'Before SNV introduced the Sustainable Nutrition for All (SN4A) project in our district, the growing and consumption of vegetables and fruits at home was considered unimportant. Animal protein rich foods such as meat, poultry and fish were reserved for the household head and the children if they were lucky got only sauce. In the last three years, we have witnessed a significant change as more household heads begin to appreciate the importance of ensuring that their children consume nutrient rich and diverse foods to grow up healthy and not stunted. Most households now consume at least 3 meals a day that constitute of vegetables, fruits, and animal protein. I believe that stunting with time will be history in our district,' Harriet Katusiime the Deputy Chief Administrative Officer and Chairperson Kyenjojo district nutrition coordination committee narrates.
Expectedly, the agrobiodiversity index score (a tool that interprets data about the number of edible crop species found in the household’s food system and number of domestic animals bred for food) in the three project districts improved from an average of 9.8 in 2018 to 16.7 at the end of 2020.
Cascading the Uganda Nutrition Action Plan to the grassroots
The Government of Uganda developed the Uganda Nutrition Action Plan (UNAP) II as a framework to implement the National Nutrition Policy. UNAP II 2020-2025 empathises reduction in stunting through homemade solutions like households taking lead in availing necessary nutritious foods in their families. The plan was intended to support the roll out of the policy across the country to reduce the prevalence of malnutrition in Uganda and its impact on individuals, households, and communities. Its implementation however did not take off in many districts across the country with 2.2 million children under 5 years (29%) suffering from stunting (low height-for-age), according to the Demographic and Health Survey (DHS) (UBOS and ICF 2018). Without a common messaging and action plan, many districts struggled to implement the nutrition action plan.
Recognising that most of the actions needed to address malnutrition were already embedded within the mandates of the various key departments in the districts, SN4A with funding from the Swiss Agency for Development & Cooperation Agency set out to equip stakeholders with knowledge, tools, and support to leverage resources and move the nutrition agenda forward. All the three project districts - Kasese, Kyenjojo and Kakumiro were supported to develop their Nutrition Action Plans which plans were subsequently cascaded down to sub-county Nutrition Action plans in line with UNAP II and District Development plan III. The project also sought buy-in for improved nutrition as a top priority from the leadership across the three districts.
Triggering for better nutrition outcomes
At the household level, the project used triggering as an approach to induce behaviour change. Communities were engaged to understand the critical factors for improved nutrition including production, consumption, care, and sanitation practices so that they can ably reflect on how their habits are impacting their lives, particularly the physical and cognitive development of their children.
Once the triggering process was successfully undertaken, 1,200 Nutrition Action group (NAG) members were selected by community members across the three districts as nutrition champions to support the change process.
The NAGs were trained on the SN4A approaches so that they can facilitate triggering within their communities. Households were supported to formulate their own solutions with locally available resources which contributed to the development of Village Nutrition Action Plans. Currently, there are 100 multisectoral Nutrition Action Plans at village level, three sub-county nutrition action plans and three District Nutrition Action plans that are reviewed on a quarterly basis across the three districts. Despite the restrictions on movement brought about by COVID-19 the NAGs, due to solid local structures, remained operational while observing the standard operating procedures.
By the end of December 2020, more than 17,200 households in Kasese, Kyenjojo and Kakumiro had adopted good practices of production and consumption of vegetable, fruits and animal source foods which were previously neglected. Consumption of three meals with at least five food groups per day, also increased from 88% in 2019 to 89.2% in 2020 despite the COVID-19 pandemic that affected the economic activities in most rural areas in Uganda.
The District Nutrition Coordination Committees (DNCCs) in the three districts have successfully mobilised most of the Nutrition implementing partners and organisations in the districts (like CARE Uganda, SAVE the children, World Food Program and Government of Uganda Multisectoral Food security and Nutrition Project) to adopt some components of the SN4A model especially triggering and the five-finger approach. The DNCCs also scaled the model to four additional sub-counties in Kasese and Kyenjojo without financial or technical support from SNV.