Malnutrition is a complex problem. So must be the solutions.
Seas of verdant crops surround many towns in northern Uganda. It’s a landscape that stands in stark contrast to one of the biggest development challenges here: malnutrition.
The problem isn’t merely a lack of knowledge about what makes a healthy diet. Many landowners choose profits from cash crops over local food production. Loans for small farms are onerous and often trap producers in cycles of debt, and many people lack access to clean water and sanitation, leaving children exposed to disease.
“With no latrine, my children had diarrhea often,” one mother explains.
Even when nutritious food is available in local markets, families living below the poverty line often can’t afford it, as economic opportunities here are limited.
The problem of malnutrition in Uganda is complex.
It was in this context that USAID’s Uganda Mission decided to try an innovative, integrated approach to address these root causes to finally drive down poor nutrition and stunting. Partnering with FHI 360, the mission launched Community Connector, a five-year, multi-sectoral project that would operate in 15 northern districts.
Past failures had taught FHI 360 that bringing together diverse sectors — each with its own goals, staff and perspective — can be difficult. So we made some critical early choices to try to ensure success. Perhaps the most important was using USAID’s collaborating, learning and adapting approach, or CLA, to build a flexible process.
CLA allows projects to be nimble, to engage in intentional participatory learning, and to course-correct as they go. For Community Connector, CLA meant regular assessments of progress toward our desired outcomes — better nutritional status for women and children and improved livelihoods for vulnerable households — as well as chances to adjust. CLA’s 5-year plan includes three stages, each with a 6-month learning phase followed by an implementation phase. This approach gives all stakeholders — most notably communities — a way to participate in a project’s design and evolution, as well as a clear picture of desired outcomes, planned strategies, and progress.
This flexibility was critical when we learned through formative research that our original starting point – behavior-change communication – was not what communities wanted. We thought a light touch and traditional nutrition-focused messages would be the easiest way to introduce the project to beneficiaries, and we’d then expand services from there.
But communities resoundingly told us they needed better economic opportunities and increased income first. If we’d used a traditional project structure, we’d have likely only had room for small adjustments. In this case, though, we were able to use what we’d learned to change our approach, creating the project with the community, rather than for the community.
We shifted our focus to livelihoods, building Community Connector around existing community groups – village savings groups, farmers groups, youth groups, women’s groups, groups for people living with HIV, and others – many of which were already involved in some form of group savings activities. We established relationships with the groups and then added services in various areas, including classes on entrepreneurship, nutrition, health and sanitation. For groups that weren’t engaged in savings activities, we helped them start. This turned out to be a successful strategy; involving community members in an activity in one sector – livelihoods – helped to sustain their activities and gains in other sectors – food security and nutrition.
But when trying something new in the name of greater impact, there are always risks. During Community Connector’s second learning phase, about a year after the project launched, we uncovered a significant complication: We were missing the most vulnerable families within communities. We’d built Community Connector to work with established community groups. However, the most vulnerable families often weren’t a part of those groups.
And that wasn’t all. The groups’ savings activities weren’t consistently benefiting households as intended. Savings were being released on a schedule, in this case during December, the festive season. This meant that much of the money was being spent on the holidays. At other times of the year, families still weren’t able to cover costs such as school fees and investment in agricultural production.
As hard as it was, we had to admit that our current staff, partners, and savings model weren’t equipped to achieve everything the community needed. We had to make changes again.
We brought in a new partner that specialized in supporting highly vulnerable community members so they could begin saving and establishing small businesses. And we adopted an entirely new, ‘Saving with a Purpose,’ or SWAP, model, which encourages members to save for a particular goal with the support of their group.
None of it was easy. We had to integrate the new partner into an already established, already complex, multi-sectoral system, which required amending agreements with existing partners. Our staff had invested a lot in the project as it was, and our volunteers had just become familiar with it. And now everyone had to adapt and re-train.
“It was painful for partners at some points,” one staff member recalls.
But it was also worth it.
By the end of its fourth year, Community Connector had reached more people than it had initially planned to reach over its entire lifespan. We documented marked improvements across sectors, including, for example, an increase in land ownership among women, who used the plots to grow food for their families.
“I have been able to build a house with two rooms,” one man told us.
With more income, “I have been able to improve the food my child eats,” a young mother explained, adding that she soon planned to buy a sewing machine to make and sell clothes to boost her income even more.
Integrated development is not easy, but Community Connector found success because it was designed specifically to facilitate integration through flexibility. We acknowledged going in that we didn’t know everything, so we built in mechanisms for learning and adapting as we went.
In the end, it made all the difference. Many of our beneficiaries told us that without solutions in multiple areas, they could not have made the progress they did. As one of our staff members said, “With integration, we are able to holistically bring someone out of poverty.”