Amidst one check-in conversation with my Global Health Corps (GHC) advisor, Paul Ellingstad, he remarked; ‘Not everything that can be counted counts, and not everything that counts can be counted’. He was reacting to my expressed worries in figuring out what to count as fellowship accomplishments instead of looking at what could be listed as worth sharing at the impending quarterly retreat. The wheels of time were still rolling, faster than my appreciation of what could count as crucial milestones’ by then. I quickly felt like losing the plot, the energy getting drained, facing a long year ahead. The task list read; ‘Work-plan development’, and yet we felt more time needed to break the ice. We really needed some focus to keep moving.
Eleven months down the line, we are transitioning out of the fellowship, having found our way. It feels like yesterday. Time has run so fast, but not too fast for me to pick out critical steps that counted in our efforts all the way.
I reminisce the first day that we made an introductory visit to one key stakeholder’s office with sketches of program specifics. I realized then that we would have to retrospectively do some home-work to communicate our objectives productively. Community Nutrition is not a new phenomenon to Malawi. So much is being done to that effect. The first step was to define our purpose and identify ourselves in the face of many nutrition interventions being implemented then.
Because the SUN initiative has been underway since 2011, any mention of a nutrition program would be perceived with regard to such a national agenda. Scaling Up Nutrition (SUN) is a country-led movement that brings organizations together across sectors to support national plans to scale up nutrition by helping to ensure that financial and technical resources are accessible, coordinated, predictable and ready to go to scale [1]. It focuses on promoting the implementation of evidenced-based nutrition interventions, as well as integrating nutrition goals into broader efforts in critical sectors such as health, social protection, development and agriculture. With a limited scope, we needed to clarify our portion of the bigger cake. Oddly enough, our target catchment population had not been reached by any component of the innovative SUN initiative, despite being in an implementing district for over 3 years. It was overwhelmingly crucial to underline our purpose and angle of focus.
We all appreciated that no clear definition would be arrived at without reliable information and resources to inform the program direction. Gathering information and identifying community voices was thus the second step. We realized it would only be ideal to ascertain the need at the community level and prioritize the interventions. We needed to make contacts with line Ministries and departments to ensure no duplication of activities. A needs assessment would then help identify the key issues, available resources and knowledge gaps. It was the imperative to map out partnerships and relationships through which to anchor the program. Which services could be integrated, who could be the drivers in our absence and how do we maximize on utilizing the existing structures? In furtherance of this, we considered building a team as the third step in the process. A core team of extension service workers from Education, Agriculture, Health, Gender, Child and Community development was then formed. This would, in due course, help with monitoring the progress of program outputs. Their core members are to integrate nutritional education sessions in their routine extension work through collectively identified structures such as demonstration gardens [2]. Nutrition is diverse, so too should be the constitution of the teams working on related programs.
It would have been easy to lose focus due to unstructured and unsustainable incentive systems that have characterized community projects. We had wanted as much to model a community-owned program. Something appraised and appreciated across the stakeholders. We could the identified need suffice to be an incentive? The challenge, however, is to identify quick-win areas and communicate one’s motivations so that every party appreciates why it needs to be engaged and partake in the program. Sharing motivations and inspiring voluntary participation from the community was our fourth step.
Consequent to sharing motivations and inspiring voluntary participation, it was critical that we keep stock of the details of any discussion and interests but also expectations as they form the building blocks of the sustainability potential. Paying attention to details assured the participants that their interests, perspectives and inputs were being considered and appreciated. Even more critical was the appreciation and acknowledgement of others’ efforts and contribution to the progress at every stage of implementation. We realized that working in a team is productive when members feel encouraged to bring forward their heartfelt opinions. All together the two steps would be ideal in building trust, most especially when they can relate to the actionable items identified throughout the implementation process. One would comfortably claim ownership of such a program and be compelled to ensure lasting success. We realized the communities actually know their challenges, and potentially solutions. What they need is a facilitative environment that affords them the opportunity to solving their own problems, especially social and behavioral challenges. A listening hand helps in empowering them towards community owned solutions and interventions.
In a year, we have learnt that these are really great steps that might not be easy to measure but substantially are key to long term positive returns on a community nutrition program. However, it is imperative that the momentum is kept intact along the path of continuous improvement. It is common knowledge that GHC offers us an opportunity to participate in what be described as a ‘relay race’ where to maintain the pace, there ought to be some unity of purpose and shared understanding. Henceforth, documenting all the above steps as reference points for the incoming colleagues so that there is informed continuity of progress and direction. We have established community teams and groups and there is a collective understanding of what needs to be accomplished in a broader sense of sustainable nutrition programs. As we transition out, we can comfortably count these action-points as having helped as stay our course.
While I look at the next course of life beyond the fellowship, I am reminded that I have to stay in the present and nourish the focus to ensure that we sustain the momentum that has driven as thus far.
References
[1] “Scaling Up Nutrition, or SUN, is a unique Movement founded on the principle that all people have a right to food and good nutrition. It unites people—from governments, civil society, the United Nations, donors, businesses and researchers—in a collective effort to improve nutrition.”
http://scalingupnutrition.org/about
[2] Demonstration gardens: Model sites to demonstrate desirable practices regarding organic nutritious vegetable garden development and management.