Integrated Primary Health Care Program for the Bateyes of Quisqueya
This is one of 50 Harvesting Nutrition project case studies. Harvesting Nutrition was a contest held in 2012 and 2013 that showcased active projects working to improve the impact of agriculture and/or food security on nutrition outcomes. Co-sponsors were SecureNutrition, Save the Children UK, and the Global Alliance for Improved Nutrition (GAIN). Learn More.
The main objective of this program is to reduce child mortality. It is an integrated program that includes nutrition, clinical, community health, water and sanitation, and capacity building components. Each component has a strategic objective that contributes to the overall goal of reducing child mortality. The strategic objective of the nutrition component this year is to reduce undernourishment in children under-5 in communities served by the project from 1% to 0%.
The nutrition component is made up of three essential elements: treatment of undernutrition, nutrition education, homestead gardens, and provision of albendazole and Vitamin A. In fiscal year 2012 (Oct 2012 - Sep 2013), the project targets were to treat 40 children for undernourishment, begin 30 home gardens, and provide nutrition education to 200 mothers.
At this time, the project has already met its yearly goals for undernutrition treatment and education and is on track to meet its goal for homestead gardens. Between April and June of 2013, only 2 new children were identified with undernourishment and 10 children recovered from undernourishment. The project team has helped families begin 18 homestead gardens and is confident that they will meet the goal of 30 new homestead gardens by the end of the fiscal year in September.
Impact of project:
The project in Quisqueya has been one of our most successful projects, although we address nutrition in all of our projects. While there are many elements that contribute to its success, the most important thing that we have learned from this project is the importance of an integrated approach. Undernourishment has complex and multifaceted causes, including food insecurity, diarrheal disease, poor infant and young child feeding practices, and others.
In 2009, our project team was identifying almost 150 undernourished children each quarter. We began our project by focusing on treating undernourished children, as this was the most pressing need. Over time, we realized that a large part of the problem was a lack of understanding in the communities about what constituted proper nutrition for children. At this time, we added a Community Health Worker component and increased our educational activities in the communities. Although this improved our results, we still found that families had difficulty buying nutritious foods for their families. With a fairly small initial investment, we were able to start helping families take advantage of the arable land around them to start homestead gardens.
Why this project is a Good Practice example:
The investment for the homestead gardens, the agricultural aspect of this program, is relatively small, less than $3,000 per year. However, by integrating this intervention into a well-established program we have been able to leverage it to produce impressive results. The constant presence of our CHWs and the routine monitoring visits by our Project Team have contributed to the success of homestead gardens that families have started. Gardens that were started over three years ago are still being maintained and provide families with food as well as a source of income. Most gardens are large enough for families to eat the fruits and vegetables they produce and sell the excess. This addresses poverty, which is one of the root causes of food insecurity in these communities.
This year, our project has been recognized as an important investment by the Dominican Ministry of Agriculture. After being informed about the project, the Ministry of Agriculture has pledged to provide seeds and equipment to support the project and allow us to reach more beneficiaries.
Additionally, our project has shown a lasting impact. Undernourishment has been eliminated in many of the communities that we work in through this project. The continuing community health and clinical interventions in these communities reinforce the importance of nutrition and prevent the resurgence of undernourishment.
Maintaining open lines of communication with our country partners and staff is an essential tool is designing and implementing effective interventions. The evolution of this project came about through a combination of technical knowledge from our staff and the invaluable perspective and innovative ideas of in-country partners. This project is an excellent example of how the on-the-ground reality shaped the project over time. Due to the mutual trust we share with partners, we explore new ideas and were rewarded with great success.
Although the idea of homestead gardens is rather simple, it can be complicated to implement. Education has been a key element of this intervention. Families are interested in beginning home gardens, but are often interested in planting foods with limited nutritional value. It is important to provide education about nutritious food and how to grow plants that may be new to the family. Education about how to prepare foods that may be unfamiliar is also a key element.
Most importantly, continual monitoring and support is essential. Our success with homestead gardens and reducing undernourishment would not be possible without a long standing relationship to the communities that we work in and the trust of the people.
Funders: Medicines for Humanity
Primary Contact: Amelia Brandt, Regional Program Manager
Country: Dominican Republic
Project Dates: 2009 to present
Interventions: Incorporate explicit nutrition objectives and indicators, Assess the context at the local level, Target the vulnerable and improve equity, Collaborate and coordinate with other sectors, Facilitate production diversification, Incorporate nutrition promotion and education,
Target Population: Children under 5, Rural households,
Project Stage: Ongoing activities
Geographic Coverage: Village/Municipality