PINKK creates a circle of care for mothers and children in Senegal

In the dusty heat of the midday sun, a group of women gathers in the shade in Kolda, southern Senegal. The reason for their meeting is held in their hands - each one carries a healthy newborn child, shrouded in a rainbow of colourful fabrics with only their sleeping faces visible. “We are waiting for Coumba!” they inform us happily.

Coumba Diassy is a community health volunteer, designated by the villagers to teach, assist and monitor the health of new mothers and babies as part of the PINKK project - a ground-breaking initiative to scale up nutrition, strengthen local health systems, and support income generation in some of Senegal’s most vulnerable communities, particularly women and children.

Launched in December 2015 under the leadership of Nutrition International (NI) and funding from the Government of Canada, the Integrated Nutrition Project for the Kolda and Kedougou Regions has been working to improve the lives of 5550 households, using an innovative, multi-sectoral approach which tackles the varied causes of malnutrition on all fronts.

Community ownership of nutrition and health activities is one of the defining features of PINKK, and that’s where health volunteers like Coumba are starting to attain visible results, serving as a link between remote villages and health information and delivery.

With health clinics and hospitals located up to 40km away, few people in the village had the capacity and information to access them. Transport by motor bike or horse-cart along unpaved roads is arduous and expensive; in the rainy season, many roads are flooded for months on end. The impact on mothers and children was especially severe –  the area suffered one of the highest maternal and infant mortality rates in the country, with treatable illnesses and malnutrition major contributing factors.

In response, PINKK has brought health delivery directly into to the community by training and equipping 2,800 community health workers, nurses, midwives and local health professionals to implement a network of maternal and newborn health and nutrition packages.

The results speak for themselves. Child mortality rates have fallen from 71 ‰ to less than 45‰ since the start of the project.

Today, Coumba has come to teach a group of 20 young mothers about best practices in newborn care. Using an illustrated manual, she takes them through the importance of exclusive breastfeeding and hygiene practices. She explains the importance of iron and folic acid tablets and makes sure they take them. If she spots instances of poor health in either mother or child, she is able to refer them for further treatment and monitoring at local health posts.

Coumba also ensures that all newborns attend the growth monitoring sessions coordinated by World Vision Senegal, one of PINKK’s key implementing partners. One of the reasons behind PINKK’s success lies in bringing on board a range of development partners, thereby harnessing the greatest complementary expertise required to attain results.

Children up to the age of 24 months are assessed monthly to ensure that they are receiving the nutrients they need to grow.

“Growth monitoring is a crucial platform for promoting nutrition at the community level,” explains Cheikh Tidiane Samb, Regional Nutrition and Public Health Coordinator at Nutrition International. “It allows us not only to monitor closely the growth of children, but also to promote good nutrition practices through one-on-one interviews with mothers, cooking demonstrations, and verification of compliance of children’s immunization records. Community health workers are also able to provide related services such as routine vitamin A supplementation, deworming, fortification of domestic food, community management of diarrhea, and to refer any children showing signs of under-nourishment or illness for further treatment, ensuring that cases do not become severe.”

Thanks to PINKK, mothers and children are enveloped in a full circle of care and information to ensure no one slips through the cracks, no matter how poor. 95,685 women and newborns in Kolda have been reached by the project to date.

Towards this end, PINKK has also harnessed informal practices and traditions to ensure greater uptake of health interventions, including community radio and social circles for pregnant women. Older women and grandmothers were also identified as playing a key role in the health of young families, and in respect of their traditional status, PINKK created grandmother associations who received training and information on health and nutrition.

“In our village many grandmothers take care of children since parents are busy working, that’s why we are happy that the PINKK project has trained us” says Fatoumata Kande, who has 18 grandchildren. “Since the PINKK project has started, I see fewer children getting sick.”

Grandmother associations meet regularly in Kolda to share knowledge and experience, and pass these lessons on to younger women. Bringing the entire community onboard in caring for mothers and children is key part of the project’s sustainability.[nm1] 

“I am very happy with my work because I have seen people feeling better since PINKK started” says Coumba, “good nutrition will help the children in our village achieve a good future.”

“When I walk through the village I feel proud. People come to me to ask questions and make tea just to talk to me.”  

PINKK’s low cost, community-based solutions can be used as a model for other communities faced with similar challenges for pregnant women and their newborns.

PINKK fosters young female leaders in Senegal

At just 16 years of age, Amy Mandiang’s ambition is to become a doctor, and her hard work at school and as a volunteer ‘nutrition champion’ in her community are helping to pave the way towards attaining her bright future. Amy is a member of the Young Girl Leader Clubs in Kolda, Senegal, an initiative supported by the PINKK project to both empower young women and instil good nutrition and hygiene practices in the area.

Since its inception in December 2015, the project has worked to improve nutritional and health security in Kolda, an area which has suffered from one of the highest food-insecurity rates in the country. No single solution can tackle this complex challenge, and PINKK’s innovative approach has been to implement a broad, targeted package of interventions, including nutrition and hygiene practices, as well as health care, agriculture, and business development – all with the direct involvement of community members like Amy.

PINKK’s support of the Young Girl Leader Clubs are a part of this solution. The project has supported 30 existing clubs and set up 15 additional ones in more remote areas, directly benefiting a total of 1430 girls to date and creating a new generation of role models for the entire community.

As part of her club membership, Amy regularly visits three families of young girls, and, following the nutrition and hygiene training she received from PINKK, she instructs the children and their mothers on regular hand washing, the washing of food, and the consumption of nutritious foods to ensure children grow up strong and healthy.

Adana, one of Amy’s two-year old charges, learns how to use the tippy tap, installed with training and support from PINKK outside most of the houses in the village. Children in Kolda frequently suffered from diarrhea, due in part to a lack of information about the importance of handwashing. Each year, thousands of Senegalese children die of diarrheal diseases and acute respiratory infections; a huge portion of these deaths could be prevented by washing hands adequately with soap and running water, and Amy’s lesson to Adana works to counter this trend.

The tippy tap is an effective, simple hygiene solution in areas without running water. Consisting of a soap stand and a plastic bottle filled with clean water collected earlier from the well, the tippy tap disburses water with the press of a foot pedal. They can be built at a minimum cost and effort using readily available items, and are easy enough for even Adana to use.

After they have washed their hands, Amy and Adana share a papaya, and Amy explains its benefits - a rich source of micronutrients like Vitamin A, critical for children under five to boost their immune system and prevent blindness. In an area where malnutrion and child mortality rates are high, a more diversified diet complete with essential micronutrients is a simple and cost-effective way to ensure children’s survival and good health.

Papaya trees are now widespread in gardens in the village, following PINKK’s support to farmers in growing nutrient-rich foods, including the distribution of fruit tree seedlings and seeds, and training in growing vegetables and fruits.

Amy understands the nutritional benefits of fruit and vegetables well, helping her mother tend their family garden.

“In the past, only a few people maintained gardens, particularly during the dry season. Now that I know how different foods can be good for health, especially for children, I encourage everyone to do it,” says Amy.

Amy’s self-assurance is all the more impressive considering the traditional barriers faced by young women in Kolda. Education often came second to making ends meet, particularly for girls who faced additional tasks of looking after siblings, fetching water and cooking. A lack of information on reproductive health also meant that teenage pregnancies and early marriage were particularly high, leading to further school drop-outs.

“Because of their gender and young age, girls in the Kolda region are more susceptible to fall victim to violence, female genital mutilation and early pregnancy,” says Cheikh Tidiane Samb, Regional Nutrition and Public Health Coordinator at Nutrition International. “It is therefore critical to strengthen girls' leadership to enable them to defend their interests and needs at the community level. In short, to be recognized.” 

The clubs have helped girls achieve this aim, by teaching them topics like sex education and encouraging them to stay at school. As a result, Amy and her friends are a new, confident breed of young women better equipped to serve their communities. Club members spread the message to their friends at school, and the young girls they mentor.

“School is important for girls because it can help them get good jobs and the means to look after their families,” says Amy. “I want to be a doctor, so that I can continue to participate in my village and to help people.”

The volunteer activities supported by PINKK have given young women the confidence, expertise to take on future leadership roles in their community, backed by good health and nutrition. Strong community ownership of health and nutrition activities is a key part of PINK’s sustainability strategy, giving people the tools to implement and innovate beyond these valuable advances in the future.

Nutrition and business go hand in hand in Kolda, Senegal

Looking around Suleiman’s green and thriving vegetable garden, it is hard to believe that the father of four from Kolda, Senegal, used to spend up to 6 months at a time away from his home and family, working as a farm labourer just to be able to afford to buy a fraction of the food he now grows himself.

“Every evening that I was away, I would think about my family,” says Suleiman. “They would have to wait for me to come back with my earnings so that they could eat, or borrow money or food from neighbours. We could afford mostly rice and leaves, there was not many vegetables here,” he says.

With 40% of people living below the poverty line, many families in Kolda endured long periods of separation with men leaving the village to earn what little money they could. Few opportunities for women to contribute to household expenses existed, and thus families faced a precarious existence - with meagre household earnings, the food that they could afford was low in diversity and nutrients, leading to high rates of illness and mortality, especially for women and children.

To break this cycle of poverty and food insecurity, three years ago the PINKK project begun assisting farmers in growing more nutrient-rich fruit and vegetables in their own backyards, and to make these gardens a source of economic empowerment, particularly for women.

The project targeted an initial 5,500 households with agricultural and agri-business training, and distributed seeds and seedlings of nutritious, high-value crops such as tomatoes, orange-fleshed sweet potato, and fruit trees including moringa fruit and papaya. To date, 4025 gardens have been set up with PINKK support in both Kolda and Kedougou.

Awa Kande, a widow with seven children, was assisted by PINKK in setting up a successful plot in the “Laabal” communal market garden.

“Before, I used to work on a rice field in the rainy season to earn money. We didn’t have any vegetables, we ate mainly rice and millet,” says Awa. “Since I started the garden, my children have more food like potatoes and salad.”

Laabal garden brings together 65 women who farm small plots for both sale and household consumption. Although their individual surpluses are small, the women market their produce together with the help of a caretaker. Three women are regularly selected to deliver and sell the vegetables at the market, up to 40km away, distributing the profits to contributors, and eliminating the need for expensive and sometimes risky middle-men. This pooling of resources eliminates the high barriers of time, distance and expense in selling their produce and increases their profits.

So far, Awa has been able to buy a goat with her earnings and to pay for the enrolment of all her school-age children.

“I miss my husband who has been gone for 22 years. Now, it is up to me to look after the family and to be self-reliant,” says Awa. “My future plan is to make my garden bigger, to have more livestock and poultry, so that if my family has needs, I can fill them immediately, and we don’t have to wait. 

Her oldest daughter, Rubi, attends university in the capital city of Dakar on a scholarship, and Awa is able to fund her supplies.

“We will never be able to repay out mother for all she has done for us,” says Rubi. “She has supported our studies, she has kept the house, and satisfied all our needs. That’s why we have to succeed and get good jobs, to make her happy.”
PINKK aims to support the women from Laabal further by building irrigation pools in the garden and buying a solar pump, to reduce the time and effort spent watering the plots by hand from a well during the dry season.

In addition, PINKK has supported women in setting up savings and loans schemes (SACCOs) to enable them to grow their businesses, under the leadership of key implementing partner Developpement International Desjardins (DID). 6089 women have benefited from the scheme so far, with the project setting up 380 in Kolda and 160 Kedougou. PINKK trains the women in financial literacy before they join the scheme, supports them in creating viable business plans and teaches them how to apply for loans and save money.

As a result of loans ranging from 15,000 – 100,000 CFA ($35 - $230 CAD) women have been able to set up diverse income-earning activities including the buying, breeding and selling of livestock, high-value crops, setting up neighbourhood shops, and even making and selling ice. 

“Women are now able to invest back into their families, including the purchase of nutritious foods, medicines and education for their children,” says Cheikh Tidiane Samb, Regional Nutrition and Public Health Coordinator at Nutrition International. Already, these initiatives are starting to achieve results, with child mortality rates falling from 71 ‰ to less than 45‰ since the start of the project.

Empowering both men and women by giving them the independent means to generate wealth is a key part of PINKK’s sustainability strategy, ensuring that the positive trends in income, food and health continue to rise under the stewardship of the communities themselves.