Here you will find links to other OVC resources available on the Internet This link provides you with a printer friendly version of the OVC Toolkit in Adobe Acrobat format! Please give us your comments and suggestions for the OVC Toolkit! If your Internet connection is slow you can copy the Toolkit to your computer and browse it from there!
DO I NEED THIS TOOLKIT?
WHAT DO I NEED TO KNOW?
WHAT DO I NEED TO DO?
WHAT'S SPECIAL ABOUT MY SECTOR?
ØCAS, PRSP AND PRSC
ØMulti-sector demand driven (CDD)
ØMulti-country HIV/AIDS (MAP)
ØPost-conflict projects
ØEarly child development (ECD)
ØEducation
ØHealth
ØTransport
ØEnergy
 
Recommended Reading:

Waivers and Exemptions for Health Services in Developing Countries

A World Bank assessment of Targeted Conditional Transfers Programs

The FRESH web site

Promoting Psychosocial Well-Being Among Children Affected by Armed Conflict and Displacement: Principles and Approaches

International HIV/AIDS Alliance – FHI – OVC Support Toolkit: Health and Nutrition


  OVC in Health Sector Programs

Addressing OVC Nutrition

Many of the OVC groups we have discussed in this toolkit are likely to be under-weight and stunted for their age. There are also a high percentage of children in the developing world, who may not fit into any of the OVC categories we have focused on in this toolkit, but who lack adequate nutrition and are, therefore, more vulnerable than their peers. The World Bank-funded program described below was designed to improve the nutritional status of children under the age of three, primary school children, and pregnant and lactating mothers in Madagascar. The strength of the Community Nutrition II (SEECALINE II) project is that it offers a continuum of nutrition interventions, both community-based and school-based, that make it feasible to reach some out-of-school OVC. Furthermore, the approach outlined below could possibly be merged with a more aggressive home visitor program component that could address a wider range of OVC needs – particularly in HIV/AIDS affected households – and serve as a means of identifying OVC who may be out-of-school because they are caring for a sick relative, are severely disabled, or who are being abused by their caretakers.

COMMUNITY NUTRITION II – Madagascar

The Community Nutrition II project was a follow-on to an IDA financed project designed to address Madagascar’s high child malnutrition rates. In 1998, stunting was evident in 50 percent of Malagasy children under five. The project involved an investment of over US$40 million ($27.6 million to come from IDA) over five years.

The project sought to achieve tangible and sustainable results in combating malnutrition by improving the capacity of village communities to address its determinants and increasing the quality and quantity of food intake by children at home. Specifically, the project sought to:

  1. Reduce underweight in children under three by 30%
  2. Reduce vitamin A deficiency among children under three by 30%
  3. Reduce parasitic infections among pre-school and school-aged children by 25%; and
  4. Increase community awareness of malnutrition and improve the capacity of communities to take appropriate action to address the determinants of malnutrition.

The project had four main components:

  1. The Community Nutrition Program (PNC), which would focus primarily on pregnant and lactating mothers and under 3 year old children
  2. The School Nutrition Program (PNS), which would focus primarily on children enrolled in primary school, as well as some primary school-aged children out of school
  3. Inter-sectoral activities in the health sector, which involved training health workers on the Integrated Management of Childhood Illness (IMCI), and in the agriculture sector to disseminate technical guidelines on improved diversification and storage of agricultural and food products.
  4. Information, Education, and Communication (IEC) training and project management

The Community Nutrition Program supported the following activities:

  1. Growth monitoring and promotion for children under three;
  2. Food supplementation for malnourished children under three and pregnant women;
  3. Vitamin A supplementation for children under three and lactating women;
  4. Rehabilitation of severely malnourished children;
  5. Information, education and communication (IEC) and community mobilization; and
  6. Support to community-based activities aimed at improving nutrition workers and social workers.

The School Nutrition Program supported the following activities:

  1. Iron/folate supplementation for enrolled primary school children;
  2. Deworming of enrolled and non-enrolled children aged 3 – 14 years;
  3. IEC as well as nutrition and hygiene promotion in the classroom;
  4. Monitoring of the iodization of salt;
  5. Support of school based activities aimed at improving nutrition and hygiene in the school environment; and
  6. Training of primary school teachers in nutrition and hygiene.

The implementation arrangements for the project included an Advisory Committee including representatives from the ministries of Education, Health, and Agriculture, donors, and NGOs, and a national Project Coordination Unit assisted by regional coordination units. The regional coordination units were responsible for implementing the community nutrition program at the village level in collaboration with NGOs; the Ministry of Education was responsible for implementing the School Nutrition Program; and the Ministry of Health and Agriculture were more tangentially involved in implementing component 3.

Given our interest in reaching out-of-school OVC, we will focus on the Community Nutrition Program and suggest ways that it might be adapted to more successfully reach the OVC targeted in this Toolkit.

As a first step, districts with a child malnutrition rate over 43 percent were targeted. NGOs were contracted by the regional coordination units to implement the project at the community level. The plan was to establish community nutrition centers within the targeted districts, each serving a population of 2000 people, which initially meant directly serving approximately 220 children under 3 years. After the mid-term evaluation, this figure was lowered 180, to allow for better quality service and more time with severely malnourished children. The final decision of whether or not to locate a community nutrition center in a village was made by the contracted NGO and depended upon whether the community had taken the initiative to find an appropriate site for the center and to select a Community Nutrition Worker.

The Community Nutrition Workers (CNW) were for the most part women with the necessary technical, organizational, and social skills to run the site, which in practice meant that she should be able to read and write, have experiences with taking care of children and be good at listening and advising women. The CNWs were elected by their communities and then put through 10 days of initial training to prepare them for starting up project sites. This initial training included information on how to register women and children for the centers, growth monitoring, cooking demonstrations, and nutrition education. The CNWs had difficulty following the training course content, so the curriculum was later adjusted to make it more practical and hands-on and less theoretical. Since they were expected to work full-time, the CNWs were paid, but at a below-minimum wage in an attempt to build sustainability into the model.

As their first task, the CNWs had to register all children 0 – 3 years old and pregnant women in the community. In a model of this project adjusted to better address a wider range of OVC, this activity could serve as a means of identifying other OVC in a community, who may not fall into either of these two categories, but are in need of improved nutrition or other special services. During the registration process, children were weighed and measured. This information was recorded on the child’s health card, kept by the mothers, and updated regularly at the community nutrition center.

While food supplementation was considered as an important aspect of the community nutrition program early on, in part as a result of the legacy of the nutrition program that preceded this project, its importance declined during the project implementation period as it became evident that the lack of food is not the main factor causing malnutrition. Over time, more emphasis was put on addressing micronutrient deficiencies, the correct case management of sick children, and on activities that served to change the behaviors of mothers. These included cooking demonstrations and nutrition and hygiene education. In making this change, the project enhanced the long-term impact and sustainability of its investment. Regional and national radio broadcasts were used to transmit messages on nutrition in the form of interviews, sketches and songs, to complement the CNW’s educational efforts. Regional and national newsletters were also developed and read by the CNWs to the women the served. The CNWs also organized campaigns and competitions to ensure that children received their Vitamin A supplements. This activity was carried in partnership with the local health center. Immunization services were also offered at some of the nutrition sites.

While not a central part of their work, the CNWs did make home visits, first at the beginning of the project to identify the seriously malnourished children and then later, but only to the homes of malnourished children whose parents were not participating regularly in growth promotion sessions. This aspect of the project would need to be expanded under an adapted version of the project serving a wider range of OVC groups.

For the OVC groups that the toolkit targets, such as children living in AIDS affected households, disabled and abused children, the training should target older caretakers, and thus emphasize non-formal education styles, and be diversified to cover a wider range of relevant issues. Clearly, in expanding the scope of such a program, more community workers would be necessary and each capable of addressing a wider range of issues. An approach used by the project to make it more sustainable might be a way of increasing the number of CNWs without significantly increasing the project cost. The trained CNWs organized mothers support groups to assist them as volunteers in carrying out their duties.

One aspect of the project that was never fully implemented was the Community Evaluation and Micro-projects sub-component. The community evaluation was envisioned as a participatory activity involving the community in identifying the causes of and contributing factors to malnutrition in their own area. The project had funds available to finance micro-projects that could help mitigate the conditions contributing to malnutrition. The contracted NGO was expected to lead this process, but most were too busy just establishing and supervising Community Nutrition Centers. For an adapted model of this project, tailored to the needs of a more diverse group of OVCs, this community evaluation would be a good opportunity to shape the role of the community center to the specific needs of the OVC in the community. It may be useful in establishing a community committee that would be responsible for helping the CNWs to identify children and households most in need of services. (LINK to community targeting section.)

Throughout the life of the project, more than 3,600 community nutrition sites were established, each serving about 180 children and mothers for a total number of direct beneficiaries of close to 650,000. A quick and dirty calculation, using the total cost of the Community Nutrition Program (US$28.11 million), yields a rough cost per direct beneficiary of $45, which would be considerably lower if one includes all of the indirect beneficiaries (for example, the children who were not direct participants in the nutrition centers, but whose mothers received education). Likewise the cost per beneficiary would decline if one expanded the range of services to be offered by the centers to a wider range of OVC. If we also include the 2 million primary school children served in the 9,000 schools that participated in this project, the cost per beneficiary is only US$2.12 per child reached.


Select a topic from the menu to go directly to the page of your interest: