proposal nutrition- imam fundation la caixa natcom espagnol mauritania baja reso

8/2/2019 Proposal Nutrition- IMAM Fundation La Caixa Natcom Espagnol Mauritania Baja Reso

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Proposal IMAM Nutrition Mauritania Spain Natcom Page 1

SUMMARY

ProjectFight child malnutrition in 4 regions inMauritania by providing capacity building forcommunity management of acutemalnutrition and prevention of malnutrition.

Intervention areas: Brakna, Gorgol, Assaba,Guidimakha

Background: In Mauritania 75% ofhouseholds foods needs are imported.Population is facing vulnerability du a lack of

food and prices crises. Infant and childrenpractices are not appropriate amoingschildren that are early affected bymalnutrition. Acute malnutrition rates arehigh at the lean period in a recurrent manner,notably in the 4 regions.

Starting date: Once funds are transferred toMauritania country office

Duration: 24 months

General Objetif:Contribute to progres towards MillenniumDeveloppement Goal #1 and #4 by improvingnutritional status of children under five in fivevulnerable regions (Brakna, Assaba, Gorgol,

and Guidimakha).

Specific ObjetifsHealth facilities and local partners capacities in the regions are strengthened in order toimprove coverage of the treatment of acute malnutrition and of prevention interventions.

Results

R1. Health facilities in the intervention zones of the project are reinforced in order to improvethe response time of the screening, prevention and treatment of malnutrition; 70% of healthpersonnel should receive specific training.

R2. Behaviour change in infant and children feeding practice has been promoted in 40% ofwomen

Budget:400.000 Euros


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NEEDS ASSESMENT

The Islamic Republic of Mauritania, located in West Africa, maintains the Sahara Desert as

its western border, also sharing a northeast border with Algeria, southeast with Mali andsouthwest with Senegal; this large country possesses a surface area of 1,030,000 km; itswestern border is the Atlantic Ocean, the coast totalize 600 km.

Situated between Sub-Saharan Africa and North Africa, Mauritania has encompassed acrucial role in commercial trade in the Saharan region. Desert makes up 80% of the land andonly 0.2% of the soil is fertile. The country only has one permanent waterway, the SenegalRiver, which forms the natural border with its neighboring nation, Senegal. In 2011, there arean estimated 3.255.777 inhabitants. Nearly half of the population (46%) lives in rural areas.The population density is 2,9 individuals/km. 44% of the population is made of individualsyounger than 15 years (18.5% of these are less than 8 years), and only 6% of the populationis older than 60 years of age. The male to female ratio is 100:116. The entire population is

Muslim and is composed of Arabs, pulaars, soniks and wolofs.

Mauritania has experienced rapid transformations, going from being a traditional nomadicsociety to being a society in which more than half of the population is living in urban areas.Even so, the contrast between the moderately developed sector and the traditional sectorstill strongly exists. The main portion of the resources of Mauritania is obtained throughcommercialism (mining and fishing). With a GDP per inhabitant of $280 in 2002 and 43% ofthe population living on less than $1/day, Mauritania pertains to the group of the leastdeveloped countries.

Situation analysis on women and children was done in 2010 in the country focusing in

an equity approach.

In Mauritania, poverty remains, beside periods, a predominantly rural phenomenon in that59% of the rural population lived below the poverty line in 2008, against 21% in urban areas.The distribution of the incidence of poverty across regions is still very unequal. According todata from the EPCV 2008, can be grouped into 3 sets Wilayas:The poorest, with an incidence greater than 60%: Tagant, Gorgol, Brakna;The moderately poor with an incidence between 30 and 60%: Hodh El Charghi, Adrar,Guidimagha; Assaba; Hodh El Gharbi, Trarza Inchiri;

According to the Human Development Index (2010), Mauritania was ranked number 136 ofthe 169 nations. In the education sector, the registration rate is 85%, with a boy-girl of 75%;

less than 57% of the population can read and write.

The literacy rate is 68% in boys and 58% in girls. Access to adequate medical care isinefficient and unfairly distributed, as only 67% of the population lives within 5 km of a healthcenter. The only establishments that are actually counted in this fact are those that maintaina fixed location, correctly equipped with the proper physical and human resources. Thisparticular situation significantly influences the utilization of necessary services and thereforehalts the progression of quality healthcare rates.

The main rates in the health sector, particularly those referencing children and women, haveseen limited progression over the past 10 years. The maternal mortality rate has reached930 of every 100,000 births; (1995) 747/100,000; (2000) (DHSM Demographic HealthSurvey in Mauritania) 686/100,000; (2007) (MICS Multiple Indicators Cluster Survey). Thesynthetic fertility rate is higher than that of the sub region (4.7 in 2000), which is higher than


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in 1995 when it was 6.5. The rate of child mortality (>5) has increased to 122 deaths per1000 children, of which 77 die within the first year, according to the MICS survey in 207.

In this way, infant mortality rates (for children >1 year) and child (>5 years) have gone from75 to 125 per 1000 births in 2000 (EDSM), 78 to 123 per 1000 in 2004 (Survey of infantmortality rates and malaria), and 77 to 122 per 1000 in 2007 (MICS). The recent regressionis very slow, only 4% per year. The main causes include: (i) Acute Respiratory Infections, (ii)Diarrhea, (iii) Malaria, (iv) Malnutrition and (v) Measles for children >5 years old. Theneonatal morality rate is half of the infant mortality occurrence in Mauritania, with leadingcauses including asphyxia, neonatal infections, low birth weight (premature birth,hypertrophy) Neonatal care has not been a priority over time and is only gradually makingits way into the priority of intervention work (communal medical care).

Nutrition situation

In 2008 REACH-Renewing efforts against child hunger Initiative was piloted in

Mauritania and in a early stage REACH working groups compiled key information toanalyse nutrition situation and actors mapping.

Largely surrounded by the Sahara (the Sahel region), Mauritania has been in crisis since1990, as child survival has been an issue due to the poverty and nutritional situation in theseareas. Things improved during the last 5 years, but this was broken in 2007. The nutritionalstatus of children under 5 years is now precarious, due to poor and inappropriate feedinghabits of children, threatening their survival and growth, also due to the access to basichealth care and social services, particularly for the most vulnerable groups. For example, thepractice of exclusive breastfeeding went down by 20% from 2000-2001 and by 11-14%between 2007 and 2008. Children under 5 years old in Mauritania have been mostvulnerable during food and nutritional crises in recent years, due to a diminishing supply offood in homes as well as droughts and emergency situations; this has also occurred due toan increase in the occurrence of infectious diseases like malaria, respiratory infections,intestinal parasites and, most-commonly, diarrhea.

Mauritania only produces 30% of the food products they need and therefore depend onimports and exterior aid. The increase in the price of food is most prevalent in importedproducts and has perpetuated the lack of access to these products, which in turn increasesnutritional insecurity, especially for families with small children. This situation was madeworse when tourism took a fall in December 2007, when the nation became most unstableand also during the recent political tension that has resulted from two consecutive changesin power in March and July of 2008, following a coup in August 2009.

At a national level, the prevalence of global acute malnutrition is 12,5% during the leanperiod and 6,8% in post harvest. This date differs, depending on the geographical region.The highest rates of acute malnutrition during the lean period 2010 were found in Gorgol(19,9%), Guidimakha (19,8%) and Brakna region (18,4%). During lean periods in 2009, fiveregions has prevalence upper the 15% of WHO emergency threshold.

Chart. Evolution of the prevalence of severe acute malnutrition between 2000 and 2009(Reference NCHS)


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Chronic malnutrition is not related to seasons, but is directly linked to poverty and the lack ofaccess to regular and diverse nutrition (which includes all essential nutrients). In 2000, 2001and 2009, the prevalence of global chronic malnutrition has decreased considerably, by50%. However, this improvement is not accurate in every region, and leaves some in avulnerable nutritional situation. This global improvement could be due to nutritionalinterventions (preventative and curative), carried out by governments and their collaborators.Another reason could be the improvement in data collection and information, as the gravityof the situation can be determined, as well as those areas that do not have reliable officialdocuments providing information.

Figure: Evolution of underweight (Reference NCHS)A phenomenon oftemporal tendencies ishighly noticeable inunderweight. This typeof malnutrition isstrongly linked to thetime in which thesurveys wereconducted, which wasduring periods ofcultivation, while thecrops were mostaccessible.

This situation presents external elements which influence the nutritional state of children,putting them at risk for suffering malnutrition, including some of the following aspects:

a) Price tendencies of basic food materials: In February 2011 the overall index FAOfood prices reached a record level exceeding that of 2008, year of global food crisis.In terms of cereals, the increase in international prices is particularly sensitive forwheat (+85%) and maize (+76%). Wheat prices in Nouakchott increased 40%

compared to last year with the same period. Other commodities of first need(Including maize, sugar, oil, rice) also recorded significant increases in prices. Thisincrease in food prices coincided with the resumption of crude oil prices, favored by


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the recovery of the global economy.b) Innapropiate infant and child feeding pratices. Although there is a positive evolution

in exclusive breasfeeding practice (45,9% in 2010), efforts should continue to

increase the number of children receiving exclusive breastfeeding between 0 and 6months of life to hav a huge impact in malnutrition reduction. One major problem, asnutrition data shows is the lack of diversity of complementary feedin ans the lowpercentage of the minimum adequate diet (frequency and diversity), which is 20.7%in 2010. The KAP-Knowledge, Attitudes and Practices of February 2009showed thatsome behaviors do not correspond with the practice of proper nutrition:

a. one third of mothers give birth at home, sometimes because of lack of accessto health facilities, sometimes for cultural reasons;

b. In the rural sites, especially among first time mothers, they rely on a nurse tofeed the baby sometimes up to several days;

c. The tradition of giving water and other sweetened liquids is very strong. Itoften occurs at home after a delivery in a health facility (which way the water

could bed. Half of pregnant women were told that the child "in need of drinking water";e. Many Mauritanian mothers do not use an optimal position or put the child at

the breast during a feeding;f. The grandmother serves as a conseulor and is often next to the new mother

during the first 45 days while the stepmother is often present throughout thelife of the child.

c) Beyond dietary behavior, other underlying causes are the Mauritanian context. Theseare (i) low access to care and basic services (health and education), (ii) a highprevalence of childhood diseases in a restrictive environment and (iii) a precarioushygiene.

NUTRITION STRATEGY IN MAURITANIA

In Mauritania the problem of malnutrition is complex and multisectoral causes. Despite manynutritional interventions on the part of government with the support of all its partners - morethan 30 actors are involved - most activities are very fragmented and only implementedsome small scale. REACH reverses this trend by setting a global goal, the needs of children,and focusing on how each partner can contribute to reducing malnutrition.


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Multisectoral Nutrition National PlanThe national plan aims to accelerate progress towards MDG-F #1 and elimination childrenmalnutrition. The selected interventions in the national plan, focus on five priority areas that

target the direct causes and underlying causes of malnutrition: improve breastfeeding and complementary feeding; increase the intake of micronutrients; improve the treatment of diarrhea and parasite control; improve the treatment of severe and moderate malnutrition; improve household food security;

National protocole of acute malnutritionIn 2007, alerted by acute malnutrition situation (MICS survey in 2007 showed 4 regions witha emergency prevalence of acute malnutrition and 3 regions below the alert threshold) anational protocole to care acute malnutrition children was adopted and the programme wasscaled up to all regions.

The management of acute malnutrition initially focused on launching the program planningand processes i.e. development of tools, early procurement of equipment, and on thetraining for trainees. Since 2008, the focus was put on the implementation of themanagement of acute malnutrition Protocol and at raising national interest in the project andat raising self awareness in the regional and national health services. Also, nutritionintegration in the health information system was started.

The constraints were coverage and the quality of the treatment. Mobile units introductionalong with the strengthening of f ield interventions were possible through technical assistanceinputs that innovated the health structures. Additionally, an increased interest and presenceof international NGOs in some areas led to the better quality of assistance provided by

partners.

Since 2007, there has been a progressive introduction and scaling up of effective nutritionalinterventions to manage severe and moderate acute malnutrition in Mauritania. The programhas been organised and managed by National Government with the assistance of manydifferent International agencies and non-governmental organisations.

Community health workers or volunteers can easily identify the children affected by severeacute malnutrition using simple coloured plastic strips that are designed to measure mid-upper arm circumference (MUAC). In children aged 659 months, a MUAC less than 110mm indicates severe acute malnutrition, which requires urgent treatment.Community health workers can also be trained to recognize nutritional oedema of the feet,another sign of this condition. Once children are identifi ed as suffering from severe acutemalnutrition, they need to be seen by a health worker who has the skills to fully assess themfollowing the Integrated Management of Childhood Illness (IMCI) approach. The healthworker should then determine whether they can be treated in the community with regularvisits to the health centre, or whether referral to in-patient care is required. Early detection,coupled with decentralized treatment, makes it possible to start management of severeacute malnutrition before the onset of lifethreatening complications.

In some context, the majority of children who have severe acute malnutrition are neverbrought to health facilities. In these cases, only an approach with a strong communitycomponent can provide them with the appropriate care.


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Evidence shows that about 80 per cent of children with severe acute malnutrition who havebeen identifi ed through active case fi nding, or through sensitizing and mobilizingcommunities to access decentralized services themselves, can be treated at home.

The treatment is to feed children a ready-to-use therapeutic food (RUTF) until they havegained adequate weight. In some settings it may be possible to construct an appropriatetherapeutic diet using locally available nutrient-dense foods with added micronutrientsupplements. However, this approach requires very careful monitoring because nutrientadequacy is hard to achieve.

In addition to the provision of RUTF, children need to receive a short course of basic oralmedication to treat infections. Follow-up, including the provision of the next supply of RUTF,should be done weekly or every two weeks by a skilled health worker in a nearby clinic or inthe community.

With modern treatment regimens and improved access to treatment, case-fatality rates canbe as low as 5 per cent, both in the community and in health-care facilities. Community-based management of severe acute malnutrition was introduced in emergency situations. Itresulted in a dramatic increase of the programme coverage and, consequently, of thenumber of children who were treated successfully yielding a low case-fatality rate.

In 2010, two major evaluations (Community Mamangement of Acutre Malnutrition UNICEFexperts (1) and FANTA-2 (2)) were carried out at the beginning of 2010. Sommerecommandations were:

For Inpatient Therapeutic feeding centers (OTF-CRENI)- Ensuring a screening in external consultation and emergency room

-Harmonize admission and exit criteria including MUAC (Middle Upper ArmCircunference) tools to be used.

- Tracking sheet and register - transfer reference card: harmonized and translated intoFrench - Arabic tools

- using the F75 phase 1- OTF list available in all structures (OTF, InTF) applying decision- Children monitoring for discharge - tracking sheet and register available

For Outpatient Therapeutic feeding Centers (InTF-CRENAS)- Training, evaluation and supervision strategies enhancement- Reinforcing community sensibilization (WFP, local NGO)- Available tools in arabic and french, available drugs for systematic treatment

-Scale-up mobile teams of acute malnutrition management

For Nutrition Service and regional nutrition respondents- Supplies management improved (logistics, stock..)- Single country in integrating nutrition in health information system- Improvement of retro information to structures and DRAS- Assure link with hospitals data base and SNIS data base Improving supervision (quality and tools)

The results of these two important evaluations were applied in the revision of the nationalprotocol to improve the quality and coverage of acute under-nutrition treatment. Mauritania

programme is focused on:


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1. Adopting and promoting national policies and programmes that: Ensure that national protocol for the management of severe acute malnutrition have

a strong community-based component that complements facility-based activities.

Achieve high coverage of interventions aimed at identifying and treating children in allparts of the country and at all times of the year through effective communitymobilization and active case fi nding.

Provide training and support for community health workers to identify children withsevere acute malnutrition who need urgent treatment and to recognize those childrenwith associated complications who need urgent referral.

Establish adequate referral arrangements for children suffering from complicatedforms of severe acute malnutrition so they can receive adequate inpatient treatment.

Provide training for improved management of severe acute malnutrition at all levels,involving an integrated approach that includes community- and facility-basedcomponents.

2. Providing the resources needed for management of severe acute malnutrition,including:

Making RUTF available to families of children with severe acute malnutrition througha network of community health workers or community-level health facilities.

Ensuring funding to provide free treatment of severe acute malnutrition becauseaffected families are often among the poorest.

3. Integrating the management of severe acute malnutrition with other health activities,such as:

Activities related to the Integrated Management of Childhood Illness at fi rstlevelhealth facilities and at the referral level.

Preventive nutrition initiatives, including promotion of breastfeeding and appropriatecomplementary feeding, and provision of relevant information, education andcommunication (IEC) materials.

National Strategy on Infant and Young Children FeedingThe aim of the national strategy is to improve the nutritional status and health, the growth,development and survival of infants and young children Mauritania through the promotion ofbreastfeeding and appropriate practices supplementary feeding.The strategy provides the tools to improve nutrition status through prevention. The objectivesof the national strategy, which will be completed by 2015, are:

Increase and maintain the proportion of newborns breastfed within time after delivery; Increase the percentage of newborns who are not breastfeed (tea, water, fruit juice,

milk, animal etc.) Increase and maintain the percentage of infants under six months exclusively

breastfed Increase and maintain the percentage of infants aged 6-9 months breastfeed and

who receive appropriate complementary feeding Increase the percentage of children who are still breastfeeding at age 20-23 months Promote the use of appropriate complementary foods maximizing the use of local

products

Breastfeeding promotion targets a national coverage taking into account the 5 components forsuccess of the IYCF:

Strategic action at national level: policy, legislation, planning, budget, monitoring andevolution. Organization of the health system.


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Community level intervention. Communication for behavior change; and IYCF in difficult situations (e.g. emergencies, HIV).

Children Survival and development communication strategyThis strategy was developed on the basis of a qualitative research carried out in2009.UNICEF translated it into an integrated communication plan linked with NationalStrategy of Children Survival with four main messages to encourage healthy behaviors andimproved knowledge, attitudes and practices and participation of families, individuals &communities, as in below:

(1) Promotion of exclusive breastfeeding for < six months and adequatecomplementary feeding;(2) Promotion of hand washing with soap;(3) Promotion of long lasting impregnated bed nets;(4) Control of diarrhea.

FIELD COORDINATION

The REACH initiative started as a pilot project in Mauritania with the support of the UnitedNations system (UNICEF, WHO, FAO, WFP) in May 2008. This is a multi-sectoralpartnership between government, the UN, civil society and the private sector to foster thestrengthening of coordination and promotion of joint programs for nutrition and food security.This initiative is leading efforts to (i) support the immediate causes of malnutrition(individually), focusing on increasing micronutrient intake and improved feeding practicesinfant and young child, (ii) the management of underlying causes (at Community), whichfocuses on increasing the availability and accessibility to food and basic health services and

interventions preventive.

REACH is based on the definition of a multisectoral package of interventions tailored to thespecific context of the country and with the extension of coverage will have an impact onreducing malnutrition in children. These combined interventions have shown an efficacy rateof 60% in reducing malnutrition. Thereafter, reaching a coverage of at least 80% of each ofthese interventions would significantly reduce the "burden"of malnutrition among childrenunder 5 years (Lancet Nutrition Series, 2008).


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REACH initiative is used as a coordination platform at the national level of actors onnutrition. This nutrition coordination is now also stablished in some regions with the supportof International NGO, as Gorgol and Guidimakha. Its a multisectoral coordination that allows

to harmonised approach and to improve analyse and availabillty of prompt information.

In the humanitarian domain, a national Emergency Coordination Forum is leaded by theResident coordinator of the UN System in Mauritania in tight collaboration with government.This forum has developed a humanitarian mapping and gets quick information of situation toshare it amongst stakeholder and to initiating decision and action in a possible response.During the last 3 years this forum has largely contributed to help nutrition community in theresponse in lean periods to localised emergency nutrition situation (acute malnutrition ratesbelow 15%).

OPERATIONAL FRAMEWORK

Title Project:Fight child malnutrition in 4 regions in Mauritania by providing capacity building forcommunity management of acute malnutrition and prevention of malnutrition.

MalnutritionLocationThe project will be implemented in 4 regions, Brakna, Gorgol, Guidimakha and Assaba

Duration24 months

Target populationIndirect: All children population in those 4 regions will be target by project: 218.456 underfive children.

Direct:Focus in 49.595 under two year old children.The projet will touch 108,000 women.Children suffering from acute malnutrition (see table with estimations)


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Estimated numbers of direct and intermediary beneficiaries

Interventions Year 1 Year 2

Direct beneficiariesIn-patient therapeutic Feeding centres for Treatment of sever acute under-nutrition withcomplications

20 30

Out-patient therapeutic Feeding Centres for treatment of Acute under-nutrition withoutcom lications*

1800 2000

Adult women (15 and older) receiving information on exclusive breast feeding,complementary feeding, hand washing, ITN and diarrhoea control**

108 000 110 000

Intermediary beneficiaries

Programme managers at local level, non-government and UN agencies 40 50

Front-line Service providers (health workers, Personnel of NGOs and teachers of universityand school health)*****

500 600

Supplementary feeding centers for treatment of moderate acute under-nutrition 200 200

Totale Children 0-59 Children 0-24Children

Severe acutemalnutrition

Childrenmoderate

acute malnutrition

ASSABA 314,478 58,178 22,013 252 4,991

GORGOL 315,057 58,286 22,054 556 10,050

BRAKNA 320,632 59,317 22,444 720 9,457

GUIODIMAKHA 230,677 42,675 16,147 814 7,322

TOTAL 1,180,844 218,456 82,659 2,341 31,820

Table: indirect target based on estimations from 2010 acute malnutrition prevalence.

SectorNutrition, health, humanitarian action

General Objetif:Contribute to progres towards Millennium Developpement Goal #1 and #4 by improvingnutritional status of children under five in five vulnerable regions (Brakna, Assaba, Gorgol,Guidimakha and Nouakchott).

Specific ObjetifsHealth facilities and local partners capacities in the regions are strengthened in order toimprove coverage of the treatment of acute malnutrition and of prevention interventions.

Specific Objetif IndicatorsRates of global acute malnutritionRates of global underweight

80% of acute malnutrition cases are detected and screened at the community leveland refered to health facilities

60% of children with severe acute malnutrition admitted in the health care facilitiesare treated and cured.

Verification sourceSMART Nutrition Surveys


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Results and indicators

Result1. Health facilities in the intervention zones of the project are reinforced in order to

improve the response time of the screening, prevention and treatment of malnutrition; 70%of health personnel should receive specific training.

Indicators:

% of health personnel and agents trained involved in treatment and prevention ofmalnutrition

% of children screened and monitored % of health facilities providing monthly information on acute malnutrition

management program

Result 2. Behaviour change in infant and children feeding practice has been promoted in40% of women

Indicators:

Number and percentage of adult women (15 and older) receiving information onexclusive breast feeding, complementary feeding, hand washing, ITN and diarrhoeacontrol

Verification sources

Register books from health care facilities Monitoring reports National Health information system tally monthly sheets

Activities

Result 1Activity 1. Adoption of new protocole of acute malnutrition and editing of new toolsActivity 2. Equipment of 50% health care facilities with anthopometric equipment andmedicinesActivity 3. Training of up to 600 health agents in the protocole of acute malnutritionmanagementActivity 4. 50% of hard to reach localities are covered by mobile teams of acute malnutritionmanagement

Result 2

Activity 5. Interpersonal and group discussions (home visits, working with women's groups)to counseling on essential nutrition actions.Activity 6. Mass communication campaigns leaded by health agents at the community leveltarget to womenActivity 7. Training of health and community agents in the family essential practice (breastfeeding promotion, complementary feeding, handwashinhg, etc,..)Activity 8. Develop communication materials to promote good practices


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Implementation chronograme

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A7 X X X X X X X X

A8 X X X X X X

Monitoring and evaluation- Impact: The twice yearly SMART surveys will gave thekey information of nutrition

status of children and feeding practiceso July survey: Malnutrition prevalence indicators in lean periodo December survey: Infant and Young children feeding practices and

malnutrition prevalences indicators in post harvest.- Monitoring: The consolidation of the nutrition and health information system. The four

regions are equipped and assisted to integrate the indicators of acute under-nutritiontreatment into Health Information System monthly. A semester report is alsoproduced.

- Monitoring: a community based M&E system will collecte information about BCC atthe community level and mass campaigns.

RISKS AND HYPOTHESIS

In initiating the project, the reaching of the objectives directly depends on the state of thefollowing criterion:

1. Political Instability: Proper and firm political relations for project development arenecessary in order for the projects lasting impact.

2. Firm and lasting political relations are also necessary for all parties associated withthe project (UN organizations, NGOs, civilians and beneficiaries).

3. The timely mobilization of financial and human resources.4. Significant emergencies or natural disasters must not be present nor affect the

health centers in the community.5. Safety issues dealing with expat kidnappings can also negatively affect the impact

of the projet

RESSOURCES

Total budget : 400,000 euros (see annex)

Human ressources:a) UNICEF staff: 2 international nutrition staff and 2 national staff and 2 consultants

(technical assistance)b) Ministry of Health: 3 staff in the National Nutrition Survey

DRAS: 4 nutriton focal points in the regionsDisctrict: 25 nutrition focal point in districts


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c) NGO: 4 international NGO working in the regions

Material ressources

Result 1 Protocole and gudelines, and tools (register books and mothly reports sheets) Training and manual materials Height boards and scales, MUACs Essential drugs dans RUTF. Vehicule to mobile teams

Result 2 Flip charts and posters. Househoulds monitoring tools (focus groups and home visits) Campaign monitoring tools Manual and training materials


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CROSS-CUTTING ISSUES

Gender

More than half (59%) of women 15-49 are married and only 29% are single. A third ofwomen do not have any education, as compared to 24% of men. The average level ofeducation in rural areas is much lower than that of urban areas; 41% (urban) and 22% (rural)in women and 31% (urban) and 31% (rural) in men. According to the average resident, morethan half of women live in rural areas and 46% in urban areas. Due to migrations, more menlive in urban areas (56%).

Mauritania possesses Arabic and Islamic populations, as well as black African groups, givingit a rich diverse cultural aspect. Gender relations continue to be influenced by cultural andhistorical aspects. The generation of the 1960 independence was very influenced by

womens emancipation values. This womens rights defense should be brought to life inIslamic values, which are governing elements of current Mauritanian life. Since the time ofindependence until the 90s, women integration and development was a dominant focus ofdevelopment work. In 1992, Mauritania created a Secretary of State of Womens Conditions.

In this context, the situation of Mauritanian womens conditions has improved in the last fewdecades (primary education, employment, political participation). The national Assembly in2002 adopted a law regarding the obligation of childrens education for ages 6-14 years.After ratifications made to the CEDAW and to the CDN (2001) in order to promote positivediscrimination.

The general statute is less valued for women than men. It is highly diverse: access to thesecond level and duration of studies, access to technical and scientific education, privateemployment, access to resources and production factors (faming, financial, etc.).

The raising of awareness of the population (for men and women) regarding traditionalpractices and certain behaviors (matrimonial precautions, divorce, polygamy, etc.)constitutes a means to achieving gender equality.

Realistically speaking, everything affecting womens health and nutrition are highly regardedbecause these women are the ones that make their own decisions (in the case of olderwomen), apart from when there are implicit expenses or major decision, such as when theyhave a serious illness or complication. Men are generally interested, but stay away; their

responsibility consists in ensuring that women are available to be responsible for the councilof for women in troublesome situations. Societal perceptions and judgments regardingspecific gender roles trigger the inequality of women.

Gender Focus (UNICEF)Gender equality is one of UNICEFs principles in all areas of the world, and one of themandate on which the Convention on Childrens Rights is based, the Committee on theElimination of Discrimination against Women, CEDAW. This applies as much inhumanitarian interventions, or development work, which UNICEF undergoes in 150developing countries, as it does in awareness raising program, carried out in industrializedcountries, through the National Committees, including the UNICEF Spanish Committee.Various issues are linked with transversal gender actions carried out by UNICEF, in which

projects related to malnutrition prevention can be found, including the project beingpresented.


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These premises are also applied in UNICEFs work in Mauritania, in the understanding ofgender equality; child development and access to basic services cannot be obtained without

reaching gender equality, including development for the mothers of these children. UNICEFis committed to balancing its efforts with girls, teenage girls and women, ensuring that theyhave the same opportunities as boys. UNICEF works in Mauritania in order to guarantee thebetterment of the lives of every boy and girl, through integrated care, the receiving of qualityof education in order to prepare them for the future, keeping in mind the gender differences;all girls, teenage girls and women should have the necessary information and capacity toprotect themselves against HIV, gender violence and all types of gender discrimination.

Gender equality is a key issue in project design. In the analysis of a situation, thepopulations uncharted information is key. In every phase of the project, an active promotionof the participation of women has been included. Teams will be formed, including hired andvolunteer workers, in efforts to obtain gender equality. Salaries will be equal (for men and

women).

A fundamental element to keep in mind is that women are also beneficiaries of the project,given that positive results cannot be obtained without also preventing malnutrition in women,which has been previously noted (women are the responsible parties for the health status ofthe family).

In conclusion, we feel that this project promotes gender equalities in the communities inwhich it will be implemented, and will seek to fundamentally improve the lives of women.

EnviromentNot envisage any negative impact on the environment.

proposal nutrition- imam fundation la caixa natcom espagnol mauritania baja reso

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