EndHiddenHunger

The problem we are solving is what may be termed as hidden hunger. Hidden hunger is the absence of essential nutrients to the meals served to small children. In Kenya, these problem is , mostly seen in the marginalised communities of North-Eastern Kenya, where several factors conspire to ensure that children, even when they are getting their stomachs full, do not receive the right nutrition and are caught in a cycle of poor health.

1)     The traditional diet of these communities is milk, other dairy products, and some form of carbohydrate for little children. For adults’ carbohydrate and meat, they traditionally don’t eat fruit and vegetables.

2)     The communities do not prioritise education for the girl child and so many mothers are illiterate or semi-illiterate with most and having been pulled out of school to marry young.

3)     Given the climate in this region, cultivation isn’t possible with the area being prone to drought and famine and the focus is more on getting food in the stomach than if it is the right food.

4)     There is a knowledge gap in understanding nutritional value required for children and only when the effects of hidden hunger become irreversible do they seek medical attention. This is a rare case where education alone can produce a transformational change because these are people who value children and also have wealth in the form of livestock, if made to understand the value of proper nutrition they would be able to sustain themselves by providing it. 

5) For various traditional reasons, these communities are not proactive when it comes to medical intervention, they wait for disaster to strike before seeking help. In the case of hidden hunger, the gap between lack of nutrients in early childhood and the consequence is such that by the time disaster strikes, it is too late to get a solution

6)     The micronutrient deficiency in hidden hunger then leads to delayed milestones, impaired physical growth, poor cognitive function, low immunity, and hence low resistance to infection and predisposition to other degenerative and chronic diseases.

These communities, not to be confused with the refugee camps set up in Northern Kenya, often have health centres in each town as in Kenya, health is a devolved function implemented by the local country governments.

This is one public health tragedy that can be solved through education alone, as it is requires not comprehensive education, but an awareness in these communities that infants and young children, after breastfeeding still require nutritionally rich food.

Our solution provides for an information database with education materials addressing nutrition in infants and young children. The database will be stored in tablets distributed in schools coupled with a USSD function allowing caregiver to locate nearest health centre or location for pre-mixed nutritional products.

Our model incorporates Kenya’s oldest media organization, The Standard Media Group with whom the prototype was developed. The choice to develop this solution with the media, was informed by two things:

1)     Most pastoralist communities do not trust innovation and prefer to maintain their lifestyle as is with little interference from the outside world.

2)     However, the media remains to be the most trusted source of news in these communities. This is evidence by the fact that Standard Media group, utilizing their USSD and Bulk SMS platform have been able to conduct surveys and disseminate information to these communities. Most recently, in a partnership with UNICEF they were successfully able to mount a WASH Campaign in schools.

It is this prototype, the USSD platform that we are leveraging and enhancing with a content platform to combat hidden hunger.

Further, the media organization runs a newspaper for schools’ distribution program which has proved to be extremely popular in these communities and making a case for

Given the literacy levels of care givers in these communities, we are utilizing animation videos as part of the content distribution plan and health tips sent out as bulk sms. Once the caregiver enrolls, they are also able to access the USSD platform to query where they could access the premixed nutritional formulations based on their movements.

Our model includes three partner organizations- Donkeyworks (content generators), Standard Media Group (content distributors) and a product partner (KEMRI who would ensure the product distributed in the initiative is appropriate).

Importantly, there have been several initiatives that sought to distribute products such as Unimix, ORS and often fell short in meeting the needs in pastoralist communities and this was evidenced by the fact that infant mortality in these regions remain to be the highest in Kenya.

Our solution is pegged on the fact that knowledge is power and to drive behavioural change the caregivers must first understand why the intervention is necessary (content requirement) and be empowered enough to seek solutions/adapt solutions at hand (ussd location and product access).

The solution serves the underserved women, infants, and young children in pastoralist communities of Northern Kenya. Communities where women have an average of seven children, having been pulled out of school to marry young.

Child and infant mortality in these communities is the highest in the country. According to the Kenya Demographic Health Survey, the under-five mortality rate in north-eastern Kenya is 163 per 1000 compared to other regions such as central Kenya where it is estimated at 54 per 1000. In a region, where the estimated to be 2.5 million, this is a staggering figure.

To give an example, Kenyans were able to access Caesarean section pre-independence, in the 1960s, but the first C-section was performed in North-eastern Kenya in 2010.

Kenya has a devolved healthcare system means each region should have access to healthcare services at their regional level. North-eastern has public health facilities but very few mothers attend the antenatal and prenatal services – this is a factor of knowledge for informed decision-making.

To drive behavioral change, the tablets would be distributed to schools, health centers, women's groups, and religious institutions, in particular Islamic clerics, Imams, who serve as leaders in these communities.

Our distribution model leverages the success of Newspaper for schools in pastoralist communities and successful execution of similar initiative for UNICEF and WFP.

The donkeyworks team consists of medical doctor, public health communication experts and technology enthusiasts- all of whom have worked in the previous initiative.

The solution has been implemented for other existing initiatives, we simply seek to implement it to focus on hidden hunger in infants and young children.

Our target market is the 2 million population in the north eastern region

Combating hidden hunger is a multi-sectoral approach where we seek to leverage the partner network MIT would offer to expand on the solution. Therefore, barriers we face if classified as

1)     Legal – the regulatory framework is addressed by our product partners such as KEMRI

2)     Financial – initial funding for content creation has been raised through our media partner and would require additional capital to purchase tablet and design the merged platform some local even county for data, for content creation and tablet purchase.

3)     Technical – The singular platform that links to the USSD prototype would require enhancement to drive efficiency.

4)     Market- A partner network to leverage our distribution model would be essential and could allow for plug in of other partners working in the space of food security.

This is an innovation that it addresses a very narrow and specific challenge, hidden hunger in infants and young children. Previous solutions have focused on product distribution solely and often as ‘treatment’ rather than prevention. Yet the only affordable path for a developing nation to health systems strengthening and a healthy population is prevention.

We have set a foundation to address a specific nutritional challenge, but these could be leveraged to address other paediatric challenges such as vaccination and immunisation challenges.

Our solution has then been developed with two key factors in mind:

1)     Creating an infrastructure framework that we could pass on to the local county government as part of a health systems strengthening effort.

2)     Drive ownership of the solution in the affected communities and more so as they are mobile, addressing cultural norms and a focus on a simple to use technology platform was key.

According to the Kenya Demographic Health Survey, the under five mortality rate in north-eastern kenya is 163 per 1000 compared to other regions such as central Kenya where it is estimated at 54 per 1000. In a region, where the estimated to be 2.5Million, these is a staggering figure. Our goal in the next year is to half the under-five mortality rate in north-eastern kenya. We start with the first step, the first year, getting our platform in at least 24 school and religious institutions in the region and initial utility rate of 25% for the USSD function.

Indicators include queries on the ussd platform and number of infant mortality recorded in the region. We require support in formulating a measuring and evaluation framework.

Education is what bring change and technology is a driver. For the beneficiaries to adopt a solution they need need to first understand why they need to feed their young children, nutritionally rich meals. And in a region, where majority of the caregivers are illiterate or semi-illiterate animations and simple to use codes are the foundation of education too change the conversation on hidden hunger.

Our core technology is anchored on a combined USSD and content distribution platform placed on modified tablets distributed in schools, health centre, womens groups and religious

The north-eastern part of kenya is underserved and lags behind on most, if not all, health indicators. We are targeting the future- infants and young children- who otherwise face significant development delays and some do not make it to their fifth year of life. We want to pull this region of Kenya, back into the map and key to these would be our incorporation of community leaders including teachers, nurses, community health workers, church leaders and women’s groups

Social entrepreneurs must be ready to work themselves out of a job, we are opening the door and creating an infrastructure for adoption by the local county government. Our B2G model seeks to sell these to the government and other partners for utility for other initiatives looking for a distribution model for the demographic.

Sustainability would be based out of grants from partners, government and non governmental organizations.