THE WEEKLY IRON AND FOLIC ACID NUTRITION PROGRAM
Three counties in Kenya have anaemia rates which are higher than the WHO recommended rates of 20% and PS Kenya is intervening in those counties through a demonstration project to improve adolescent health and nutrition. Through the Weekly Iron Folic Acid Supplementation Project (WIFS), we target school going and out of school adolescent girls aged 10-19 years to ensure that they have enough iron to reduce anaemia by providing them with 60mg of Elemental Iron once a week. This will help with productivity, school performance and in the long run reduce child mortality and malnutrition rates.
The 3 counties Busia, Kitui and Nakuru were selected based on the Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) framework that lists them among the 21 priority counties with poor reproductive health indicators. These counties are also listed under UNFPA as counties with high prevalence of maternal mortality and high cases of teenage pregnancies. The WIFS project is funded by Global Affairs Canada (GAC) Right Start initiative through Nutrition International (NI) formerly known as Micronutrient Initiative (MI). Because this is a unique audience, we use a 360⁰ ‘surround & engage’ communication strategy combining both existing and new communication messages and channels to influence behavior change towards the use and consumption of WIFS.
STORIES OF CHANGE: FROM ZERO TO HERO
In the middle of Busia county lies St. Mary’s Asinge Primary School in Teso South Sub County. The shool like others in the sub-county was mapped for the implementation of the WIFS demonstration project that seeks to improve the nutrition status of adolescents through nutrition education for adolescent boys and girls and weekly iron and folic acid supplementation to adolescent girls.
However, what was meant to be a cut and go scenario for the implementation project turned out to be a more complicated situation as girls were stopped from uptaking the supplementation. So as other schools kicked off with WIFS in January, St. Mary’s Asinge did not. According to the then Acting Head Teacher Ms. Gloria Wekesa and the health teacher/WIFS Champion, resistance from a few parents led to resistance of all parents of girls who were targeted with the supplementation. “When a few parents initially refused their children from receiving the IFA (iron folic acid) supplement, other parents heard of this and also barred for their girls from consuming the supplement, so no girl was receiving the supplements in the entire school,” they said.
Faced with this challenge from parents, the teachers knew that they had to change these perceptions if they were to see their girls taking the IFA supplement. Through funding from Nutrition International, teachers are empowered with knowledge so that they can articulate the benefits of the supplements to these parents. The teachers would also need to leverage their authority as opinion leaders in the community and good will to change the minds of the parents. The process begun with the teachers investigating the barriers to the uptake of WIFS and realized that the community around the school area is deeply rooted in cultural and religious beliefs which influenced the behavior and choices of most parents. It was found that the Asinge community is notorious for resisting and questioning any health program that is geared at improving the health of the population. The Asinge also remain skeptical of modern medicine hence do not consider seeking modern medical interventions when sick. Finally, they had a negative perception that WIFS was a camouflaged contraceptive or a fertility pill. For the teachers therefore, the problem was largely lack of knowledge and the solution was to close this gap with information on WIFS.“We realized that individually and collectively, we were responsible for bridging the gaps created by the lack of information on WIFS and had to rectify it immediately,” said Ms. Wekesa.
The teachers got the local administration, that is, the Chief and Assistant Chief of Chakol Location, the Sub County Director of Education (SCDE) and the Diocesan Education Priest, Father Wesonga to intervene by being present and attesting that they are aware of project during the schools parents meeting.
A parents meeting was held to create awareness on WIFS and to address any concerns. At the meeting parents were sensitized on the project, why it was being implemented in the school, and the benefits the girls would reap from taking the supplement. This message was reconfirmed by the chief and assistant Chief, the Sub County Director of Education (SCDE) and the Diocesan Education Priest who confirmed that IFAS is a nutrition supplement which is similar to those given to pregnant women and is in line to the World Health Organization recommendations. Being a catholic school, the presence of Father Wesonga sensitizing them on the supplement and that it is in line with the Ministry of Education guidelines was appreciated by the parents who agreed to have their girls enrolled in the program.
When the WIFS programmatic team paid a visit to the school during part of routine supportive supervision, all (105) school girls between 10 – 19 years of age were taking the supplements. St. Mary Asinge has become a beacon of hope because the WIFS champions were able to arouse positive attitudes, driving the WIFS agenda from resistance to awareness to 100% practice.