DAP RWANDA Development Assistance Program A multisectoral approach to livelihood security in Rwanda. USAID funded. FY FY Overall goal: improve livelihood security for 700, 000 households in Rwanda Partners: WV/R, ADRA and FHI

Country overview Population: 9 million Population density- 336 persons per square km 5 provinces, 30 districts. Each district made up of sectors, each sector made up of cells. DAP coverage- Northern province: Gicumbi, Gakenke, Musanze; Eastern province: Bugesera; Southern province: Nyamagabe and Nyaruguru.

Situational analysis Livelihood of rural Rwanda is largely dependent on subsistent farming (over 90%) Causes of livelihood insecurity/malnutrition are numerous and often intricately related: Mainly can be categorized into: 1. Factors leading to low agricultural productivity Land scarcity from high population density (average of 0.7 hectares per capita) Soil erosion from unfavourable topography, deforestation and poor land practices (Rwanda between 1,000 and 4500 meters, 50% reduction of forest areas post genocide) Poor climactic conditions: erratic rainfalls leading to drought and flooding. Limited agricultural information, knowledge and skills (poor quality extension services)

Situational analysis II 1. Factors related to limited market and economic opportunities Limited market access: poor rural roads network, lack of transportation and small size of local market. Lack of collective bargaining power and little influence on market forces. (smallholder farmers poorly organized) Lack of capital and access to credit: limited financial management skills and unfavourable borrowing terms. 2. Factors related to the depletion of human capital High OVC and HIV burden (Rwanda prevalence- 3%) leads to workforce depletion and reduction of household earnings. Malnutrition and HIV/AID mutually aggravate one another and impact negatively on productivity. Productivity loses to malnutrition is approximately 10% of life time earnings (World Bank)

Country health indicators IndicatorInternationa l target (%) Current Prevalence (%)-DHS 2005 Rwanda Is this a priority in FY07 (Yes/no) Is this a priority in FY08+ (Yes/no) Breastfeeding Breast feeding in first hour after birth 100%41%Yes Exclusive breast feeding for 6 months 100%88%Yes Breast feeding for 24 months 100%69.5%Yes Anthropometrics less than –2 SD Stunting U5s <20%45.3%Yes Wasting U5s <5%3.9%Yes Underweight U5s <10%22.5%Yes

IndicatorInternatio nal target (%) Current Prevalenc e (%)- DHS 2005 Rwanda Is this a priority in FY07 (Yes/no) Is this a priority in FY08+ (Yes/no) Micronutrient Status Anemia in children under 5 years (Hb<11g/dL) <20%56.3%Yes Anemia in pregnant woman (Hb<11g/dL) <20%Yes Anemia, women years (Hb<12g/dL) <20%32.8%Yes Night-blindness child months 0%No Night blindness pregnant woman 0%No Vitamin A coverage, child under 5 years >80%84.1%No HH Iodized salt >70%87.8%

IndicatorInternatio nal target (%) Current Prevalenc e (%)- DHS 2005 Rwanda Is this a priority in FY07 (Yes/no) Is this a priority in FY08+ (Yes/no) Prevalence, Prevention & Management of Childhood illnesses Full immunization of child before first birthday (child months) 90%69.3% Yes Diarrhea past 2 weeks U5s <25%14.1% Yes ORT use with diarrhea 100%18.6% ARI past 2 weeksN/A17.1% Antibiotic use for ARI100%26.9% (% seeking care in health facility) Yes

IndicatorInternatio nal target (%) Current Prevalenc e (%)- DHS 2005 Rwanda Is this a priority in FY07 (Yes/no) Is this a priority in FY08+ (Yes/no) Malaria Malaria Treatment100%69.3% Yes ITN at HH (% with at least 1 ITN in HH) 100%14.7% Yes U5 sleep ITN (% who slept under ITN previous night) 100%13% Yes Pregnant woman sleeps under ITN (% who slept under ITN previous night) 100%17.2% Yes

DAP Objectives A multisectoral approach with interacting sectors. Increased household agricultural Production and Productivity through: Improved farming systems, strengthen soil conservation practices, diversification of assets base. Increased Economic Opportunities in Rural Areas through improved market access and efficiency Improved health and nutrition for women, children and vulnerable groups and reduction of risk and impact of HIV/AIDS Improved governance through increased positive interaction among diverse groups of people.

HIV Sector Objective: reduce risk of and mitigate the impact of HIV/AIDS A. Dissemination of Behaviour change messages: 1. Health education for PLWHA on nutrition and hygiene 2. Disseminating HIV prevention messages among farmers. 3. HIV prevention education to womens group. B. Supplementary food ration for PLWHA Family ration consisting of: (CSB, fortified bulgur and vegetable oil) PLWHA in need of food assistance surpass resources: criteria used include ARV status, children, lactating mothers and BMI<18. PLWHA kept on food ration for minimum of 6 months

Nutrition and Health sector Objective: improved nutritional status of targeted vulnerable groups: Growth monitoring and selection of malnourished children for supplemental feeding. Provision of supplementary ration and vitamins for nutritional recuperation of target children. Training mothers/foster parents and nutrition and health workers on PD/Hearth model and Care group concept. Nutritional rehabilitation through the PD Hearth approach. Mothers care group to improve infant and young child feeding (FHI) Sensitive community on malaria prevention. Mothers provided with improved vegetable seeds Mothers trained in bio-intensive kitchen gardens

Livelihood sector 1. Improved farming systems Promote the use of improved varieties of key crops Promote best cultural practices Enhance crop diversification Strengthen research-extension-farmer linkages 2. Strengthen soil conservation practices Control soil degradation on hillside (Land terracing through the FFW program) Train farmers in environmentally sound practices Promote tree panting and agro-forestry practices Promote the use of energy saving stove. 3. Household food security enhanced through diversification of assets base. Promote bio-intensive market gardening Promote bio-intensive farming and small animal rearing.

Inter-sectoral integration For for Work (FFW): land terracing increases land productivity in the long term but increases household food security in the short term. PLWHA included in FFW program: reduces socio-economic impact of HIV/AIDS. PLWHA trained in non-labour intensive (context specific) farming methods: kitchen gardens, planting in sacks: sustains immediate gains from food supplementation programs. Farmers given HIV prevention education: leads to long term productivity gains. Mothers of malnourished children given improved vegetable seeds and trained in bio-intensive kitchen gardens: sustains nutrition rehabilitation programs.

Nutrition Rehab. Clinic / Health Center Community Health Promoters Health extension workers Rally Point Malnourished under 5s) Hearth (moderately) gardens Mothers Care Groups (15) Positive deviant leaders Households (10) Families Kitchen gardens Small animals Fruit & vegetables Growth Monitoring,Screening CTC (Severely) Under 5s Preg./Lac. PLWA OVCs Input Supply Production Assembly Wholesale Retail Functions Value-chain approach Associations, cooperatives, mothers groups Multiplication of improved varieties Farmer field schools Individuals On farm trials, demonstrations Link to markets, technologies, credit Training in business skills, access to markets & credit Safety nets (food for work, etc.) Kitchen, community, health center gardens Entrepreneur start-up support Public SectorPrivate Sector Seed fairs, vouchers, etc. Integrated Nutrition / MCH / Food Security Framework Ag Marketing / ProductionNutrition / MCH

Key Achievements FY 07 Trained 3473 farmers on bio- intensive gardening and 3153 on organic farming (FY 07 target for both was 2400) Trained 11, 895 beneficiaries on HIV prevention. Trained mothers on key health and nutrition lessons. 36% of targeted farmers adopting bio-intensive gardening (FY 07 target- 20%) 40% of targeted farmers adopting organic farming practices. (FY 07 target 25%) MCH Outcomes: (Mid-term survey results) 1. 91% of mothers adopting proper hand washing behaviour (baseline 19%) 2. Stunting rate reduced from 47.6% to 40% 3. Underweight (weight for age) reduced from 27.7% to 22%. 4. Number of men and women who can mention at least 2 ways of preventing HIV/AIDS- 95% (baseline- )

Achievements

Outcomes 2 (FGDs) 1. Nutrition knowledge and practices All mothers knew to exclusively breastfeed their infants for 6 months and then introduce complimentary foods, continue to offer breast milk on demand for up to 24 months Had or were breastfeeding their infants and some for up to 24 months Knew the importance of providing dense complementary foods using local foods and could identify local nutritious foods Knew to continue to feed their children during illnesses.

Outcomes 3 (FGDs) 1. Health knowledge and practice among mothers: 97% participated in the growth monitoring program 84% received vitamin A 85% received deworming All had their children sleep under bed nets All had at least 4 prenatal visits and know the importance of skilled attendants for labour and delivery. All had their children fully immunized. All could state at least 3 ways that HIV is transmitted

Outcomes 4 My name is Nyirabashongore Amerberga of 37 years old. Im married with 2 kids. My husband died in 2000, and after his death, I used to get sick without knowing the cause. After being trained, I was tested and found that Im positive in 2006 and I decide to join association. Before getting food, I was having 30 CD4 (in September 2006). In March 2007 she had CD4153, and now she is having CD4 197.

Key Challenges Applying criteria for including PLWHA into food supplementation programs in the midst of huge needs. Therapeutic feeding centres sometimes non-existent. Resource/budget constraints limiting income generating activities for PLWHA graduated from food supplementation programs. Removal of Rwanda from the list of high priority countries. Slow sales of monetization commodities and hence cash flow problems Integration of the DAP with other WVR programs. On-going AID Reforms and the need to make adjustments