1. 1 CAPACITY DEVELOPMENT FOR RESEARCH AND MICRONUTRIENT DEFICIENCY CONTROL David Sanders Mickey Chopra Chantell Witten School of Public Health University of the Western Cape Private Bag X17, Bellville, 7535 South Africa

2. 2 Capacity Development for Micronutrient Programme Implementation Actions to develop and sustain the ability of country’s own institutions to successfully undertake Policy Development, Advocacy, Design, Implementation, Monitoring, and Evaluation of Micronutrient Programmes

3. 3 Micronutrient Deficiency Control Programmes Supplementation e.g. Vit. A capsules, iodised oil Supplementation e.g. Vit. A capsules, iodised oil Food fortification e.g. salt iodation, fish sauce, noodles Food fortification e.g. salt iodation, fish sauce, noodles Dietary diversification e.g. seafood, eggs, meat, fruit, green vegetables Dietary diversification e.g. seafood, eggs, meat, fruit, green vegetables Public health control measures e.g. malaria control, improved diarrhoea management; E.P.I.; breastfeeding; improved complementary feeding; water, sanitation & hygiene; deworming Public health control measures e.g. malaria control, improved diarrhoea management; E.P.I.; breastfeeding; improved complementary feeding; water, sanitation & hygiene; deworming

4. 4 Progress in Implementing the Programme Elements Since the early 1980’s there has been considerable progress in the coverage of populations with the essential elements of care. (Source: WHO 1998B,p 4)

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6. 6 Health Systems ”HARDWARE” ”HARDWARE” oFacilities e.g. Health Centres oTechnology / Equipment / Drugs oTransport oCommunications “SOFTWARE” “SOFTWARE” Health Personnel Health Personnel Human Resources Communities Communities

7. 7 Health Personnel Quantitative Quantitative Numbers / Distribution Numbers / Distribution Health Personnel Qualitative Qualitative Competence: Competence: Knowledge Knowledge Skills Skills Attitudes Attitudes

8. 8 Importance of Health Personnel Development Personnel account for ±70% of recurrent expenditure Personnel account for ±70% of recurrent expenditure Health personnel development is primary step in health systems development Health personnel development is primary step in health systems development Move to decentralised health services which need to implement a Primary Health Care Approach has increased need for public health skills dramatically- for policy, advocacy, planning, programme design, implementation, monitoring and evaluation Move to decentralised health services which need to implement a Primary Health Care Approach has increased need for public health skills dramatically- for policy, advocacy, planning, programme design, implementation, monitoring and evaluation

9. 9 The Challenge Need to train personnel from different backgrounds to facilitate process of change Need to train personnel from different backgrounds to facilitate process of change Short to medium term priority is to upskill those already in the field Short to medium term priority is to upskill those already in the field Needs to be as least disruptive, both to the participants and the health services, as possible Needs to be as least disruptive, both to the participants and the health services, as possible

10. 10 Educational Strategies Based on assessed training needs Based on assessed training needs Problem-oriented Problem-oriented Adult education techniques Adult education techniques Linked to systems development Linked to systems development Training guides Location should be as close to workplace as possible Training of teams

11. 11 Nutrition Programme Development Nutrition is a major public health problem in developing countries esp. in SSA Nutrition is a major public health problem in developing countries esp. in SSA Large amount of resources invested with relatively little return Large amount of resources invested with relatively little return Berg has identified the need for ‘nutrition engineers’ who have the capacity to understand, assess, design, implement and evaluate interventions. Berg has identified the need for ‘nutrition engineers’ who have the capacity to understand, assess, design, implement and evaluate interventions.

12. 12 Education and Training in Nutrition UWC was running short courses in Nutrition Programming. Felt need to base capacity development on a more objective basis. Support from SANA/AED UWC was running short courses in Nutrition Programming. Felt need to base capacity development on a more objective basis. Support from SANA/AED Two workshops and in-depth interviews with key informants in the field and academia Two workshops and in-depth interviews with key informants in the field and academia Long comprehensive list of competencies with an emphasis upon nutrition knowledge and high level diagnostic skills Long comprehensive list of competencies with an emphasis upon nutrition knowledge and high level diagnostic skills

13. 13 Education and Training in Nutrition Important to refine list based upon actual implementation of a district nutrition programme Important to refine list based upon actual implementation of a district nutrition programme Partnered with Mount Frere district – one of the poorest districts in the country Partnered with Mount Frere district – one of the poorest districts in the country Aim: “To help develop appropriate systems, structures and policies for the implementation of an integrated nutrition programme” Aim: “To help develop appropriate systems, structures and policies for the implementation of an integrated nutrition programme” Based upon the programme implementation cycle Based upon the programme implementation cycle

14. 14 Education and Training in Nutrition Refinement of competencies according to the needs of implementation. Refinement of competencies according to the needs of implementation. Increased emphasis upon simple research and community participatory skills coupled with essential nutrition knowledge for a multi-sectoral team to conduct a participatory assessment Increased emphasis upon simple research and community participatory skills coupled with essential nutrition knowledge for a multi-sectoral team to conduct a participatory assessment Translated into training manual with input from pedagogical expert Translated into training manual with input from pedagogical expert

15. 15 Education and Training in Nutrition Following widespread training demand for skills in planning and management Following widespread training demand for skills in planning and management Development of second volume Development of second volume