Sustainable Nutrition for All (SN4A)

The Sustainable Nutrition for All (SN4A) is a three year project being funded by Swiss Development Co-operation. The project is being implemented by SNV in Uganda and Zambia in partnership with KIT-the Royal Tropical Institute and the Centre for Development Innovation, Wageningen UR (CDI).

Relative to its size, Uganda has a large population (34.5 million) and a high population growth rate of 3.2% compared to the world average of 1.2%. Uganda is generally considered self-sufficient in terms of food production. However, Uganda still grapples with high costs of certain foods as well as distribution challenges that lead to acute seasonal and chronic year-round undernutrition and food insecurity. Subsequently, children become severely malnourished due to poor diets that result from suboptimal maternal feeding practices as well as the high disease burden resulting from malaria, diarrhoeal diseases, acute respiratory infections, and worm infestations. The approach At the start of the SN4A project, community mapping and baseline studies were carried out in May 2015. The baseline study showed that there are high levels of stunting at 39.7% in Kasese and 30.1% in Kyenjojo for children under 6-23 months. The 2016 Uganda Health and Demographic Survey puts the stunting levels in Tooro where Kasese and Kyenjojo are found at 40.6% which is the highest in the country compared to 29% national averge. The project goal is to improve nutrition outcomes in 12,310 households through adoption of agro-biodiversity and improved dietary diversity at the intra household level. This is being promoted in two sub-counties; Kisinga in Kasese and Nyabuharwa in Kyenjojo district through the following interventions:

• Building capacities among local leaders and district level service providers to trigger and maintain demand for intra household dietary diversity at scale

• Promoting behavioural change at intra household level through communication targeted on the benefits of dietary diversity, nutrition and agrobiodiversity

• Strengthening nutrition-sensitive agriculture production and innovation systems • Strengthening national governance capacity for intra household dietary diversity and

improved nutrition

Sustainable Nutrition for All (SN4A)

NATIONAL,REGIONAL AND GLOBAL POLICY DEVELOPMENT FOR IMPROVED NUTRITION

Recommendations from the project promoted to policy through SN4A, Policy Champions and SUN

EVIDENCE OF IMPROVED NUTRITION OUTCOMESImproved nutrition outcomes through adoption of agro biodiversity

and dietary diversity at intra household level

Triggering Demandfor Intra Household Dietary

Diversity at Scale

Build local capacity of local authorities to trigger intra-household demand and steer

demand triggering

Individual and household awareness of their own nutritional practice and

decision making

Community Nutriton Champions trained and locally

situated

Behavioural Changeat intra Household Level

Behavioural Motivators research and gender analysis to indentify

determinants influencing choice onproduction, consumption, allocation

and investment of resources

BCC campaigns to increase household knowledge , attitudes

and practice of good nutrition dietary diversity and agro

biodiversity

BCC included in District levelplanning

Nutrition Education in Schools

Strengthen Nutrition Sensitive Agricultrual

Production

Nutrition Hubs to demonstrate nutrition-sensitive crops for household agro bio-diversity

Post harvest handling and utilization

Community Seed Banks and Market Linkages

Extension Officers trained innutrition sensitive production,

processing and utilization

Women’s empowerment

National Governancefor intra Household Dietary Diversity and Improved

Nutrition

Multi stakeholder coordination and mobilization through Innovation Platforms

Addressing needs , capacities and vulnerabilities of households and men and women farmers

Developing and setting standardsand targets

Gender aware District Nutrition Teams and District Nutrition

plans

SN4A MODEL

The Sustainable Nutrition for All model builds on the combined experience of SNV, KIT-the Royal Tropical Institute and the Centre for Development Innovation, Wageningen UR (CDI) in nutrition-sensitive agriculture, Water, Sanitation and Hygiene (WASH), nutrition, and gender. The project uses primary schools as nutrition hubs. Village health teams (VHTs) mobilise parents to come to schools and learn about nutrition-sensitive agriculture, particularly vegetable growing.

Behavioural change is triggered in a range of areas, including nutrition, hygiene, and intra-household gender relations. Long-term sustainability is enhanced through the capacity building of local and national governments to stimulate and maintain demand for nutritious diets. VHTs are empowered to promote the adoption of recommended food production, preparation, and consumption practices at the household level to ensure dietary diversity.

because

Sustainable Nutrition for All (SN4A)

Improving

nutrition for

12,310by 2017

I didn’t know the relationship between the foods I used to prepare. Sometimes I would buy rice or posho (maize meal) and that’s what we would eat day in and day out when I did not have money. After the triggering in my village, I realised that my elder children could have gotten stunted and I did not want that to happen to my grandchildren. I planted a variety of vegetables around my home. Now, even if I don’t have money, we are still able to eat healthy because we have vegetables in our garden. - Bigirwa Yolesi, a housewife in Kisinga sub-county, Kasese district.

Through a participatory process, triggers for improved nutrition were identified as fear for failure and a strong desire for success. Based on this, triggering tools were developed and a triggering team made up of district staff trained on the triggering process.

To improve nutrition outcomes, Kasese and Kyenjojo districts are being supported to increase adoption of agro-biodiversity and dietary diversity at the intra-household level by implementing the following interventions:

Building the capacity of districts to trigger and maintain demand: The project has developed the capacity of a core team of 30 technical officers (15 in each district); and an additional 90 at community level. The 30 officers are working with 910 Nutrition Action Group members (NAGS) to trigger demand for improved nutrition in 66 villages linked to 18 government-aided primary schools. All the targeted 66 villages have been triggered with over 7,600 households attending the triggering sessions. All the 66 villages have been followed up with post-triggering support.

Inducing behavioural change for improved nutrition: SNV, together with the two districts carried out a study to understand household behaviour motivators and barriers. The results informed the formulation of a behaviour change communication strategy and tools; and BCC campaign that was rolled-out in the districts in the month of March 2016. A mini-survey carried out in December 2016 indicated that the BCC campaign is on track; the content is relevant; and some behaviour had started changing. In Kasese for example, consumption of silver fish is reported to be increasing. In both districts, consumption of fruits and vegetables has increased.

Strengthening nutrition-sensitive agricultural production: Current household production and consumption patterns focus on staple crops such as maize, cassava, and matooke. Although these staple crops provide energy, they lack other essential nutrients. The project is supporting 18 schools which have been transformed into nutrition hubs to serve as community seed banks. Village households are trained on the production of nutritious fruits and vegetables. In a result tracking survey in December 2016, 72% of the 7,000 households followed up were growing vegetables; 86% were growing legumes; 83% had fruit trees in their compound; 79% were raring small animals (rabbits, chicken, ducks, guinea pigs).

Strengthening national governance capacity for improved nutrition: Working with district nutrition coordination committees (DNCCs) and committees at the sub-county level, the project is developing a coherent district-wide approach by supporting the development of a district nutrition action plan and sub-county nutrition action plan. The DNCC is directly involved in the implementation and monitoring of project activities. The team of 30 technical district officers (including members of the DNCC) and supported by NAGs are spearheading implementation of the project in 66 villages. Kasese has an approved district nutrition action plan; Kyenjojo plan is before District Council for approval. Nyabuharwa and Kisinga Sub-counties have functional sub-country nutrition coordination committee; their sub-county plans are before the sub-county council for approval.

Evidence base to support nutrition related policies: The project is developing evidence for improved policy at national, regional and global levels in the following areas:

• Adopting agro-biodiversity at the household level leading to improved dietary diversity• Examining the role of gender in improved dietary diversity at the intra-household level• Tracking SN4A model in Zambia and Uganda to determine its impact and applicability.

SNV experience shows that it is easier to influence policy if policymakers are involved in the development dialogue from the beginning. Thus, SNV is working with selected policy advocates at the regional and global level. SNV is also working closely with the Scaling up Nutrition (SUN) network and the Civil Society Scaling Up Nutrition (UCSUN) where SNV is a member. The two platforms will be used to share evidence emerging from the project which will feed into the national-level nutrition policy discourse. Draft papers are in place and will be ready for sharing by 30th June 2017.

The 1000 days of life-Window of Opportunity

All the targeted 66 villages have been triggered with over 7,600 households attending the triggering sessions 7000 (57%) out of 12,310 households established vegetable gardens in their homes and have incorporated vegetable consumption into their meals. A results tracking study on dietary diversity carried out between November – December 2016 showed that the percentage of children that consumed food from less than 4 food groups i.e. percentage of children below the minimum Individual Dietary Diversity Scores (IDDS) of 4 had greatly reduced from 53.7% in Kisinga and 51.8% in Nyaburwa in 2015 to 10% in Kisinga and 6.0% in Nyabuharwa.

IDDS for children: percentage below score 4 and mean IDDS per age

Kisinga (2015)

Kisinga (2016)

Nyabuharwa (2015)

Nyabuharwa (2016)

% of children with DDS below 4

53.7 10.0 51.8 6.0

Mean IDDS All 3.5 4.34 3.4 4.74 6-12 months NA 3.3 NA 5.0 13-18 months N 5.0 NA 5.0 19-24 months NA 5.0 NA 4.0

2016 resultsChange in dietary diversity

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SNV Uganda

The same study also showed the Individual dietary diversity score for women was as 5.6 compared to the 3.3 baseline findings. This means that on average, a high number of women are consuming food from at least 5 food groups daily in the target sub-counties.

One of the main factors that has contributed to the improvement of the IDDS is the increase in consumption of fruits and vegetables. Consumption of this food group is a major intervention in the SN4A project through promotion of establishment of backyard gardens. Possession of backyard gardens was seen to have a positive correlation with consumption of especially green leafy vegetables. Improvement of knowledge about nutrition from the triggering sessions by the SN4A project in the community was also seen to greatly contribute to consumption of more diverse meals. Mothers said that they were keen to feed their children on more diverse meals in order to enhance their brain development and increase their productivity in the future. Behavioural change products: Behaviour change communication (BCC) campaigns and materials have been developed. A team of 30 district staff members was trained to build the capacity of VHTs to play a critical role in promoting BCC campaigns at the community level. A team of 910 NAGs has been trained on BCC and continue to engage households on a one-on-one basis. Each reaches out to approximately 15 homes. To date, 237 teachers, 114 political leaders and 83 religious leaders have been trained on BCC and continue to disseminate nutrition messages using existing platforms.

Strengthened nutrition governance: Kasese and Kyenjojo districts were supported to complete their district nutrition plans. The district nutrition coordination committees (DNCCs) in the two districts were trained on how to trigger demand for dietary diversity and on behaviour change communication. They have spearheaded the triggering and post triggering sessions. 18 schools have established nutrition hubs and a team of 5 local leaders per hub have been trained to steer activities of the hub. The DNCCs were involved in the baseline, community mapping and year-round crop availability studies as part of the capacity-building process so that they fully understand the challenges related to nutrition in their districts. 910 nutrition action group (NAG) members (volunteers selected by the community after the triggering sessions) have been established and trained.

Nutrition sensitive Agriculture: Nutrition hubs have been established in 18 public schools (1 per parish), each having a demonstration garden which is used by the NAGs and the community to learn about nutrition sensitive agriculture. A demonstration garden has also been established in each of the 66 villages. All the 910 NAG members established their own demonstration garden at home which they use to train the 15 to 20 households attached to them. By December 2016, a total of 7000 households out of the targeted 13210 had established a vegetable garden. SNV in partnership with the National Agricultural Research Organisation (NARO) developed a training manual on nutrition sensitive agriculture and trained 75 farmers as seed multipliers to sustain vegetable production at community level. Nutrition calenders have been developed which guide individual households on production and consumption of vegetables and fruits throughout the year.