Implementation challenges and successes of an AG4Nut project in the eastern region of Burkina Faso

Box 1: EHFP

• A communal garden or VMF is established in each village, including infrastructure such as a well when possible.
• In this VMF, women learn improved gardening and animal husbandry practices.
• Interactive nutrition education improves their understanding of the causes of malnutrition, including suboptimal health, hygiene and nutrition behaviours, and potential solutions.
• Women are encouraged to establish individual gardens and to apply improved infant and young child feeding and hygiene practices within their families.
• Gender empowerment activities support more equitable intra-household decision-making. Activity examples include group discussion with men and community leaders to improve women’s access to land, and improving women’s capacity to manage income resulting from surplus production.
• As a result, participants cultivate micronutrient-rich foods, improving dietary diversity of children and families, combatting malnutrition and improving child health and growth.

When they have mastered the new production techniques, beneficiary women are encouraged to establish an individual garden and apply the techniques at household level. Those who have established individual gardens have fresh micronutrient-rich foods available almost year-round, most of them very close to the homestead. Produce includes dark green leafy vegetables (spinach and other traditional leaves, jute mallow, baobab), carrots, orange-flesh sweet potatoes (OFSP), beans, sesame, moringa, okra and eggs. The leader farmers and other trained volunteers, such as grandmothers (who have an important influence on childcare practices in these communities), continue to support the women with group discussions on nutrition and hygiene topics. They also conduct home visits to support small, doable changes in nutrition and hygiene practices that fit the reality, aspirations and needs of households.

The community-led total sanitation (CLTS) approach is also used to improve sanitation and community hygiene practices (visit www.communityledtotalsanitation.org for more information). CLTS, first developed by Kamal Kar in Bangladesh in 1999, is a methodology for mobilising communities to eliminate open defecation – a key element in the disease-spreading cycle of faecal-oral contamination. Since simply providing toilets does not guarantee their use, CLTS focuses on the behavioural change needed to ensure sustainable change in practice. This is achieved through a series of awareness-raising activities to create disgust about open defecation and motivate a community to undertake collective change. Hygiene committees are set up and hygiene agents are identified by the communities to perform outreach and household visits, during which they urge households to take key actions, such as construction of latrines and hand-washing stations, and to reinforce the importance of hand washing.

In one of four experimental arms of the RCT (new EHFP; old EHFP+WASH; new EHFP+WASH; old EHFP+WASH+LNS distribution (old EHFP are projects implemented since 2010; new EHFP are those implemented since 2013)), HKI is also providing lipid-based nutrient supplement (LNS) in 15 villages to all children six-23 months for an 18-month period (start at six months and continue to 23 months). This approach is being tested based on the experience that food-based approaches may not be sufficient to reduce the high burden of micronutrient deficiencies, in particular anaemia. Every month, beneficiary children receive a supply of LNS to allow daily consumption of one 20g sachet; distribution is at the community level but overseen by health workers from the nearest health centre. During the distributions, children are screened for acute malnutrition and suspected cases are referred to the health centre for diagnosis and treatment if necessary. In addition, these events provide another occasion for reinforcing nutrition messages and for organising demonstrations of recipes for nutrient-dense complementary foods based on garden production and other locally available ingredients.

To ensure high quality results, activities are regularly supervised by field agents from HKI and by agents from community-based organisations, as well as government agriculture, health and animal husbandry offices trained by HKI. These partners also actively participate in the project-steering committee that meets every quarter.

Lessons learned and successes

Monitoring to date suggests that CHANGE is contributing to increased production of nutritious foods and improved nutrition practices, which in turn is expected to improve nutrition and health status in participating households. Reinforcing the links between agriculture and nutrition is an explicit aim of the model and is ensured by village farm leaders and grandmothers. After almost three years of implementation, the following outputs have been delivered:

In total, 2,494 direct beneficiaries have been trained in improved gardening and animal husbandry techniques through 60 VMFs established in an earlier phase. Project staff and partners have supported local VLFs, community health workers and grandmothers to reach more than 2,000 beneficiary women each year with Essential Nutrition and Hygiene Actions (ENA-EHA), using the model farm as a platform to gather, debate and encourage participants to take their newly-acquired knowledge home. More than 2,700 home gardens have been created in the project area, extending the availability of fresh micronutrient-rich vegetables from only three months per year to almost year-round.

Salmata Zidwemba, a beneficiary farmer from Kalwatinga village: “In the dry season [when few vegetables are available], I would prepare for her a dish with fresh vegetables from my garden. Impressed, she would taste it and ask, ‘How can you have all these vegetables in the dry season?’ This would convince her to visit my garden and learn to do the same.”

The project emphasises safe and sustainable production techniques, including bio-pesticides and organic fertilisers, which can be produced from ingredients that are easily available in these communities. It also supplies drip irrigation systems to reduce the labour burden on women and on water resources. As Sana Azaratou, one of the beneficiary women from Abaza village reported following training, “Organic fertiliser is very important! My soil is weak and the crops don’t do well without it”.

The activities of this project are attracting the attention of other community members. Project staff have noticed spill-over to non-beneficiary households in both intervention and non-intervention villages, who have begun growing vegetables at their homes, feeding their children more diverse and nutritious foods and using improved nutritional practices. They too decided to set-up home-gardens, established plots on their own and requested training to help them produce properly. In response, HKI mobilised resources and provided training to an additional 1,200 women. This effect is particularly encouraging and suggests that the project is meeting a felt need in these communities.

Project-monitoring data also suggest that sales of surplus production have enabled the mothers to improve the family diet by purchasing high-value foods that are not produced in the garden or to cover other crucial expenses such as health or school fees. This has also increased women’s influence over important household decisions. OFSP, which is particularly rich in beta carotene and promoted by HKI and others to address vitamin A deficiency, is observed as being increasingly cultivated in household gardens and VMFs. Many households now own more than 20 chickens and are feeding eggs to young children: According to latest monitoring data, about 80% of children under five consume eggs regularly. Monitoring data also shows that 92% of women are consuming leafy greens, 92% of children consumed meat and poultry product and 65% of children ate fruit and other vegetables rich in Vitamin A during the previous seven days. It also appears that the income generated by the selling of the surplus is allowing women more autonomy in expenditures for children’s health and education.

The results to date of the CLTS activities are also very encouraging. The approach is conducted in 45 villages by hygiene committee members trained by HKI, who monitor latrine construction and promote good hygiene practices among the community. In the words of Djaneiba Naba, the chair of one of these committees: “For me, there aren’t things that are difficult to change; there are just things that we don’t know about yet. Like with latrines, we used to think they were just too expensive to build; now we know this is within our reach and the men have already started digging. The rest will come in time.”

The CLTS approach has been integrated into a nutrition-sensitive agriculture approach to increase the impact on child nutritional status. Infections increase nutritional needs while reducing nutrient uptake. Environmental enteropathy, in which constant faecal-oral contamination results in changes to the intestines, significantly impacts absorptive and immunologic functions. It is thus fundamental to tackle hygiene and nutrition at the same time to achieve the expected results.

Monitoring results suggest that while nutrition knowledge and practices are improving, more efforts are needed in areas such as feeding the sick child and the integrated control of anaemia. Men appear increasingly convinced that home gardens contribute to family health and are encouraging their wives to continue the gardening activities during the rainy season, when staple crops are usually given priority. Men are also contributing by investing in henhouses of more durable materials.

The project is guided by a steering committee comprised of various stakeholders, including representatives from the regional and provincial directorates of agriculture, animal husbandry, environment, women’s promotion and health as well as local community-based organisations. During the quarterly meetings, achievements and challenges are discussed and recommendations provided to improve the project implementation and to find solutions to problems related to the local context, give advice and make decisions if necessary. These partners are also closely following project progress through periodic field visits. The mechanism is helping to build ownership of the project that should continue after external support ends.

Challenges

The major challenge of implementing an agriculture-oriented nutrition project in Burkina Faso, and in particular in the eastern region, is access to water. Water is fundamental not only for gardens but also optimal hygiene. If gardens must be watered by hand using distant sources, the labour burden may have unintended negative consequences on women’s and family health. Drip-irrigation systems are only a partial solution, as in some locations silt levels in the water lead to clogging. The hard and rocky soil also makes digging latrines more arduous.

More approaches are needed to strengthen women’s legal access to land. Currently the garden plots do not belong to women and can thus be repossessed at any time. Encouraging evolutions in community norms have been observed (Van den Bold, Pedehombga et al, 2013) but much still needs to be done in this field. It is also important to be vigilant to make sure the additional responsibilities for gardening are not detrimental to child-care activities. It is even more challenging to reconcile production objectives and child wellbeing during the rainy season, when mothers are staying in the fields far from health facilities while the risk of malaria and diarrhoea diseases increases. During the rainy season the family relocates to focus on staple crop production, making it difficult to reach beneficiaries with project training and behaviour change activities and LNS distributions.

The contributions of the community relays are considerable. However, high levels of illiteracy pose significant challenges in Burkina and the ability to learn is limited among illiterate community relays. Images are used in job aids as much as possible, but abstract concepts are more difficult for low-literacy volunteers to understand and master. Routine project reporting is also often weak.

Finally, sustainability remains a major challenge in the local context. The project has endeavoured to create a supportive enabling environment, building the capacity of individuals as well as institutions, and experience suggests that positive outcomes can be achieved with limited external supports. Continued engagement of local authorities and the recognition of their contribution to the fight against malnutrition will be crucial to fully hand over the key project activities.

Conclusions

The experience in Burkina Faso shows that integrating nutrition and agriculture into a multi-strategy and cross-sectional approach project is an essential ingredient to fighting the multiple and interrelated determinants of undernutrition. Monitoring data must be used to increase the effectiveness of such interventions and evaluation data will provide more evidence of what works best.

For more information, contact Regina Khassanova, tel: +226- 25 36 00 23 or Marcellin Ouedraogo, tel: +226 25 36 00 23

References

Aguayo V.M., & Baker S.K., (2005) Food and Nutrition Bulletin 26 (4): 348-355, Vitamin A deficiency and child survival in sub-Saharan Africa: A reappraisal of challenges and opportunities.

EDS, 2003. Enquête démographique et de Santé.

ENIAB, 2014. Enquête national d’iode et d’anémie.

Micronutient Initiative/UNICEF, 2004. Vitamins and minerals: A global damage assessment.

Van den Bold M., Pedehombga, A., et. al. (2013) IFPRI Discussion Paper 01315 Can integrated agriculture-nutrition programs change gender norms on land and asset ownership? Evidence from Burkina Faso.

¹An Ag4Nut Project seeks to realign existing agricultural approaches and encourage new ones in order to better meet the nutritional needs of the target population.