Author: Russell Parkinson, Programme Manager
The Power of Nutrition has been working with the World Bank in Côte d’Ivoire since 2018. In December I took the opportunity to travel to Abidjan and Yamoussoukro to meet with World Bank colleagues and the project implementation team, as well as visit villages where the programme has been implemented. As we approach the end of this multisectoral nutrition and child development programme, it was great to see what they have achieved, learn more about the current priorities, and discuss sustainability and their plans for the future.
Taking inspiration from a similar programme in Senegal, the $60m Multisectoral Nutrition and Child Development Project was designed to support the implementation of Côte d’Ivoire’s National Multisectoral Nutrition Plan. The programme is delivered through community platforms, locally known as FRANCs (Foyer de Renforcement des Activités de Nutrition Communautaires). Supported by local NGOs, members of the community are trained to deliver proven nutrition interventions, such as antenatal care and nutrition counselling for pregnant women, promotion of early and exclusive breastfeeding, education on infant and young child feeding and community-based management of moderate and acute malnutrition. Given the clear link between good nutrition and child development, FRANCs also provide child friendly spaces and advice to parents on the benefits of play and early child stimulation. Embracing a multisectoral approach, the FRANCS also serve as hubs for delivery of other key maternal and newborn health services alongside water, sanitation & hygiene, and social protection interventions. This effective FRANC model is ensuring communities are at the heart of decision making around programme needs, whilst the integrated multisectoral is making the most of the interconnectivity between nutrition and different sectors.
Despite the challenges of a global pandemic, the programme was initially piloted in three regions. Once agreed how the model could work, it was scaled up to be implemented in a total of 14 regions across the country where the burden of stunting was highest. Over 2,300 villages (approx. a quarter of the country) now benefit from community level decision making and delivery of crucial nutrition and early child development interventions.
The priority in the last few months of this initial phase of the programme is to double down on efforts to ensure a consistent quality of delivery across all regions, through additional support to local partners, updating guidance and minimum standards, or providing refresher training to fill gaps in knowledge. The aim is that all FRANCs will be delivering a similar level of service whether operational for three years, or for just six months.
I was fortunate enough to visit the villages of Bla and N’Da Akissikro near Yamoussoukro and see the FRANCs in action. Children were making full use of the colourful child friendly spaces to play, whilst inside a group of mothers accessed information on breastfeeding, diversifying their diet using local produce, and having their newborns weighed and measured to check on their development. The mothers and community facilitators who run the FRANCs shared that already they could see that the children were healthier, stronger, more engaged, and more confident as a result of the programme. We met officials at the village, regional, and national level who also commended the programme and highlighted the importance of investing in children, giving them the best possible start in life, and therefore investing in the future of Côte d’Ivoire.
Whilst I was there, World Bank colleagues shared the fantastic news that a new $800m investment package over 10 years has now been agreed with the Government. This will bring together a number of health and nutrition programmes, but will continue to fully fund the Multisectoral Nutrition and Child Development Project, and expand it to cover a further two regions. In addition, the Islamic Development Bank is providing investment to replicate the programme in an additional 11 regions. This means that by 2033, the programme will have been rolled out in 27 out of 33 regions in the country, which will have a significant impact on health, nutrition, and child development outcomes, putting Côte d’Ivoire well on track to meet SDG and WHO targets.
Whilst the programme has achieved a lot in the last few years to establish the community hubs, meet its targets, and ensure a consistent roll out, there is recognition of the need for more work to be done in order to mature and sustain the model in government policy and decision making, which is why the World Bank have decided to continue investing. Key issues to be addressed include: i) the motivation and incentivisation of community facilitators, as well as the management of turnover, recruitment, and retraining; ii) reviewing the role of income-generating activities as a means to support facilitators, the hubs, and the community as a whole; and finally iii) continuing to strengthen the governance mechanism, and advocate at all levels to create an enabling environment in which political will is created within Government, and across sectoral ministries, to take ownership of the programme and establish the programme’s strategy of convergence in the long term.
The Power of Nutrition is delighted to have played an integral role in establishing the original programme, helping it to reach a place where it can be scaled up, matured, and really embedded in national policy and decision making. This is a hugely exciting stage in the programme’s development. The Power of Nutrition will be eagerly watching to see how it develops and championing the approach and learnings whenever and wherever we can.
Thanks to World Bank, TRECC (a partnership between Bernard Van Leer Foundation, Jacobs Foundation and UBS Optimus Foundation), FCDO and the Bill and Melinda Gates Foundation for partnering on this programme.