Supporting maternal, infant and young child nutrition in the context of COVID-19: the Rwanda risk communication and community engagement (RCCE) response

This is a summary of a Field Exchange field article that was included in issue 65. The original article was authored by Annet Birungi, Ken Limwame, Desire Rwodzi and Youssouf Koita

Annet Birungi is a Communication for Development Specialist at UNICEF Rwanda.

Ken Limwame is currently working on the COVID-19 RCCE in the Middle East and North Africa with the UNICEF Regional Office.

Desire Rwodzi is a former Knowledge Management Officer for the Nutrition Section with the UNICEF Eastern and Southern Africa Regional Office (ESARO).

Youssouf Koita is the Chief of Nutrition Section at the Rwanda Country Office.

Approach

Nutrition interventions in Rwanda continued during the COVID-19 pandemic as directed by the Government of Rwanda and the United Nations National COVID-19 Joint Taskforce. Programme adaptations were developed to ensure that nutrition activities, such as growth monitoring and severe acute malnutrition (SAM) treatment, continued with minimal risk to staff. Implementing an effective risk communication and community engagement (RCCE) response was critical to the continuation of nutrition services. This provided Rwandans with continuous access to accurate information about the pandemic, including the related impacts on nutrition, and allowed them to make appropriate decisions to protect their own and their family’s health.

Development of Rwanda’s RCCE strategy

The COVID-19 RCCE strategy was developed by the Ministry of Health (MoH) and nutrition partners, including UNICEF. The following activities were central to the strategy’s development and success:

• Ensuring a centralised coordination structure

Led by the MoH, two sub-committees were set up to develop and implement the RCCE strategy. One focused on nutrition data management and the other on social behaviour change and communication.

• Building on existing strategies and available data

The RCCE strategy was built upon the national plan for Ebola preparedness. Information from government reports, mainstream media and social media reports was used to identify knowledge gaps and perceptions on nutrition and COVID-19, as well as any related myths and misconceptions. This information was supplemented with insights from community health workers (CHWs) and used to generate key maternal, infant and young child nutrition (MIYCN) messages in the context of COVID-19 and to develop related information, education and communication (IEC) materials (see Box 1). These were revised regularly as the pandemic shifted.

• Developing mechanisms for capacity strengthening and training

Since COVID-19 was a new and ever-changing disease, the training and capacity strengthening of nutrition staff and CHWs was essential. This was achieved through simplifying digital MIYCN training material and conducting remote training using Zoom, WhatsApp, email and telephone conversations. In a report produced by the Rwanda Biomedical Centre in December 2020, CHWs reported being confident in conducting nutrition counselling, growth monitoring and home visits during the pandemic as a result of the training.

• Ensuring a wide range of communication channels  

To ensure broad engagement, nutrition messages were shared widely across all available communication channels. These included print and electronic media (WhatsApp, group emails and virtual/telephone briefings) as well as mass media communication channels such as community radio stations. Members of Parliament (MPs) were engaged to share nutrition and health messages through local radio stations. During radio talk shows, MPs were able to discuss issues related to food security and MIYCN as well as to answer listeners’ questions. Media channels were also used to share testimonials from mothers to address rumours and misinformation.¹ The UNICEF-led initiative, Internet of Good Things, was used to reach those with low connectivity.

Results

Results in several key areas suggest the success of the RCCE strategy:

• Admissions for treatment of SAM, coverage of growth monitoring and coverage of distribution of micronutrient powder to children 6 to 23 months remained similar or even increased relative to pre-pandemic levels suggesting the continued confidence of community members in utilising services.
• Hygiene practices improved. Social media and community-level monitoring revealed that mothers reported washing their hands with soap and running water more frequently than prior to the COVID-19 pandemic.
• Community feedback showed that caregivers appreciated MIYCN counselling by CHWs in person and approximately 85% of caregivers were reached in this way. By the end of May 2020, approximately three million people had received the key nutrition messages via radio broadcasts. Community feedback suggested that caregivers appreciated the radio talk shows. The use of mobile platforms allowed frontline workers to continue nutrition education during the pandemic.

Challenges

• Despite strong MIYCN messaging to the contrary, myths and misconceptions around infant and young child feeding and COVID-19 continued and spread throughout the pandemic, particularly through social media. In some cases, this resulted in breastfeeding mothers being separated from their infants for the two-week isolation period when the mother was a suspected or confirmed COVID-19 patient.
• Considerable delays in the approval of key messages for IEC materials were experienced.  Continued stakeholder engagement through the coordination structures helped to overcome this challenge.
• Limited access to resources (e.g., personal protective equipment, clean running water, soap and alcohol rub) restricted the ability of CHWs to provide timely nutrition counselling services in some cases. 

Conclusion

As the COVID-19 pandemic continues, it is vital to continue adapting RCCE messages, broadening ways of communicating and tackling myths and misperceptions. Vital learnings that will inform this process include:

• Clearly defining roles was effective in optimising nutrition RCCE and ensuring the efficient use of resources.
• Adapting existing regional and global tools and guidance allowed for the development of contextualised nutrition-related RCCE activities.
• Remote online training was useful in building the capacity of frontline health workers.
• Using a variety of channels to disseminate RCCE messaging allowed for broad sharing of accurate information.
• Working with parliamentarians to champion advocacy and social mobilisation to improve nutrition at all levels was critical to support RCCE initiatives.

As a next step, the Government of Rwanda intends to conduct a rapid assessment to understand the impact of RCCE messages on behaviour and further support improvements to nutrition-related RCCE interventions.  

For more information, please contact Annet Birungi at abirungi@unicef.org