Case Studies on Leaving No One Behind

7. A holistic approach to tackling malnutrition and its consequences in Burkina Faso, Mali and Niger

Raymond Midelaire

Nora Loozen

Malnutrition has serious negative consequences on health, especially on the health of the most vulnerable

Malnutrition has a negative impact, especially on vulnerable groups such as women and children under five years old. Several studies show the correlation between nutritional deficits and profound cognitive deficits in young children; the consequences can be disabling, or even fatal in the case of severe acute malnutrition. While the treatment of acute malnutrition is now effective, stimulation and psychosocial support are not yet standardised. The ESSPOIR programme (Les Enfants malnutris du Sahel sont Stimulés, Protégés, Orientés et Intégrés dans leur communauté devenue plus Résiliente - Malnourished Children of the Sahel are Stimulated, Protected, Oriented and Integrated in their Community Become More Resilient) was implemented in sharply deteriorating security situations in Burkina Faso and Mali, and in the Maradi region of Niger where malnutrition is escalating. The health systems in the three countries have little knowledge of the benefits of “psychosocial and physical stimulation” in managing malnutrition - physiotherapy in particular.

A comprehensive and holistic approach to tackling malnutrition and its consequences

ESSPOIR is a project implemented by Handicap International in three countries of the Sahel - Burkina Faso, Niger and Mali - with funding from the Belgian Directorate General for Development Cooperation and Humanitarian Aid (DGD).

The programme aims to prevent and reduce the risk of complications and disabling sequelae in children under five years old with malnutrition and/or showing signs of delayed development in order to enhance their development. In particular, the project aims to strengthen the capacity of communities and families to meet the specific needs of malnourished children by providing access to developmental care and improving resilience to chronic crises. Psycho-social and physical stimulation improves nutritional recovery and limits disabling sequelae. Parental and appropriate psycho-social support helps the families of malnourished children and the communities in which they live to develop and provide stimulating, protective, secure environments for the children. With support, community, institutional and governmental actors are able to play a protective role for the most vulnerable children and families. Tackling the problem in a comprehensive manner does not just focus on helping to combat malnutrition but also integrates awareness-raising of the benefits of stimulation and psycho-social support in communities and health centres.

Focus on strong involvement of local communities, raising awareness and partnerships with institutional actors

The ESSPOIR project has improved knowledge and enhanced attitudes and practices in the fight against malnutrition among a significant number of communities. The project has equipped and operationalised 37 centres dedicated to practicing stimulation, stimulated 39 194 children, provided 159 183 adults with information on malnutrition, made nearly 10 000 home visits and trained close to 500 local leaders. The project has affected many people living in areas where malnutrition is most chronic.

Several lessons can be drawn from the difficulties, challenges and successes encountered during the project, these include:

• The involvement of community beneficiaries enables sustainability. The establishment of local monitoring committees and the involvement of mother‑educators have demonstrated the effectiveness of the approach, particularly for building referral networks for children and providing support to vulnerable families.

• The integration of stimulation and awareness-raising activities has had positive effects on the psychomotor recovery of malnourished children. Seeing this recovery has made people aware of the effects of malnutrition and is helping end taboos regarding malnutrition and developmental delays.

• Co-operation with institutional staff working in the early childhood and nutrition sector has encouraged complementary activities, shared expertise, enhanced synergies and developed partnerships for improving management of malnutrition.

• Institutional advocacy has made it possible to integrate psychosocial stimulation activities into socio-health planning and health centres.

Towards institutionalisation of the approach

To sustain these approaches to managing malnutrition it is necessary to advocate for integrating provision for psychosocial management of malnutrition in the budgets of local authorities. Such allocations could fund stimulation activities, notably purchasing or manufacturing toys and supporting mother-educators. In addition, creating synergies with other partners is important to build bridges with community-based organisations to ensure continuity and sustain community activities. Seizing opportunities to push for institutionalising psychosocial and stimulation services for vulnerable children will be a priority for Handicap International and its partners going forward.

For more information please contact Laurence Gerard, Responsable Partenaires Institutionnels, Handicap International Belgium at [e-mail].