Menu ENN Search

IYCF in Zimbabwe

By Fistum Assefa

Fitsum Assefa is currently working as UNICEF Nutrition Manger, in Zimbabwe.

Zimbabwe has a high prevalence of stunting (32%) and low prevalence of wasting/acute malnutrition (3%) (DHS 2011). The trend in stunting suggests deterioration as compared to the early 90s, while the prevalence of acute malnutrition remained the same or slightly improved. Of note, the national average masks the prevailing disparities across geographic regions and wealth status, for example, there are districts with stunting prevalence of over 40% and both stunting and acute malnutrition are much higher among the poorest segment of the population as compared to the wealthiest.

CMAM services in Zimbabwe were initiated as of 2006, with rapid expansion from 2009 (see Figure 1). Due to the low acute malnutrition context and existing health care infrastructure1 it has been possible to integrate the management of severe acute malnutrition (SAM) in Zimbabwe with the existing curative and preventive health care delivery system. Currently over 70% of the 1600 health facilities provide inpatient and outpatient SAM treatment on a routine basis.

To help fill an existing gap, training materials to support integration of infant and young child feeding (IYCF) in CMAM were developed at international level in 20092 and piloted in Zimbabwe (2010), However, this approach has failed to show any impact on prevailing IYCF practices. This is partly related to the fact that it is unrealistic to expect a rare situation (<0.5% SAM) to be an entry point to a universal problem (>90% of infants and young children with poor IYCF practices). Also, CMAM offers no contact with newborns and generally speaking, with infants in the first six months of life. On the contrary, we find our cIYCF initiative as a key opportunity to ensure access and compliance to other health and nutrition services, including treatment of SAM.

The cIYCF assessment and counselling service initiated in Zimbabwe is one of the many solutions we are pursuing simultaneously to ensure optimal IYCF is practiced. These include improving policy, guidelines and tools for use at different levels of management and service delivery, addressing the socio-culturaleconomic barriers that take account of the role and influence of others/gatekeepers within the family/community (grandmothers, elders, fathers), addressing the health workers’ and managers’ knowledge and skill gaps, and advocating for longer term commitment, integration and resources for IYCF programming.

The missing elements in previous IYCF promotion efforts (e.g. through world breastfeeding week (WBW) communications, and the WHO 40 hours training to master trainers, facilitators and health workers) is lack of vision and accountability mechanisms that link the training to provision of counselling service and changes in IYCF practices. A typical ‘cascade’ approach in IYCF training takes 8 – 10 people at a time as ‘master trainers’ (who are not always trained through a competency based approach), who in turn train ‘facilitators’ (training usually undertaken in a hotel or a training facility, mainly theoretical, with little skills based training), who then are expected to further train the frontline facility staff and VHWs. Often when country training action plans are drafted, after regional or national TOT, the cost and time implications are unrealistically huge that discourage national decision makers and donors.

Because of resource and logistical challenges, training of frontline workers typically lacks quality and coverage. Such an approach results in a few ‘trained’ health workers spread thinly throughout the country. This means that those who are not trained or are trained using earlier guidelines outweigh those trained using more recent guidelines. The few newly trained staff often cannot exhort significant influence and their skills, knowledge and passion slowly dies off.

Zimbabwe has attempted to address this by finding a means for efficient and rapid expansion of knowledge, skills and tools covering a whole district at a time (within a week) and attaching trained people to real cases that they follow, starting with pregnancy/early infancy to about two years of life. In our approach, quality of training is emphasized and the trainer/trainee ratio is 1:4/5, as per evidence of the ideal ratio that can facilitate skills based training. Valuable tools are included in the training package for pre-post assessment that determine improvement in knowledge and skills. An example of the impact of training in one location is shown in Figure 2.

To date, 14 districts have been covered by this initiative, resulting in over 2,000 CCs and over 20,000 mothers/infants accessing counselling services on an on-going basis (1CC:10 mother/infant pairs). In addition, these 20,000 women take part in supporting other mothers and access peer support themselves, as every trained health worker facilitates the establishment of at least one mother-to-mother support group in their village.

During the trainings and supportive supervision visits, it is emphasised that assessment and counselling on IYCF is one of the key interventions towards addressing undernutrition in Zimbabwe and that the role of VHWs is pivotal to the current momentum in the country to address stunting as a matter of urgency (e.g. SUN movement, National Food and Nutrition Security Policy, etc.). We encourage a sense of accountability by each VHW towards ensuring optimal IYCF practices and to contribute to further understanding of barriers and facilitation of IYCF practices in their catchment community. Accountability is increased through location training reports that record who has trained who, the contact details of trained VHWs (including cell phone numbers where available) and who is following up which infant/mother pair. This will allow determination of any pattern of training and service provision outcome that can be explained by quality of training and support.

So far, the VHWs appear motivated and inspired to identify pregnant mothers from the early days of pregnancy (which is also required by other initiatives such as Maternal Mortality Reduction, PMTCT3, etc.) and provide IYCF counselling. They are also motivated to keep a record of how feeding practices are evolving with each infant/child over time. This can easily be linked to nutritional outcomes, given the demand for a growth monitoring and promotion service in Zimbabwe. Such a system of ongoing identification, assessment and counselling of mothers will serve as an opportunity to promote use and compliance of other health and nutrition services and serve as a backbone to build on additional interventions in IYCF, such as home fortification of food. This in turn can improve the demand and effectiveness of community level IYCF counselling services.

Zimbabwe hopes to share experiences in relation to results of this initiative on IYCF practices and nutritional outcomes in future issues of Field Exchange.

For more information, contact: Fitsum Assefa,

Show footnotes

1Though weakened by the recent crisis, it is in the process of recovery/being rebuilt stronger.

2Integration of IYCF support into CMAM, Oct 2009. ENN, IFE Core Group, Nutrition Policy Practice. Funded by the Global Nutrition Cluster (IASC).

3Prevention of Mother to Child Transmission of HIV

More like this

FEX: Frontline experiences of Community Infant and Young Child Feeding in Zimbabwe

By Wisdom G. Dube, Thokozile Ncube and Paul Musarurwa Wisdom G. Dube is the Gokwe North district nutritionist, Ministry of Health and Child Welfare (MOHCW),...

FEX: Use of RapidPro for remote collection of nutrition data during the drought emergency and COVID-19 pandemic in Zimbabwe

View this article as a pdf By Nakai Munikwa, Pauline Tsikayi, Desire Rwodzi, Mara Nyawo and Mathieu Joyeux Nakai Munikwa is the Nutrition Cluster's Information Management...

FEX: Use of RapidPro for remote collection of nutrition data during the drought emergency and COVID-19 pandemic in Zimbabwe

This is a summary of a Field Exchange field article that was included in issue 64. The original article was authored by Nakai Munikwa, Pauline Tsikayi, Desire Rwodzi, Mara...

FEX: Increased diarrhoea following infant formula distribution in 2006 earthquake response in Indonesia: evidence and actions

By Fitsum Assefa, Sri Sukotjo (Ninik), Anna Winoto and David Hipgrave Fitsum Assefa is a nutritionist with over 15 years experience working on public nutrition in various...

FEX: Nutrition-sensitive agriculture in Zambia: work in progress

By Abigail Moyo, Eunice Bwalya Chishimba and Mary Corbett Abigail Moyo is the Nutrition Facilitator with Self Help Africa (SHA), working in Luwingu District since May 2014....

Combining WASH and nutrition activities within a multisectoral package to improve young children’s diets and reduce child stunting in Sindh province, Pakistan

View this article as a pdf Click here to listen to an interview with the author on the ENN podcast channel Dr Sahib Jan Badar is the Programme Coordinator of the Accelerated...

FEX: Promoting infant and young child feeding in Lebanon: Lessons learned from programming

Lamis Jomaa Associate Professor at North Carolina Central University and Affiliate Associate Professor at the American University of Beirut, Lebanon Kate Price Intern at the...

FEX: Use of educational videos to improve maternal breastfeeding knowledge and practices in Ethiopia

View this article as a pdf By Ritu Rana, Hatty Barthorp, Liya Assefa, Alemayhu Beri and Mary T Murphy Ritu Rana is a GOAL Nutrition Research Advisor (Management of At-risk...

FEX: China case study: Capacity building of primary health workers. From piloting to national Infant and Young Child Feeding programming

Xinya Zhu is a Nutrition Officer at UNICEF China Shuyi Zhang is an Associate researcher at the Capital Institute of Pediatrics Tao Xu is the Division Director of Child Health...

FEX: A review of nutrition-related service delivery packages: What they train providers to deliver

View this article as a pdf Summary of research1 By Sascha Lamstein and Kelsey Torres Sascha Lamstein is a senior technical advisor for the United States Agency for...

FEX: Community-based management of severe malnutrition: SAM and SUW in children under five in the Melghat tribal area, central India

By Dr Vibhavari Dani, Dr Ashish Satav, Mrs Jayashri Pendharkar, Dr Kavita Satav, Dr Ajay Sadanshiv, Dr Ambadas S Adhav and Dr Bharat S Thakare Dr. Vibhavari Dani is a...

FEX: Nutrition-sensitive agriculture in Zambia: A continued work in progress

Nutrition-sensitive agriculture in Zambia: A continued work in progress1 View this article as a pdf Lisez cet article en français ici By Mary Corbett Mary Corbett is...

FEX: Infant and young child feeding support in Lebanon: strengthening the national system

By Pressila Darjani and Linda Shaker Berbari Pressila Derjany is the Infant and Young Child Coordinator at IOCC. She has a B.Sc. in Nutrition and Dietetics. She joined IOCC...

FEX: Independent and combined effects of improved WASH and improved complementary feeding on child stunting and anaemia in rural Zimbabwe

Summary of research1 Location: Zimbabwe What we know: Stunting and anaemia remain prevalent in children; plausible interventions have shown limited or inconsistent...

FEX: Contributing to the Infant and Young Child Feeding in Emergencies (IYCF-E) response in the Philippines: a local NGO perspective

By Romelei Camiling-Alfonso, Donna Isabel S. Capili, Katherine Ann V. Reyes, A.M. Francesca Tatad and Maria Asuncion Silvestre Romelei Camiling-Alfonso has worked for the...

FEX: Supporting healthy growth in infants in low-resource settings in Mumbai, India

View this article as a pdf Lisez cet article en français ici By Rupal Dalal, Shruthi Iyer, Marian Abraham and Lahari Yaddanapudi Rupal Dalal MD FAAP IBCLC is a...

FEX: Improving nutritional outcomes of rural households through a community-based approach in Ethiopia

This article has been updated since the original version was published in March 2020. View this article as a pdf Lisez cet article en français ici By Haimanot Abebe,...

FEX: Adapting infant and young child feeding interventions in the context of COVID-19 in Somalia

View this article as a pdf By Sahra Moalim Ahmed, Bishar Osman Hussein and Emmanuel Barasa Sahra Moalim Ahmed is an Infant and Young Child Feeding Officerat Concern Worldwide...

Addressing micronutrient gaps to reduce anaemia in Bhutan’s young children: Early experiences in home fortification

View this article as a pdf Laigden Dzed is Deputy Chief Programme Officer in the Nutrition Programme, Ministry of Health, Bhutan. Hari Prasad Pokhrel is a Senior Nutritionist...

Translating the Home-Based Care for the Young Child initiative into action for young child feeding in Bihar, India

View this article as a pdf Manoj Kumar is an Indian Administrative Service Officer, Executive Director of the State Health Society, Bihar under the Department of Health,...


Reference this page

Fistum Assefa (). IYCF in Zimbabwe. Field Exchange 43: Government experiences of CMAM scale up, July 2012. p96.



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.