In Mozambique, the dreadful fact is that 38% of all children under-5 suffer from chronic malnutrition. In 2013, the Government launched a five-year national plan to reduce chronic malnutrition – called the PAMRDC. The objectives of this plan include strengthening nutrition education, improving the health of adolescent girls, reducing micronutrient deficiencies; increasing levels of exclusive breastfeeding, improving family diets and the better use of locally available food.
Tete Province was the first Province to develop its own action plan to achieve these objectives. With the help of numerous stakeholders, including children and as part of the education component of this plan, a government team in Tete devised a rights-based child-focused nutrition education programme, Children’s Participation in Learning and Action for Nutrition (PCAAN – in Portuguese). Children for Health was engaged for two years to provide mentoring and training and other technical support.
The PCAAN programme has recognised:
Between January 2014 and December 2015 and with funding from DANIDA and USAID, the PCAAN approach to Nutrition Education was created and tested by teachers and other stakeholders in 15 schools: 12 in Tsangano District and 3 in Tete City.
Tsangano is a district in Tete Province with high levels of chronic malnutrition despite high levels of food availability. The programme is structured around eight nutrition topics, all linked to the objectives of the PAMRDC, the National Primary School Curriculum plus health messages created for families by the Provincial Ministry of Health.
During regular fortnightly Saturday morning sessions, twenty-five child members of the School Club learn and adapt nutrition messages and practice activities with their adult facilitators – usually a teacher and a member of the community. Fun, engaging methods are used like drawing, singing, puppetry, dancing and role-play.
Between the fortnightly School Health Club Sessions, children share messages and demonstrate activities with children at their grade level at school, using formal school time allocated for ‘local curriculum’ – a characteristic of the decentralized Mozambique primary school system.
Following this school-based activity, all children at the school from Grades 4-7 are tasked to work together to plan and share messages and conduct outreach activities with other children and younger siblings at home and in the community and in so doing become nutrition activists. This is nutrition education by children, with children, for children. It is nutrition education that begins in a club – is shared in the school and then is shared again with families and in the community.
The PCAAN programme began with a training of 60 teachers, community youth workers, school principals and community leaders. 120 Children also joined this workshop for three afternoons of practical work. Since then we have had several other workshops to build capacity and to co-create a suite of pedagogical materials that are closely tied to the specific abilities and constraints of the classroom. We have also developed tools to help the teachers and education officers at different levels monitor and evaluate the progress of the nutrition education in the schools and its impact on family practices. In 2015, we conducted a training of trainers’ workshop and helped to facilitate an evaluation of the programme with the University of Zambezia. We have a case study that documents the successes and challenges of the programme to date in its pre-pilot phase.
We characterise this PCAAN Programme phase as a ‘pre-pilot’ as the practitioners themselves helped a great deal in the creation of the materials to be tested at the next phase. This involved three rounds of training, practice and feedback. Thus it is only at the end of this phase that we have completed the tools, methods and curriculum.
During the co-creation process, teachers requested that we co-create a Children’s Recipe Book and story books linked to the eight topics in the programme. In 2016. four children’s storybooks were created and completed and each of them linked to stories of change in the programme. For example, the story ‘Everyone Counts’ is about the families buying plates so family food can be shared out fairly and portion sizes more closely monitored so everyone in the family gets a balanced diet every day.
The characters in the stories are named after teachers who are very actively promoting the programme in their schools.
Towards the end of the pre-pilot, the PCAAN programme team requested that we help them develop a poster to visualize key messages and activities that could be used with existing and new schools as the programme plans to scale. This PCAAN poster was developed.
During the programme period, we have explored the use of SMS as many school are remote and it’s hard for district teams to get the fuel and transport to get to the schools. This is still ongoing.
The programme is currently reaching around 6,000 children and their families in 12 villages in Tsangano District, Tete province and 3,000 children and their families in Tete City. The PCAAN programme has been designed carefully alongside teachers and children to make it easy to replicate in all school throughout Tete Province without too many additional resources. The programme is also catching the interest of those involved in designing and running nutrition programmes throughout Mozambique. Several schools in Maputo have also taken up some of the PCAAN ideas with the help of a local NGO as a result of the participation of Maputo –based medical advisers participating in training in Tsangano. It is heart warming to observe that the programme has the capacity to spread organically.
At the end of 2016 we are very proud to have helped co-create:
In November 2016, this suite of materials are undergoing final editing and translation. In addition we are planning to assist with the making of a documentary film on the programme and best practice films to be used by Master Trainers as they roll out the programme.
All these materials are now available for free from our Resources section.
More than anything Clare has loved worked with the teachers and with the manger of the team in Tete, Bibiche Sangwa. Bibiche and one of the teachers in this programme, Lourenco Govate, won the Children for Health inaugural Hugh Hawes Outstanding partner Award of 2015.
Without the skills, enthusiasm and dedication of the practitioners involved, the development of this programme would have been very tough as we did not know the country and Clare does not speak Portuguese.
This programme reminded us to be realistic about the length of time it takes for a programme to take root. And that the more patience and the more too and fro that can be done, the stronger the programme grows.
This programme has also taught us how vulnerable even government programmes are to the experience and skills of those funding and/or advocating for the it.
Clare describes her involvement in PCAAN as one of the most fulfilling pieces of work in her career – perhaps because of the opportunities to steer the programme over a long period.
We wish PCAAN and the team every success and we hope to be involved as it goes from strength to strength.
For more information on this exciting programme please check out these links:
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