Presentation on theme: "Nutrition Specialist, UNICEF"— Presentation transcript:
1Nutrition Specialist, UNICEF Updates on IYCF- integrated with MNP & Child Grant, Vit A and GMP ProgramsPradiumna DahalNutrition Specialist, UNICEF
2Vitamin A CoverageUNICEF will focus on under-reached and unreached children (children 6-11 months and children in given in urban areas)VAS modeling for 6-11 months children is proposed in Jumla, Kavre and Chitwan districts for aiming to scale up this approach to rest of country by 2017.
3Protocol for Vit A Modeling The Routine Vit A Biannual Supplementation continued with BCC focus on urban/Children 6-11 months.After 6 months the child receive 100,000 IU vitamin A supplement (In HF or through FCHV- Only the first dose)Integrated with routine measles vaccination - If the child is fails to receive routine Vit A biannual supplementationThe time gap should be more than 30 days
4Anemia Prevalence High in Children: The Problem is serious among 6-23 months children Percent of children age 6-59 months with anemiaSource: NDHS 2011
5Trends on IYCF practices in Nepal: Complementary feeding (CF) DHS 2001, 2006, 2011Source (Year)Breastfeeding (BF)Complementary feeding (CF)Early initiation (within 1 hour)EBF among 0-6 monthsCF (6-9 months)NDHS (2011)45%70%NDHS (2006)35%53%75%NDHS (2001)31%68%66%
6IYCF Practices among Under 5 Children Percent of children 6-23 monthsBreastfeeding Status Under 6 MonthsRecommended IYCF Practices among 6-23 months children
7IYCF Community Promotion linked with MNP National ProgrammeTo Improve Anemia, Other micronutrient deficiencies and timely introduction of Complementary foodFeasibility study on MNP distributionin two districts, Makawanpur and ParsaPhase IPiloting of the MNP program(6 districts: 2010 Onwards) and roll out in 9 districts by 2012Phase IIScale up of the MNP Programmeby 2015Phase III
8IYCF/MNP Program Goal Pilot Objectives To improve the nutritional status of children aged 6 to 24 months by reducing prevalence of anemia and by improving complementary feeding and care practices.Pilot ObjectivesTo identify an effective delivery mechanism to distribute MNPs integrated with IYCF counselling to children 6-24 months of age.To use the findings of this pilot program to develop national strategy for nationwide scale up
10HEALTH FACILITY (RURAL MODEL) FEMALE COMMUNITY HEALTH VOLUNTEERS Distribution ModelsUNICEF/DOHS/LMDDHO/DPHO6 to 24 months ChildrenPHC/HP/SH PFCHVProcurement Department/UNICEFDHO/DPHOMunicipality Office6 to 24 months ChildrenWard OfficeFCHVProcurement Department/UNICEFDHO/DPHOHP/SHP/PHC6 to 24 months ChildrenHEALTH FACILITY (RURAL MODEL)FEMALE COMMUNITY HEALTH VOLUNTEERS(RURAL MODEL)MUNICIPALITY WARDS (URBAN MODEL)
11Updates from External Survey: Preliminary Report New Era CoverageCompliance
12Updates from External Survey: Preliminary Report New Era Infant and Young Child Feeding Practices
13Draft IYCF/MNP Scale up Plan by 2016/17 Sub-EcologyAnemia (6-59)RankAnemia (6-23)DistrictsNo. of DistrictsScale up Plan*Far West Terai60.4168.45Kailali, Kanchanpur215 districts to be covered by 2012 (UNICEF).In case of additional funding fromNAFSP – 8 Districts (Jumla, Kalikot, Dolpa, Mugu, Humla, Bajhang, Bajura and Jajarkot andWB Health Swap-7 districts (Ramechhap, Jhapa, Chitwan, Tanahun, Pyuthan, Surkhet and Kavre,UNICEF 3 possible districts Dhanusha, Nawalparashi and Baitadi]33 by 201375 by 2017Mid-West Terai56.983.8Bardiya, Banke, Dang3 (1)West Mountain52.7380.3Darchula, Bajhang, Bajura, Kalikot, Jumla, Dolpa, Mugu, Humla, Mustang, Manang10East Mountain51.3465.98Solukhumbu, Sankhuwashaba, Taplejung3 (2)Eastern Terai49.574.8Siraha, Saptari, Sunsari, Morang, JhapaWestern Terai48.86659Kapilvastu, Rupandehi, NawalparashiCentral Terai46.7767.7Chitwan, Bara, Parsa, Rautahat, Sarlahi, Mahottari, Dhanusa7 (6)Western Hill43.66311Palpa, Tanahun, Arghakhachi, Syanja, Parbat, Gulmi, Baglung, Myagdi, Kaski, Lamjung, Gorkha11 (9)Eastern Hill42.359.712Okhaldhunga, Khotang, Udaypur, Bhojpur, Dhankuta, Terathum, Panchthar, IllamFar-West Hill40.970.4Baitadi, Dadeldhura, Doti, Achham4 (2)Central Hill40.266.6Dhading, Nuwakot, Makwanpur, Kathmandu, Lalitpur, Bhaktapur, Kavre, Sindhuli, Ramechhap9 (8)Mid-West Hill3658.513Dailekh, Surkhet, Salyan, Rolpa, Pyuthan, Rukum, JajarkotCentral Mountain33.163.7Rasuwa, Sindhupalchok, DolakhaTotal Number of Districts756 Districts in Orange IYCF/MNP Piloted, 9 districts in Blue IYCF MNP being expanded in 2012
14IYCF PROMOTION LINKED WITH CHILD GRANT (IYCF/CG) BackgroundSince 2009/10, - GoN- Child Cash Grant (CG) (NRs 200/child for maximum 2 children) is provided for each child in Karnali. Dalit families in rest of the countryDisbursed through VDCs quarterlyMeant to be utilized for the improvement of nutritional status of the targeted children.UNICEF- complemented Infant & Young Child Feeding (IYCF) training/Social mobilization in 4 districts
15Objectives Strategies Improve Child Grant beneficiaries’ knowledge on IYCF, Hygiene and Sanitation and other key nutritional behavioursAssist mothers and caretakers to identify the best possible locally available food - to improve the nutritional status of the childrenBuild capacity of health workers and volunteers on IYCFStrategiesAdvocacy: Capacity buildingOrientation:Process monitoring:BCCEvaluation
16VDC Influential People Training AchievementSNDistrictFCHVHF StaffsVDC Influential PeopleTraditional HealersMGM1Jumla51414634727047112Kalikot26413135326745903Humla2401o831023646554Dolpa151511881442440Total1169436119891716396.
17Challenges/Future direction Optimum utilization of the Cash Grant in improvement of nutritional status of targeted children.Easy access to nutritious food for buying.Focus for 2012Monitoring of the IYCF/CG programme.Midline Evaluation of IYCF/CGPromotion of locally available foods.Sustainability - functioning/revitalization of the mother’s group meetings (MGM) and use of the VDC block grant.Airing of IYCF messages, performance of street drama and advocacy meetings at the ward level.
19Old Growth Monitoring Card New Growth Monitoring Card Unnecessarily covers under five children-not evidence based and also extra burden to health workersUses -3SD for lower line-thus only identifies severe malnutrition, which defeats the purpose of GMP promotion and its too late for action19