Children's Participation in Nutrition and Health: Critical Components of an Effective Program

I've recently been asked to reflect on the critical components, the 'ingredients' that have made our Nutrition and Health Programme in Mozambique work, and why I've devoted SO MUCH time and effort during these last 12 months to get PCAANS to the next stage as invited by the Government of Mozambique.

Broadly speaking it is exposing key decision-makers at all levels to the competence of children and the joyful enthusiasm with which they undertake simple health promotion and disease prevention activities. This is a mindset issue and what you see in a school or community where this is happening is not that visible...but when you speak to children it really is different. Here is what parents noticed and reported:

Now we can see the light of good health and our children are true heroes.

With the children’s insistence, the mothers try to vary the food, consuming a lot of vegetables that they grow in the garden, which were initially meant for sale.

The children help each other children by teaching them about nutrition and help to keep the school healthy

Even folks from international non-government agencies - soaked in the language of children's rights can get quite teary when they see (for example) 10-year old boys role-playing mothers, cradling our parrot mascots, in dialogue about the importance of colostrum in the first days of a baby's life and its relative growth and health when breastfed exclusively....after (literally - we promise) a 10-minute input from one of their teachers prior to setting up this role play.

I sometimes reflect that we just have NOT done a good enough job in communicating this basic insight. Otherwise, it would be far more widespread than it is.

Other important factors include:

• SUPPORTING THOSE TEACHERS! Teachers are on the front line and almost always the ones that have to pick up the ideas that others dream up for improving this or that. Often with very little support and (can you believe), they are not often part of the conversation when programmes are being designed. We hope that with our programme we made sure teachers were not only involved but driving the programme in ways they felt were realistic and fun. Interventions must build a careful bridge between current practice and the scientific literature on effective instruction.
• (From the start) The programme needs to be amenable to being scaled up and mainstreamed as part of Government policy.
• Getting a good understanding right up front what factors affect the choices of people in their communities and looking at this through the lens of at least 5 factors including culture, systems, environment, biology, and cognitive development. This can be complex work (and is often missed out). We have worked for YEARS on the questions and how to 'ask'; them of children in ways that are fun and engaging. We have our colleague and adolescent behaviour expert, Sarah Newton for her help with this too.
• Exploring, 'what works' within the existing education and other systems - in terms of curriculum, teaching, pedagogy, community support for learning, family relationships to learning institutions.
• Understanding the existing external pressures on the institutions (like schools) that you may be seeking to add to. (Many schools seem to have a lot of outside agencies pressuring them to undertake externally funded activities to further their agenda).
• To co-create with colleagues a simple enough approach that does not rely heavily on lengthy textbooks, that can be integrated easily into the life of the school or informal education systems and/or into in-service and pre-service training activities.
• Communicating the DETAIL of what contributed to the successes so that those involved can understand and feel motivated. For example, a shift from white to brown Chima in the families and villages happened when children learned of the relatively low nutritional content of highly processed white Chima - maize meal and the higher nutritional content of the less processed meal and the high nutritional content of fresh Chima, They coined the nickname, Chima ZERO  for the white Chima and this was their idea and then they used this in dramas and songs they made up about Chima and - informally almost as a taunt. brown Chima was 'labelled Chima SIX and fresh maize was labelled Chima TEN . So using these nicknames - children were discussing, singing about their staple food and sensitising families to the need to switch to Chima of higher nutritional value and to use fresh maize form from time to time. This of special importance when very young children are being given Chima to fill them up as a very high percentage of their diet. Teachers, local officials, and decision-makers at the Provincial level loved stories like this. It's helped them understand in fine detail HOW children can influence change.
• Another example from the same programme is the increased use of plates and sharing food out between members of the family more fairly and this happened after children took the described activity to their families where they were drawing all the foods they ate in a week on a round cardboard circle - representing a plate - and then using colours to colour in the items on the plate (or label the colour if they did not have colour pencils). This led to discussions about the use of plates and the sharing out of the coloured food equally in the family...and THIS led to a rush of families buying plates in the community. We only discovered this when we consulted teachers and asked them 'what's changed?' and they told us the business people running small kiosks which sell plates among other things, were VERY pleased with the programme! This lovely result and story are documented in our storybook, Everyone Counts.

We could set out very many more detailed stories of activities that gently nudge families through discussion and the way this leads to the decision-makers in the family (often fathers), discussing with other decision-makers about the messages and ideas that the children are bringing home. The result is a genuine shift in habits within the family and habits which are sustained.

Our Role

Our roles have included:

• contributing to or revising the programme design process within existing structures and systems;
• designing and helping to conduct training;
• to examine existing curriculum materials and discover where they can be developed
• to co-create new elements (content and activities) that enhance or strengthen what already works; and
• provide tools and tips that enable programmes at every level to understand how the programme is working and what to do to amplify successes.

Relevant - Whatever the Topic

Recently I have been attending a few webinars about the effort to get the vaccines to low and middle-income countries and the importance of involving 'Civil Society/ to maximize community engagement and acceptance. Children can be a powerful part of this effort and the factors above will be relevant to this too. We are currently talking to partners in Nigeria and in Sierra Leone to understand better how child involvement in the community engagement effort linked to immunisation could look.