Successful Community Nutrition Programming:lessons from Kenya,Tanzania,and Uganda

Learning from success is the most effective and efficient way of learning.This report brings together the main findings of a series of assessments of successful community nutrition programming carried out in Kenya, Tanzania, and Uganda between 1999 and 2000. The overall aim of the assessments was to identify key lessons, or the main driving forces behind the successful processes and outcomes in these programs. Such elements of success fundamentally have to do with both what was done and how it was done. Experience with community-based nutrition programming, as documented in various syntheses and reviews during the 1990s, does show that malnutrition can be effectively addressed on a large scale, at reasonable cost, through appropriate programs and strategies, and backed up by sustained political support. In most cases, successful attempts to overcome malnutrition originate with participatory, community-based nutrition programs undertaken in parallel with supportive sectoral actions directed toward nutritionally at-risk groups. Such actions are often enabled and supported by policies aimed at improving access by the poor to adequate social services, improving women’s status and education, and\ud fostering equitable economic growth. Successful community-based programs are not islands of excellence existing in an imperfect world. Rather, part of their success has to do with contextual factors that provide an enabling or supportive environment. Some of these contextual factors are particularly influenced by policy, some less so. Contextual factors may include, for example, high literacy rates, women’s empowerment, community organizational capacity and structures, appropriate legislation. Nutrition program managers cannot normally influence contextual factors, at least in the short term.\ud In addition to favorable contextual factors, certain program factors contribute to successful programs, such as the design, implementation, and/or management of the program or project, which can, of course, be influenced by program managers. Both contextual and program factors, and the way they interact, need to be identified in order to understand the dynamics behind success. In 1998, under the Greater Horn of Africa Initiative (GHAI) supported by the United States Agency for International Development (USAID), nutrition coalitions were formed in Kenya, Tanzania, and Uganda. These nutrition coalitions, comprising individuals representing government, non-governmental organizations (NGOs), donors, academic institutions, and the private sector, seek to advance the nutrition agenda both in policy and programming through coordination and advocacy efforts. One of the first tasks of the nutrition coalitions, under the leadership of the Program for Applied Technologies in Health (PATH) in Kenya, the Tanzania Food and Nutrition Centre (TFNC) in Tanzania, and the African Medical Research Foundation (AMREF) in Uganda, was to prepare an inventory of community nutrition programs in their respective countries and identify of better practices in community nutrition programming. Country teams, supported by USAID/REDSO/ESA and LINKAGES/AED, then selected three successful programs in their respective countries based on preestablished "process" and "outcome" criteria. UNICEF has a long history of promoting and supporting community-based programs in Eastern and Southern Africa and has supported many reviews and evaluations. As part of its continued effort to strengthen community-based programs by learning from new success stories, UNICEF also identified for review a relatively large scale successful program in Tanzania\u