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AIMING FOR PROGRAM EXCELLENCE — HOME FORTIFICATION WEBINAR SERIES Moderated by Jonathan Siekmann, PhD Technical Advisor, GAIN Secretariat, Home Fortification.

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Presentation on theme: "AIMING FOR PROGRAM EXCELLENCE — HOME FORTIFICATION WEBINAR SERIES Moderated by Jonathan Siekmann, PhD Technical Advisor, GAIN Secretariat, Home Fortification."— Presentation transcript:

1 AIMING FOR PROGRAM EXCELLENCE — HOME FORTIFICATION WEBINAR SERIES Moderated by Jonathan Siekmann, PhD Technical Advisor, GAIN Secretariat, Home Fortification Technical Advisory Group (HF-TAG)

2 Home Fortification Webinar Series What: A series webinars organized by UNICEF, CDC, and HF-TAG to address the increasing demand for technical support and to continuously address knowledge capacity gaps in home fortification Objectives: Increase knowledge and capacity to design and implement effective home fortification programs. Share country experiences and lessons learned with developing, implementing, and scaling up home fortification programs Target audience: The main audience for the webinars will be program implementers who are either planning or implementing home fortification programs. Where: The HF-TAG site Frequency: Bi-monthly

3 Today’s webinar Global evidence and policies for home fortification WHO guideline and HF-TAG complement each other in support to countries Monitoring to improve program effectiveness Speakers – Dr. Werner Schultink (UNICEF)10 min – Dr. Martin Bloem (WFP)10 min – Dr. Juan Pablo Peña-Rosas (WHO)10 min – Dr. Laurence Grummer-Strawn (CDC)10 min

4 Home Fortification Webinar Series Launch Werner Schultink, Chief, Nutrition Section, UNICEF Headquarters, New York

5 Session Outline Overview of global nutrition situation UNICEF’s work Home fortification technical resources to address increasing demand

6 6 The global picture: stunting prevalence UNICEF Improving Child Nutrition Report 2013

7 The global picture: severe acute malnutrition UNICEF Improving Child Nutrition Report 2013

8 Vitamin and mineral deficiencies account for over 50 million disability- adjusted life years (DALYs) lost globally (Murray et al, 2013) Global estimates of anemia prevalence are 42% in pregnant women and 47% pre-school age children. (WHO, 2009) Severe anemia kills more than 50,000 women a year during childbirth. (Micronutrient Initiative, 2014) 18 million babies are born mentally impaired due to iodine deficiency each year. (Micronutrient Initiative, 2014) Deficiencies of vitamin A and zinc account for nearly 300,000 child deaths annually (Black et al., 2013) 8 The global picture: “Hidden Hunger” Iron Folic acid Iodine Vitamin A Zinc

9 Growing momentum to scale up nutrition Scaling Up Nutrition (SUN) movement Interest in nutrition increased dramatically Investing in nutrition key development priority Partnerships are more operational, enhanced complementarity 54 countries have committed to SUN

10 Markedly improve nutrition for all children and women by creating an enabling environment that results in evidence-based, sustainable, multisectoral nutrition actions delivered at scale Adolescent girls Women of RA Adolescent girls Women of RA Pregnant & lactating women Maternal nutrition (prevention of low birth weight) Infant & young child feeding Prevention and treatment of severe acute malnutrition Micronutrient fortification and supplementation Nutrition support for those with infectious diseases Maternal nutrition (prevention of low birth weight) Infant & young child feeding Prevention and treatment of severe acute malnutrition Micronutrient fortification and supplementation Nutrition support for those with infectious diseases Health, WASH, early childhood development, social protection, education, agriculture, poverty reduction Target populations (focusing on the most disadvantaged) Nutrition-specific interventions Nutrition-sensitive approaches Children under 2 years Children aged 2−5 years Children under 2 years Children aged 2−5 years UNICEF programme actions Reduce micronutrient deficiencies Prevent and treat SAM Improve nutritional care for those with infectious disease Protect, promote and support appropriate feeding & adequate food Increase synergies with health, WASH, ECD and social protection Promote strengthened linkages with agriculture Promote linkages with health & education to prevent childhood obesity UNICEF’s commitment to nutrition UNICEF’s programmatic work in nutrition

11 Markedly improve nutrition for all children and women by creating an enabling environment that results in evidence-based, sustainable, multisectoral nutrition actions delivered at scale Operational approach 6: Strengthen systems to ensure effective monitoring, evaluation and knowledge management for policy and programming for nutrition. Operational approach 6: Strengthen systems to ensure effective monitoring, evaluation and knowledge management for policy and programming for nutrition. Operational approach 5: Foster a community- centred approach that empowers communities with the knowledge and tools to address their own nutrition issues. Operational approach 5: Foster a community- centred approach that empowers communities with the knowledge and tools to address their own nutrition issues. Operational approach 4: Develop human, institutional and organizational capacity to implement contextually relevant nutrition programmes. Operational approach 4: Develop human, institutional and organizational capacity to implement contextually relevant nutrition programmes. Operational approach 3: Support the scale-up of evidence- based, sustainable nutrition- specific interventions and nutrition- sensitive programming. Operational approach 3: Support the scale-up of evidence- based, sustainable nutrition- specific interventions and nutrition- sensitive programming. Operational approach 2: Build commitment, strengthen leadership and strengthen governance for improved nutrition. Operational approach 2: Build commitment, strengthen leadership and strengthen governance for improved nutrition. Operational approach 1: Perform a rights-based, equity-focused situation analysis for nutrition and its determinants to inform policy development and programme design. Operational approach 1: Perform a rights-based, equity-focused situation analysis for nutrition and its determinants to inform policy development and programme design. Reduce micronutrient deficiencies Prevent and treat SAM Protect, promote and support appropriate feeding & adequate food Increase synergies with health, WASH, ECD and social protection Promote strengthened linkages with agriculture Promote linkages with health & education to prevent childhood obesity Improve nutritional care for those with infectious disease UNICEF’s commitment to nutrition UNICEF programme actions Notes: Green arrows illustrate that the operational approaches are interrelated. UNICEF’s operational approaches to improving nutrition programming for mothers and children

12 Partnership Global/national policies and guidelines Capacity: Workshops reaching 66 countries on design, implementation, scale up and monitoring of HF programs Information: 2011 global assessment of HF. UNICEF to make it annual through NutriDash from 2013 Implementation of home fortification programs 12 Work in Home Fortification using MNPs

13 13 Impressive scale-up 2011*  36 MNP interventions implemented in 22 countries  Planned interventions in 20 countries  4 countries were implementing at national scale 2013**  62 MNP interventions implemented in 42 countries  MNP interventions are planned in 19 countries  13 countries implementing at national scale **UNICEF NutriDash, 2014 * Home Fortification Global Assessment 2011

14 With rapid scale up Increased technical needs Variation in challenges depending on the level of implementation Great opportunity for inter-country and inter-agency learning

15 – Community of practice online opportunity for inter- country learning – MNP toolkit ( upcoming) consolidation various tools, best practices and examples on implantation of home fortification – Series of Home Fortification Webinars 15 Technical Resources to address the growing capacity needs Aiming for Program Excellence

16 Home fortification webinars are great and timely opportunity to enhance capacity of program implementers for program improvement Webinars and resources are open to all program implementers 16 Timely opportunity to build capacity

17 HF-TAG Home Fortification Webinar: Session One Martin Bloem Senior Nutrition Advisor, Nutrition Advisory Office World Food Programme

18 Key messages Home fortification (HF) is a key and promising intervention to address micronutrient deficiencies and to improve quality of food for young children Home fortification is a priority nutrition intervention for WFP WFP is working with HF-TAG partners to enhance capacity and provide harmonized guidance on why and how to implement HF Home fortification webinars are an important opportunity to enhance understanding and capacity of program implementers for design and implementation of infant and young child feeding (IYCF) programs that have an HF component

19 Home fortification (HF) is a promising intervention Rationale for home fortification Young children require a large range of nutrients in order to grow, develop and remain healthy Even when affordability and availability do not constrain food access, it is difficult to meet the recommended intakes of some nutrients, – e.g. iron and zinc, particularly for children 6-23 mo Objectives of home fortification programs Increase micronutrient (MN) intake and improve IYCF practices Improve MN status Improve child health, appetite and growth, and reduce morbidity and mortality

20 WHO guideline based on review of studies that provided MNP Studies primarily focused on anemia and iron deficiency and used limited set of MN Hence: WHO guideline: Minimum 3 micronutrients and at least 60 sachets/6 mo Note that this is a guideline for decision making, not a fixed prescription HF-TAG programmatic guidance brief further expands WHO guideline Improve micronutrient intake in order to meet the recommended nutrient intake(FAO/WHO RNI) for more micronutrients, in addition to those relevant for anemia Considering programming circumstances and experience Integrate with wider infant and young child nutrition & ‘1000 days’ programming HF-TAG brief & WHO MNP guideline

21 HF is a priority intervention for WFP’s work WFP is committed to preventing undernutrition and meeting nutrient requirements during the critical first 1,000 days MNPs play a critical role in combatting micronutrient deficiencies through fortifying meals of vulnerable populations, in particular young children WFP and UNICEF are the main procurers of MNPs, and WFP is the only organization that utilizes MNPs in school feeding WFP’s work in home fortification WFP uses MNPs in 19 countries in nutrition programming In 2013, WFP reached over a half a million beneficiaries under 5 in 7 countries Through school feeding programmes, WFP reached almost 900 thousand school children aged 6-15 in 12 countries

22 WFP is working together with HF–TAG partners to enhance capacity for home fortification WFP is a committed partner of HF-TAG, with the aim of providing harmonized guidance on why and how to implement HF HF-TAG works closely with private sector partners, including manufacturers of MNP WFP also works with HFTAG partners through the Scaling Up Nutrition (SUN) Movement and the SUN Business Network HF-TAG: Better results through partnership

23 Webinars are a high potential opportunity to enhance capacity for program improvement Webinars and resources are open to everyone, and particularly aimed at program implementers Webinars will cover design and planning of home fortification programs, including: For whom? What formulation? How much and for how long? What frequency for distribution and use? Cost? How quickly can a program start? What distribution channels to use? What to monitor and evaluate?

24 Point-of-use fortification of foods with multiple micronutrient powders: WHO recommendations Dr Juan Pablo Peña-Rosas Coordinator, Evidence and Programme Guidance Department of Nutrition for Health and Development

25 WHO core functions providing leadership on matters critical to health and engaging in partnerships where joint action is needed; shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; setting norms and standards and promoting and monitoring their implementation; articulating ethical and evidence-based policy options; providing technical support, catalysing change, and building sustainable institutional capacity; and monitoring the health situation and assessing health trends. These core functions are set out in the Twelfth General Programme of Work, entitled "Not merely the absence of disease", it covers the 6-year period from 2014 to 2019

26 Vitamin and mineral malnutrition It is estimated that 42.6% of children 6-59 months of age are anaemia (2011), which represented million children worldwide, with SEARO and WPRO having the absolute highest numbers of children affected. Children's haemoglobin status might have deteriorated in some southern countries in Africa. It is estimated that about half of the anaemia is due to iron deficiency although the relative contribution varies. Iron deficiency is thought to be the most common cause of anaemia globally, although other conditions, such as folate, vitamin B 12 and vitamin A deficiencies, chronic inflammation, parasitic infections, and inherited disorders can all cause anaemia. Data on the prevalence of other vitamin and mineral deficiencies is scarce.

27 WHO evidence-informed guideline development process New WHO guideline development process 2 nd edition of WHO Handbook for guideline development released in December 2014 – Provides guidance on the development of documents or publications containing WHO recommendations – Sets out procedures to follow

28 WHO evidence-informed guideline development process

29 WHO. Guideline: Use of multiple micronutrient powders for home fortification of foods consumed by infants and children 6–23 months of age. Geneva, World Health Organization, WHO evidence-informed guidelines

30 De-Regil LM, Suchdev PS, Vist GE, Walleser S, Peña-Rosas JP. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD DOI: / CD pub2. The evidence

31 WHO recommendations Home fortification of foods with multiple micronutrient powders is recommended to improve iron status and reduce anaemia among infants and children 6–23 months of age (strong recommendation)

32 WHO recommendations In malaria-endemic areas, the provision of iron should be implemented in conjunction with measures to prevent, diagnose and treat malaria. Programmes should be preceded by an evaluation of the nutritional status among children and existing measures to control anaemia and vitamin A deficiency Behaviour change communication strategy that promotes: awareness and correct use of the powders along with information on recommended breastfeeding practices; commencement of complementary foods at 6 months of age; preparation of complementary foods at age-appropriate frequency, amounts, consistency and variety

33 WHO recommendations Hand washing with soap and hygienic preparation of food; prompt attention to fever in malaria settings; and measures to manage diarrhoea. The selection of the most appropriate delivery platform should be context-specific, with the aim of reaching the least favoured populations and ensuring an adequate and continued supply of the powders.

34 Adoption and adaptation WHO offers several tools to help countries adopt and adapt the global guidelines into their national and subnational contexts. To ensure that WHO global guidelines and other evidence- informed recommendations for micronutrient interventions are better implemented in low and middle-income countries, the Department of Nutrition for Health and Development works with the WHO Evidence-Informed Policy Network (EVIPNet) programme. EVIPNet promotes partnerships at country level between policy- makers, researchers, and civil society to facilitate policy development and implementation through use of the best available evidence.

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36 Home-Fortification Technical Advisory Group (HFTAG) The Home Fortification Technical Advisory Group (HF-TAG) is a community of stakeholders involved in home fortification comprised of members from the public, private, academic and non-governmental organization sector. Its vision is a world without malnourished children. WHO has observer status in this group.

37 HFTAG resources for implementation

38 Updating WHO recommendations To include recommendations to the preschool and school-age children informing by the growing body of evidence. Confirm results from previous 2011 recommendations with updated evidence from Cochrane reviews. Identify research gaps, particularly in the area of implementation research. Highlight the need to address the social determinants of health in the implementation of these interventions.

39 Acknowledgements The Evidence and Programme Guidance Unit receives financial resources from several external sources for biennium – Ongoing support – longer term agreements Bill & Melinda Gates Foundation ( ) US Centers for Disease Control and Prevention (CDC) ( ) – IMMPaCt Programme – National Center on Birth Defects and Developmental Disabilities The Micronutrient Initiative ( ) Harvest Plus (2014) Donors do not fund specific guidelines and do not participate in any decision related to the guideline development process including the composition of policy questions, membership of the guideline groups, the conduct and interpretation of systematic reviews, or the formulation of recommendations.

40 Monitoring Home Fortification Programs Laurence Grummer-Strawn, PhD Chief, Nutrition Branch Division of Nutrition, Physical Activity, and Obesity U.S. Centers for Disease Control and Prevention

41 Principles of monitoring Monitoring improves program effectiveness – Helps achieve good coverage and adherence to the intervention – Programmes must be well designed, implemented and monitored in order to achieve and sustain impact Different data collection systems needed for different purposes Monitoring changes and adapt over time Capacity in country can impact the quality of monitoring systems

42 Monitoring Manual Multi agency and institutional involvement Monitoring frameworks Practical tools –such as worksheets Case studies

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44 Will be available late 2014 at: HF-TAG MNP Toolkit

45 Webinar series Future sessions will include monitoring topics Potential topics might include: Log frames and logic models – how to develop these tools for your program How to select monitoring indicators Developing a monitoring protocol Pros and cons of different approaches to monitoring

46 Thank you Source – GAIN Global Alliance for Nutrition


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