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Integrating WASH & malnutrition response in drought emergencies

Integrating WASH & malnutrition response in drought emergencies - case of HECA in 2011
by

Jesee Kinyanjui

on 4 January 2013

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Transcript of Integrating WASH & malnutrition response in drought emergencies

Background photo by t.shigesa Turning Point Success Challenge Integrating WASH and malnutrition in drought and food crisis: What, Why and How based on indepth research in Turkana, Kenya Sample of Turkana integrated community health IEC materials – infant feeding game Key learning from the field assessments…… 1. Aid and Household Food Security
Despite aid, HH very food insecure.
Targeting (food security/livelihoods interventions) less effective due to inter-household food sharing culture.

2. The WASH and Public Health Aspects: How they Contribute to Malnutrition
Inappropriate young child feeding, healthcare and hygiene practices through the year (KAP issues).
Majority of field PH professionals and communities unable to make WASH-malnutrition link further perpetrating malnutrition-disease cycle Qualitative Methods
3 community participatory tools:
Household food security and seasonal access to food
Knowledge, attitude and (seasonal) practices relating to infant and young child feeding and care
Community health, including KAP on malnutrition-related common childhood illnesses and health-seeking behaviors 5 villages in Turkana, Kenya Study Location and methods Field Assessment....... Objective 3:
To learn about the seasonal incidence of diseases and understand community knowledge, beliefs and practices on health and diseases that increase the risk of malnutrition and morbidity
Additional Objective:
To explain why the already chronic (child) malnutrition rates were exacerbated by the drought and why aid interventions were relatively less effective in reducing the heightened rates of malnutrition. Acknowledgements * Oxfam Turkana Public Health Team
* Oxfam Kenya Program
* Oxfam Humanitarian Dept: Public Health and M&E Teams
* Govt. of Kenya, Ministry of Agriculture: Dept. of Home Economics List of resources available for sharing Integrated WASH-Malnutrition link assessment tools used in Turkana and Somalia – In English
Community health assessment tool
Household food allocation & sharing assessment tool
Infant and child feeding hygiene & nutrition assessment tool
Assessment reports – Turkana, Kenya and Burco, Somaliland
Integrated WASH malnutrition link IEC materials – PDF soft copy
Atabo story cards
Infant feeding & care cards – good practice pile
Infant feeding & care cards – bad practice pile
Children’s hygiene board game
Infant feeding game
WASH malnutrition link training materials
A sample integrated WASH malnutrition link community health strategy - under implementation in Turkana Sample of Turkana integrated community health IEC materials – Hygiene board game for children Turkana integrated community health IEC materials Creative Methodology
No ‘health talks’ and group lectures!
Story cards—to establish WASH-malnutrition links… “This is me…this is the story of our village…”
Picture cards for child feeding/ care/hygiene practices
Peer education using child-to-child approaches (board games/ story telling/ hygiene clubs etc)
Fathers’ Groups (during men’s recreational evening sessions/ playing of ‘Peyeri’)
Use of ‘Edonga’ and community traditions & celebrations for health promotion. Turkana integrated community health strategy Context-specificity that recognized:
i) limited resources available to community
ii) rationale for seasonal variation in feeding and care practices
iii) Socio-cultural aspects of health behaviour

Community Health Education therefore emphasized:
Frequency of feeding as opposed to insisting on types of food to be fed.
Messages on food hygiene/ food preparation instead of insistence on exclusive breastfeeding.
Influencing intra-household food allocation patterns, including working with the men, to advocate for prioritizing feeding young children.
Enabling the community to understand the link between WASH and malnutrition Project Outcomes Integrated assessment tool to understand links between food security, nutrition, health and WASH

Much more than doing sectoral assessments in multi-disciplinary teams!
Adapted to other contexts (Yemen, West Africa…)
Qualitative tool can be/ has been used to develop a quantitative (HH survey) tool.

Integrated analysis of food security, nutrition, health and WASH findings – Turkana.

Integrated/ context-specific community health strategy and IEC materials - Turkana. Key learning from the field assessments contd…
The Black-Box: What happens to the aid at household level and why children are (still) malnourished
High levels of intra and inter household food sharing further reduce HH food security
Inadequate food access to young children.
Supplementary feeding programs not effective due to poor general food security at HH level + sharing of inter and intra-HH sharing of Unimix.
Age and gender hierarchies that do not prioritize young children in HH food allocation.

. Field Assessment.......
Objective 1: To understand seasonal variations in inter and intra household patterns of food allocation and sharing and how this impacts food access to the most vulnerable family sub-groups.

Objective 2: To identify maternal and child nutrition knowledge and practices in various seasons, and how they change according to access and availability of food and impact nutritional status of children <5

Objective 3: To learn about the seasonal incidence of diseases and understand community knowledge, beliefs and practices on health and diseases that increase the risk of malnutrition and morbidity

Objective 4: To explain why the already chronic (child) malnutrition rates were exacerbated by the drought and why aid interventions were relatively less effective in reducing the heightened rates of malnutrition. How the project was implemented In-depth qualitative analysis and field research to understand contexts, challenges and opportunities for integrated WASH & Malnutrition response in drought situations – Kenya (& Somalia)
Development of integrated response strategies
Development of integrated response tools – including assessment and community education & engagement tools Old Hat, New Name…And So What? New Name
‘Integrated Programming’—the way forward.
Integrate: WASH and food security/livelihoods; food security and nutrition; WASH and nutrition…

And So What…
All agencies agreed but few appeared to do it.
Organizational mandates, sectoral divisions continued to persist.
Where was the evidence to show it was done?
How to do integrated programming? What tools?
Oxfam initiated an exploration of what it means to implement integrated programming in the field…how to translate theory into practice in a drought context. Old Hat, New Name…And So What? Old Hat…
UNICEF Framework-Oxfam Adaptation.docx
The importance of addressing WASH-malnutrition links:
Child survival research: Poor nutrition and inadequate water/sanitation/hygiene contribute to child morbidity and mortality.
Drought contexts: access to adequate food and water affected, increasing the risk of opportunistic infections and transmission of water-borne/communicable diseases.
In chronic / recurrent drought contexts: chronically high rates of malnutrition exacerbated by periods of acute drought. Background and Rationale Worst drought in the horn of Africa in 60 yrs, 12.4 million affected spread in Kenya, Ethiopia, Uganda & Somalia
Young children most at risk
Unprecedented high malnutrition rates – GAM up to 40% and SAM of up to 24%
Could not continue as business as usual – public health actors needed to re-look at their approaches!
Humanitarian agencies implementing Public health employed same approaches/tools used in acute/sudden onset emergencies.
This project sought to develop public health approaches/tools that:
Fitted drought context
Synergetic in addressing increasing GAM & SAM rates Integrating WASH and Malnutrition response in Drought & Food Crisis What, Why and How We Did in Turkana, Kenya
Sheila Ramaswamy,
Public Health Promotion & Nutrition Support
&
Jesee Wainaina Kinyanjui ,
Global Public Health Advisor Hyperlink to PDF of Atabo’s story cards Sample of Turkana integrated community health IEC materials – The story of Atabo What does this mean for us here How will we respond to the next drought/malnutrition related emergency
Would the analysis and materials developed so far be useful
What else/more do we need to do
Full transcript