Reducing chronic malnutritionand child anemia in AncashThe Ally Micuy Project2007

Reducing chronic malnutrition and child anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

Cáritas del Perú President: Monsignor Miguel Irizar Campos Secretary General: Jorge Luis Lafosse Quintana Development and Projects Manager: Dr. Hector Hanashiro Hanashiro Social Development Manager: Dr. Andres Moran Tello

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010 Key Project Technical Team: Andres Moran Tello Carlos Villanueva Aragon Herman Edgar Castillo Ramon Javier Garay Almonacid Jose Moran Mendoza Luis Campo Sanchez Milton Moreno Cordova Marlene Rojas Cordova Nerida Ovalle Mejia Regulo Canchaya Alvarez Reynaldo Dongo Adrian Roberto Canaza Vega Publication Team: Andres Moran Tello Carlos Villanueva Aragon Javier Garay Almonacid Marlene Rojas Cordova Regulo Canchaya Alvarez

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Secretarial Assistance: Mirtha Gavelan Velasquez Layout and Design: Impactum Creativos Printing: Studio Digital Editores S.A.C. Telephone: 425-1504 Jr. Chavin 051 Breña, Lima Print run: 1000 Legal deposit made in the National Public Library of Peru. #2011-10092 Printed in Peru

Please Note Using inclusive language, i.e. that does not discriminate against or show the difference between men and women, is something we at our institution take very seriously. However, its practical use in Spanish has created very different solutions on which linguists have still not come to agreement. Therefore, and in order to avoid the graphic overload of overusing the Spanish expression “o/a” to refer to both sexes, we have decided to use the classic general masculine reference with the understanding that it shall always include both men and women whenever used.

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

Table of Contents 07

Acknowledgements

Preface

Executive summary

1. Introduction

27 27 27 27 27

2. Project objectives 2.1 Project goal 2.2 Project purpose 2.3 Overall objective 2.4 Project activities per result

31 31 31 31 31 31 34 34 34 36 36

3. Baseline study 3.1 Baseline monitoring study objectives 3.2 Methodology 3.2.1 Study population 3.2.2 Sampling method: LQAS 3.2.3 Determining the sample 3.2.4 Data gathering instrument creation and validation 3.2.5 Baseline and final monitoring study training 3.2.6 Data gathering and supervision 3.2.7 Data processing 3.2.8 Data analysis

39 39 42 45 48 49 52 58 61 62 69 72

4. Results 4.1 Family socio-demographic information 4.2 Access to clean water and basic sanitation 4.3 Improved stoves 4.4 Maternal and newborn healthcare 4.5 Vaccinations 4.6 Breast feeding and infant feeding 4.7 Prevalent childhood diseases 4.8 Hand washing 4.9 Child nutrition and anemia 4.10 Parent participation in child care 4.11 Rights of the child

5. Discussion

6. Conclusions

7. Lessons learned

8. References

Annexes

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

Table of Contents 07

Acknowledgements

Preface

Executive summary

1. Introduction

27 27 27 27 27

2. Project objectives 2.1 Project goal 2.2 Project purpose 2.3 Overall objective 2.4 Project activities per result

31 31 31 31 31 31 34 34 34 36 36

39 39 42 45 48 49 52 58 61 62 69 72

5. Discussion

6. Conclusions

7. Lessons learned

8. References

Annexes

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Tables and Graphs

Table Nº 01:

Number of supervised areas per each project setting in the 2007 baseline study and the 2010 final study

Graph Nº 15:

Table Nº 02:

Graph Nº 16:

Table Nº 03:

Percentage of heads of household who are man at the beginning and end of the project Percentage of families with proper floors in their houses at the beginning and end of the project Percentage of children or mothers registered in the Comprehensive Health Insurance Program by province Percentage of families with access to clean water at the beginning and end of the project Basic sanitation at the beginning & end of the project Percentage of families with improved stoves at the beginning and end of the project Percentage of institutional deliveries at the beginning and end of the project Percentage of children aged 12-23 months vaccinated at the beginning and end of the project Percentage of mothers who begin breastfeeding within the hour of giving birth of her last child aged 6-23 months at the beginning and end of the project Percentage of mothers who exclusively breastfeed the last child aged 6-23 months for the first 6 months at the beginning and end of the project Percentage of children aged 6-23 months who eat 4 or more solid foods per day at the beginning and end of the project

Graph Nº 17:

Graph Nº 18:

Graph Nº 19:

Table Nº 04:

Graph Nº 01:

44 47

Graph Nº 02: Graph Nº 03:

Graph Nº 04:

Graph Nº 05:

Graph Nº 06:

Graph Nº 07:

Graph Nº 08:

Graph Nº 09:

Graph Nº 10:

Graph Nº 11:

Graph Nº 12:

Graph Nº 13:

Graph Nº 14:

Effect of iron sulfate administered twice per week for 2 consecutive six month periods on the prevalence of anemia in children aged 6-35 months per province Comparative analysis of anemia levels in children aged 6-35 months who received supervised iron sulfate supplements twice per week for 2 consecutive six month periods Percentage of fathers of children younger than 36 months that play with their children at the beginning and end of the project Percentage of fathers of children younger than 36 months that do not drink excessive amounts of alcohol at the beginning and end of the project Percentage of children younger than 36 months registered in the city hall at the beginning and end of the project

Prevalence of diarrhea in children younger than 3 years at the beginning and end of the project Percentage of mothers of children younger than 3 years who recognize 4 or more danger signs of their child being sick at the beginning and end of the project Percentage of mothers of children younger than 3 years who wash their hands at the 5 key moments at the beginning and end of the project Prevalence of chronic malnutrition in children younger than 3 years at the beginning and end of the project Prevalence of chronic malnutrition in children younger than 5 years at the beginning and end of the project Prevalence of anemia in children aged 6-35 month

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Tables and Graphs

Table Nº 01:

Number of supervised areas per each project setting in the 2007 baseline study and the 2010 final study

Graph Nº 15:

Table Nº 02:

Graph Nº 16:

Table Nº 03:

Graph Nº 17:

Graph Nº 18:

Graph Nº 19:

Table Nº 04:

Graph Nº 01:

44 47

Graph Nº 02: Graph Nº 03:

Graph Nº 04:

Graph Nº 05:

Graph Nº 06:

Graph Nº 07:

Graph Nº 08:

Graph Nº 09:

Graph Nº 10:

Graph Nº 11:

Graph Nº 12:

Graph Nº 13:

Graph Nº 14:

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Acknowledgements

We wish to extend our deepest gratitude to the Antamina Mining Fund (AMF) for comprehensively funding the Ally Micuy Project and to all the AMF officers for their invaluable support during its creation, implementation, and activity monitoring. We also wish to thank the Secretary Generals of Caritas Huari, Caritas Huaraz, and Caritas Chimbote for having made possible the successful implementation of this project that the Caritas network saw fit to take part in since it benefitted child nutrition and maternal health in Peru. We furthermore want to express our appreciation to the Ancash Department of Health and, by extension, its health workers who participated actively in drafting project proposals and strategies and in running project activities, especially related to primary health care. A special recognition goes to all the mayors, local authorities, and community leaders in the Ancash Region, the setting in which Caritas Peru conducted Ally Micuy. Similarly, we want to stress our sincerest gratitude and recognition to all the families and Community Nutrition Educators, who through their nobility, generosity, and energy implemented each activity to benefit the children from the Ancash Region. We would like to give special mention to all the Community Nutrition Educators who through their effort, commitment, and vocation, contributed to the project's peer counseling strategy for changing key habits in their very own communities, demonstrating through their accomplishments that they are very valuable volunteer local stakeholders in reducing chronic malnutrition in rural Ancash communities. Finally, we want to thank all the personnel that worked on the project and that showed great responsibility in achieving the objectives: Adriana Gutierrez Simbron, Alipio Cruz Balabarca, Amancio Tucno Carhuapoma, Amira Dianelis Marcos Lavado, Amparo Ramirez Castro, Ana Lescano Alva, Ana Levano Alfaro, Ana Maria Llallahui Velasquez, Ana Maria Llicahua Chino, Ana Maria Silva Saldivar, Andres Bernuy Azaña, Anyela Sanchez Perez, Beato Salinas Vasquez, Binser Palacios Lara, Cariño Moran Tello, Carola Pichilingue Diaz, Carol Piscoya Magallanes, Carla Tatiana Colonia Silva, Carina Cisneros Caycho, Carlos Rubiños Carranza, Cesar Apolin Montes, Cinthia Quispe Gala, Cynthia Gonzales Horna, Charlie Cordova Rojas, Clarita Cordova Villacorta, Cleotilde Lezama Zavaleta, David Soto Alba, Deisi Milagritos Valverde Kaiser, Diamira Calderon Ruiz, Edgar Ruben Arias Rosales, Edith Rosa Del Rio Moreno, Edith Saenz Espinoza, Eduardo Cruz Cerrate, Edwin Pari Peña, Edwin Vidal Sanchez, Elmer Turpo Castillo, Eliseo Antonio Achahuanco Huallpamayta, Elizabeth Duniam Paredes, Elizabeth Javier Jara, Elvia Quispe Calla, Erika Alegre Quito, Erika Quiroz Pineda, Evans Giron Torrealva, Fany Lazo Ccoto, Fanny Velasquez Pita, Federico Eberth Jesus Ubaldo, Feliciano Castillejo Cacha, Fernando Martel Mamani, Fernando Mestanza Pera, Flor Cadillo Bazan, Freedman Raul Perez Casas, Freddy Roberto Ricci Leon, Guadalupe Tadeo Huerta, Guillermina Ramirez Valera, Gloria Ocaña Muñoz, , Hermelinda Villalba Mamani, Irma Lizet Chumpitaz Garcia, Irma Mendoza Albornoz, Jaime Capillo Mezarina, Jaime Eber Mendoza Sacarias, James Carhuaz Sanchez, Jesus Caballero Ramirez, , Jimmi Apolin

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Acknowledgements

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Montes, John Solis Toro, Jorge Obregon Saavedra, Jose Rosales Cabello, Jose L. Alarcon Tenorio, Jose L. Alvarado Figueroa, Jovana Edith Camones Cano, Jose Luis Rodriguez Bautista, Jorge Mejia Ayala, Juan Bernardo Herrera, Juan Miguel Escudero Ortega, Juan Romero Acevedo, Judit Talledo Alcover, Julia Ninaquispe Soto, Julio Guzman Tocto, Jhimer Edgar Castillo Amando, Kuusela Rodriguez Suarez, Himeron Trujillo Muñoz, Katerin Montes Cruz, Ladislao Roque Quito, Letty Acosta Collazos, Leslie Rodriguez Angulo, Libia Guerrero Trejo, Liliam Prado Fernandez, Liliana Rosales Aguilar, Liz Chinchay Obregon, Liz Magally Aranda Morales, Liz Villafana Machco, Lisset Blas Tapia, Leonel Llacuachaqui Quispialaya, Leonel Quispe Chambi, Lorena Cerna Toledo, Luciano Guevara Vasquez, Luis Alberto Palomino Remon, Luz Sotelo Leon, Madeleine Chiriboga Garcia, Maria Elena Quiñones Aranda, Maria Lopez Pomalina, Maria Veronica Jimenez Vasquez, Marlene Pineda Rodriguez, Martin Alva Diaz, Martha Torres Arce, Matilde Cruz Namay, Maximo Valverde Pizarro, Melina Moreno Flores, Melissa Lopez Alvino, Melissa Oliva Cuevas, Miguel Galvez Tarrillo, Milla Zavala Corpus, Mirma Escudero Ortega, Milagros Bedoya Tello, Nancy Avalos Vasquez, Nancy Illanes Vasquez, Nancy Rodriguez Espinoza, Narciso Antunez Calvo, Nerida Bertha Ovalle Mejia, Noelia Rios Mayhua, Nury Yanina Garcia Solis, Onelia Portocarrero Aguinaga, Oswaldo Ruben Blacido Gonzales, Percy Pillaca Cayllahua, Percy Vilcarano Quispe, Pompeyo Veramendi Huayanay, Ponciano Ticona Lerma, Raul Rodriguez Palacios, Robert Canaza Vega, Rolando Rojas Jaramillo, Rossmery Zuñiga Pomiano, Ruben Palma Perez, Ruth Hidalgo Cruz, Samuel Guerra Ruiz, Segundo Isaac Garay Santisteban, Seila Cruz Perez, Silvia Flores Leveau, Sugeyli Yui Ramos, Susan Ostolaza Espiritu, Teodorico Reynoso Ascencios, Vanesa Olea Trejo, Veronica Llanos Condori, Victor Aliaga Pari, Vilma Huayaney Valverde, Vladimir Gonzales Pacheco, Walter Calderon Castillo, Wendy Maguiña Salazar, Yeni Bañez Laurente, Yesenia Chavez Morillo, Yone Linian Izaguirre, Yonel Gomez Penalillo, Yoni Richard Zuñiga Gonzales and Ximena Duran Flores.

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

Preface Knowing the dramatic situation that poor Ancash children are facing, the Antamina Mining Company decided to use its Antamina Mining Fund (AMF) to design and to implement the Ally Micuy Project (Good Food) with the resolution to contribute to eradicating chronic child malnutrition in rural areas and in the remotest small towns across the 20 provinces of the Ancash Region.

Presentaciones

As a means of guaranteeing the successful implementation of this ambitious intervention, we decided to partner with organizations that boast well known track records and proven experience in executing wide ranging social programs that return positive results. After thoroughly investigating the options and exhaustively researching field experiences, the AMF identified two institutions with demonstrated efficiency in the fight against chronic malnutrition: Caritas Peru and ADRA, both of which were invited to become project partners and implementing agencies. After several months of intense joint work to design the initiative, we signed a cooperation agreement with Caritas in June 2007 to launch the project under its supervision in the northern section of the Ancash Region. It is fitting that we stress the enormous professionalism, dedication, and leadership of Caritas' staff that, along with AMF officers, formed a solid working team with a single vision and shared objectives. However, none of the achievements would have been possible without the willingness and commitment of the participating families, Community Nutrition Educators, authorities at the Ancash Regional Department of Health, mayors, and hired professionals. The coordinated effort from all stakeholders in each of the communities, districts, and provinces that comprehended the Ally Micuy project setting demonstrates that it is possible to promote collective action effectively in the struggle against the terrible affliction that is chronic child malnutrition. What the project achieved more than justifies that optimistic perspective. In 36 months of work, Ally Micuy reduced chronic malnutrition by 11 percentage points (39.3% to 27.7%) and anemia by 16 percentage points (63.2% to 46.6%). The project's success is a clear indication that, contrary to popular belief, it is possible for malnutrition indicators to decline much faster through similar interventions, managing to reduce them up to three percent per year. In the specific case of northern Ancash, the Ally Micuy project involved 19,422 children younger than three years, 4352 pregnant women, and 17,688 families in its first three years, using a participatory working dynamic that banked on direct empowerment of mothers from organized families under the firm belief that â&#x20AC;&#x153;a well fed child guarantees progressâ&#x20AC;?. The transforming impact of this initiative can be seen in improved eating habits, hygiene, and child care, and even more importantly, in creating healthier communities. In recognition of the project's important progress, it received different awards from several institutions, notably the SNMPE - National Mining, Oil, and Energy Society's 2008 Sustainable Development Award, the radio station RPP (Radio Programs of Peru) Unity and Integration Award, the BHP Billiton 2009 Merit Award, and the ExpoMina 2010 Corporate Social Responsibility Award. Finally, Ally Micuy is an important benchmark of good corporate citizenship that proves it is

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

Presentaciones

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Prologue possible to achieve positive results when mining companies, NGO's, public institutions, and communities work together. These partnerships are exactly what enable the AMF to contribute unquestionably to improving the quality of life for Ancash residents. I personally wish to take this opportunity to underscore the profound commitment of Caritas Peru to improving the health of the poor in the Ancash Region and to extend my deepest gratitude for its valuable contribution.

Pablo de la Flor Belaúnde Vice President of Corporate and Environmental Affairs Antamina Mining Company

This document is an opportunity for the country to have proof of the efficiency and effectiveness of a variety of interventions that, being properly adapted to each reality, shall produce similar successful outcomes because they implement those “practices” that boast demonstrated global efficacy. However, this experience also shows how important it is by placing on the table valid, but chiefly appropriable, strategies for realities like ours. In other words, strategies that guarantee their sustainability and, therefore, their replication, when incorporated by the different community, health sector, and government stakeholders. The executed interventions share the same approach, which is comprehensiveness throughout childhood and the inclusion of health determinants and community participation, aspects that are defined in Peru's Health Ministry's comprehensive care model that has been in force since 2001. Because I believe it is important, I should like to highlight four of the fifteen lessons learned: 1. Solutions to a community's problems are found within: This follows the principle of subsidiarity, i.e. nobody better implements interventions than the people who live closest to the problem. And this project set out three levels: 1) the family, by prioritizing counseling through home visits and by engaging husbands in the gender equity approach, 2) community agents, through peer education, and 3) community authorities and leaders, by having them commit to monitoring the health of the people they represent. 2. Using information to make decisions: No one intervenes in a situation if he does not see it as his problem since this is one facet of appropriation; afterwards, he leverages his knowledge and resources to solve it. I am, of course, referring to information given to people in a simplified form that moves them to accept lifestyle changes because it is related to the love parents have for their children. These are the so-called key habits for a person's own good, coupled with brief and understandable instructions and community commitment that is promoted and monitored by the local authority. This information, locally applied, puts a twist on the traditional perspective of “writing reports and producing data to send to the central level”. 3. Supervision and technical assistance through teamwork: It is a confirmation of the proverb: “While the cat's away, the mice will play”, whereby progress is properly monitored and, in particular, actions for overcoming difficulties and deviations or biases in the implementation are chosen by a group. The experience has proposed a “certain number of working hours per staff member” for supervision per level, which is an input to be taken into consideration during resource planning. We all know there is a huge dearth of professional health resources in terms of

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Pablo de la Flor Belaúnde Vice President of Corporate and Environmental Affairs Antamina Mining Company

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Presentation primary care, a situation that needs to be reduced in order to meet the health-related goals. Yet, a major portion of the work rests on the shoulders of the Community Nutrition Educators – CNE (community agents qualified in health and child nutrition matters); moreover, a proposal has been validated so that CNE's are promoted and funded by the local government, and fifteen of the fifty-eight local governments in the project setting might have agreed upon implementing it. We need to join forces here with a) the Strategic Coordinated Nutrition Program since it has assigned guidelines for this type of work that are under the authority of the local government and not being used and b) the budgets allocated to the Local Government Incentive Program, which should be maintained and improved.

“Caring for children is an eloquent testimony of love for human life, particularly for the life of those who are weak and dependant on others in all things and for all things… For her part, the Church – always, but especially when a child's life is at stake – is prepared to offer cordial collaboration with the intention of transforming the whole human civilization into a “civilization of love”. (HH BENEDICTUS PP. XVI, Feb. 2009)

4. Community-based approach to promoting child growth and development: We could talk about a “community-based CRED” (Child Growth and Development), which would imply empowering parents to monitor the “proper growth of their children” and the “development of their complete potential”. Once again, the principle of subsidiarity plays an important part here: the person who is constantly with the child will recognize developmental deficiencies sooner. Involving parents and/or guardians who manage suitable knowledge contributes to developing a child's potential. We still need to involve teachers and health workers, who are trained with standardized, shared early stimulation methods, to a greater degree.

Supporting the process to build a pro-life society and culture from the reality of the poorest and most vulnerable population is a moral imperative for the entire society and the state; and for us Christians, it certainly represents a public testimony of our faithfulness to the God of life.

Lastly, and assumed from the outset, we are showing through this experience that chronic malnutrition health indicators drop as we address health determinants and when all directly involved sectors (health, education, women and social development) and the civil society work together using a comprehensive approach that encompasses the life cycle (stages of life). Another way of putting it is that we are promoting health care as a right and a responsibility as well as advocating an organized demand with a territorial focus, transformed into a government policy. One required aspect is accountability to a multi-stakeholder forum, which in my opinion should be local, thereby adding to and energizing initiatives already underway, such as the Roundtable in the Fight against Poverty and the program, Mining United with the People. We acknowledge the valuable contribution given by the Antamina Mining Fund since it opened the way for implementing this encouraging experience which should continue as an ongoing policy within the framework of the principle of solidarity. Dr. Luis Miguel León García Comprehensive Health Care Director Department of Human Health Ministry of Health

The Ally Micuy Project, which purposes to improve the health and nutrition of children younger than three years in eleven provinces in the Ancash Region, is one of Caritas Peru's most representative experiences in terms of child and pregnant women's health and nutrition in poor, socially marginal areas. Doubtlessly, this project, which is implemented by the Huaraz, Huari, and Chimbote Caritas Diocesans and made possible with the financial support of the Antamina Mining Fund, is furthermore a landmark and instructive experience, and in the spirit of the words of HH Pope John Paul II, a fine example of the “imagination of charity”. Dozens of health and education professionals, agricultural engineers, and others, along with hundreds of female community volunteers, Community Nutrition Educators (CNE's), thousands of family mothers, and community, city, sub-national, and health sector authorities joined forces to reduce the prevalence of child malnutrition and to create a healthy environment where the lives of children will flourish in the dignity and beauty that is its very own. It has been three years of immense dedication, enormous effort, and great sacrifice for Caritas, but it has also been a very fruitful time of serving and accompanying each one of the diocesan technical teams for the purposes of building their technical capacities and of encouraging and living the spirit of brotherly and unified communion. We are aware that Pope Benedict XVI asks us through his Encyclical Letter “Deus Caritas Est” that the work carried out by Catholic church institutions must be done with professional competence, but even more important, it must be distinguished by the “dedication to others with heartfelt concern, enabling them to experience the richness of their humanity.” Consequently, in addition to their necessary professional training, these charity workers need a “formation of the heart”. (DCE 31 a) The professional intervention coupled with fraternity and solidarity with the Ally Micuy participating individuals and families enables us to show truly encouraging results, such as: reducing chronic child malnutrition by 10% (37% to 27%), counseling and home visits had a positive impact of increasing the number of deliveries performed in health centers by 17.5%, increasing the number of vaccinated and exclusively breastfed children (more than 10.9%), and lowering the number of child diarrhea cases.

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

A worthy aspect we need to stress and that shows child health indicators can be significantly improved is that we lowered the prevalence of anemia on average by 33.2%. We are proud to share in this document, the fruit of these three years of pro-child health and nutrition work. This good news is the outgrowth of trust, dialogue, and joint work among the Caritas Peru network, private enterprise, government authorities, and the organized community. We are putting this on the discussion table, where stakeholders interested in comprehensive human development sit, with the expectation that it shall become a support tool for other initiatives that look to contribute to building a more unified, just, brotherly, and reconciled Peru.

Ing. Jorge Luis Lafosse Quintana Secretary General CĂĄritas del PerĂş

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

Ing. Jorge Luis Lafosse Quintana Secretary General CĂĄritas del PerĂş

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

Executive Summary

Executive Summary The Ally Micuy Project was conducted in all provinces of the Ancash Region under the program, Mining United with the People. It was financed by the Antamina Mining Fund and implemented by Caritas Peru, in coordination with Caritas Chimbote, Caritas Huaraz, and Caritas Huari, in eleven provinces in the northern section of Ancash from September 2007 â&#x20AC;&#x201C; November 2010. This report shall present project results from data analyzed from the initial baseline study of family knowledge, attitudes, and practices on child health and nutrition matters as well as from the July August 2010 final study. Project purpose was to improve health and nutrition in children younger than three years in communities spread throughout eleven provinces of the Ancash Region. Methodology: Both studies were conducted randomly, following the LQAS (Lot Quality Assurance Sampling) method that is recommended for baseline studies and social program and project monitoring. Baseline study surveys were applied by district project managers, who were health professionals, under the direction of provincial coordinators and project supervisors. Final study surveys were applied by specially hired interviewers. Prior training on methodological procedures and interviewing was provided to the interviewers and supervisors. The results were processed using software the Caritas central team specifically designed. Results: 71% more families with children younger than three years have an improved stove. Deliveries performed at health centers increased from 60.1% to 77.6%. Basic vaccinations (polio, DPT, BCG, and measles) increased slightly in children aged 12-23 months from 78.8% to 84%. The percentage of mothers who breastfeed their child within the first hour of delivery increased from 65.8% to 79.9%. The percentage of mothers who exclusively breastfeed their child to the sixth month increased by 10.9%. The percentage of children aged 6-23 months who receive four or more solid foods per day increased from 10.4% to 36.2%. At project launch, no mother could recognize four danger signs of a sick child. By the end, 27.2% could recognize four or more. Prevalence of diarrhea in children younger than three years decreased from 29.1% to 24.5%. At project launch, no mother with a child younger than three years washed her hands during the five key hand washing moments. By the end, 16.3% were doing so. Prevalence of chronic child malnutrition in children younger than three years dropped from 37% to 27%. In children younger than five years, the figure fell from 42.2% to 34.8%. From 2009 to 2010, anemia in children aged 6-35 months dropped from 63.1% to 51.8%. The 2929 children who took iron sulfate supplements for two six month periods recorded a 33.2% decrease in anemia, from 69% to 35.8%. These same children also recorded a notable decrease in the prevalence of severe and moderate anemia. The percentage of fathers who play with their child younger than three years increased from 43.7% to 60.2%.

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

Executive Summary

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

Conclusions First, families with children younger than three years with an improved stove in the home increased sharply. Secondly, household organization and the use of simple technologies for better food preservation and handling improved. Next, the percentage of institutional deliveries increased, which is also seen as successfully promoting the demand for health services. Third, child vaccinations also rose. Other important achievements dealt with increased hand washing during the key moments, better knowledge of the danger signs of a sick child, and a greater number of children aged 6-23 months eating solid foods at least four times a day. The project furthermore attained an important increase in exclusive breastfeeding of children up to the sixth month of life. The prevalence of diarrhea in children younger than three years dropped, yet that situation could improve if families had greater access to clean water and basic sanitation. Moreover, the project recorded an important decrease in the prevalence of chronic malnutrition in children younger than three years and, in children younger than five years, a somewhat smaller drop. We demonstrated that properly supervised iron sulfate supplements, administered twice a week, are an effective means of reducing anemia in children aged 6-35 months. In large part, what the project accomplished is owed to the dedicated work of the CNE's, who received a small stipend based upon their performance. These individuals proved the efficacy of peer-to-peer nutrition counseling in the fight against child malnutrition and nutritional anemia.

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Introduction

Financed by the Antamina Mining Fund, the Ally Micuy Project ran from September 2007 to November 2010 in the Ancash Region. Caritas Peru worked in eleven northern provinces. If we were to order the regions of the country by greatest to least prevalence of chronic malnutrition in children younger than five years, then Ancash would fall within the intermediate group. Likewise, close to 20% of mothers with children younger than three years living in this region's rural communities are illiterate. Small scale farming is the main economic activity in most of the communities, and there is limited access to markets. In communities above 3500 m., raising livestock is the most important activity; in those above 3000 m., farmers raise crops using a rainfed system, which is why cropland productivity is low and there is only one harvest per year. At the end of 2006, the program, “Mining United with the People”, was created through an agreement between the Peruvian government and the largest mining companies in which the latter would contribute funds on a voluntary, extraordinary, and temporary basis since at that time their earnings were incredibly high due to the international price of metals. In keeping with the law that gave birth to the program, its funds had to be invested primarily in child nutrition, education, health, production chains, and social infrastructure. Its purpose was to contribute to improving the living conditions of populations living in each mine's sphere of influence. For investment purposes, each company had to establish a local and a regional setting and to invest most of the funds at the local level, defined by the district or province in which the mine was located. The Antamina Mining Company in the San Marcos District, Huari Province, Ancash Region, was the country's largest contributor to the total amount allocated to the program. In this context, the project Reducing Chronic Malnutrition and Child Anemia in Communities in the Ancash Region, given the shorter name Ally Micuy – a Quechua phrase for “Good Food” or “Well Fed” – was formulated. After several months of discussions among the three parties: the Antamina Association (entity created to manage the AMF), ADRA, and Caritas Peru, a bilateral agreement was signed by AMF and Caritas Peru in August 2007. One month later, the Caritas network, formed by Caritas Chimbote, Caritas Huaraz, and Caritas Huari and led by Caritas Peru, launched the program in the northern sector of Ancash. The area over which Caritas Peru was to oversee was northern Ancash, comprised of eleven provinces and assembled into two settings: the local and the regional. The local setting encompassed these provinces: Carhuaz, Huaylas, Mariscal Luzuriaga, Pomabamba, Sihuas, and Yungay, while the regional encompassed these provinces: Casma, Corongo, Huaraz, Pallasca, and Santa. We chose districts in these provinces featuring the greatest levels of child malnutrition, according to the 2005 Student Height and Weight Census. Then, we picked close to ten communities in each district. In short, project setting was comprised of eleven provinces, fifty-eight districts, and four hundred twenty-seven communities, more than half of these located above 3000 m. As shown by the provinces that made up the local and regional settings, the local Ally Micuy setting was not just the province where the donating company operated, but also several other provinces with elevated levels of

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 – 2010

Introduction

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

malnutrition. The entire project was carried out in twenty Ancash provinces, eleven of which sit within the Caritas Peru work zone. One other fact we would like to underscore is the AMF's decision to be part of the project in all the Ancash provinces and not just in its direct sphere of influence. At the beginning of the project, Caritas conducted its own baseline study, assuming that one the government would have carried out through the INEI or another institution might have taken too long to complete or not have had sufficient desegregation, facts that were effectively confirmed. We initiated the baseline study in September 2007 and concluded it in October 2007, basically two months before we launched the project. We furthermore conducted a baseline monitoring study, following the same methodology, at project conclusion, between July and August of 2010.

Reducing Chronic Malnutrition and Child Anemia in Ancash The Ally Micuy Project 2007 â&#x20AC;&#x201C; 2010

Reducing chronic malnutritionand child anemia in AncashThe Ally Micuy Project2007 – 2010