This story describes how evidence-based advocacy is helping to forge a new trajectory towards eradicating malnutrition in Rwanda.
It illustrates the three-year journey of the DGIS-funded Voice for Change Partnership (V4CP) programme, which partnered with local civil society organisations (CSOs) to build a convincing advocacy case for systemic change and for an inclusive, multi-stakeholder national malnutrition strategy. It highlights how this approach led to a stronger connection between the authorities and communities, which not only increased thematic knowledge and skills, but also led to more relevant interventions that could have greater impact.
Today, while there is a lot more work to be done to fulfil the Government of Rwanda’s targets to eliminate malnutrition, thanks to the concerted efforts of a wide range of organisations working as part of the V4CP, the country’s District Plans to Eliminate Malnutrition (DPEMs) have been revised and their committees, which are responsible for carrying the plans forward, have been strengthened.
In addition, a food and nutrition strategy has been put into motion across the country. This includes specific and measurable plans for each district, so service delivery at ground level can be routinely monitored and evaluated, and the authorities can be held to account.
Setting the scene
Malnutrition continues to challenge Rwanda. Over a third of young children have stunted growth or suffer from anaemia, while many others are underweight or wasting.
The Government of Rwanda has been trying to tackle this problem for many years. In 2007, it developed the country’s first nutrition policy and, in 2010, it started rolling out a national strategy. To implement the change, it set up District Plans to Eliminate Malnutrition (DPEMs) within communities across the country (read more in this Story of Change).
However, in 2016, when the V4CP programme started its food and nutrition security programme across Rwanda’s thirty districts, it was clear that the DPEMs were dysfunctional, in spite of efforts by the Government to consolidate them in 2012, under the national Joint Action Plan for the Elimination of Malnutrition.
Gathering and assessing evidence
Upon commencing its programme, the V4CP started the process of assessing the current performance of the District Plan to Eliminate Malnutrition (DPEMs). It invited a local CSO, Scaling Up Nutrition (SUN) Alliance, to become a partner and trained its staff in multi-stakeholder processes (MSP) skills. Next, working together with SUN Alliance’s implementing partners, such as Rwanda Consumers' Rights Protection Organisation (ADECOR) and the Association for Integrated Rural Development (DUHAMIC ADRI), it started to gather information on the functionality of the DPEMs. By drawing on stakeholders’ knowledge of food and nutrition security, as well as previous studies and requests from national and district stakeholders, it assessed a wide range of elements. These included the DPEMs’ resource mobilisation approach, their level of gender and social inclusion, their coordination and knowledge management capacity, as well as the level of monitoring and evaluation (M&E) they employed, and their use of data to improve performance.
The assessment revealed that DPEM district coordination committees had been set up too late, and that they had never been expanded to include a wide range of sectors and villages as planned. This meant that the DPEM’s roles were often too generic and were not relevant within the context of the communities they intended to help. In addition, each district had developed its own plans and budgets; there was no centralised strategy or system.
Collaboration and capacity building
The information gathered provided a number of insights and helped build a powerful evidence-based case for the DPEM committees to improve their planning, budget allocation, coordination and accountability mechanisms, and of the need for an improved national strategy to tackle malnutrition.
Having strengthened SUN Alliance’s advocacy capacity, in July 2018, the V4CP programme presented the case to district leaders during a series of formal meetings with the vice mayors in charge of social affairs and officials from the National Early Children Development Program (NECDP). Not only did the evidence help highlight systemic gaps and improvement options for the DPEMs, it proved to be a convincing tool in strengthening collaboration with these district leaders.In light of this increased, high-level support for systemic change, in August 2018, the DPEMs agreed to review their plans. They asked the V4CP to help develop the capacity of their committee members, who had never been trained in the skills, systems and strategic approaches required to conduct an effective multi-stakeholder partnership. The V4CP responded by holding a series of trainings on nutrition issues, leadership, M&E, resource mobilisation, communication and information management, and on coordination.
Vice mayors of Nyarugenge and Gakenke districts during DPEM meeting.
Source: Duhamic Adri
Subsequently, the DPEMs requested the V4CP to contribute towards their planning review by developing improved strategies, systems and processes, and by drawing up a fundraising strategy. The NECDP also requested V4CP’s assistance in helping the districts elaborate and contextualise the DPEM’s implementation plans. During this collaboration, the programme advocated for accountability mechanisms to be included in the revised strategies.
In September 2019, a revised national nutrition strategy, with specific and measurable plans for each district, was agreed by the DPEMs. Importantly, the new accountability mechanisms, such as the nutrition M&E framework, mean that district leaders and the NECDP can set and monitor the DPEMs activities, outputs and outcomes, and to routinely track its progress against indicators and targets. In addition, the new fundraising strategy has enabled the DPEMs to commit to increase the budget allocation for nutrition.
The Director of Health in the Nyabihu district said:
“The committee in charge of eliminating malnutrition didn’t work well and I think that the cause is that we were setting a budget, but we were unable to get it. As you know training people requires a budget and activities are carried out at the village level. Therefore, it requires the hospital, the district or the committee members to have means so that we can go to supervise those activities, advise them, see where problems are, and what is missing for things to work out. So, when you don’t have financial resources, you cannot do all those things. But thanks to SUN Alliance, who trained us and advocated for fundraising and the increase in budget raised from 2.7% (2016/2017) to 4.1% (2017/2018). The knowledge and supervisions are now there, and coordination has improved.”
Today, the roles of all stakeholders at all levels have been contextualised so that they are relevant to individual communities’ needs. In addition, a capacity development plan has been devised, along with an advocacy and resource mobilisation strategy to support its implementation. The development of a communications strategy has improved information exchange on key nutrition interventions and is helping to raise awareness amongst communities.
Crucially, there is collective understanding that plans alone will not solve the problem, so communities’ voices are being heard and their needs and recommendations are considered in the DPEM’s plans. For example, some district authorities are holding cooking demonstrations, and a quarterly newsletter, initiated by DUHAMIC ADRI in the Nyamagabe district, updates the community on food and nutrition security issues. The information this contains can also be used by the local authorities to hold the stakeholders responsible to account.
Marie Claire Uwamariya, the vice Mayor for Social Affairs of Musanze district, said:
“DPEMs were not well functioning due to lack of enough support, we faced a lot of challenges in planning and implementation. The district couldn’t put in funds and the partner’s funds were limited. Therefore, we were not able to carry out all DPEM activities like we had planned to. But now with support from SUN Alliance we are implementing activities very effectively.”
Throughout its three-year food and nutrition programme in Rwanda, the V4CP carried out a series of agriculture and nutrition service surveys in order to monitor whether its interventions had genuinely improved service delivery within communities. The surveys included interviews conducted with a wide range of stakeholders, including government officials, such as the district health directors, as well as farmers’ cooperative committees, agricultural importers, community workers, pregnant women and mothers.
The first, baseline survey was carried out across six sample districts in 2017, followed by another in the same districts in 2018. This revealed that community satisfaction levels in these communities had increased by an average of 10%. It also revealed that gaps in service delivery, flagged in a citizens’ report card introduced by Rwanda Governance Board (RGB), were being responded to. The community and their leaders at district level acknowledged the successful advocacy by the V4CP programme and the efforts made by the CSOs in pushing for improving service delivered to the community and farmers.
A follow up survey will be conducted in 2020.
High-level political will and support - and will - to implement a robust national strategy with people-centred, measurable interventions is growing, as is collaboration between the authorities and CSOs. This is key for sustaining momentum towards long term results for malnutrition because it filters into, and strengthens, district performance contracts.
On 23 October 2019, Rwanda Development Organization (RDO) and SUN Alliance representatives had a fruitful face to face meeting with Dr. Asiimwe Anita, coordinator of the National Early Childhood Development programme. During the meeting, she agreed to support farmers and stakeholders in order to prioritise the farming of nutritionally rich foods, including dietary diverse foods, and the scaling up of food fortification to overcome malnutrition. In addition, she committed to assist with improved coordination among CSOs and to help strengthen their partnership with other sectors. She agreed that CSOs should hold community leaders accountable for food and nutrition service delivery and pledged to catalyse support from district officials. Her backing for advocacy is fully guaranteed.
President Kagame and his Government continue to urge Rwanda’s districts to act on hunger and malnutrition, with stunting reduction as top priority.
Who we are
The Voice for Change Partnership strengthens the capacities of civil society organisations to foster collaboration among relevant stakeholders, influence agenda-setting and hold the government and private sector accountable for their promises and actions. It is funded by the Dutch Ministry of Foreign Affairs.
 DHS Rwanda 2014-2015 figures in children under 5 years old: Stunting 38%, anaemia 37%, underweight 10%, wasting 2%.
 For further background on this story, read the SNV blog in November 2018: https://snv.org/update/story-change-improving-food-and-nutrition-security-rwanda
National coordinator for NECDP receives CSOs.