Examples of capacity building
Nursing staff at rural hospitals were shown how to calculate case-fatality rates. They found that 25-50% of children admitted with severe malnutrition died. They identified shortcomings in treatment and took action by implementing the WHO malnutrition guidelines. Malnutrition deaths were halved and several operational aspects of the health system improved. Some nurses became trainers and helped staff at other hospitals to improve their practices.
One clinic in each municipality of La Paz has been designated a ‘nutrition clinic’. Staff are trained to help mothers rehabilitate severely malnourished children at home, after early discharge from hospital. Malnutrition is the catalyst for building human resources and developing an integrated programme that has both preventive and curative elements. The ‘nutrition clinic’ has become the base to deliver improved prenatal nutrition, breastfeeding support, growth monitoring and counselling, and improved complementary feeding. The integrated expansion has been included in the Nutrition Strategic Plan.
A training course for nurses was developed with local staff in Tanzania. The training course provides on-the-job training for nurses involved in the treatment of severe malnutrition and is highly interactive. Following the training, facilitators helped nurses put new procedures into practice on the wards. Nurses from three hospitals received the training and improvements were seen in the quality of care provided.
Examples of advocacy
Thirty carers of severely malnourished children were visited at home one month after the children were discharged from hospital. Over 70% could repeat the home feeding advice but few had implemented it as basic food items were lacking. All had very low incomes that entitled them to the Government’s child support grant, yet none received it. The data were used to advocate for better access to the child support grant and were presented to the Commission on Social Welfare, reported as front page news, used as the basis for a TV documentary and used to ask questions in Parliament.
The result was that the Minister for Social Development took steps to improve access. This improved by 40% countrywide.