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Field Article
Volunteer
Health Workers
and facilitators
at Svisivi,
Gokwe South
Frontline
experiences
of Community
Infant and
Young Child
Feeding in
Zimbabwe
By Wisdom G. Dube, Thokozile Ncube
and Paul Musarurwa
Wisdom G. Dube is the
Gokwe North district nutritionist,
Ministry of Health
and Child Welfare (MOHCW),
Zimbabwe.
Thokozile Ncube is the
UNICEF Nutrition Officer and
one of the Master Trainers
for community infant and
young child feeding (cIYCF)
trainings in Zimbabwe.
Paul Musarurwa, is a district
nutritionist for MOHCW in
Goromonzi district. He took
part in the cIYCF training in
Gokwe North district as a
facilitator and was a Team
Leader in one of the training
sites.
The authors acknowledge the leadership of
the Ministry of Health and Child Welfare,
Department of Nutrition, for championing
expansion of IYCF services in Zimbabwe. We
would like to specifically acknowledge the
work and support of Mrs. Ancikaria
Chigumira (Deputy Director of Nutrition),
Zephania Gomora, Provincial Nutritionist for
Manicaland and Miriam Banda, Nutrition
Intervention Manager. The authors also
gratefully acknowledge the work of Mary
Lung’aho and Maryanne Stone Jimenez
(master trainers) and the facilitators in the
Gokwe North training (see table of names at
the end of the article). Finally, many thanks
goes to all the trained community IYCF
counsellors for their taking part in the training
and the Gokwe North district health
executive team for their support during the
training.
UNICEF, Zimbabwe, 2011
This article shares the perspective of three
individuals in Zimbabwe, directly involved
in rollout of community based support to
infant and young child feeding (cIYCF). The
content was captured in an exchange
between the authors during training
between 10-14th of October, 2011 in Gokwe
North, one of the districts in Zimbabwe. A
postscript by Fitsum Assefa (UNICEF
Zimbabwe) provides some context to the
cIYCF approach in Zimbabwe.
Background to IYCF in Zimbabwe
Undernutrition is widespread in Zimbabwe,
with 1 in every 3 children being stunted. Despite
subscribing to the Global Infant and Young
Child Strategy 1 since 1991, being a ‘breastfeeding
nation’ with 77% of infants breastfed at least
until their first birthday (mean duration of
breastfeeding 18 months), and years of effort to
expand infant and young child feeding (IYCF)
interventions (e.g. BFHI 2 , training of health
workers on IYCF, integration of IYCF in CMAM
etc.), key IYCF practices in Zimbabwe remain
very poor and unchanged.
Only six per cent of Zimbabwean infants
under the age of 6 months are exclusively breastfed.
Nearly one in three children (27 per cent)
receive soft, semi-solid, or solid foods before the
age of 3 months, and more than half (52 per cent)
receive soft, semi-solid, or solid foods before the
age of 6 months 3 . Less than one in ten children (8
per cent) receive a minimum acceptable diet,
and very few regularly receive eggs, meat,
legumes, or fruits and vegetables, owing to
economic constraints but also strong food
taboos. Seventy-five per cent of Zimbabwean
infants are reported to initiate breastfeeding
within one hour after birth, however, qualitative
studies reveal widespread use of pre-lacteal
feeds and discarding of colostrum (the first
breastmilk produced after birth). Considering
the evidence that support for optimal IYCF practices
remains the highest impact intervention
towards ensuring survival, growth and development
of children, improving the IYCF practices
of mothers, infants and young children remains
one of the key priorities for Zimbabwe.
Motivation behind community infant and
young child feeding (cIYCF)
innovation in Zimbabwe
In Zimbabwe, the need to build the capacity of
Village Health Workers (VHWs) to support
mothers and caregivers on optimal infant feeding
practices and to refer issues they cannot
handle to the health institutions was apparent.
Hundreds of health workers at different institutions
in the country have been trained in IYCF
counselling using the WHO 40 hour training
manual since 1991. However, the impact of the
training has not been felt, as evidenced by the
low rates of exclusive breastfeeding in the country
(32%) that has not changed over the past two
decades (DHS 2011 4 ). When the UNICEF
community IYCF counselling package was introduced
in 2011 (see Box 1) , Zimbabwe had
already identified the need and was ready to
strengthen and scale up effective IYCF counselling
in the community.
We believe that the provision of skilled IYCF
counselling services at community level, where
trained VHWs have direct contact with mothers,
their infants/children and broader families at
large, can contribute significantly to improving
IYCF practices and the reduction of chronic
undernutrition. For many years, IYCF initiatives
in Zimbabwe have concentrated on training
health workers. This assumes IYCF counselling
is mainly provided at health institutions.
However in reality, health workers are very busy
and do not have enough time to give adequate
attention and time (especially considering the
recent economic and social crisis that has
resulted in severe understaffing of the health
system). At a health facility, IYCF ‘talks’, given as
part of health talks, are mostly limited to informing
mothers of the benefits of breastfeeding
rather than listening and counselling based on an
individual mother’s condition. Such an approach
only reaches those who are accessing health services
because of scheduled services (e.g. antenatal
care (ANC) and immunisation) or due to illness
and does not reach those who are not able/have
no need to access these services. In addition, such
talks miss critical contact times to assess, counsel
and influence IYCF practices in a proactive and
sustained manner. It is also worth noting that
while the social and cultural determinants of
IYCF are significant, the approach of health
education at a facility focuses on the mother, who
does not have the sole responsibility or control
over deciding IYCF practices.
While the role of VHWs in Zimbabwe
includes communicating on all aspects of health,
including nutrition, to date there has been very
limited IYCF included in their training and job
aids. Thus VHWs have not been enabled to
provide an effective IYCF assessment and counselling
service.
cIYCF strategy
The cIYCF strategy is to ensure that all mothers
and caregivers of babies aged 0 to 24 months of
age in Zimbabwe have access to skilled IYCF
assessment and counselling within the communities
they live in. An individual VHW covers
about 100 households and knows the population
in his/her catchment and their various needs
very well.
Box 1: UNICEF Community IYCF Counselling Package
UNICEF has developed a set of generic tools for programming
and capacity development on community based IYCF
counselling. Aimed for use in diverse country contexts, the
package of tools guides local adaptation, design, planning
and implementation of community based IYCF counselling
and support services at scale. It also contains training tools
to equip community workers, using an interactive and
experiential adult learning approach, with relevant knowledge
and skills on the recommended breastfeeding and
complementary feeding practices for children from 0 up
to 24 months, enhance their counselling, problem solving,
negotiation and communication skills, and prepare them
to effectively use the related counselling tools and job aids.
The package contains:
• Facilitator Guide
• Planning and Adaptation Guide
• Key Messages Booklet
• Training Aids
• How to breastfeed your baby - Brochure
• Nutrition During Pregnancy and Breastfeeding -
Brochure
• How to feed a baby after six months - Brochure
• Counselling Cards for Community Workers
Participant materials
It is available in English and French. Download from:
http://www.unicef.org/nutrition/index_58362.html
1
A national commitment/cabinet decision for improving food
and nutrition security in Zimbabwe and a response to the
call by the Convention of the Right of the Child 1990, of
which Zimbabwe is signatory
2
Baby Friendly Hospital Initiative
3
Available from http://www.measuredhs.com
4
However, giving oil for infants is widely practiced in Zimbabwe,
and survey conducted in 2010 that probed on giving oil has
shown only 5.8% EBF, majorly explained by the addition of
oil in the analysis.
5
Available at http://www.unicef.org/nutrition/index_58362.html
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