Menu ENN Search

Impact of community mobilisation activities in Uganda

By David Doledec, ACF-USA

A qualified nurse, David Doledec joined Action Contre la Faim in 2002, working in Democratic Republic of Congo, Sudan, Liberia and Uganda before joining the ACF-USA headquarters team as a Nutrition Advisor in 2007.

The author would like to acknowledge the ACF-USA teams in both Kampala and Lira offices, the village leaders, community health workers, traditional birth attendants and other community members who assisted the teams in their home communities, and the individual families who participated in the survey. The author also acknowledges the work of the consultant, Dr Mark Myatt, who adapted the methodology used in this survey.

Measuring height during the ACF survey

In July 2006, ACF-USA implemented an out-patient programme for the treatment of severely malnourished children in the main internally displaced people (IDP) camps of the districts of Lira and Apac, Northern Uganda. ACF-USA nutritional centres were already present in the IDP camps where they also served the resident communities. The beneficiaries admitted at that time were 90% IDPs and 10% from the resident population.

Assessing coverage

In January 2007, ACF-USA enlisted the assistance of a consultant to assess the programme and in particular, to measure its coverage and identify weaknesses. An adaptation of the Centric Systematic Area Sampling (CSAS) methodology was developed to suit the context of the IDP camps and a coverage survey was carried out1. The survey teams were comprised of ACF-USA local staff, who were mostly IDPs residing in the camps and who had had previously been recruited and trained by ACF USA. The surveys, which took place during a two week period in January 2007, were conducted in the main camps where the nutritional centres were located, followed by further surveys in nearby camps (one centre area was defined as a quadrat).

The results showed that the programme coverage was low2,3:

Several of the main contributing factors and programme weaknesses were identified through the survey including:

Identification of these problems resulted in a complete re-organisation of the programme. Supplementary feeding and outpatient therapeutic programme (OTPs) centres were integrated into a single unit with teams combined into one. Trainings were provided for all staff members and a community mobilisation campaign was started in March 2007, following Valid International guidelines5.

Monitoring progress

In order to monitor programme performance as well as the progress and impact of the community mobilisation activities, a second coverage survey, using the traditional CSAS methodology, was conducted in January 2008. However, the situation in the main IDP camps of the districts had changed since the previous coverage survey leading to substantial population changes. In early 2007, a massive return process began in the districts of Lira, Apac and Oyam. Between March and November 2007, 99.5% of the 466,103 IDP's were reported to have left the camps to return to their areas of origin6. Such massive population movements were likely to result in a significant impact on the programme and its coverage.

Following the 2008 survey, the coverage rates were found to be:

The survey highlighted three main reasons for severe cases of malnutrition not being enrolled in the programme. These was a lack of awareness about malnutrition and the programme, a lack of time for caretakers to attend the distribution centres, and too lengthy a distance to reach the closest centre. Problems that were identified during the 2007 survey appeared to be less of an issue. In addition, the fact that coverage rates had improved in a context where they could easily have worsened (as the population was much more spread out), was seen as encouraging with regard to the efforts that had been made to improve the program. Community mobilisation was still ongoing and seemed to show a positive impact. However, the second coverage survey threw up more questions than answers. As the surveyed communities had faced such a dramatic change with the returnee process, it was not possible to consider the measured coverage rate as an indicator of the effectiveness of the community mobilisation activities.

Evaluating effectiveness of mobilisation

Community mobilisation activities were conducted with the aim of developing a comprehensive detection and referral network at the community level. In addition, through regular meetings in all communities, it aimed to improve people's awareness of malnutrition, its prevention and the treatment programme. In order to evaluate the effectiveness of the community mobilisation activities, the team collected several indicators:

  1. The referral system Figure 1 highlights clearly that the level of referral from the community increased significantly throughout the year. Community mobilisation activities had an impact on both referrals from the community volunteers trained by the nutrition team and on self-referrals. 'Other' data mainly represents referrals through nutrition surveys and screenings conducted by the team in non-catchment areas.
  2. Attendance Admission trends is another set of information to consider in conjunction with data on referrals. As shown in Figure 2, monthly attendance in the programme increased significantly in 2007 compared with 2006. As a result of this increase, the team increased the number of centres from 5 to 10, as well as opening a therapeutic feeding centre (stabilisation centre) in the area.
  3. Prevailing malnutrition rates An analysis of attendance in the TFP requires knowledge of the changing rates of acute malnutrition in the population. As can be seen in Tables 1 and 2, the rates of acute malnutrition, though steady in the Apac and Oyam districts, had increased slightly in Lira district since 20057.
  4. Other factors It is also necessary to consider important factors or events that may impact attendance and referal indicators, as well as community mobilisation itself. If massive population movements occur in areas where community mobilisation activities have already been implemented, it is likely that the same mobilisation process will need to be conducted again. Several communities in Northern Uganda increased dramatically in size during the return process. The team therefore had to go back to these communities to train more community volunteers in community mobilisation.

Table 1: Results of nutrition surveys in Lira district
LIRA DISTRICT February 2005 (n=965) May 2006 (n=921) April 2007 (n=651)

Global Acute Malnutrition
(W/H <-2 Z-scores and/or oedema)

1.90%
(0.9% - 3.7%)
5.90%
(3.9% - 8.6%)
7.10%
(4.5% - 9.7%)
Severe Acute Malnutrition
(W/H <-3 Z-scores and/or oedema)
0.60%
(0.1% - 2.0%)
0.70%
(0.1% - 2.1%)
0.80%
(0.1% - 1.4%)

 

Table 2: Results of nutrition surveys in Apac and Oyam districts
APAC / OYAM DISTRICTS February 2005 (n=956) April 2006 (n=900) April 2007 (n=669)

Global Acute Malnutrition
(W/H <-2 Z-scores and/or oedema)

4.40%
(2.8% - 6.8%)
4.70%
(2.9% - 7.2%)
4.60%
(3.0 - 6.3%)
Severe Acute Malnutrition
(W/H <-3 Z-scores and/or oedema)
1.40%
(0.5% - 3.0%)
0.80%
(0.2% - 2.3%)
0.90%
(0.0% - 1.9%)

 

Conclusions

There is now a wide range of evidence showing the positive impact of community mobilisation on the treatment of acute malnutrition. It improves programme coverage, acceptance and sustainability. However, measuring the actual outcomes of community mobilisation requires an analysis of the whole programme, as coverage surveys alone cannot fulfil this objective, especially in complex and rapidly evolving contexts. A comprehensive understanding of a programme is therefore only possible through analysis of a wide range of available information, including malnutrition rates, coverage rates, referrals to nutritional centres, attendance, and context analysis.

For further information, contact: David Doledec, email: dd@aah-usa.org

Show footnotes

1All survey reports are available on ACF-USA website, http://www.actionagainsthunger.org under Resources

2SPHERE standards recommend 70% coverage in IDP / refugee camps settings

3CI: Confidence Interval

4MUAC: Middle Upper Arm Circumference, WHM: Weight for Height % of the median

5Community-based Therapeutic Care Manual. Valid International. Available at http://www.validinternational.org

6IASC working Group report, November 2007

7Results expressed using the NCHS reference tables (1977).

More like this

FEX: Home treatment for severe malnutrition in South Sudan

By Josephine Querubin, ACF-USA Josephine Querubin is a medical doctor who has been working in humanitarian work for the past 12 years. Beginning in her home country, the...

FEX: UNHCR feeding programme performance in Kenya and Tanzania

Summary of research1 Settlements of new arrivals in the outskirts of Dadaab Routine monitoring data are available from the many nutrition programmes operating in camps...

FEX: Fresh food vouchers for refugees in Kenya

By Lani Trenouth, Jude Powel and Silke Pietzsch Lani Trenouth and Jude Powel were the ACF Food Security and Livelihood programme managers who implemented the programme in...

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: Transforming awareness and training into effective CMAM Performance

By Maureen Gallagher and Armelle Sacher Maureen Gallagher is the Senior Nutrition & Health Advisor ACF USA based in New York. She has worked for the last 10 years in nutrition...

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: Blanket BP5 distribution to under fives in North Darfur

By Hanna Mattinen, ACF Since 2005, Hanna Mattinen has been Food Aid Advisor at the Action contre la Faim (ACF) headquarters, focusing on policy and operational issues around...

FEX: Community case management approach to SAM treatment in Angola

By Sarah Morgan, Robert Bulten and Dr Hector Jalipa Until the end of August 2014, Sarah Morgan was Senior Nutrition and Child Health Advisor for World Vision UK, with...

FEX: Impact of non-admission on CTC Programme Coverage

By Saul Guerrero, Valid International Saul Guerrero is a Social and Community Development Advisor working for Valid International. Over the last four years, he has assisted in...

FEX: Community based approaches to managing severe malnutrition: case study from Ethiopia

Summary of report1 A mother attends the CTC programme A recent published paper describes Save the Children US's (SC US) experience of setting up a community therapeutic care...

FEX: A fragile situation in Sudan: review of the 2001 nutritional situation

By Mutinta Nseluke-Hambayi Mutinta Nseluke-Hambayi is a nutritionist who has been working as a Nutrition Emergency Officer for the past 3 years, supporting all WFP emergency...

FEX: Nutritional response in north-eastern Nigeria: Approaches to increase service availability in Borno and Yobe States

View this article as a pdf Lisez cet article en français ici By Sanjay Kumar Das, Dr Sule Meleh, Dr Umar Chiroma, Bulti Assaye and Maureen L Gallagher Sanjay Kumar...

FEX: Implications of a Coverage Survey in Ethiopia

By Simon Kiarie Karanja Simon Karanja is currently the regional nutrition advisor with GOAL in East Africa. Previously he worked as the CTC Coordinator for GOAL Ethiopia and...

FEX: SQUEAC: Low resource method to evaluate access and coverage of programmes

By Mark Myatt Mark Myatt is a consultant epidemiologist and senior research fellow at the Division of Ophthalmology, Institute of Ophthalmology, University College London....

FEX: Issue 28 Editorial

This issue of Field Exchange features four field articles about community based therapeutic care of the severely malnourished, a type of programming that is increasingly being...

NEX: Tackling high defaulting rates in refugee camp settings – lessons from Chad

Seife Kifleyohannes Temere Seife Kifleyohannes Temere is a Nurse Nutritionist. He has been working for International Medical Corps since 2010. In eastern Chad there are 12...

FEX: Cash supported income generation activities in Southern Sudan

By Emily Sloane and Silke Pietzsch Emily Sloane was a Food Security and Livelihoods Trainee at ACF-USA supporting the evaluation of the project's income generating activities...

FEX: Farming in Bags: Micro Gardening in Northern Uganda

By Holly Welcome Radice, Action Against Hunger-USA Holly Welcome Radice has worked as a food security officer for AAHUSA in Liberia, Uganda, and as programme co-ordinator in...

FEX: WHO response to malnutrition in Syria: a focus on surveillance, case detection and clinical management

By Hala Khudari, Mahmoud Bozo and Elizabeth Hoff Hala Khudari, WHO Technical Officer at WHO Syria, joined WHO in 2011 and is a BSc (Nutrition and Dietetics) and MSc in...

FEX: Delivering Supplementary and Therapeutic Feeding in Darfur: coping with Insecurity

By Gwyneth Hogley Cotes, GOAL Gwyneth joined GOAL in November, 2005 as the Nutrition Coordinator for Darfur, Sudan. She has a BA in International Studies and Master of Public...

Close

Reference this page

David Doledec (2008). Impact of community mobilisation activities in Uganda. Field Exchange 34, October 2008. p14. www.ennonline.net/fex/34/mobilisation

(ENN_3834)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.