Background to Milk Programme:

The Milk Programme for Orphaned & Vulnerable babies in Lukulu District, Zambia began in the latter part of 2006 and thus has been in existence for over 5 years.  It began as a direct response to needs of the community, and more specifically the first babies were enrolled when Sr Pat Hanvey IBVM (Programme coordinator) was approached by the Medical Superintendent at the local hospital for emergency milk for four orphaned babies.  The poorly resourced local District Hospital had no means to supply or purchase milk and the extended families too impoverished to buy milk.  Since then, because of the seriousness of the HIV & AIDS pandemic in Lukulu, and the high maternal mortality rates, many babies are orphaned or left vulnerable and malnourished if mothers are there but too ill to breastfeed.  The programme has developed over the years to address the ongoing needs of these orphaned and vulnerable babies.

Objectives of the Milk Programme:

The desired outcome of the project is to provide adequate nutrition for orphaned and vulnerable babies, and thus secure life and well-being in their early formative stages of growth.

Geographic Scope of the Project:

Due to the remoteness of the location, the lack of development and lack of transport, the scope of the project is limited to ‘reasonable footing distance’ within a 10 - 15 km radius of the small township of Lukulu, and within a similar radius respectively of four Rural Health Centres which are themselves located between 22 and 70 kms distance from Lukulu, in an area of harsh sandy terrain with no roads.

The Central distribution point is at Sancta Maria Mission in Lukulu itself.  In addition milk is distributed from four Rural Health Centres (RHCs) some distance from Lukulu to make milk more accessible to the babies in need close to their rural villages.  These Centres are; Luvusi, 70 kms from Lukulu; Lishuwa, 33 kms; Mbanga, 40 kms (through deep sand) and Simakumba, 23 kms.  (See map below).  Milk can be distributed from these centres due to the cooperation of the staff at the RHCs. Milk at the main Centre is distributed once weekly by two committed community volunteers.

Beneficiaries:

Each year up to 140 babies are directly assisted by the Programme, and indirectly their extended families benefit as the burden of trying to support these babies from limited or non-existent means is alleviated.  Up to 80 babies are enrolled at one time since babies are enrolled as the need arises and discharged once they are weaned from milk and/or reached a stable level of growth and nutrition.  They are usually discharged between 12 -18 months but may be assisted for longer periods with a High Energy Protein Supplement (HEPS) if needed.

Initial referral at the main Centre is through the nearby hospital where nurses or the nutritionist identify orphaned and vulnerable undernourished babies.  Guardians or parents of the enrolled babies collect milk from the Home Based Care Centre on a given day each week.  They are required to bring the baby to the children’s clinic at the hospital each month for weighing and review and progress is monitored.  Detailed records are kept regarding the distribution of milk to the babies, and of the progress of each.  Staff at the respective RHCs take responsibility for identification, monitoring and discharge of babies for the programme, and also for the storage and distribution of the milk from their Centres on an ongoing basis. 

Breastfeeding is always promoted where possible and babies are not enrolled on the programme if the mother is medically fit to breastfeed.  The programme does not support replacement feeding as an option but only when, for medical reasons, it is not safe for a mother to breastfeed or where a mother cannot for medical reasons adequately provide sufficient milk for the baby.

Supplies of milk are purchased in bulk from Lusaka on a quarterly basis as there is generally none available in Lukulu and when available only at very inflated costs due to the remoteness of this place.

Periodic workshops on such topics as hygiene, nutrition and care of babies are conducted by Nurses or the Nutritionist from the local hospital for the mothers and guardians on collection day at the main centre.

On average up to 40% of babies enrolled on the Programme are orphans.  Because of the lack of infrastructure in the area, and limited access to basic health care many babies are born in the rural villages, and sadly many mothers die in childbirth.  It is known that Zambia has one of the highest maternal mortality rates in the world.  As we enrol babies we become aware of the very difficult circumstances endured by families and hear sad stories such as a mother bleeding to death on an oxcart as the family try to get her the long distance to hospital after a difficult home delivery.  Zambia is also a country that has been ravaged by the HIV & AIDS pandemic and some of the babies have been orphaned directly as a result.  Vulnerable babies are supported when  mothers are too ill with AIDS and other illnesses to be able to feed their babies and in such cases a milk supplement is provided for these vulnerable infants. 

The community of Lukulu District is an impoverished community who largely survive through basic subsistence farming on poor soils.  As a result there is a high incidence of malnutrition within the community and such malnourished babies are also assisted on the programme. Although we try to limit enrolment (for the sake of access and monitoring of the babies and milk) to those living a reasonable ‘footing’ distance from any one of the designated centres, many desperate mothers or guardians, are willing to walk long distances, sometimes up to six hours footing in each direction to get milk for their babies on a weekly or two-weekly basis.  Unfortunately, due to a few experiences in the past when babies at a far distance were given a month supply of milk to alleviate such hardship, this was abused.  Thus assistance is limited to those who can access the centres at least every two weeks, and thus responsible use of the milk can be monitored.

Project Costs:

The bulk of the costs involved in the programme is for the purchase of Formula milk which is expensive.  Costs per annum are indicated below:  

Total Costs $ 40 950 per annum for nutritional supplements.

Monitoring & Follow-Up:

Apart from the ongoing weighing and monitoring of the growth of the babies by medical personnel at the hospital, the community volunteers are engaged in a programme of visitation of the village homes where the babies stay.  Here they try to assess that the information provided by the family at the time of enrolment of the babies is accurate.  They also advise the mothers and guardians on care of the babies. 

In a similar way they try to trace the small number of babies who stop coming for milk in order to ascertain if the infant has died or whether the family has secured another source of nutrition.

Periodically medical and nutrition personnel are invited to provide input or short workshops to the parents and guardians when they come to collect milk at the point of distribution.

A new initiative has been introduced whereby once or twice a year, babies discharged from the programme are invited for a morning of follow-up.  Once again a professional is invited to provide input for the gathered parents. In addition, while the parents and guardians share with us, and with each other the progress of their child since they have been discharged from the programme the little ones engage in playful activities in a safe environment.  This encounter benefits all and most importantly helps us to appreciate the gift of life that has been afforded to a large number of children through the milk programme.

Nutritionist speaks to parents & guardians

Results:

The programme has now been running for over five years, and during this period around 500 babies have been assisted.  30 babies (6%) are known to have died while on the programme although in many cases this was due to reasons such as malaria or other diseases.  The remainder have been successfully discharged as healthy toddlers  (some of whom are presented below)while a small number stopped coming when on the programme and were unable to be traced.

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