Systematic stakeholder identification

and engagement to explore commitment

and capacity to address infant and

young child feeding practices in

Worcester, Breede Valley, Western Cape,

South Africa

LM du Plessis, MH McLachlan & SE Drimie

Su - Faculty of Medicine & Health Sciences

Department of Interdisciplinary Health Sciences

Division of Human Nutrition

Introduction

In 2007 the rector & vice-chancellor of SU, Prof

Russel H. Botman, articulated his vision of a

“pedagogy of hope” and a new positioning for

the university

Vision → “Overarching Strategic Plan” (OSP)

Included Food Security Initiative funded by SU

Council

Community-Based Nutrition Security Project

Division of Human Nutrition - CNSP

The Community Nutrition Security Project

(CNSP) baseline research investigated the food-

security situation in vulnerable communities in

the Breede Valley, Western Cape, South Africa

Target population: mothers and their young

children (0-36 months) – focus on the first 1000

days of life

-9 months

(conception)

0 months (birth)

6 months

12 months

24 months

The first 1000 days of life

The first 1000 days of life

The right nutrition during first 1,000 days of life

can have a huge impact on how a child grows,

learns and develops

It is one of the best investments we can make to

reach long term progress in health and

development around the world

In 1 000 days we can change the

future!

The right nutrition during 1 000 day window can:

save more than one million lives each year;

significantly reduce the human and economic burden

of diseases e.g. TB, malaria, diarrhoea & HIV/AIDS;

reduce the risk for developing various non-

communicable diseases such as diabetes, and other

chronic conditions later in life;

improve an individual’s educational achievement and

earning potential; and,

increase a country’s GDP by at least 2-3 percent

annually

http://www.thousanddays.org/about/

Stellenbosch University - CNSP

Selected findings

Nutritional assessments indicated, among

other, poor infant and young child feeding

(IYCF) practices and high levels of stunted

growth in young children

Infant & Young Child Feeding in

Worcester area

About 7 out of 10 babies are put to the breast

after birth

About 3 out of 10 babies are never breastfed

Around 9 out of 10 babies are not breastfed as

babies should be breastfed

Most drink or eat other milk and/or foods before

the age of 3 months (water, tea, juice, “meelbol”, pap, “behoedmiddel” etc)

Infant & Young Child Feeding in

Worcester area

3 in 10 are still breastfed at age 12-15 months

Most babies receive solids foods at age 6-8 months

BUT, only half of the babies received more than 4

different foods

grains (bread, cereal, pap)

legumes and nuts

dairy products (excluding breastfmilk – milk, yoghurt, cheese)

meat, fish, poultry and liver/organ meats

eggs

vitamin-A rich fruits and vegetables (sweet potato, carrots,

pumpkin, butternut, spinach, broccoli, apricot, peach, mango)

other fruits and vegetables

CNSP Phase 2

Applied a systematic approach to identify and

engage with many different stakeholders that

can impact IYCF practices at the district level

The research explores the perspectives,

commitment and capacity of key stakeholders,

the relationships among them and their relative

power and influence with regard to IYCF

(Acknowledgement: Engesveen 2008 & Kent 2000)

(Acknowledgement: Engesveen 2008 & Kent 2000)

(Acknowledgement: Engesveen 2008 & Kent 2000)

(Acknowledgement: Engesveen 2008 & Kent 2000)

CNSP Phase 2 - Methods

A strategically selected group identified key

stakeholders in IYCF

This was followed by individual in-depth

interviews with particular stakeholders

Findings from Interviews

Good understanding of the link between IYCF

and development

Appropriate practices – not well known

Factors influencing IYCF practices

poor knowledge

poverty & unemployment

misuse of social security grants

teenage pregnancies

child neglect

gangsterism, drug abuse, HIV

Complex

issue!

Findings from Interviews

Not everyone knew exactly why I wanted to talk

to them and referred to them as “stakeholders in

IYCF”

A lot of willingness to help in many different

ways at many different levels

Resources mentioned were humble

Some issues were out of the immediate scope of

the stakeholder, but could be identified as

another stakeholder’s area of focus

CNSP Phase 2 - Methods

Hereafter, stakeholders were engaged in a

workshop through a participatory research

method (“NetMap”) that defines relationships

among stakeholders as well as their priorities

and powers

Green line = Money/Funding

Blue line = Information/Advice

Red Line = Command/authority

Orange line = Advocacy

Findings from NetMap Workshop

Disjuncture between various government

sectors was highlighted as a contributing factor

to sub-optimal service delivery and poor

community response

Process revealed a significant flow of financial

support from National Treasury towards services

focused on young children

This allocation of funds corresponds with rigid

command/authority

Findings from NetMap Workshop

Local jobs are under pressure, because of

external issues and individual employer

responses to National Government policy

changes

Information flow on IYCF is sketchy and

advocacy on the topic almost non-existent

Findings from NetMap Workshop

Factors that impact IYCF at the district level are

very complicated

A range of issues are connected in a complex

network that transcends time and scale

Issues far away affect those close-by

Process highlighted some collective capacity

that could be unlocked to address IYCF

The community (mothers, fathers,

grandmothers, CBOs) is willing to engage

Findings from NetMap Workshop

The University can act as a partner for advocacy

and knowledge generation

The Business forum was also mentioned as a

medium for possible interventions

Liaison group consisting of Departments of

Health, Education, Social Services and

Community Development and Planning was

highlighted as a forum where joint solutions can

be developed

What has happened up to now?

Phase 1 - Baseline information

Phase 2 – Stakeholder engagement

Awareness

Advocacy

Dialogue

Reflection on current interventions / practices

Broad thinking of what can be done differently

What can be done together

What next?…Phase 3 – Interventions

Black et al 2013 – Lancet Series

Acknowledgements

CNSP team

Fieldworkers

Other colleagues

Family & Friends

Funding

SU Hope project

FIRRH

SURMEPI

Thank you!

Acknowledgement: Guiocommo Pirozzi, UNICEF