Menu ENN Search

The challenges faced in providing sustainable management of acute malnutrition services in Ituri Province, Democratic Republic of the Congo

Agricultural project in Democratic Republic Of CongoCosma Bakemwanga Sapeke is the coordinator of the Ituri National Nutrition Programme (Pronanut by its French acronym) in Bunia, Democratic Republic of Congo. He has worked at the Ministry of Health since 2002

The Democratic Republic of Congo (DRC) has a population of almost 75 million, of whom two thirds live below the poverty line. The DRC is characterised by ongoing conflict, poor infrastructure and highly challenging logistics, all of which have had a severe impact on the health infrastructure and government-funded services. Conflict in the eastern provinces causes continued displacement. According to DRC’s Demographic and Health Survey 2013-14, among children under five, 43% are stunted and 8% are acutely malnourished (wasted), with ten territories having rates of acute malnutrition above the emergency threshold of 15%.

Making the benefits of a post-conflict or emergency nutritional intervention sustainable is a necessary process, but it is not always easy to implement and can sometimes lead to frustration in the performance of the programmes. Ituri Province in the east is notorious for conflict and violence and the population shifts that have taken place over the last ten years. As in most of the country, the population has very limited access to basic social services such as health, education, drinking water and electricity. The area has witnessed various changes of strategy for themanagement of acute malnutrition, alternating between a focus on treatment with excellent results but with low programme coverage and the exclusion of the community from the programme, to a focus on more integrated approaches with the health sector and the prospect of greater sustainability, but which is more problematic in terms of programme quality.

Local solutions for local problems

The Rimba health zone in Ituri Province was supported by an international NGO, but in 2008 the partner withdrew its support and the responsibility was transferred to the National Nutrition Programme (Pronanut). Integration of the management of acute malnutrition (iMAM) in the health system is now effective and functional, but the regular supply of treatment products remains a major challenge. The health zones are dependent on outside supplies and they have no control over quantities or delivery times. This often leads to stock shortages. In the face of frequent shortages of therapeutic milk, some of the therapeutic nutrition units follow the WHO recipe with dried skimmed milk to make therapeutic milk. Maximum care is given, but the protocol is not strictly adhered to, resulting in excessively high death rates in the Therapeutic Feeding Centres (Unités de Nutrition Thérapeutiques – UNT), as well as low recovery rates and a high turnover. These stock-outs impact on the quality of care as well as on the motivation of the staff.

The health authorities in Ituri have decided to also focus on preventative activities and to do so by integrating nutrition into other sectors. This includes promoting the early initiation of and exclusive breastfeeding, adequate complimentary feeding, strategies to address vitamin A, iron and iodine deficiency, deworming and the consumption of a varied diet.

In order to foster preventative approaches to addressing malnutrition, it has been necessary to involve other partners to cover all the health areas.

The leadership of local authorities, in the framework of the Local Nutrition Committee (Comité Locale de Nutrition – CLN), has also been instrumental to ensure this coverage. For example, designated land is used for farming demonstrations by extension workers, promoting the planting of diversifiedcrops rich in nutrients (beans, peanuts, sweet potato, tomato and aubergines) for local consumption by households with malnourished children and they have set up women’s farming groups and provided education on healthy eating.

In the Rimba health zone, an appeal to the FAO has enabledseeds and tools for tilling to be distributed in 18 health areas. Members of the CLN have thus been able to promote locally produced food thanks to the support of women’s agricultural associations in the region.

Community participation and capacity-strengthening have enabled the communities to participate in identifying problems and tracking cases of malnutrition. Nutritional screening at community level still exists, even if it is not as intensive as when NGOs supported these activities through a financial incentive. The involvement of the people concerned is vital to ensure the sustainability of these activities.

Conclusions

It is essential that good-practice examples, such as that of Rimba health zone’s new approach focusing on preventative measures, be taken up by others if malnutrition is to be prevented. It needs to be recognised as being part of a multisector approach and the responsibility of all concerned.

The experience of Ituri has shown that the best method of combatting malnutrition is integration of nutrition activities into the existing health system – ensuring sufficient financial resources and systems to provide an adequate supply chain for nutrition products where treatment is needed – and the development of mechanisms to prevent new cases of malnutrition through raising awareness and increased production and consumption of locally produced, micronutrient-rich foodstuffs.

Previous high levels of international actor investment to address acute malnutrition cannot be maintained once the nutrition partner and the funding goes; however it is hoped that with time, the previous implementation experience can be adapted in line with will local capacity and resources.

More like this

FEX: Alert and rapid response to nutritional crisis in DRC

By Alain Georges Tchamba View this article as a pdf Lisez cet article en français ici Alain Georges Tchamba is the Nutrition coordinator at Cooperazione...

en-net: Medair is Recruiting Nutrition Advisor

Role & Responsibilities
Working as an important member of a diverse team who are committed to serve the world’s most vulnerable with practical and...

FEX: Development and added value of the Nutrition Cluster in Turkey

By Wigdan Babikir Makki Madani View this article as a pdf Lisez cet article en français ici Dr Wigdan Madani is the Nutrition Cluster Coordinator for Turkey, based in...

FEX: Innovation and success in prevention of konzo

By Dr Howard Bradbury1 This article was prepared by Dr Howard Bradbury, who is an Emeritus Fellow at the Australian National University. Since the mid-nineties he has been...

Resource: Transcript of the podcast : Alert and rapid response to nutritional crises in DRC with Alain Tchamba

Listen to this podcast in French Ambarka Youssoufane (AY) : Regional Knowledge Managment Specialist, West/Central Africa Alain Tchamba (AT) : Coordinator at Cooperazione...

FEX: Post-Rome integrated action: Experiences from North-eastern Nigeria

By Kirathi Reuel Mungai and Adeola Goriola Makanjuola View this article as a pdf Lisez cet article en français ici Kirathi Reuel Mungai is a nutrition specialist...

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: Practical pointers for prevention of konzo in tropical Africa

By J.H Bradbury, J.P.Banea, C. Mandombi, D, Nahimana, I.C. Denton and N. Kuwa Dr J Howard Bradbury, Emeritus Fellow, Australian National University, developed the cassava...

FEX: Building health service capacity to manage severe acute malnutrition in Mali

By Dr Malam Kanta Issa View this article as a pdf Lisez cet article en français ici Dr Malam Kanta Issa has worked as the Head of Mission for ALIMA Mali since 2015....

NEX: Moving towards multi-sector programming in Mauritania

Moving towards multi-sector programming in Mauritania Mohamed Ould Saleck is the coordinator of the National Nutrition Programme at the Ministry of Social Affairs,...

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: UNHCR experiences of enabling continuity of acute malnutrition care in the East, Horn of Africa and Great Lakes region

View this article as a pdf By Naser Mohmand Naser Mohmand is currently working with UNHCR as Senior Regional Nutrition and Food Security Officer in the East, Horn of Africa...

FEX: Competing for scarce resources: the new concern for Syrian refugees and host communities in Lebanon

By Bassem Saadallaoui Bassem Saadallaoui was Country WaSH Coordinator for ACF Lebanon from May 2013 to July 2014. He is a post-graduate Water and Sanitation Engineer,...

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: 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...

NEX: Mobile clinics as a strategy to identify and treat children with acute malnutrition in difficult-to-reach areas in Chad: A case study of the Wadi Fira Region

Dahab Manoufi is an economist and manages the NGO Bureau d'Appui Santé et Environnement (Health and Environment Support Bureau), Chad. Dr Hervé Oufalba Mounone...

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: 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...

FEX: Lessons learned from evaluations of the impact of WFP programmes on moderate acute malnutrition in the Sahel

View this article as a pdf By Jonas Heirman, Mica Jenkins and Jennifer Rosenzweig Jonas Heirman leads impact evaluation activities for the World Food Programme (WFP). Jonas...

FEX: Emerging cases of malnutrition amongst IDPs in Tal Abyad district, Syria

By Maartje Hoetjes, Wendy Rhymer, Lea Matasci-Phelippeau, Saskia van der Kam Maartje Hoetjes is a Medical member of the MSF emergency team, currently working in South Sudan....

Close

Reference this page

The challenges faced in providing sustainable management of acute malnutrition services in Ituri Province, Democratic Republic of the Congo. Nutrition Exchange 6, May 2016. p19. www.ennonline.net/nex/6/drcacutenutrition

(ENN_5262)

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.