Problem: What problem is this project trying to address?
Malnutrition afflicts over 45% of children under five in Rwanda, resulting in retarded growth, reduced mental function and low productivity. In rural areas, where prevalence of malnutrition is particularly high due to a comparatively greater rate of poverty and illiteracy, mothers- who are unaware of the signs of malnutrition- don’t notice it until their children are in critical condition. More than 90% of the cases of malnutrition that make it to the village health care centers, only do so in emergency cases, where children are already in critical condition. Widespread ignorance at the community level and a reactive stance taken by health centers means that most children who receive emergency treatment are often re-exposed to the same high risk environment that led to their condition the first place. Moreover a small but good number of mothers attribute their children’s “strange” condition to witch craft and hardly seek any professional help, preferring instead to visit traditional doctors. The risk involved in children living in nutritionally risky environments under the care of ignorant mothers is particularly dire for those living with HIV/AIDS. Without a proper diet, the use of ARVs or other medicines in the case of other common diseases becomes less effective, drastically shooting up the risk of a fatal outcome.
The government of Rwanda- one of the most progressive in Africa- has made an effort to combat the endemic malnutrition that threatens a significant portion of its young population. Among the strategies implemented is the national distribution of emergency food supplements targeted at health centers for the treatment of emergency cases. The mass distribution of food supplements was done off the backs of military personnel dispersed across the country with little or no health expertise to train health workers. In addition, the government promoted the concept of kitchen gardens and distributed vegetable seeds to a few farmers but without any further support in much the same way as the few farmers who received a cow through the “one cow per poor family campaign”. Through the ministry of health, the government designed a nutrition protocol to guide health workers on how to address malnutrition in rural communities. This protocol was, however, published only in English without any follow-up training, making its contents inaccessible and hard to use for most health workers. The common trait among all the cited government interventions is that they are short-term, top-down and unsustainable.
A closer look at policies in different government ministries reveals that, while they are well-meaning when looked at individually, together, they tend to be counterintuitive. Take for example, priorities at the ministry of health which include proper nutrition and advocacy for kitchen gardens and food crop farming, compared to policies at the ministry of agriculture which advocate for commercial farming of cash crops aimed at poverty eradication. Agricultural extension workers, typically attached to the ministry of agriculture, are expected to give farmers advice and guidance on commercial farming with little or no attention paid to food crop farming for dietary purposes. Private sector players in the agricultural value chain too fail to see the connection between nutrition and their business. Take the Northern province of Rwanda for example; the area is the most productive in agricultural production of major cash crops, like coffee and cotton, yet shows the highest prevalence of malnutrition in the country.
Solution: What is the proposed solution? Please be specific!
Julie is broadening the scope of health care centers at the village level in Rwanda to include healthcare and agriculture in a bid to provide a long-term, homegrown and community-led solution to the endemic problem of malnutrition that afflicts more than 45% of children below the age of 5. Julie is demonstrating a powerful new way of leveraging synergies between two sectors- which have traditionally operated independently of each other and, at some level, counterproductively- to address a complex problem that to her, requires a multi-sector approach.
Through her organization, Gardens for Health, she is transforming healthcare centers so that they are able to provide- in addition to medical services- education, psychosocial support and agricultural extension services to mothers affected by malnutrition and, in effect, is empowering them to become part of the solution. Julie sees that when mothers- who traditionally have the responsibility of deciding what food their families’ eat- are empowered to make better dietary choices, malnutrition can be sustainably rooted out of Rwanda. She has developed a groundbreaking training model, co-created by the mothers themselves. The simplicity of her training material, the fact that it is co-created by her beneficiaries, and the engaging and fun way in which it is administered, completely demystify complex nutritional concepts, making them accessible and easy to understand even to the most primitive rural communities.