Sunday, June 20, 2010

Nutrition and Early Childhood Development Project - Has it delivered?

The question asked is whether this project (Nutrition and Early Childhood Development) actually has delivered.
William Kituuka

Good PracticeInfobrief
Findings Infobriefs reports on Good Practice in ongoing operational, economic and sector work carried out by the World Bank and its member governments in the Africa Region. It is published monthly by the Knowledge and Learning Center on behalf of the Region. The views expressed in Findings are those of the author/s and should not be attributed to the World Bank Group.
Africa Region • Number 111 • April 2005
The “Good Practice Infobrief” series is edited by P.C. Mohan, mail stop J-8-811, Knowledge and Learning Center, World Bank, 1818 H Street
NW, Washington D.C., 20433. Tel. (202) 473-4114; e-mail:
Uganda’s Nutrition and Early Child Development Project -
Counting on Communication
In 1998, a $34 million World Bank loan for the Nutrition and Early Child Development Project (NECDP) was approved to support the National Program of Action for Children. The NECDP covered about 8,000 communities in 20 of Uganda’s 39 districts, selected based on levels of malnutrition, infant mortality, and primary school enrollment rates.
The project sought to halve malnutrition among preschool children, raise primary school enrollment, reduce dropout and repetition rates, improve psycho-social and cognitive development, and increase the number of mothers practicing appropriate childcare.
A strategic communication program was designed to help mothers and other caregivers adopt new behaviors needed to achieve project outcomes. It helped the NECDP team identify necessary changes in behavior, knowledge or attitude for all target audiences; frame project-related issues relevant to different stakeholders, such as parliamentarians, mothers, community leaders, educators, and local government administrators; craft persuasive messages according to their needs, concerns and perceptions; and use the most appropriate communication channels.
The communication strategy included a:
• National advocacy effort aimed at parliamentarians, health and education ministry officials, district officials and community leaders;
• Multi-media campaign that emphasized three behavior change interventions: weaning practices, de-worming and ECD-related behaviors;
• Training program for health workers and pre-school teachers on their role in improving the health and nutritional status of pre-school children; and
• Monitoring and evaluation component to ensure that materials were disseminated via cost-effective channels of communication and that messages reached target audiences.
How Communication Helped Mobilize Parliamentary Support
Parliamentary support was not readily apparent as little as three months prior to project approval. Parliamentarians were locked in heated debates on whether it was in Uganda’s interest to borrow money for such a project.
Many were asking why Uganda needed to incur debt to learn how to take care of its children since Ugandans have been raising children for generations. To gain support within Parliament, a Parliamentary advocacy group was established. This helped raise awareness of the issue of stunting and its implications both for children’s cognitive development and for the long-term development of the country. Members of the advocacy group were given media skills training to help in their advocacy efforts and audiotapes with latest information project activities and
How Communication Helped Parents and Caregivers Improve Childcare Practices
The national multi-media campaign C.H.I.L.D. (Community and Home-based Interventions for Long-term Development) aimed to raise awareness of caregivers of the risks and negative implications of stunting and to address behavior changes needed to prevent it.
Communication activities focused on three practices: hygiene and sanitation (including de-worming), complementary feeding, and positive parental interaction. The main objective was to help caregivers understand the relationship between specific behaviors they undertake (such as feeding practices) and stunting. Communication sought to help correct misconceptions about hygiene and de-worming and publicize the availability of de-worming tablets at Child’s Days events and in health centers. Radio messages were aired to announce the schedule for Child’s
Days in communities and reminded parents to bring children for de-worming.
Communication research demonstrated that current perceptions of proper childrearing were at odds with the new childcare concepts of encouraging the child to be active, inquisitive, and to explore his/her surroundings. Beliefs and attitudes about the “attention” a child needs emphasized meeting the infant’s basic needs for food, clothing and shelter, and downplayed the value of play and affection.
Communication activities to trigger behavior change included modeling the new behavior through radio dramas and street theatre, disseminating information to clear up misconceptions about specific child rearing practices, and mass media edutainment via roadshows, songs, awareness raising workshops in district and community centers.
Posters/pictographs, newspaper inserts and radio spots carried messages about healthy diets, prevention from illnesses, helping a child achieve their potential, brain development, nutrition, hygiene and hand-washing practices.
A community guide and training booklet were also distributed. Community-based activities (nutrition counseling, group meetings, home visits, training of community health workers and teachers) complemented and reinforced media-driven messages.
What The Project Accomplished: Evaluating Communication Impact
Improved knowledge and practices in childcare, health and nutrition
Increased awareness in … Positive behavior change in …
Source: Evaluation of Communication Activities. Steadman Research Services, Uganda, June 2003.
Persons accessing the Bank’s external website can get more information on Health, Nuitrition and Population by clicking on Topics in Development. Bank staff can access this information from the Bank’s Intranet by clicking on
Effective delivery of services: Child Fairs, an existing service delivery channel for integrated health and nutrition,
was successful in increasing demand for de-worming medicine and Vitamin A. Child’s Fairs proved to be a costeffective channel to reach people with both health services and strategic messages, with a cost per child of about $1.00 to $1.33 for services, including inoculations, growth monitoring and Vitamin A supplements. They were also one of the more effective channels of communication for the delivery of messages through demonstrations, skits
and songs to provide information about child care, food production and income-generating possibilities because they conveyed messages through interpersonal contact, a more effective channel than written materials.
Higher school enrollment: Campaign messages on the benefits of ECD practices appear to have had reinforcing effects on increasing demand for early schooling. The longitudinal study confirmed a positive impact on enrollment both relative to the control group and relative to the initial enrollment in the project communities, particularly for pre-school age children. Findings further suggest that by age 12.5, the average child in the project area will have higher school attainment than children in non-project areas.
Lessons Learned
• Develop a comprehensive communication strategy during project design. This can provide a clear understanding of the perceptions and positions of key stakeholders and address perceived fears and barriers to change.
• Integrate upstream and downstream communication. While upstream communication is necessary to obtain support of the project’s key “influencers”, downstream communication is needed to help project beneficiaries learn about new development concepts and practice new skills.
• Design a client-centered, research-driven and participation-based communication strategy. Effective communications is grounded on knowledge of the client’s perspective.
• Articulate behavior change required in Project Appraisal Documents (PADs). Include a communication strategy that identifies what knowledge, attitudes, and behaviors need to change for each target group.
• Measure behavior change, not behavior change communication inputs.
• Create national partnerships and build national capacity for communication. Behavior change is a long-term process; national groups are best able to maintain activities over the long term.
This article was written by Cecilia Cabanero-Verzosa, Communication Advisor, EXTCD. For more information, e-mail
Improved health and nutritional status: Malnutrition among children (0-36 months) was reduced by 30% in the project area. Exclusive breastfeeding, supplementary feeding, immunization rates, and intake of Vitamin A, and de-worming among children less than 72 months of age improved.

C.H.I.L.D. Project - Uganda
Programme Summary
The C.H.I.L.D. (Community and Home Initiatives for Longterm Development: Nutrition and Early Childhood Development) Project was initiated by the World Bank and the Ministry of Health to promote the health and development of children. A larger goal was to improve the quality of life of 2.4 million children in 25 districts in West and Central Africa. Within families and communities, the C.H.I.L.D. project was designed to:
* Create awareness of the needs and rights of their children;
* Build on their knowledge and skills and help them provide appropriate care, diet, stimulation, and protection for their child;
* Help to generate additional resources and manage their money efficiently in order to provide adequate childcare.
Communication Strategies
The project's communication strategy involved increasing knowledge, fostering positive attitudes, and promoting specific behaviours in the following areas:
1. Complementary feeding practices and food security
2. Hygiene and sanitation practices
3. Early Childhood development and positive parental interaction (PPI)
The project began with Formative Communication Research to identify the beliefs and perceptions of the target audiences, guide the communications strategy process, and develop 'client-oriented' messages.
Development Issues
Early Childhood Development, Children, Rights, Health.
Key Points
38% of children under six years of age in Uganda are affected by stunting, in comparison to two percent of the general population worldwide. Therefore nearly half of Uganda's young children are physically under developed as well mentally under developed. If these problems are not addressed and rectified before a child reaches the age of six, that child will be stunted for life.
World Bank in partnership with Ministry of Health.

Counting on Communication - The Uganda Nutrition and Early Childhood Development Project
World Bank Working Paper No. 59
Cecilia Cabañero-Verzosa
The World Bank
Publication Date
March 1, 2005
This publication is the first in a series of Working Papers sponsored by the Development Communication Division (DevComm) of the World Bank’s External Affairs Vice-Presidency. This series is designed to share innovations and lessons learned in the application of strategic communication in development projects. The series forms part of an effort by DevComm, together with other donors, non-governmental organisations (NGOs), and private sector partners, to mainstream the discipline of development communication in development practice. In order to demonstrate the value added by strategic communication, this report offers a detailed analysis of the communication strategy used in the Uganda Nutrition and Early Childhood Development Project (NECDP).
The overall objectives of the Uganda Nutrition and Early Childhood Development Project were to:
* reduce to half the prevalence of malnutrition among preschool children in the project areas by the end of the project, and increase school readiness of preschool children;
* raise enrolment in primary schools and reduce dropout and repetition rates;
* improve psycho-social and cognitive development; and
* double the proportion of mothers practicing appropriate childcare, from one in four to one in two.
The project's specific objectives included:
* helping communities organise services for children under six years old through growth monitoring and promotion, and the establishment of Early Childcare Education (ECE) facilities;
* strengthening the capacity of families and communities through sensitisation, education, and skills training on early childhood development and nutrition, as well as training for savings and income generation; and
* support communities through community grants and incentives.
In fulfilling its objectives and activities, strategic communication was made an integral part of the project. The project firstly included the use of formative research about values and attitudes with respect to child rearing. This helped to understand and identify barriers to positive behaviour, to segment audiences to be reached, and to develop persuasive and relevant messages conveyed through effective channels of communication.
According to the report, the communication strategy was developed in a highly participatory manner and included policymakers, district officials, community leaders, and grassroots organisations. It also included two-way communication activities developed to address the practices and behaviours that would need to be changed in order for the project to be successful.
Equally important, the communication strategy also focused on securing policy and political commitment at the national level through advocacy efforts to increase awareness and to build consensus among parliamentarians and policymakers who can provide the leadership to marshal resources needed for long-term support to nutrition and child development initiatives. This was achieved through building coalitions of support and developing national champions of nutrition and child development programmes, while at the same time educating and motivating parents and caregivers to adopt positive behaviour change in the care, feeding, and active learning of children.
According to the report, the final measure of an effective communication strategy is its contribution to the successful outcome of any development initiative. Evidence from the project’s longitudinal evaluation study confirms positive impacts of improved health and nutritional status, improved knowledge and practices in childcare, and increased demand for schooling and health and nutrition services.
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Formative Communication Research on Early Childhood Development in Uganda: Source -
Carol Baume
Stella Neema
Richard Kibombo
Cecilia Cabañero-Verzosa
Executive Summary
The purpose of the study was to identify the factors that inhibit and encourage positive parental interactions (PPI) with young children, in order to guide the development of project communication and intervention strategies.

* Opportunities for parent-child interaction
o Both men and women cited "work/lack of time/fatigue" as the major reason it would be difficult to interact with their young children. Parents are often away from the house for long period, and are often tired or ill.
* Concepts of Intelligence
o Parents thought of a bright child as one who is able to follow instructions, but they also mentioned characteristics that indicate creativity as indicative of intelligence.
o Children who are withdrawn or slow to learn, as well as those who are disobedient or obstreperous, are considered "dull."
o Innate intellectual capacity and being from a "good family" were seen as the main determinants of whether a child is bright or dull.
* Parental Role in School Outcomes
o Although most parents thought that a child's success in school has to do with natural intelligence or coming from a good family, many also recognized that a parent can help prepare a child for school by teaching him/her things.
o Mother's roles in affecting school outcomes were identified as feeding the child properly; teaching the child good manners and self administration; providing emotional support; teaching the child to read and write; and assisting with homework.
o The father's role was seen as primarily provider of material support, responsible for school fees and supplies, food, and housing. Fathers were also seen as disciplinarians.
* Beliefs and Attitudes about Child Development
o Most parents agreed with statements about positive parenting concepts.
o Parents agreed that infants as well as children in the 4-5 year age range need a lot of attention. Attention was most often thought of as providing for physical needs, or, for older children, as instruction.
o Most parents thought that talking to a young child stimulates the child to talk and learn.
o The great majority of parents agreed that it is good if a child of 4 or 5 asks a lot of questions because it helps the child learn and reassures the parent that the child will be bright.
o There was somewhat less consensus on punishing children or making them fearful of parents. This appears to be a matter of degree: Children should not be punished for every infraction or be afraid of parents; however, children are expected to obey and respect parents.
* Current Parental Interaction with Children
o The majority of parents, both male and female, reported that they played with the child on most days, although it is difficult to determine how play is defined. Almost half said they told a story to the child on most days; over 1/3 said they read to the child on most days; and over 2/3 said they sang to/with the child on most days. (None of these activities was observed.)
o Most of parents said that they taught something to the child on most days--usually practical daily skills such as feeding or dressing oneself; domestic or agricultural tasks such as preparing food, washing clothes and dishes, or digging; or teaching "good behavior" such as greeting people and respecting parents.
* Behavioral Analysis and Program Implications
o The socio-economic context of poverty, hard work, and illness, as well as domestic problems such as drinking and parental discord, curtails parents' ability to spend time in relaxed interaction with their children. Instability and violence in the north present especially serious problems. Project messages must ask caregivers to do things that are in fact feasible within this context. Wherever possible, underlying socio-economic problems should be addressed.
o It is unlikely that parents will be able to set aside time for special activities devoted solely to a child; opportunities must found within the course of routine activities to engage in PPI. "Active feeding" is such an example.
o It will be important to promote ways of relating rather than specific activities; it appears that many parents define "attention" or "interaction" as providing for basic needs, instructing, or even disciplining. Since the concept of PPI may be new, it will be important to model the interaction, even if just verbally. It may be possible to convey the concept by referring to how some mothers interact with young infants. This kind of interaction with infants is more acceptable than with children aged 2 and above.
o Portraying activities as "playing with the child" should be avoided, as many parents consider it undignified to be playing with children. Further, portraying situations that might be viewed as children taking too many liberties should be avoided; respect for parents is of very high value.
o "Child-to-child" approaches should be considered, since very young children are often left in the care of children aged 7, 8, and 9.
o There is little awareness that positive interaction stimulates brain development. This is likely to be a good motivator, as doing well in school is valued.
o PPI could be linked to a happy and harmonious family; parents desire family harmony.
o The project will have to work on community norms, on making PPI more acceptable. There are fears, especially among mothers, that if they engage in PPI, neighbors will either be jealous or disapprove.
o It does not appear that women can "negotiate" with fathers to spend more time with their children. Paternal involvement is better addressed through working on community norms by providing models, associating PPI with being a provider, and building on the positive outcomes of PPI that fathers identify in the behavioral analyses.
This is a report on findings from formative communication research on parental interaction with young children in Uganda. The research was commissioned by the Nutrition and Early Childhood Development Project (NECDP), financed by the World Bank. The purpose of the research was to serve as the basis for planning strategies to promote more frequent positive interactions between adults and children under six years of age. The research was not intended to be a thorough sociological study of early childhood development (ECD) but rather to be a focused study to identify the factors that encourage and the factors that inhibit positive parent-child interactions, in order to guide the development of project communication and intervention strategies.
The NECD project and the research are important because a child's experiences during the first years of life are critical to his or her physical, intellectual, and social development. In order for brain capacity to develop, a child needs not only adequate nutrition, but also generous amounts of psychosocial stimulation that actually "wire" the brain for learning. Consistent attention from caring adults increases the child's ability to learn. A toddler who receives affection, hears conversation and music, sees pictures and colors, and is frequently cuddled is likely to develop intellectual capabilities superior to those of children who do not have these experiences. The NECD project is attempting to encourage more frequent and positive interactions between caring adults and young children. As shorthand, we refer here to such experiences as "positive parental interaction", or PPI...

It is not clear whether "Govt to provide milk to school children" as reported in the Monitor newspaper of Saturday, January 16 2010 by Ismail Musa Ladu is a component of the project as funded by World Bank.
William Kituuka

In the next two and half months about 300 schools in Kampala will have milk as part of it regular menu, a senior official at the dairy regulatory body confirmed the development on Wednesday.
The Dairy Development manager, Mr Isha Muzira, said Dairy Development Authority (DDA) has finalised all the arrangement with the major stakeholders, including the diary processors to kick start the project dubbed “the school milk programme,” an initiative of DDA and development partners.
“We should have started this pragramme in the beginning of the term, but the school closed before we met the Parents Teachers Association (PTA). We are going to do now and have the pilot project started by April or in the second term,” Mr Muzira said at the sidelines of a workshop organised by Land O’ lakes, an organisation that has an interest in the developing of diary sector in Uganda.
He, however, said for sustainability, the milk will cost Shs300 per each pupil, “We want to sustain this pragramme so it we expect parents to pay only Shs300 per 300mls pack.”
Pilot project
The programme is a pilot project that will later be spread to other schools throughout the country.
“Those under UPE will not be part of this programme because government has objected to introduction of anything that will have parents incur additional costs,” Mr Muzira said.
Meanwhile, Land O’ Lakes, Country Manager Abbey Ariong said should more funds be available, attention of dairy development will be focused in the Northeastern part of the country. He said previously much attention was given to the western and central region because it has been largely peaceful compared to other regions.

A Paper presented to the 1st Eastern and Southern Africa
Regional School Milk Conference
Hotel Africana
27th-30th 2005
By: Dr. J. P. Saamanya
Department of Animal Production and Marketing
Ministry of Agriculture, Animal Industry and Fisheries
P. O. Box 513
Entebbe, Uganda
Uganda by virtue of its agro-ecological conditions is endowed with high potential for
agriculture development, including dairy production. Although the current milk
production is estimated at 1.1 billion liters, we have potential to produce up to 4 billion
To support development, the government has undertaken macro-economic reforms,
which include:
•Privatisation and liberalization
•Decentralization and good governance
The main development agenda of the country is poverty eradication as elaborated in the
pillars of the Poverty Eradication Action Plan (PEAP). All sector policies and programs
are aimed at supporting the pillars. The pillars relevant in our case are listed below:
1. Enhancing production, competitiveness and income
2. Human development
In relation to the school milk program, the following policies and programs are pertinent:
1. The Plan for Modernization of Agriculture (PMA), is a strategic framework for
eradication of poverty especially among the rural population. It is being implemented
by Ministry of Agriculture, Animal Industry and Fisheries focussing at the poor to
increase their income through improved market oriented farming. Increase in
livestock as well as the country’s annual milk production, which currently stands at
more than 1.1 billion liters are some of the results from implementation of the PMA
and other related strategies.
2. Universal Primary Education program is another strategy focussing at enhancing
human development. This program gives all children an opportunity to attain at least
basic education. This is expected to contribute to development of human capital that
is necessary for economic development.
3. Food and nutrition policy: one of the guiding principles of this policy is that access
to adequate food and nutrition is human right. The policy recognises that good
nutrition is a pre-requisite for adequate growth and development, health, learning
capacity, work performance and good overall quality of life. It is also an indicator of
economic well-being.
Challenges toUPE and dairy development
There are a number of challenges that have been encountered in the implementation of
the school milk program;
1. Low effective demand for milk: the per capita consumption of milk is estimated at
40 liters. This is much lower than 200 liters as recommended by FAO and WHO.
People cannot afford paying for milk because of poverty. In addition, government
has not been able to fund this program due to budgetary constraints. As a result farmgate
price remains low and also much of the milk produced goes to waste due to lack
of markets. This causes heavy losses at farm level, because even the excess is not
processed due to an even lower demand for the processed dairy products.
2. High malnutrition for the under five: poverty impinges on quality and quantity of
food available to a household. About 39% of the national children under five are
stunted (PEAP, 2004) as result. Malnutrition not only affects growth, but also the
development of the individual and thus may impede the attainment of the required
mental stamina.
3. Increasing school drop out and poor grades: children are dropping out of school at
an alarming rate especially in the north and east of the country. In the year 2003
PEAP only 33% of the enrolled children reached P. 6 and a mere 22% reached P.7%
(PEAP, 2004). Lack of lunch is cited as one of the causes of absenteeism and
dropping out of school. This implies that even those who stay in school are too
hungry to pay attention to their studies. This situation perpetuates high the national
illiteracy levels and consequently delays achievement of the human development
4. Lack of funding for the program: funding the school milk program by government
has not been possible due to budgetary constraints. Cost sharing and full payment by
the parent has also not been possible as it leaves out children from poor families.
Benefits of School milk program.
The potential contribution of school milk program to national development cuts across a
number of sectors including health, education and agriculture.
1. Health benefits:
•School milk will supplement the quality and quantity of food available for the
children. Milk being a good source of proteins, vitamins and minerals will
enhance attainment of sound health and development in children. The child’s
body immunity would be boosted thus reducing infections in this age group and
subsequently good nutrition will contribute to the effect of other interventions in
reducing infant mortality.
•A child who is taking milk is likely to develop a better mental capacity than one
who is not because of the nutrients contained in.
2. Education related benefits:
•Increase enrolment and retention in school: the prospect of having milk will
attract more children in school and improve their participation in school
activities. This gives them the opportunity to access education and compete
favourably. They become good material for human development and also
contribute to the country’s goal of increasing national literacy rates.
•The schools will have relatively healthy children with high morale for education.
3. Dairy sector benefits:
•Supplying milk to schools will increase demand for processed milk. This will
call for increase in quantity and quality of processed milk thus enabling the
manufacturers to utilize their redundant processing capacity. This could have an
impact of the tax revenue of the country as well.
•Milk in schools will increase per capita milk consumption and therefore increase
demand for milk and dairy products. A milk drinking culture is likely to start
with these children and continue with future generations, developing a
formidable local market for dairy products. This will stimulate milk production
and eventually lead to a vibrant dairy industry in future, while contributing to
poverty national eradication efforts. Increased income to farmers will enable
them to diversify production and penetrate other available market avenues.
•Increased milk production and subsequent increase and diversification in
processing would gradually replace milk imports, which come in the form of
condensed milk, milk powder and infant milk powder. In this way the country
would become self-sufficient in milk.
•Increased milk production would also allow Uganda to realize its potential for
export in the Eastern Africa region and beyond. The country is agro-ecologically
suited for dairy production at low cost, thus has a comparative advantage over
its sister countries.
•Once farmers are assured of markets they will form dairy cooperatives,
eliminate middlemen and make bigger profits from their farming efforts.
School milk program has significant direct or indirect contribution to the economy. It will
contribute to human development and human capital accumulation and play a key role in
increasing household incomes. It offers on-farm and off-farm employment and has
potential for increasing tax revenue.
School milk program should therefore be supported for realizing nutritional and
economic benefits.

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