1. Mobilizing grass-root community development practitioners to empower women and enhance improved maternal, adolescent, infant and young child nutrition Experience of World Vision In Africa Harnessing opportunities for production, access and consumption of nutritious, safe and diverse diets Kampala, Uganda November 29, 2015

2. Outline WV Program in Africa Key Health and Nutrition Program Approaches Strategy for Mobilizing Community Health Workers How we work with partners/community How we build their capacity Evidence of success/Impact Lessons and recommendations

4. Background World Vision aims to achieve sustained well-being of children within families and communities, especially the most vulnerable children : Long term community based and child focused development programs (10-15 years) Advocacy, Policy Influence and Engagement Emergency Response and Disaster Risk Reduction In Africa, World Vision works with communities, governments and partners in 26 countries through its three regional offices: East Africa (9 countries): Burundi, Ethiopia, Kenya, Rwanda, Somalia, South Sudan, Sudan, Tanzania and Uganda Southern Africa (10 countries): Angola, DRC, CAR, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe West Africa (7 countries): Chad, Ghana, Mali, Mauritania, Niger, Senegal, Sierra Leone, WV approach for food and nutrition security is a multi year integrated development program

5. World Vision Reach and Funding in Africa - World Vision is serving over 18 million children and their families across Africa through 600 long term projects and 151 short term programs on Health and Nutrition Resilience and Livelihood Education Water supply and sanitation Humanitarian emergency Cross cutting themes WV programs focus on food and nutrition security at the grassroots Out of the total global income of US$2.7 billion in 2013, World Vision International funded projects with over US$1.06 billion is in Africa

6.  Integrated development approaches  Evidence based technical models as delivery vehicles Women and children Timed and targeted counseling Paediatr ic HIV & TB care Community PMTCT Nutrition Care Groups & Positive Peer Couples Positive Deviance Hearth CMAM Integrated Community Case Management Bio and Fortification Kitchen/Key Hole Gardens WV Key Health and Nutrition Approaches Promotion of Growing and Utilisation of High Nutritious foods

7. WV Key Health and Nutrition Approaches Timed and Targeted Counseling Targets pregnant and lactating women through 13 household visits over the 1000-day window of opportunity Garners support for behaviour change Empowers families to make their own decisions without ‘giving instructions ’

8. Nutrition Care Groups Targets women and men with children aged 0 – 59 months Provides training, supervision and support in Essential Nutrition Actions. Curricula integrate key skills in WASH, FP, MNCH etc. Volunteer women or couples act as peer educators for a cluster of households WV Key Health and Nutrition Approaches

9. Positive Deviance Hearth Identifies behaviors practiced by caregivers of well-nourished children from poor families and transfers such practices to others with malnourished children. Same concept can be applied to other health- related behaviours Platform for integration of agriculture and livelihood skills WV Key Health and Nutrition Approaches

10. Integrated Community Case Management Accelerating control and management of diarrhea, malaria, pneumonia, neonatal sepsis and malnutrition in children under 5. Contributes to halting the vicious cycle between malnutrition and illness in children. WV Key Health and Nutrition Approaches

11. Strategy for Mobilizing Community Frontline Workers World Vision is committed to supporting 100,000 CHWs across the world in 2016 Referred to differently in different countries (Uganda – Village Health Teams; Ethiopia – Community Health Extension Workers working hand in hand with the Women Development Army; Niger – Relais Communitaire etc. Guided by country CHW policies and guidelines, WV CHW programmes aim to strengthen existing community health structures through strong, long-term partnerships Community system strengthening includes components of functionality, capacity building, motivation, linkage to the health system and country ownership. Community health workers and volunteers supported to deliver primary health and nutrition education and behavior change communication at household level, empowering caregivers and children

12. Individual/ HH: CHWs Community: CSS Environment: Advocacy, HSS World Vision socio-ecological model focuses on individuals, systems, and the policy environment.

13. Nutrition Framework & Interventions

14. Evidence of Success

15. Uganda - Mother Care Groups Children 6-59 months having 3 meals a day – Amuru area program

16. Uganda – Positive Deviance Hearth in Kiboga

17. Burundi: Positive Peer Couples promoting Family Planning Contraceptive prevalence rate in Mushikamo Area Program = 50.6% (n=135) in 2015 from 17% in 2013 Percent of women aged 15-49 who can name at least three modern methods of family planning: 99.7% Percent of women aged 15-49 who can name at least one long-acting reversible contraceptive (LARC) or permanent method (LAPM) of contraception : 99% Number of FP users by method

18. World Vision’s largest iCCM grant is in Niger ($10M). Funding by CIDA through WHO Niger: CHWs contribution in iCCM Niger’s experience working on iCCM Number of districts4 Number of CHWs1074 Size of grantUS$10M Period of grantFive years Diarrhea cases treated24,080 Malaria cases with +RDT treated24,080 Pneumonia cases treated47,497

19. Visit at the 3 rd trimester or at delivery (by peer mother) and initiation of BF within 1 hr, Colostrum feeding and pre-lacteal feeding Ethiopia - Using peer mothers to promote Infant and Young Child Feeding

20. Key messages Situation: Progress on maternal, adolescent and infant and young child nutrition remains slow due to due to inadequate access to services, sociocultural, economic and behavioural factors. Sustainable solutions exist: Progress is possible but requires increased investments in mobilising communities and scale up of evidence based, community-driven multi-sectoral approaches. Call to action: Nutrition cannot wait. Every delay has dire consequences for maternal and child survival, learning ability, population productivity and ultimately the economic development of Africa.

21. Recommendations Create effective policy and legal frame-works from national level to the grassroots for improved community mobilisation to support the scale-up of proven interventions in countries. Promote a strong and sustainable multi-stakeholder dialogue from national level to the grassroots for better accountability and strengthening community health systems. Governments and development partners should allocate more resources for CHW programming in Africa to reach the most vulnerable communities. Need to strengthen partnerships to increase demand creation and uptake of proven, high impact interventions using community health workers.

22. Thank You! We bale!