How close is Sierra Leone to implementing nutrition action at scale?

How close is Sierra Leone to implementing nutrition action at scale?

Malnutrition continues to hound Sierra Leone, where there has been virtually no improvement in wasting or stunting levels in recent years (Global Nutrition Report, 2018). Parliamentarians and other actors are cognisant that the stakes are high and that if unabated, malnutrition will impede wider development, including the attainment of the Sustainable Development Goals (SDGs). Yet, less than half of Sierra Leone's core nutrition actions (10 out of 25) are implemented in all provinces according to the results of a Nutrition Stakeholder and Action Mapping, supported by UNN-REACH. Even where geographic coverage is high or somewhat high, beneficiary coverage – the number of people who receive a given service – may be low or even unknown due to prevailing data gaps, particularly for some of the nutrition-sensitive actions such as promoting 'eat what you grow practices' (not selling everything) in the northern and eastern provinces and training on post-harvest management of crops in the northern province. 

The mapping engaged eight sectors and five different SUN networks (UN, civil society, donor, parliamentarian and scientific) with a total of 149 stakeholders and 22 actions mapped. This, in turn, provided fertile ground for participatory dialogue about how to plan and where to scale up nutrition actions. A specific analysis was conducted on the delivery mechanisms employed by the government and partners. It was found that on average, more than 40 percent of the actions mapped were delivered by Community Health Workers at district level. These findings will support the development of the National Plan on Community Health Workers. The exercise also identified bottlenecks, such as infrequent registration with district councils, which some felt hinder intervention coverage. Magnus S. Conteh from Marie Stopes International, found the “mapping is very useful to spot areas that need more attention and subsequently, spread out partners equally across districts and regions, avoiding duplications.” The UN Network Secretariat trained a local mapping team on its increasingly popular tool and provided back-stopping support for data analysis and visualization, leveraging experiences in other countries.

Bo District Mapping Validation Workshop

Mapping workshops, held at both the national and sub-national levels, provided a forum for actors to validate the results and decide on concrete next steps. They also provided an opportunity to reflect on lessons learned, including the timing of the exercise and need for further training. During the workshop in Freetown (12 March 2019), the Minister of State, Mrs. Francess Piagie Alghali, thanked stakeholders for their commitment to the exercise, particularly acknowledging the teamwork between the country’s SUN Secretariat and the UN Network’s intensive support arm – REACH. The workshops attracted representatives from the Vice President’s Office, six ministries (Agriculture and Forestry; Health and Sanitation; Local Government and Rural Development; Primary and Secondary Education; Social Welfare, Gender and Children’s Affairs) the SUN Government Focal Point and other government officials from parliamentarians to members of multi-disciplinary district councils and SUN desk officers. They were also joined by members of civil society, the UN, private sector and donor community, who brought their ideas and views to the table.

Thanks to this diverse following, multi-sectoral nutrition is now standing on two feet. The workshops created a buzz and were even covered in local newspapers, TV and radio broadcasts. Participants were enthusiastic, noting that mapping was especially useful for strengthening M&E as well as partnerships in nutrition. The findings are also providing valuable inputs to improve nutrition planning processes and coordination for nutrition gains. As Laurent Michaels from the Irish Aid stated, “from a human rights perspective, it also raises an important question related to accountability: who are the duty bearers?”

Stakeholders have decided to replicate the exercise on an annual basis, starting in 2019. Similar mapping workshops were/will be held in Lesotho (March) and Niger (May) while the mapping exercise in Chad is in the final stages of completion. Madagascar and Sudan have recently launched the exercise and other countries are also planning to do so in the coming months. Stay tuned to learn more, including how these mappings are influencing stakeholder behaviour.

Photo credit @ UN Network Secretariat/Sarah Cruz