Ensuring children in Rwanda have the opportunity to reach their full potential

New village led approach brings hope in fight to reduce stunting

Vera, a community health worker, checks the the individual child score card. A guiding tool to easily identify malnourished children at the village level and provide guidance on specific actions to improve a child’s nutritional status. Photo: WFP/JohnPaul Sesonga

“It requires smart efforts to reduce stunting among young children” said Vera Lugutuah Kwara, Nutritionist for the United Nations World Food Programme (WFP) in Rwanda.

Sometimes being ‘smart’ means being ‘simple’, and putting local people at the heart of the solution.

Through the ‘Smart Simplicity stunting-free village model,’ Rwandan villagers are using a combination of tools to easily identify malnutrition and make quick decisions to improve a child’s nutrition status.

What is stunting and why does it matter?

Stunting does not just mean children are small for their age but their brain development has also been impaired. It is caused by poor nutrition, repeated infection, and inadequate psycho-social stimulation.

Stunting in early life has life-long consequences, particularly in the first 1,000 days of a child’s life from conception until the age of two. Stunted children fall sick more often and are more likely to suffer from chronic diseases, as well as under performing at school and as a result they are more likely to grow up to be economically disadvantaged.

The prevalence of stunting in Rwanda is very high at 35 percent (affecting approximately 590,000 children) compared with the average of 25 percent in most developing countries. The main causes of stunting in Rwanda include: inadequate quantity and quality of food, infectious diseases, limited access to safe water, sanitation, hygiene and health services, and inadequate care practices. These problems are particularly severe in Rwanda’s Western Province where a staggering 44 percent of children experience stunting.

Local health workers are at the heart of the solution

“I assist and advise pregnant and breastfeeding mothers in my village,” explains Vestine Mukakimenyi, a community health worker (CHW) in Gasiza village in western Rwanda. “I truly appreciate the training I’ve received through this new model as it has enabled CHWs like me to more easily identify children at risk of stunting and quickly provide support to parents,” she added.

The Smart Simplicity approach re-imagines the way nutrition actors target stunting by empowering local actors and stakeholders at all levels to resolve the absence of central, standardized data. Previous approaches were hampered by poor data collection and sharing between actors leaving local health workers unable to tell where chronic hunger is occurring and where to best focus efforts.

The new approach uses a combination of tools, such as the maternal and child scorecard and the length mat, to easily identify malnutrition and make quick decisions to improve a child’s nutrition status. This allows data to be aggregated on a local and district level providing unprecedented insight. Plans are underway to digitize the scorecard further increasing data collection efficiency.

Timing is critical

Odette with her husband Jean-Baptiste Samvura and their son Gad Byiringiro. The are grateful for the advice they received from community health workers on their role as parents to protect Gad from malnutrition through good feeding practices. Photo: WFP/JohnPaul Sesonga

Crucially, the approach promotes early identification of stunting among children at the village level and enables CHWs and local leaders to quickly advise parents on appropriate feeding and hygiene practices. This ensures that children receive critical nutrition-related interventions to treat and avoid malnutrition.

“Before having access to these combined tools at the village level, CHWs found it difficult to easily identify stunted children and lacked guidance on what actions needed to be undertaken when stunted children were identified,” Vestine noted.

“The child scorecard trained my husband and I on how to evaluate our household feeding practices and areas to improve our child’s nutrition,” said Odette, a local fruit farmer. “Before the programme started, my wife and I didn’t fully understand just how critical it is that our son Gad be able to eat green vegetables and fruits on a regular basis,” noted Jean-Baptise, Odette’s husband. Odette and Jean-Baptise have since shared what they learnt with other community members.


Community health workers use a measuring mat to help identify stunting at the community level. WFP/JohnPaul Sesonga

This new approach is being rolled out by the Rwanda’s National Early Child Development Programme (NECDP), in partnership with the Boston Consulting Group (BCG), One UN agencies working on nutrition along with village leaders and community health workers, with the aim of supporting the reduction of stunting across the country. The roll-out in Rwanda follows the successful implementation of the Smart Simplicity approach in Tanzania.

The collaboration began in mid-2019 when the model was first tested in Kabagabo village in north-western Rwanda. 2019 data indicated that 52 percent of children under the age of five in Kabagabo are stunted. “Tools included in this new approach such as the individual maternal and child scorecard help us to monitor a child in their first 1,000 days from conception up to their second birthday,” said Jean-Baptiste Nzabonimpa, Kabagabo village leader. “Guided by the interventions listed on the scorecard, we are able to easily identify the gaps and advise parents on specific actions to improve their child’s nutritional status, including referring acutely malnourished children to health centres for treatment if needed,” Jean-Baptiste added.

The scorecard, together with the length mat help parents and local leaders to visually understand the level of stunting at the community level and the preventative actions to undertake. “Stunting is not yet well understood at the village and household level and thus not given a high priority,” noted Roger Ntawukulityayo, Boston Consulting Group (BCG) consultant, based in Rwanda.

The Smart Simplicity model has been scaled up from its testing phase in Kabagabo village in late 2019 to 42 additional villages in Nyabihu district in western Rwanda. The model will be rolled out by the Government of Rwanda to cover all 30 districts across the country by mid-2022, aiming to accelerate the reduction of stunting among children in Rwanda.



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