A multi-sectoral approach to addressing acute malnutrition and its underlying causes among vulnerable populations in northern Rakhine State, Myanmar The proposed programme is aiming to address the high malnutrition rates in Rakhine state through an integrated nutrition, Water, Sanitation and Hygiene (WASH) and Mental Health and Care Practices (MHCP) approach, mainstreaming protection. In areas with restricted access to government services, Action Contre la Faim (ACF) will provide immediate life-saving Severe Acute Malnutrition (SAM) treatment services for children under five and Pregnant and Lactating Women (PLW) by running Out-patient Treatment Programmes (OTPs) in Maungdaw and Buthidaung townships. In addition, the project is exploring the opportunity to run mobile OTPS in existing health facilities in Northern Rakhine State (NRS) to ensure access to life-saving nutrition services for beneficiaries from all communities. The intervention is designed taking into account specific needs according to gender, i.e. specific needs of PLW towards nutrition treatment, including adaptation of waiting areas and measurement spaces. The project will provide referral support for beneficiaries with medical complications to the Rural Health Centre (RHC) or the township hospital. We will conduct nutrition education sessions for mothers and caregivers of children admitted in the OTPs to increase awareness on the causes of malnutrition and the use of the Ready To Use Therapeutic Food (RUTF) enabling women to make more informed decisions regarding their health during pregnancy and their children’s well-being. 

In addition, we will provide MHCP support to caretakers of beneficiaries admitted in the nutrition programme and to PLW. Deterioration of maternal and child care practices, including unsafe delivery and disruption of breastfeeding practices, are frequently observed in crisis situations, and put newborn and SAM children, particularly those under two years of age, at higher risk of mortality and morbidity. Beneficiaries will undergo a psychosocial evaluation to identify people who are vulnerable in terms of mental health, care practices and/or mother-child interaction. We will provide counseling based on individual needs, which can include individual and/or group support on Infant and Young Child Feeding (IYCF) practices, pregnancy care, caretaker-child play sessions and infant massage. Where possible, the project will also include individual psychosocial counselling. The project will provide individual sessions for both men and women to discuss men’s responsibilities in taking care of their children and enabling women to provide adequate care for their children. The project will also promote women’s participation in decision-making. Furthermore, there are sessions that focus on changing cultural beliefs, which negatively affect women’s health, well-being and dignity. The counseling activities will focus on addressing the cultural causes of the differences in care practices for boys and girls. In areas where access is limited and the psychosocial activities cannot be overseen by qualified psychologists, the MHCP activities will be limited to care practices in order to do no harm to the beneficiaries. A referral system will be developed to ensure that beneficiaries in need of psychosocial interventions will be referred to relevant health and protection services. 

This project will also leverage ACF’s “WASH in Nutrition” strategy, based on the mother and child dyad, to improve the efficiency of nutritional treatment. We will upgrade gender-sensitive WASH facilities in OTPs, including hand-washing stations, latrines and incinerators. Furthermore, the project will distribute gender-sensitive Mother and Child kits, which will be tailored to women’s needs and conduct hygiene promotion for beneficiaries admitted in the nutrition programme designed to improve the quality of the relation between the mother and her baby. Distribution will be done either at the OTP upon discharge, or after discharge through ACF’s implementing partner Myanmar Heart Development Organization (MHDO).