Lessons From SC UK Evaluation in DRC

By Anna Taylor, Nutrition Advisor, SC UK

Summary of internal evaluation

Save the Children UK (SC UK) began implementing emergency health and nutrition interventions in eastern Democratic Republic of the Congo (DRC) in 1998, with initial activities in North and South Kivu and North Katanga. The current programme of work began in June 2002, when the geographical focus was confined to a number of health zones in North Kivu. The rationale for this refocusing was to strengthen management of the programme and better monitor its impact. An evaluation was carried out in November 2003 and was conducted as a participatory process involving SC UK's health and nutrition team and government partners. Information was gathered through:

A 13 year old boy engaged in co-operative farming in DRC

Key findings

Since June 2002, SC UK's emergency nutrition and health programme in eastern DRC has made considerable progress in implementation of planned activities and delivery of inputs/ outputs. Box 1 details the main project activitiesof the programme.

The programme has contributed to enhanced skills and capacity of government and NGO staff - especially in nutrition and cholera prevention, improved access to basic health and nutrition services, and greater involvement of communities, including children, in health, nutrition and HIV/AIDS interventions. Implementation of the National Nutrition Protocol is well underway. Routine monitoring reports suggest that therapeutic and supplementary feeding centres have achieved Sphere Minimum Standards on several key indicators.

On the other hand, the performance and quality of the work has been constrained by a number of factors, not least the wide geographical spread of the programme, engaged in a diverse range of activities and often lacking in clear focus. Difficulties working at a distance through poorly motivated government partners and the absence of a 'Protocol' (memorandum of understanding) with Provincial/Zonal Health Bureaux to delineate roles and responsibilities between SC UK and government have also hindered progress. Other limitations have included weak logistics support for the programme activities, reported problems with cash flows to carry out the work, and weaknesses in management and administration capacity internally and in government structures. Episodes of insecurity have also hampered activities.

The decision to work through existing structures, in partnership with local government authorities, local NGOs, UN agencies and other international agencies was appropriate for the context of eastern DRC. A significant strength of the programme approach has been the flexibility to switch to and from an emergency mode, while following developmental principles - for example, the flexibility to open and close nutrition centres according to findings of nutrition surveys and local needs in specific localities. The project has adapted to the changing needs and policies of government as the national security and political situation improved. It has also seized opportunities for working with and through local NGOs.

The evaluation highlighted a number of gaps and weaknesses in project design. Key amongst these were the following:

Box 1 Main project activities

  • Construction/rehabilitation of health and nutrition facilities at selected sites . Provision of essential equipment and recurrent supplies (medical/non-medical)
  • Training and support to health staff on topics such as nutrition, cholera prevention/management, disease surveillance, malaria, rational drug prescribing, vaccination, supervision systems and PRA/PLA techniques
  • Facilitating vaccination activities in areas where coverage rates are low
  • Strengthening early warning systems for communicable diseases
  • Awareness raising on HIV/AIDS among youth/school children
  • Conducting nutrition surveys/screening for malnutrition, and establishing, supporting and closing feeding centres
  • Distribution of seeds and tools provided by the Food and Agricultural Organisation (FAO) and training local agronomists and community volunteers in improved agricultural techniques
  • Studies to get a better understanding of the health/nutrition situation and needs of communities
  • Pilot activities such as operational research on community financing mechanisms,community nutrition and early warning systems to test out approaches for scaling up or replication by others
  • Documentation and dissemination of lessons learned and advocacy

Lessons learned

Amongst the many lessons learnt, the following were key to nutrition programming:

A realistic assessment of the capacity, skills, time and resources required to implement a project in a context such as eastern DRC is essential at the design stage. A programme with a wide geographical spread and many different activities and partners makes heavy demands on management and logistics. Supervision and support carried out at a distance is costly, particularly if it involves travel by air.

The investment in time, skills and resources to ensure a high quality of service at therapeutic and supplementary feeding centres should not be under-estimated, particularly where services are implemented through local partners.

A clear, comprehensive National Nutrition Protocol is an important tool for improving the management of severe malnutrition. However, a system needs to be developed so that TFC staff can provide feedback on the practical lessons, observations and issues from implementation of the Protocol. This information could be used to inform further refinement of the Protocol at national level.

Health officials/hospital directors need to appreciate the importance of ensuring that TFCs are staffed by teams of nutritionists and nurses trained and supervised to implement the National Nutrition Protocol. The practice of rotating new nurses to a centre each month is not an effective strategy. The management of severe malnutrition calls for a combination of nursing and nutrition skills, these skills can only be built over a period of time working in feeding centres.

When planning rehabilitation/construction work for health/nutrition facilities, it is important to consider the full package of requirements to meet international standards for emergencies. If it is not possible for the project to support all aspects of the package (e.g. water and sanitation facilities, incinerators), steps should be taken to try and secure support from government, communities or other agencies.

The recurrent cost implications of constructing new buildings should be careful considered before finalising plans. Temporary structures for feeding centres may be a more cost effective option.

Prompt analysis of nutrition survey data is essential for mounting a timely response to high levels of malnutrition. If there is limited capacity within the government system for this work, SC UK could offer technical support.

For further information, contact Anna Taylor, Nutrition Advisor, SC UK, email: A.Taylor@scuk.org.uk

More like this

FEX: Learning from nutrition interventions in Eritrea, Ethiopia and Kenya

Summary of evaluations1 SC UK survey team in Eriteria SC UK recently evaluated a number of emergency nutrition responses undertaken in Eritrea (Gash Barka and Northern Red...

FEX: From Pilot to Scale-Up: The CMAM Experience in Nigeria

By Maureen Gallagher, Karina Lopez, Stanley Chitekwe, Esther Busquet & Saul Guerrero Maureen Gallagher is the Technical Coordinator for ACFInternational in Nigeria since July...

FEX: Outpatient therapeutic programme (OTP): an evaluation of a new SC UK venture in North Darfur, Sudan (2001)

Summary of internal evaluation1 by Anna Taylor (headquarters nutrition advisor for SC UK) North Darfur experienced a severe drought in 1999 and 2000. This caused widespread...

FEX: Livelihoods analysis and identifying appropriate interventions (Special Supplement 3)

3.1 Livelihoods assessment and analysis in emergencies The livelihoods framework provides a tool for analysing people's livelihoods and the impact of specific threats or shocks...

FEX: Capacity development of the national health system for CMAM scale up in Sierra Leone

By Ms Aminata Shamit Koroma, Faraja Chiwile, Marian Bangura, Hannah Yankson and Joyce Njoro Aminata Shamit Koroma is National Food and Nutrition Programme Manager, Ministry...

FEX: Lessons learned in West Darfur: challenges in assessment methodologies

By Aranka Anema Aranka Anema has a background in medical anthropology. She is currently working with MSF-Holland as Medical Editor and has been involved with the Nutrition...

FEX: GPS assisted coverage survey in DRC

By David Rizzi David Rizzi graduated in Pharmacy and later took an MSc in Development at the Rome University La Sapienza, Italy. He holds a second MSc in Public Health...

FEX: Difficulties of impact assessment in ‘semi-emergencies’

By Tayech Yimer, Anne Marie Mayer and Arabella Duffield Tayech Yimer is a nutritionist with SC UK in Ethiopia. Anne-Marie Mayer has worked with SC UK for nine months in...

FEX: Effectiveness of public health systems to support national rollout strategies in Ghana

By Michael A. Neequaye and Wilhelmina Okwabi Wilhelmina Okwabi is Deputy Director of Nutrition of the Ghana Health Service (GHS), a position she has held for 2 years. Her...

en-net: WFP DRC IS SEEKING A NUTRITION ADVISOR

Terms of Reference: Nutrition Advisor/World Food Prorgamme/Kinshasa, DRC Background Despite large investment and government renewed committed to combat malnutrition, the...

FEX: Technical and Management issues within CTC (Special Supplement 2)

4.1 CTC from Scratch - Tear Fund in South Sudan By Ed Walker (Tearfund) Beneficiaries collecting their general ration in South Sudan. Tearfund has been working in Northern...

FEX: Case Studies (Special Supplement 2)

3.1 CTC in Ethiopia- Working from CTC Principles Isolated village in the highlands of South Wollo, Ethiopia. By Kate Golden (Concern Ethiopia) and Tanya Khara (Valid...

FEX: Nutrition security emergency programming in diverse urban contexts

By Marie Sardier, Joanna Friedman, Maureen Gallagher and Julien Jacob Marie Sardier is Food Security and Livelihoods Advisor with Action contre la Faim (ACF) in Paris...

FEX: Introduction (Special Supplement 3)

Glossary AAH Action Against Hunger ACF Action Contre la Faim ACF-E ACF-Spain ALDEF Arid Lands Development Focus AREN Association pour la Revitalisation de l'Elevage...

FEX: New vacancies website

Save the Children UK would like to announce the recent launch of its new vacancies website. On these pages you will find all of SC UK's current global vacancies, details on how...

en-net: Senior Nutritionist MYAP - Uganda - Concern Worldwide

Reference: ES/SN/UG Country: Uganda Job Title: Senior Nutritionist MYAP Contract Grade: B Contract Length: 2 years Date Needed By: September 2012 New Post or Replacement:...

FEX: CTC in North Darfur, North Sudan: challenges of implementation (Special Supplement 2)

By Kate Sadler (Valid International) and Anna Taylor (SC-UK) People waiting at a clinic in Darfur, North Sudan. Child eating plumpynut® in Darfur, North Sudan. North Darfur...

FEX: Quantity through quality: Scaling up CMAM by improving programmes Access

By Saul Guerrero & Maureen Gallagher Saul Guerrero is the Senior Evaluations, Learning and Accountability (ELA) Advisor at ACF UK based in London. Prior to joining ACF, he...

FEX: Integrated Management of Acute Malnutrition (IMAM) scale up: Lessons from Somalia operations

By Leo Anesu Matunga and Anne Bush Leo Matunga is currently the nutrition cluster coordinator for Somalia. He has over 12 years experience working in nutrition in emergencies...

FEX: Management of acute malnutrition programme review and evaluation

Summary of evaluation1 Young girl recovering from severe malnutrition, OTP centre in Kaedi, Mauritania By Yvonne Grellety, Hélène Schwartz and David Rizzi Yvonne Grellety is...

Close

Reference this page

Anna Taylor (2004). Lessons From SC UK Evaluation in DRC. Field Exchange 22, July 2004. p21. www.ennonline.net/fex/22/lessons