UNN-REACH work in Lesotho and Sierra Leone: Revising plans for a COVID-19 response

UNN-REACH work in Lesotho and Sierra Leone: Revising plans for a COVID-19 response

Introduction

 The COVID-19 pandemic has disrupted many nutrition programmes and activities, forcing United Nations agencies and other organizations to re-visit previous priorities and to make adjustments for the ‘new normal’. Countries such as Lesotho and Sierra Leone benefit from the presence of a UNN-REACH[1] facilitator to help guide this process.

The UN Network Secretariat interviewed Maseqobela Williams, UNN-REACH facilitator in Lesotho, and Marian Bangura, UNN-REACH facilitator in Sierra Leone, on how they have responded to the challenge of COVID-19 in their respective countries and their plans for a post-COVID-19 recovery.

REACH facilitators

Changing plans in Lesotho

COVID-19 has meant that stakeholders have not been able to go about ‘business as usual’, says Maseqobela Williams, UNN-REACH Facilitator in Lesotho.

“The country was quite slow to become affected [by COVID-19] so we were able to take precautions early and to close our borders to control the spread of infection. We were also able to look at existing food security and malnutrition problems that were already there and to get ourselves prepared,” she confirms.

Woman with mask_Lesotho

One of the first actions of the UN Network (UNN) was to contact all the United Nations agency members and government stakeholders to discuss what they could do quickly. A National Integrated Response Plan for COVID-19 had been prepared at the beginning of March but nutrition was not clearly prioritized – the focus was on agriculture and production, rather than food security. “This was a real gap in the plan,” said Maseqobela. As a result, the current UNN-REACH response has focused on bridging the gap by highlighting the sector-specific level (such as health, water, education and social development) as it relates to Food and Nutrition Security.

Lesotho’s lockdown measures led to both the public and private sectors closing down all services, with severe repercussions on food and nutrition security. At the community level, food access and availability have been particularly vulnerable. According to the Lesotho Vulnerability Assessment Committee report (2020), the country is facing increased socio-economic hardship with a projected rise in its food insecure population from 380,000 to 582,000 (by March 2021).


UNN analytics support in re-aligning workplans

To respond to the new situation, the UNN-REACH workplan was adjusted to align with both the national COVID-19 response and with one of the key result areas of the Food and Nutrition Strategy and Costed Plan of Action (2019‒23), namely ‘Nutrition During Emergencies’. UNN-REACH was compelled to re-programme its remaining funds (USD 50,000) in order to respond to the pandemic.

UNN analytics were useful in guiding Lesotho stakeholders in prioritizing activities. For example, the UN Nutrition Inventory exercise and the Lesotho Nutrition Stakeholder and Action Mapping, conducted in 2018, were used as a basis for identifying districts that needed immediate attention even before the onset of COVID-19, and have provided guidance on the type of interventions that may have immediate impact. UNN analytics have also informed a strategic approach for the adoption of joint programming by United Nations agencies (the Food and Agriculture Organization of the United Nations [FAO], the United Nations Children's Fund [UNICEF] and the World Food Programme [WFP]) with their respective areas of competence and mandates. 
 

The Maximum Intervention Programme (MIP)

“We realised that we had to strategically attend to those districts that were already affected by malnutrition,” says Maseqobela. “We chose four target districts with the highest prevalence of stunting among children under five: Mokhotlong; Thaba-Tseka; Butha-Buthe; and Mohale’s Hoek.[2] This was an emergency – we wanted to look at diversifying diets in hard-to-reach areas and among the most vulnerable populations by introducing community-based promotion on productivity of more nutritious foods.” Following the use of UNN Analytics, Mohale’s Hoek district was replaced by Quthing (which had a lower stunting prevalence), as there were already a large number of ongoing interventions in Mohale’s Hoek.

Stakeholder mapping_Lesotho

The programme recognizes cross-sectoral linkages whereby the National Information System for Social Assistance register was made available by the Ministry of Social Development for identifying eligible vulnerable households (ultra-poor and poor) with children under the age of five, to be verified by district/village records.

Food baskets are to be distributed to these districts. However, the UNN-REACH facilitator and other stakeholders realized that nutrition could be put centre-stage through two adaptations: simple vegetable production and awareness-raising on Infant and Young Child Feeding (IYCF) practices, by distributing Information Education Communications printed materials from all relevant United Nations agencies.


Focus on diversifying diets

FAO already had a plan for vegetable seed distribution in the four target districts but this had not yet been implemented. UNN-REACH collectively agreed to utilize FAO’s experience in seed procurement, and to produce a training manual in English and Lesotho in order to guide beneficiaries in growing practices and explain the importance of consuming vegetables for a healthy diet. In total, 500 households with children under two in each district will receive ten seed varieties of nutritious vegetables, including infographics on vegetable production.

Distribution of the enhanced food basket has been delayed due to harsh winter conditions and observance of COVID-19 mitigation measures, but there are plans to launch the MIP this spring to be followed by planting demonstrations and monitoring of households.


Promoting breastfeeding awareness and COVID-19 guidance

The other strand in the new UNN-REACH programme adaptation is to promote increased demand and access to nutritious foods through consumer knowledge and awareness, including promotion of optimal feeding practices for young children. This is being pursued through joint partnerships with Government and other stakeholders.  

“We realised that this was an opportunity to increase awareness of nutrition and COVID-19, and to draw on the respective areas of competence among UN agencies. WFP was already distributing food baskets – why not add more to the package, such as IYCF and COVID-19 guidance, with a focus on continued breastfeeding,” says Maseqobela.

Consequently, UNN-REACH funding has been used to develop IEC materials based on advocacy messages and social and behaviour change communications (SBCC) from different United Nations agencies, including: UNICEF’s IYCF global guidelines on breastfeeding, FAO guidelines on vegetable production and the World Food Programme’s (WFP) Food Basket and Nutrition messages. The guidance has been made available in both English and Lesotho. There is a need to be strategic in ensuring the messaging is communicated due to differing levels of literacy, but plans include sharing IYCF guidance through nutrition clubs at village level with support from district nutrition officers and with COVID-19 mitigation measures in place.

Similarly, agriculture training manuals are now being printed in the local language and agricultural personnel will be carrying out demonstrations in the target areas while respecting physical distancing to avert the spread of COVID-19. In addition to the household food security initiative, UNICEF will support end-user monitoring for eligible households.

Handbook_Lesotho

Strengthening a multi-partner and multi-sectoral response for nutrition

In Lesotho, the UNN-REACH facilitator is fortunate to be based in the Office of the Prime Minister where she provides technical support to the Food and Nutrition Coordination Office (FNCO). This has given her a vantage point for strengthening multi-stakeholder engagement through regular meetings with government and capacity-building of the FNCO technical team. Since the country went into lockdown, Maseqobela has been consulting via phone and virtual meetings with both government and UN colleagues.

“We are very lucky in having a collective culture, nurtured by the UNN chair – and exercises such as REACH and UNN mapping tools have helped inform nutrition strategy and key UN documents such as the UNDAP [United Nations Development Assistance Plan].”

COVID-19 has also proved a catalyst for broadening the network of United Nations agencies and other partners involved in nutrition in Lesotho, including plans to work closely with the International Fund for Agricultural Development (IFAD) on a food production initiative, and to further strengthen the Water, Sanitation and Health (WASH) component both within the Ministry of Health and in the country’s school feeding programme.


Before COVID-19 and now - what has changed for UNN-REACH?

“It is not that we are necessarily doing anything new,” claims Maseqobela. “Strategically, we decided to continue with our plan [2020/2021 UNN-REACH workplan] but to conduct it in a more robust manner with a wider involvement of stakeholders and with a multi-sector approach”.

UNN-REACH has created a sound enabling environment for nutrition, particularly at national level. In the wake of COVID-19, however, even more attention is now being focused on the facilitation of actions at the district and community level.

“We are striving to strengthen the Maximum Intervention Programme approach to mitigate the effects of COVID-19 – and we are doing things in a more collective manner,” confirms Maseqobela.

 

Impact of COVID-19 on health and nutrition programming in Sierra Leone

Sierra Leone registered its first case of COVID-19 on 30 March 2020, two months after the World Health Organization (WHO) declared a global pandemic. Initially, many nutrition programmes were suspended due to measures instituted by the government to stop the spread of the virus. According to Marian Bangura, UNN-REACH facilitator in the country, most United Nations agencies and development partners have diverted some of their project funds to a COVID-19 response, such as provision of infection prevention control materials (including personal protection equipment and soap), food assistance and promotion of relevant public health messages.

Unfortunately, preventative measures such as restrictions on movement, physical distancing and a ‘no touch’ policy have affected access, utilization and delivery of life-saving health and nutrition services in the country. For example, there has been a large decline in number of pregnant women accessing antenatal services, and reductions in immunizations for infants aged 0‒11 months.[3] Moreover, 63 percent of households are now food insecure (up from 48 percent in the previous quarter), and nine out of sixteen districts had a higher prevalence of children with severe acute malnutrition (SAM) than before the onset of COVID-19.[4]


Creating a new Food Assistance and Nutrition pillar

The COVID-19 pandemic in Sierra Leone has triggered the creation of a Food Assistance and Nutrition (FAN) pillar. According to the UNN-REACH facilitator, this is the first of its kind in all the emergencies that the country has faced over the years, including the rebel war, the Ebola outbreak and the mudslide that claimed thousands of lives. The pillar consists of two clusters: the nutrition cluster, chaired by the Directorate of Food and Nutrition within the Ministry of Health and Sanitation and co-chaired by UNICEF; and the food security cluster, chaired by the Ministry of Agriculture and co-chaired by WFP.

The FAN pillar, strongly supported by the Vice President (both UNN-REACH and SUN are housed in the Vice President’s office), collaborated with other nutrition and food security partners to develop the COVID-19 National Emergency Plan. The plan provides technical oversight and coordinates all food assistance and nutrition support. A coordinated approach between actors is ensured via sharing roles and responsibilities, weekly cluster meetings and reporting, and tracking of interventions by different stakeholders to avoid duplication and overlap.

Through the coordinated efforts of the different working groups, the pillar has produced a context-specific Standard Operating Procedure for Nutrition Response to COVID-19 as well as defined a food basket package for vulnerable households and individuals to be distributed to treatment centres and quarantine homes nationwide. As infection rates spread to the districts, the national-level coordination structure was decentralized. Each district established its own mechanism for coordinating the COVID-19 response activities, headed by the district coordinator.

Health worker training_SL

UNN-REACH support to development COVID-19 communications

One of the key areas identified for urgent attention was for the provision of communication materials for COVID-19 guidance. “We held a partners’ meeting under the nutrition cluster to brainstorm on activities that the cluster should embark on for the COVID-19 response. Everyone agreed that the development of communications - for raising awareness on nutrition issues - was a top priority,” said Marian.

A new workplan for UNN-REACH (2020‒21) was underway at the same time so a decision was taken to allocate some funds to support the response, with a focus on disseminating nutrition information. UNN-REACH and Sierra Leone’s Scaling Up Nutrition (SUN) Secretariat provided technical assistance, especially during the review of existing communications and adapting global guidelines to the local context. Collaborative efforts in developing the new materials resulted in new knowledge management products that are ‘owned’ by all nutrition technical staff from government, United Nations agencies and NGO partners.

Financial support (USD 10,000) was provided to produce nutrition messages through various media including: three video clips on breastfeeding by COVID-19 infected mothers and advice to pregnant and lactating women on the use of health facilities to access lifesaving services; and two radio messages on healthy eating to boost immunity especially during lockdown. Other materials include guidance notes on ‘Maternal, Infant and Young Child Nutrition in the Context of COVID-19’ for Health Workers in Sierra Leone, and ‘Questions and Answers on IYCF in the context of COVID -19’, all of which have been distributed through the Directorate of Food and Nutrition. Training has been organized for different stakeholders, such as chiefs, religious leaders and COVID-19 information dissemination officers in each district

Clip from SL video

Next steps: Designing a UN joint programme for nutrition

Even before the pandemic, there had been discussion on the need for a UN Joint Programme to reduce stunting among children under the age of two years, as progress towards global nutrition targets in the country has been very slow.

“The pandemic just threw more light on this need as it opens up opportunities not only for integration and synergies for better programming, but can also encourage donors if a much better impact could be realized in reducing the malnutrition burden,” says Marian.

So far, the technical staff from five United Nations agencies (FAO, IFAD, UNICEF, WFP and WHO), supported by UNN-REACH, have drafted a concept note to be finalized during a UN joint retreat before the end of 2020. This will also be informed by a UN Nutrition Inventory, undertaken with support from the UNN Secretariat, in order to identify gaps in nutrition actions as well as the enabling environment to inform programme design. The technical team is planning to pilot the stunting reduction programme model in at least two districts before scaling up, beginning with a baseline assessment.


COVID-19 has affected planned UNN-REACH activities in both Lesotho and Sierra Leone. The facilitators have worked with stakeholders and the UNN to adjust plans to the context – with resulting positive outlooks for nutrition advocacy and new joint United Nations programming efforts in both countries.

 

Footnotes

[1] UNN-REACH is country support mechanism for improving nutrition governance, which works in close collaboration with nutrition coordination structures and SUN networks, including the UN Network.

[2] Lesotho Demographic Health Survey (LDHS), 2014 and Multiple Indicator Cluster Study (MICS), 2018

[3] MOHS Health Information Bulletin (2020)

[4] Emergency Food Security Monitoring system report (June, 2020)

 

Photo credits

Photo 1: @ WFP/ Claire Nevill

Photo 2: @ WHO/ Saffea Gborie

Photo 3: @ UNN-REACH/SUN Sierra Leone