Promoting Orange-Fleshed Sweet Potatoes for Child Health
At the request of the provincial government, Helen Keller International will promote production, marketing, and consumption of vitamin A-rich orange-fleshed sweet potato (OFSP) in Mozambique’s Tete Province, reaching 21,000 families (105,000 people) across seven districts. The project will combine training and support for improved cultivation techniques with promotion of the Essential Nutrition Actions (ENA) for the first 1,000 day period (conception to age 2 years). This project will have a special emphasis on increasing consumption of OFSP by nutritionally vulnerable household members. This commitment will scale up a model tested in the Chi?ta District of the Tete Province.
Through training in vine multiplication, vine dissemination and proper cultivation techniques, this project will build local capacity to reproduce and grow vitamin A-rich varieties of OFSP. Training will follow a cascade structure in which master trainers at district agriculture offices, local NGO partners and HKI project staff train 200 local farmers as decentralized vine multipliers. These decentralized vine multipliers will in turn provide clean planting material and information on correct cultivating practices for the 21,000 families reached with the nutritional counseling and behavior change strategy.
Each Care Group will select a ‘Lead Mother’ to be trained in ENA. The ENA framework promotes optimal nutrition practices including: women’s nutrition, breastfeeding, complementary feeding, feeding the sick child, vitamin A, and the integrated control of anemia, vitamin A, and iodine deficiency. ENA is comprised of the evidence-based interventions highlighted by the Lancet Series on Maternal and Child Undernutrition (2008 & 2013) and the World Health Organization (2013). This nutrition training is also delivered in cascade, with HKI training master trainers in the district health office and local NGO partners. Through her Care Group, the Lead Mother will be responsible for reaching pregnant women and mothers with children under two years with counseling on optimal nutrition practices especially related to infant and young child feeding.
The International Potato Center (CIP) will also partner to provide technical assistance and capacity building for OFSP training and production, as well as OFSP cuttings. The International Potato Center currently works with HKI to advocate for increased investments in OFSP and to build institutional capacity in designing and implementing gender-sensitive projects to promote OFSP.
The three-year project will be implemented across all districts beginning September 1, 2014 (start of Year 1). Major project activities are described by year and by quarter starting from this date.
– Organize start-up, semi-annual and end-of-project meetings and workshops with key stakeholders (Year 1, Quarter 1; ongoing)
Training and Capacity Building:
– Train 200 decentralized vine multipliers (community members who will serve as a local source of information on correct cultivating practices and clean planting materials for local dissemination of OFSP) (Y1, Q4; Y2, Q1)
– Train 2,000 community volunteers (‘Lead Mothers’) in ENA and social and behavior change communication (Y2, Q1/Q2; Y3, Q1/Q2)
Community Mobilization and Behavior Change Communication (BCC):
– Organize Care Groups and select Lead Mothers in each community (Y1, Q4; Y2, Q1; Y3, Q2/Q3)
– Conduct mass community sensitization/mobilization to promote adoption of ENA and OFSP (Y2, Q2 to Y3, Q4)
– Provide inputs for permanent OFSP cutting/vine multiplication sites to allow sustainability of OFSP production and project outcomes (Y1, Q2; Y2, Q1/Q2; Y3, Q1/Q2)
– Purchase and distribute equipment for vine multiplication plots (Y1, Q2)
– Develop voucher system for vine distribution to participant families and deliver vines to all participant families (Y1, Q2; Y2, Q1/Q2; Y3, Q1/Q2)
– Establish OFSP vine multiplication plots and cultivate clean planting material (Y1, Q3)
Advocacy and Policy Development:
– Work with the local partners to develop advocacy plans with intermediate and long-term goals (Q2; ongoing)
– Document the lessons learned in order to advocate for provincial scale-up plans and inform that process (Y2, Q2; Y3, Q3)
– Advocate with government leaders and other stakeholders to support OFSP investment and promotion of OFSP (Y1, Q4; Y2, Q3; Y3, Q2)
Monitoring and Evaluation:
– Conduct formative research including project baseline survey (Y1, Q2/Q3)
– Develop M&E system and conduct ongoing monitoring of activities and outputs (Y1, Q2; ongoing)
– Conduct end line study and analyze change/outcomes (Y3, Q3)
– Analyze and disseminate results (Y3, Q4)
Approximately 842 million children and adults in the world are undernourished and an estimated 2 billion are affected by micronutrient deficiencies (FAO, IFAD and WFP, 2013; FAO, 2013). Malnutrition stunts physical and mental health, causes blindness, and is the single largest contributor to child mortality. Nearly half of all deaths in children under five years of age are caused by poor nutrition, resulting in more than 3 million child deaths in the world every year (Black, 2013). Diets poor in vitamins and minerals especially contribute to this burden of preventable malnutrition and death. In particular, children with vitamin A deficiency, which affects about 40% of the developing world’s children under five years of age, have a 25% higher rate of dying due to a weaker immune system (WHO, 2009; Imdad, 2010). Vitamin A deficiency is also the leading cause of preventable blindness in children.
Despite improvements over the last decade, inadequate or insufficient dietary intake remains a leading barrier to child health and survival in Mozambique. Approximately 69% of Mozambican children under the age of five suffer from vitamin A deficiency, with consequent impaired immune systems and risk of blindness (WHO, 2009). The rate of stunting, or chronic malnutrition, is 43%, resulting in lifelong cognitive and physical deficits (MDHS, 2011). While the traditional diet in Mozambique often provides enough energy, it is low in micronutrients, prematurely leading to an estimated 163,000 deaths a year in children under age five (ESAN-II).
Helen Keller International (HKI) has worked in Mozambique since 1997, developing, testing and scaling innovative strategies to combat malnutrition. In 2012, with the support of Irish Aid, HKI began promoting biofortified orange-fleshed sweet potato (OFSP) in Mozambique’s isolated Tete Province. Promoting the production and consumption of OFSP has been shown by international experts to be an efficacious and effective strategy for addressing chronic malnutrition, offering a source of income to women and their families, and an extremely rich source of vitamin A and energy for young children and their mothers.
HKI has achieved good progress toward the wider promotion, production, and consumption of OFSP in Mozambique. Activities to date have focused mainly on program planning and community mobilization and engagement.
HKI is utilizing a training of trainers model in order to establish a cohort of local farmers to cultivate, reproduce, and sell OFSP vines. As part of this strategy, two primary multiplication fields have been established in addition to one decentralized field. Through these fields, the 200 decentralized vine multipliers, all of whom are local farmers, will be trained early in Year Two. These farmers will become experts on the vine and its cultivation, enabling them to share knowledge with their local community members.
This project also utilizes women action groups known as Care Groups whose members seek to improve nutrition by both growing OFSP and sharing knowledge about optimal nutrition practices, including the benefits of incorporating OFSP into their family diets, especially for young children from 6 months of age. Each Care Group comprises 10 local mothers who will receive training and guidance from maternal and child health nurses. HKI engaged in a series of participatory community meetings in order to identify women to serve in the lead mothers role.
Additionally, HKI conducted a baseline survey that gathered data to be used at the end of the project in determining the extent of the project’s impact. The baseline survey combined qualitative and quantitative data collection on household exposure to OFSP and knowledge, attitudes, and practices around essential nutrition and hygiene actions promoted by the World Health Organization to mothers and caregivers of children under two years of age. HKI has also begun mentoring government agents and providing on-site support to community groups to help them master OFSP production techniques. Joint monitoring visits continue to be conducted by HKI and local government partners.