The WINNN programme aims to deliver evidence-based, cost effective interventions in five northern states in Nigeria: Zamfara, Katsina, Kebbi, Jigawa, and Yobe, while improving government capacity, leadership, and financial commitment in relation to improving nutrition in the country. A six-year programme (September 2011 – August 2017), by 2017 it is envisaged that the programme will have contributed to delivering the following:

• Provided treatment for at least 246,000 children with severe acute malnutrition; supported 670,000 women in exclusive breast-feeding; and supplied 5.4 million pregnant women and children with vitamin A, iron, de-worming, and other essential micronutrients; and
• Reduced the prevalence of stunting, wasting, and underweight by up to 20 per cent over the six-year period. This will, in turn, contribute to a 43 per cent reduction in childhood mortality (220/1,000 live births to 125/1,000 live births).

The Annual Review – Summary Sheet can be found here.

Summary of progress in 2015/16:

• Successfully increased attention given to nutrition at national and state levels with supportive collaboration for national nutrition initiatives, including advocating for approval of the National Food and Nutrition Policy and supporting the development of the National Nutrition Information System;
• Increased micro-nutrient etc coverage during two rounds of maternal, newborn and child health (MNCH) weeks with improved availability of the necessary commodities despite often late releases of government funds, security issues disrupting planned activities and the geographical remoteness of some communities that required a great effort to reach;
• Successfully scaled up the number and reach of IYCF community groups and enhanced supervision of them by trained supervisors identified for each ward in the target LGAs; started up IYCF counselling corners at the CMAM outpatient therapeutic programme centres (OTPs) and demonstrations of how to prepare nutritious complementary foods; completed a barrier study to identify what hinders women from translating messages on improved nutrition into changed behaviour and practices; and developed and implemented quality improvement initiative schemes for both the OTPs and the community IYCF groups;
• Increased the number of community volunteers (CVs) active in nutrition education for women; tracing defaulters from both the OTP-based intervention and from secondary care given at the stabilisation care centres; motivating husbands, mothers and mothers-in-law, and community and religious leaders to promote optimum IYCF practices; and identifying cases of malnourished children to be assessed for CMAM;
• Successfully developed a range of behaviour change communication materials, including musical videos and community dramas, that promote nutrition, which are at the final stage of production and will be used at a range of community gatherings in the coming months;
• Increased the uptake of effective CMAM with improved client experience;
• Supported the development of state nutrition plans in each of the five states and in two states developed agreed and costed multi-sector nutrition plans; worked to ensure all the intervention states have a functioning State Committee on Food and Nutrition (SCFN); engaged some governors and all State Houses of Assembly (SHOAs) in championing nutrition; and helped civil society organisations (CSOs) gain attention for nutrition; and
• Increased political commitment to nutrition budget lines being created in most states, with some releases by states and LGAs.

The Narrative Report to Accompany the 2016 Annual Review of the Working to Improve Nutrition in Northern Nigeria (WINNN) Programme can be found here.

This document may be accessible through your organisation or institution. If not, you may have to purchase access. Alternatively, the British Library for Development Studies provides a document delivery service.

Key research findings include:

• The concept of food groups, the unique benefits of feeding foods from each food group and the classification of foods into specific food groups is foreign
• Both cost and health considerations have an important influence on the decisions made about what foods to feed 6-23 month old infants
• The IYCF recommendations, in the short term, were feasible to put into practice; and led to improved complementary feeding practices
• The mothers valued, trusted and appreciated the support given via three face-to-face discussions with a research assistant
• Mothers were motivated to try out the recommended IYCF practices by a desire to improve their infant’s health
• Their motivation to continue practicing the IYCF recommendations was further enhanced when, after practicing the IYCF recommendations, they saw that their infant accepted and liked the new practices
• The initially perceived key barriers to practicing the IYCF recommendations was the availability and affordability of the foods/soap
• Other barriers were a misperception that young infants are unable to eat the amount or types of food recommended
• Social support was the most important enabler for successful practices
• Other enablers included environmental changes and having their own business.

Every year about one million children under five years of age die in Nigeria. Malnutrition contributes to nearly half of these deaths. There is a lack of data on long-term outcomes and rising concerns over high post-discharge relapse and mortality rates. The researchers will examine the survival, health and growth outcomes of a sample of approximately 500 children treated in out-patient CMAM centres, supported through the Working to Improve Nutrition in Northern Nigeria (WINNN) programme, in two LGAs in the state of Jigawa. The findings will be used to advocate for post-discharge follow-up programmes in the community.

The project will generate valuable research findings on the low utilisation of nutrition services. The Maiduguri team will use a mixed methods study to explore the demand-side barriers to service utilisation and propose ways to improve two nutrition interventions introduced by the Nigerian government in recent years to tackle high levels of malnutrition in the country – maternal, newborn and child health weeks (MNCHW) campaign and counselling to improve infant and young child feeding practices (IYCF) – in ways which can increase uptake. The study will be undertaken in Yobe state, but will generate findings that can be used across similar settings in the Northern states.

• How do we ensure that research evidence is used in programme design and policymaking?
• How do we identify good quality and relevant information when there is so much available?
• How do we make sure we reach the people who have the influence to change the things that matter to us?
• How we capture policy maker’s attention and commitment to act where there are so many competing demands on them?

Participants undertook a series of small group exercises to model the crucial steps for effective evidence-based advocacy:

1. Narrowing your focus to core critical issues for change.
2. Identifying your targets – the individuals or groups that have the power to influence your issues.
3. Framing key messages, based on concrete evidence, which will catch the attention of your targets.
4. Choosing appropriate strategies and communication channels to reach your audience and convince them to act – calling meetings, mounting public awareness campaigns, or using social media platforms, for example.

Low maternal autonomy and high levels of child malnutrition in Northern Nigeria

Participants used evidence around the links between low maternal autonomy and the high levels of child malnutrition in Northern Nigeria generated by the ORIE project as case material and each group worked on a different issue. One of the groups chose to work on girls’ education. This is how their evidence-based advocacy strategy looked:

1. Narrowing the focus: ensure that all girls are allowed to finish basic schooling.
2. Identifying the targets: religious and community leaders who can, in turn, convince their constituents of the importance of girls’ education. Crucially, this includes fathers attending mosques, churches and community meetings, as they often make decisions about their children’s education on their own.
3. Framing the key message: children of better educated mothers tend to be better nourished. This is important for the health and life chances of those children and for healthier and happier communities, and also contributes to lower health costs and greater productivity and wealth for the nation.
4. Choosing appropriate strategies: the group felt that a focus on Islamic teachings, which stress that to educate a woman is to educate an entire society because of women’s role in child rearing, would resonate well with religious leaders.

The workshop was a collaboration of ORIE, the Civil Society for Scaling Up Nutrition in Nigeria (CS-SUNN) and the Federation of Muslim Women’s Associations in Nigeria (FOMWAN). CS-SUNN and FOMWAN staff played a crucial role in convening the workshop participants and they are available to support participants’ efforts to use evidence in their programmes and advocacy going forward.

By Frances Hansford, Associate Consultant at Oxford Policy Management and gender specialist on the ORIE project. She can be contacted at fghansford@gmail.com.

Key evaluation findings include:

• The community management of acute malnutrition (CMAM) and Infant and young child feeding (IYCF) interventions are now established in the WINNN focal LGAs of Bukura, Bungudu and Shinkafi. Community leaders and volunteers are providing strong support.
• There has been progress with nutrition sector coordination and planning in Zamfara. A costed state nutrition plan has been developed. It is focused mainly on the health sector however. Tackling malnutrition requires the integration of nutrition work from other sectors.
• An LGA basket-fund for nutrition work was established in 2014, which was a notable achievement. It has enabled LGAs to procure routine drugs for CMAM, and provides some secure funds for MNCHWs. The LGA funds for nutrition are small compared to other WINNN-supported states, however.
• Limited funds were released from the state nutrition budget during the last Administration. Political commitment is required to ensure adequate funding, timely release and accountability for the use of nutrition funds in line with the State nutrition plan.
• State legislators have recently committed to provide oversight of nutrition work, and emphasised the need for a sustained state nutrition budget and releases. They have requested a quarterly briefing on how the LGA nutrition funds are spent.
• Civil society organisations (CSOs) in Zamfara are becoming more involved in nutrition work. They have developed an action plan and intend to do budget tracking of nutrition funds.

Key evaluation findings include:

• The community management of acute malnutrition (CMAM) and infant and young child feeding (IYCF) interventions are now established in the WINNN focal LGAs of Bakori, Jibia and Mai’adua. Community leaders and volunteers are providing strong support.
• There has been progress with nutrition sector coordination and planning in Katsina state. The state has drafted a five-year action plan for nutrition (2016-2020). A one-year multi-sectoral operational plan is now needed to guide implementation, as well as sectoral work plans funded from the state nutrition budget.
• Under Katsina’s former administration government funding for nutrition was low overall. This reduced the effectiveness of CMAM and MNCHWs.
• State legislators have recently committed to provide oversight of nutrition work. They have debated the need for a law to increase nutrition funding and ensure release of funds and effective implementation.
• The state has agreed to establish local committees on food and nutrition (LCFN). This should now be achieved, to improve coordination and implementation at LGA level.