the minimum food requirement

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 300,000 children under 5 using CHWs

• Malnutrition is known to be a contributing factor in over 35% of all child deaths

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

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”

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

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

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

Nutrition beneficiaries with their goats

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

• 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

Beneficiary case study 1: CTC

Mother Immaculee (34) with youngest child, Valentine (9 months) at CTC in

Gikore Health Centre

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

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