The Impact of COVID-19 on a promising Step Up! programme

COVID 19 hit Changara hard - and it also halted work on an impressive and innovative approach to nutrition and health education in the village that was being supported by the AstraZeneca Step Up! grants programme.

Changara is a few hundred metres off the main road in the north west of Mozambique, a couple of hours from the provincial capital Tete. People there have little money and malnutrition is a major challenge, so it seemed the ideal place for Clare Hanbury, CEO of Children for Health, to trial youth-focused work to tackle nutrition and hygiene.

An initial workshop, building on years of experience gained through their CPLAN project in the area, had demonstrated that children could become even more effective communicators if they had more control over their own work plans. The feedback from the parents, grandparents and guardians was very positive:

Zeferino Selemane said ‘my son Selemane told us that we should not all eat from the same plate together, but each from his own plate. In our house we no longer eat on the same plate’. This helped family members to get a fairer share of the food.

Domingos Dziwabzaco learned about nutrition from a song his daughter Lorena had learned, and Yuran Eugénio got his grandfather Luis to plant a greater range of crops. Everyone changed their habits on hygiene and especially washing their hands separately under running water rather than in a shared bowl. It was a behaviour change which was shortly going to become even more useful.

Bibiche Sangwa who runs the Mozambique programme was keen to see the programme expanded, “There are so many communities that would be in a better position in terms of basic health and nutrition habits if their children were prepared with good approaches like the one in Changara from a young age. We hope that soon there will be appetite to enable a national level scale up.”

Indeed, the programme was so impressive that it attracted the interest of the Ministry of Education which proposed to use it as the basis for a national nutrition education campaign. All they needed was $500,000 from donors, and Clare set off to make it happen.

Then, on 23 March, the schools shut to combat COVID-19. It is now unlikely that they will open fully until 2021.

The effect has been devastating. Children for Health’s schools programme had to stop immediately, and the 1,200 children at the primary school had to go home. For a while the school continued its teaching by remote learning using a photocopier to print out questions that parents could take home for their children to answer, but unfortunately the photocopier broke down and, with no money in the community, even this teaching had to stop.

The sometimes erratic supply of free school meals provided by the World Food Programme ended with the closure of the school, increasing malnutrition in an area in which already over one third of children under five years old had been stunted by poor diet[1].

For the girls there were even greater challenges. Filomena, one of the trained teachers, said “teenagers are very vulnerable. More pregnancies are appearing and the Health Centre’s services are reduced because of the virus - so sexual and reproductive health is a major problem too.”

The programme has, however, also had positive effects in making the community more resilient in the face of the new threat. Luis Muantachula has taken his grandson’s lessons to heart “With this new coronavirus disease, we leave a bottle of water for everyone who arrives at home to start washing their hands”.

Clare meanwhile is battling with other problems. “The AstraZeneca grant was the match that lit the fire and has given us the opportunity to take our work to much greater scale - but finding donors who will support a new project is always difficult. It is even more challenging now that already tight funds are being reallocated to coronavirus programmes. Lots of projects are being postponed or cancelled”.

The solution to the funding crisis may need to be even more creative and Clare is investigating Social Impact Bonds as a way of achieving their goal.

Children for Health’s work to help children to communicate health messages to their parents and families is more important than ever but COVID-19 has made taking this budding programme up to national level a hundred times harder.


[1] Cruz LMG, Azpeitia GG, Súarez DR, Rodríguez AS, Ferrer JFL, Serra-Majem L. Factors Associated with Stunting among Children Aged 0 to 59 Months from the Central Region of Mozambique. Nutrients. 2017;9(5):491. Published 2017 May 12. doi:10.3390/nu9050491