Community Nutrition Project (CNP)

Project Background

The state of Azad Jammu and Kashmir portrays a gloomy picture in terms of health and nutritional status of its population. In AJK, young children and women are among the most vulnerable groups from nutritional point of view. The National Nutrition Survey (NNS) 2011 shows an alarming nutritional situation in this respect. The results reveal that 32 percent of the child population in the state is stunted, 18 percent wasted while 26 percent children are underweight. This is clearly an indication of a  worst malnutrition scenario in the state.
Furthermore, the survey also narrates that, under-nutrition is one of the main causes of death among infants and young children in the country. Those who survive have less capacity to learn and gain education which eventually harms their productivity at adulthood, thus impact negatively on economy. This  undernourishment  causes  inabilities  those  affect  performance  at  all  stages  of  life.  Similarly, according to NNS 2011 there are other issues exists in the state related to malnourished children are micronutrient deficiency including iron, anemia and vitamin A&D.

In this connection, for a child, the period from beginning of pregnancy to 24 months of age and then till 60 months are critical for nutrition. Women in pregnancy requires special nutritional needs and after giving the birth she requires energy and nutrients to make her breasts milk nourishing to her baby. Similarly, young children need good quality nutrition to provide them opportunity to grow and develop their mental and physical abilities to full potential. Otherwise, it can be compromised forever.

Keeping in view the above facts, AJK Rural Support Program with the support of WFP has started the initiative name “Community Based Management of Malnutrition (CMAM) initiative in four districts (Neelum, Muzaffarabad, Huttian Bala and Havali) of AJK. The project directs all its focus at mother and young children which certainly provides a window of opportunity to get them out of the vicious circle of malnutrition. Provision of nutritious food along with education and awareness to promote healthy nutritional practices are the prime activities are focused in the project.

Partnership with WFP

AJK Rural Support Program entered into an agreement with World Food Program (WFP) on 1st of July2013 to implement Community Based Management of Malnutrition (CMAM) Program in four districts of Azad Jammu and Kashmir. Districts include Muzaffarabad, Neelum, Huttian Bala and Havli. The project was proposed to be started by the 1st of July 2013 and to end at October 31, 2013. As per FLA, a total of 171 MT foods were to be distributed to moderately acute malnourished children (6-59 months of age) and pregnant and lactating women at the agreed rate of PKR.92783/MT.

Whereas, the allocation of caseload among each targeted district was determined on the basis of intensity of need and population size. In each targeted district, an External Distribution Point (EDP) was established except in district Neelum where two EDPs were established keeping in view the toughness of its terrain and scattered outreach area. Where, WFP’s consignments directly used to bring the foods at each EDP. From where, to bring the food closer to the beneficiaries’ door step, AJKRSP itself arranged the secondary transport to carry the food from EDPs to Basic Health Units (SFP sites) based in all targeted districts.

 Targeting and social mobilization

AJK Rural Support Program has actively involved existing community networks, community groups, women groups and mother groups at each stage of the project. Particularly, in targeting, social mobilization, sensitization and exclusion and inclusion process, community participation has remained very helpful. Field activities have mainly been organized and executed from BHUs exists at community outreach level. At each BHU, a Nutrition Assistant along with an outreach worker were deputed to carry out day to day activities i.e. screening, registration, food distribution, follow up and record keeping. For screening, AJKRSP field team visited door to door to examine the nutrition status of the target groups.

In this respect, the assessment has been carried out on the basis of blanket coverage. To identify the malnourished cases, anthropometry techniques have been adopted. The children in the age group of 6-59 months  having  MUAC  >12.5  cm  and  <11.5  cm  and  those  having  no  medical  complication  were registered  for  treatment.Similarly,pregnant  and  lactating  women  having  MUAC  >  21  cm  were considered  for  supplementary  feeding  treatment.  Once,  the  cases  identified  in  outreach  were immediately referred to the respective BHUs for enrollment. Before registration at BHUs, each and every referred case was verified and cross checked by measuring another time their MOUC so as to avoid any error in identification. To promote the usage of the food, field team has frequently been involved  in  sensitization  and  social  mobilization  process  in  the  community.  In  this  respect  the community groups i.e. women groups, mother groups and the other community organizations in the areas were actively involved and sensitized to promote the best health practices in the society. At the time of food distribution, each beneficiary was imparted counseling in order to promote the best health practices and the best usage of the food.

Logistics and Food Distribution mechanism

AJKRSP arranged EDPs at the center place of each targeted district for the storage of the food commodities. Storekeepers at each EDP was responsible to receive the food dispatched by WFP and maintained proper record of all food commodities and verified all items mentioned in waybills or any loss or difference against actual quantities. He used to receive two copies of waybills, one copy was sent back to WFP after duly signing and stamping and the second was kept for office record. Stock register and Material Received Note (MRN) was maintained regularly along with display of stock card at all EDPs. While during shifting of food from EDPs to BHUs, Material Issued Reports (MIR) were signed and maintained. The selected beneficiaries were issued ration cards depicting distribution date, time, place and MUAC of each beneficiary so as to avoid any type of hassle, over crowed and interruption. In this respect, food distribution was made after checking CNIC of each beneficiaries and also confirming his/her name in screening and registration registers.

Store keeper at each EDP was responsible for handling and storage of food as per WFP defined standards. Further, to ensure the food security, two security guards were deputed at each EDP. While, at BHU, Nutrition Assistant was responsible for food management and security. The Storekeeper based at EDP in each targeted district was responsible to provide day to day technical guidance to Nutrition Assistance in order to manage all logistical arrangements related to requesting, handling and storage of food.

 Reporting and Monitoring

AJKRSP followed a participatory monitoring process  to  track  the  project  performance and  smooth execution of project activities. This included active engagement of community networks, community elders and the beneficiaries to regularly oversee and monitor the field activities. In addition to this, the combined field visits of AJKRSP monitoring staff along with representatives from health departments were facilitated on frequent basis so as to seek in time technical guidance and strengthen the process of cross verification and confirmation of achievements .For this purpose,  a series of review meetings have also been organized at BHUs, district and head office level to get regular feedback from all stakeholders so that in case of any deviation, the timely corrective measures could be taken.

To maintain regular flow of information, field monitors were responsible for collecting information from field and from distribution points and shared them back in district office on daily basis. From where, District Project Offers used to shared the information to AJKRSP head office. For cross verification purposes, M&E officer along with Project Manager based in head office conducted field visits on regular intervals in order to gather both quantitative and qualitative information. Thus, on the basis of the information gathered, the M&E Officer used to consolidate the reports on weekly and monthly basis and regularly shared with WFP. AJKRSP monitoring team also collected information on the outcomes of the activities to gauge the impact of outputs. In this respect, regular interaction with the beneficiaries community groups and other stakeholders were conducted to get feedback in order to maximize the benefits and the impact of the project.