EFFECTIVE DELIVERY OF MICRONUTRIENT POWDER SUPPLEMENTS BY COMMUNITY HEALTH WORKERS IN WAJIR
INTRODUCTION
For the last 11 months, Save the Children, through funding from the World Food Program (WFP) has been supporting the Wajir County Department of Health (DOH) to distribute Micronutrient Powder Supplements (MNP) to malnourished children aged 6 to 23 months using a number of strategies. Whilst significant progress has been achieved through the project, MNP coverage remains persistently low and further efforts will be needed to combat anaemia and other micronutrient deficiencies – and in doing so, improve the nutritional status of young children in Wajir.
WHAT ARE MICRONUTRIENT POWDER SUPPLEMENTS?
After six months of age, when children start receiving semi-solid foods, intake of several vitamins and minerals can be insufficient to meet a child’s requirements, thus increasing their risk of developing anaemia and other micronutrient deficiencies. Micronutrient powders are single-dose packets of vitamins and minerals in powder form that can be sprinkled onto any ready to eat semi-solid food consumed at home, school or any other point of use. The powders are used to increase the micronutrient content of a child's diet without changing their usual dietary habits.
WHY DO CHILDREN IN WAJIR NEED MNP?
Micronutrient deficiencies are widespread in the industrialized nations, but even more so in developing countries. Based on the 1999 national micronutrient survey, micronutrient deficiencies are highly prevalent in Kenya, especially among children under five years and women. The most common micronutrient deficiencies include: vitamin A deficiency (VAD) among under-fives (84.4%); iron deficiency anaemia (IDA) among 6-72 month olds (69%) and pregnant women (55.1%); iodine deficiency (36.8%), and; zinc deficiency among children under 5 years (51%) and mothers (52%). Feeding practices for young children are poor in Kenya. Nationally only 39% of children aged 6-23 months are fed in accordance with recommended Infant and Young Child Feeding Practices. The worst hit region is North Eastern Kenya. Improving nutritional status and reducing vitamin and mineral deficiencies are integral to achieving Kenya’s Vision 2030 and the Sustainable Development Goals (SDG).
HOW HAS THE PROGRAMME BEEN DELIVERED? – AN EXAMPLE FROM DILMANYALE HEALTH CENTRE
Dilmanyale health centre is located 21km away from Wajir south sub-county headquarters and it is among the health facility that has been implementing the MNP programme targeting children aged 6-23 months. The facility has two Community Health Workers (CHW), two nurses and one community health extension worker (chew). They work together as a team to implement integrated High Impact Nutrition Interventions (HINI).
The MNP programme implementation started well in the facility in November 2014 and has routinely been conducted with other health and nutrition activities. To date, the health workers have registered 157 beneficiaries (74 male, 83 female). Each facility has a target, derived from 30% of their <5 catchment population; the target for Dilmanyale is 247. The MNP programme faced a lot of challenges in uptake at the beginning, largely because the product was new and the community did not accept it immediately. The fact that the start of the programme coincided with the beginning of the Deyr short rains season which lasts from October to December also affected uptake. Due to the rains, the community experienced an outbreak of diarrheal diseases which they mistakenly attributed to the MNP. The health facility staff came up with a strategy on how to increase MNP uptake and utilization at the household level. They decided to integrate MNP into the CHW kits to ensure supplementation of MNPs is done alongside Vitamin A, deworming and other HINI components. After integrating the powders in their kits, the CHWs continued conducting house to house mobilization, sensitization, and distribution to reduce misconceptions around the product and this increased the coverage.
RAHA’S STORY
Raha Sirat, aged 22, has been a CHW at Dilmanyale health centre since 2013. She does her routine job such as community referral, mobilization and sensitization as well as providing HINI services such as providing Vitamin A, deworming and micronutrient supplementation at the household level. To reach more beneficiaries, the health workers came up with a sketch of the community map, divided the villages and assigned each CHW to a specific number of villages. Raha was assigned to two densely populated villages (Bulla Horra and Bulla Wagberi) since she is perceived to be the most active CHW in the facility.
During the monthly MNP distributions, Raha usually puts MNP, Vitamin A and Albendazole into her kit together with various reporting tools such as tally sheets, Expanded Programme on Immunization (EPI) defaulter register and MNP register to enable her trace beneficiaries from the villages and give them the supplements. Raha manages to distribute the MNP to all of the registered children in her villages. According to Raha, ‘as a community health worker I face numerous challenges when implementing integrated health and nutrition services but I believe that my mission in life is not merely to survive, but to thrive; and to do so with passion and compassion so that I feel proud of my work’
Dilmanyale is a sparsely populated location and it is difficult to find more children aged 6-23 months eligible for enrolment to the program. As a result, the facility could not reach its target. To avoid missed opportunities for MNP program, the facility monitors children graduating to six months using the EPI register and immediately enrols them into the program. This has helped to increase the facility’s coverage which is currently approaching its target.
WHAT ARE THE INITIAL OUTCOMES OF THE PROGRAMME?
Integrating micronutrient powders into the CHWs kit has worked well in Dilmanyale facility: 57 beneficiaries have been discharged during the program to date. Raha said, ‘There were divergent views from the community before as some people said it was bad while others said it was good. However, the entire community currently views the program positively.’ According to the information from the CHWs, community resistance on MNP has reduced since the integration process started and more community members are now demanding the powders as they understand that they contain essential nutrients. Raha says, ‘There is a lot of pressure coming from the community because people believe that we are paid huge amounts of money to give out these services. On the other hand, we are given a small stipend that is somewhat not worthy to mention. I however believe that my work is going to fill a large part of my life and the only way to be satisfied is to do what you believe is right’.
Raha said, ‘EPI defaulters have reduced and MNP consumption has improved though I feel some difficulty in going from one house to the other. I do believe change will come gradually. I am trying my best and will continue telling the community that we can't help everyone but everyone can help someone to reach more people. I will continue encouraging them to keep volunteering so that we meet the desired results.’
August 2015Author: Abdi Mohamed Abey