SUN CSN Secretariat team site visit to Kenya

SUN Civil Society Alliance in Kenya – “From Zero to Hero”

One flight from London to Nairobi and some Giraffe and Cheetah sightings later my first day as the new Scaling Up Nutrition Civil Society Network (SUN CSN) Country Support Officer started in Nairobi. Titus Mung’ou, chair of the newly formed SUN Civil Society Alliance (CSA) in Kenya showed Claire Blanchard, SUN CSN coordinator, and I some of the sites in Nairobi and explained why he is so passionate about the CSA “Beholding the launch of our CSA on 9th May was like receiving a new-born baby in my arms. I am confident the future is bright in Kenya’s quest to scale up nutrition.”We were lucky to witness a Civil Society Network Kenya Steering Committee and Member meeting. It was truly inspiring to see the passionate and committed way in which local and international NGOs have started to galvanise and coordinate around the issue of nutrition. It hasn’t been an easy process as Titus is first to admit “The journey to the establishment of Kenya’s SUN Civil Society Alliance seemed bumpy at first. But gradually many partners embraced the idea and joined us to develop the terms of reference and a proposal for funding. The rest is history”. Those partners now number 29 and growing. They include organisations working on nutrition, agriculture, education and health. Given the number of organisations agreeing on the direction they are taking together can sometimes be challenging though not unsurmountable. Sometimes it is important to disagree professionally and progress together, as James Adede from a local NGO – The Grassroots Alliance for Community Education (GRACE Africa) says “We have had professional disagreements but we agree to disagree and move on.”As the CSA is in its’ infancy it was great to have Zambia CSO-SUN Alliance Coordinator, William on hand to share his experiences of setting up a civil society alliance. The CSA in Zambia has successfully secured funding for their activities and is working towards becoming an independent organisation, though this again has risks. This is testament to the coordinated approach Zambia is taking and the support that the CSA has received there not to mention William’s enthusiasm, drive and so essential leadership. William spoke of the challenges the CSA faced in Zambia and also the value of building on existing networks “one thing that has really helped us has been networking. There are many CSOs that have been there before ourselves and so these networks have introduced us to their networks.”The SUN CSAs in Zambia and Kenya are both lobbying for increased funding for nutrition and greater political visibility at national levels. With stunting rates at 35.3%[1] in Kenya and 45.4% in Zambia[2] there is a long way for each country to go to reduce the chronic under nutrition which leads to stunting. However, I have no doubt that they will achieve their goals. As Action Against Hunger Kenya Mission, Country Director Panos Navrozidis said “we have never had this before in Kenya. This is a new model of working and we are seeing changes. We have gone from zero to hero”.

[1] Demographic Health Survey (2008) Kenya

[2] Demographic Health Survey (2007) Zambia

When Monitoring Matters

Nairobi is where the Workshop in support of the SUN movement on Monitoring, Implementation and Demonstrating Results for Nutrition was taking place. Monitoring and evaluation is rarely a topic viewed as interesting or vibrant, perhaps drawing to the keen individuals fascinated with spreadsheets, figures and indicators but with sometimes little connection to real actions. Not so for the SUN movement event! We heard from countries in the throw of a multi-sectoral nutrition coordination revolution. From Malawi to Uganda, Kenya to Mozambique we heard from inspiring interesting new ways of ensuring that nutrition leaps from its health silo and into the water, agriculture, finance and IT sectors. We saw how high level support at a Prime Minister level as in Uganda can drive collaborative action between ministries and lead to better data collection. We learnt of how Ethiopia has used the SUN developed RiSK methodology to analyse factors affecting stunting and taken positive action to pilot interventions in key districts. SUN movement early risers – who joined the movement at its inception spoke of how they have advanced, with Mozambique highlighting the importance of their civil society and multi-sector cooperation via the multi-stakeholder group which brings government line ministries, donors, civil society, business and the UN networks together for nutrition.In his afternoon intervention David Nabarro emphasised how for the SUN network “pull must come from the countries and then the global network can respond”. If the requests to the SUN Civil Society Network are anything to go by then I have no worries about country interest – The SUN Civil Society Network has more than doubled in the past year now numbering 30 countries either with Civil Society Networks or on the road to creating them.

Tackling under nutrition in kibera; Mbagathi district hospital-Kenya

The Mbagathi District Hospital Maternal and Child Health outpatient unit surprises me with its stillness and order. We have arrived late in the afternoon and so missed the rush of the morning. The stillness echoes the calm manner of Esther Kwamboka, a Nutritionist at the hospital who has kindly agreed to take time from her busy schedule to show us around.The hospital serves a catchment that includes the famous Kibera slum – no-one knows the size of Kibera but estimates a range from 500,000 to 1 million residents. Those living in Kibera have little access to decent sanitation let alone good nutrition. To compound this, their community is served solely by community health workers – these are little more than volunteers, who get a monthly stipend of Kenya shillings 2000 or 22USD. Yet, they play a vital and often overlooked role in ensuring that the local community has access to healthcare and nutrition services. The Maternal Child Health and nutrition unit alone treats approximately 90 mothers and their infants each week.Kwamboka tells us that the hospital is uncharacteristically ‘well’ staffed compared to other Government Hospitals offering the same level of Healthcare. Thanks to a temporary team of interns. A ward which would be overseen by one doctor for every 40 patients now has small teams of interns monitoring each room in the ward. However, their supervision is a challenge due the overwhelming workload of one Nutritionist. Each patient’s nutritional status is assessed on a daily basis to monitor progress, a HIV test is administered and optimal nutrition discussed and Micronutrient supplementation (Vitamin A, Iron Folic Acid, Zinc sulphate) as is appropriate for both mothers and children is done before they leave the Hospital. However, while interns currently help to ensure that there are sufficient staff it is clear that this is not enough as their stay is short-lived and only Kwamboka will be available to manage the entire ward.The government of Kenya recently made Maternity Healthcare free, yet the means to implement this have not been so forthcoming. This has resulted in the maternity ward being forced to operate a quick turn-around time with women discharged 6 hours after giving birth and only women who encounter the unpredictable events that can occur in childbirth such as the need for a caesarean section or women experiencing difficulties feeding their infants after giving birth are given consideration and can stay longer.One of the most distressing aspects of our visit is seeing the acute malnutrition ward where we find four mothers and their babies – some looking extremely frail and listless. We learn that they are undergoing intensive treatment for acute malnutrition which if left untreated would lead to long-term health problems such as poor brain development, mental retardation and weak organ development. The causes of infant malnutrition here are diverse and a result of poor socioeconomic status of the catchment population, seasonal food shortages, lack of knowledge regarding nutrition and underlying illness and disease. In the case of one young mother the desire to continue her schooling meant leaving her baby in the care of relatives who did not feed her child well.The work undertaken in this hospital is absolutely vital – without it these children might not be here. Yet, given Kenya’s poor progress towards meeting the MDG on maternal health and the fact the country will not meet other MDG targets to reduce child mortality and eradicate hunger and poverty by 2015, it is clear that there is more to be done. This is why the coordinated multi-sector, multi-stakeholder, multi-level approach to address the multiple burdens of malnutrition adopted by the SUN movement is so necessary – policy changes and commitment at government level though important, alone are not enough. Sustainable financing and a vibrant and engaged civil society, amongst other ingredients, are also required to make change happen.

Cara Flowers, SUN Civil Society Network country support officer