1. Nutrition Education and Rehabilitation Sessions (NERS)
Ministry of Public Health Afghanistan
Nutrition Education and Rehabilitation Sessions (NERS)
Dr. M. Homayoun Ludin
December 10, 2014

2. What is NERS?
Nutrition Education Rehabilitation Session is a community-based approach to successful and sustainable reduction of malnutrition in resource- poor settings. It is based on positive deviance model.
This approach is combined with CMAM for the treatment of children with moderate acute malnutrition (MAM) and prevent further deterioration of nutritional status.

3. NERS Objectives
To raise awareness of optimal IYCF (Exc. breastfeeding and complementary feeding) practices in the community;
To sustainably prevent malnutrition and common diseases in children in the community;
To Promote healthy feeding, cooking, health- seeking and hygiene practices;
To Rehabilitate malnourished children especially MAM

4. NERS Approach In this approach the community will be mobilized
volunteers from the community will be trained
to conduct (NERS) in which caregivers and volunteer facilitators meet to learn and practice cooking energy dense meals and feeding them to their malnourished children;
Caregivers at these sessions also learn about breastfeeding, danger signs in ill children, health seeking and maternal health;

5. NERS Approach
Caretakers of identified malnourished children are invited to participate in NERS for a duration of 12 days.
NERS is implemented by volunteer – they help mothers prepare/cook and feed energy rich/calorie dense meals to their children.
Caregivers bring a fist full of food to the sessions and a piece of wood.

6. How does 12 day-NERS look like?
Days 1
Every child is weighed on the first day
Preparing energy dense meals based on menus
Education (one topic each day)
Feeding children
Days 2 to 6: Feeding
Education

7. Cont’d… Day 7: Home Alone Day
Participants stay home and practice the new behaviors.
CHW/volunteers visits families and counsel
Day 8: Feedback
Preparing energy dense meals based on menus Feeding children
Education
Discussion around the experiences the caregivers faced at home and assist them

8. Cont’d… Day 9 and 10: at home Day 11: Next-to-last day of the Session
Preparing energy dense meals based on menus
Feeding children
Education
Discussion – problems faced at home
Day 12: Last day of the Session
All children will be weighed again
Caregivers counseled

10. Advantages of NERS
The approach provides a solution that can quickly address an immediate problem.
Supervised feeding is held during the session.
Caregivers learn and implement the same practices at home and report on their experiences at the sessions.
NERS is the source of learning about what positive and unique behaviors people themselves practice in the community
Knowledge and doing something empowers community

11. Lessons Learnt
building the capacity of Community Health Workers (CHW) and Family Health Action Group (FHAG) strengthens feeding babies and breastfeeding practices and participatory cooking sessions in the community level
Establishment and training of FHAG reduce load of working at community level and improved maternal and newborn care services
Close supervision of Female CHWs and FHAG has great affect on follow up of pregnant and lactating women by CHWs and FHAG

12. Challenges
Some parts of community not ready to accept women as volunteers
some areas do not have CHWs, making it difficult to reach lactating mothers
Gaining approval from IRB takes too much time

13. Recommendations Expansion to other ethnic areas and in rural areas
Integration of community-based NERS approach into BPHS
Integration of pictorial materials and guidelines of the project into MoPH MNC guidelines
Expansion of FHAGs establishment national wide
Inclusion of one Female staff for supervision and support of Female CHWs and FHAG is essential for effective and successful implementation of community based maternal and newborn care

14. Advantages of NERS Affordable
NERS is affordable and families are not dependent on outside help or resources to practice the new behaviors.
NERS is much more cost effective
Sustainable
The positive behaviors continue after the NERS sessions end. The skills practiced at the session become habitual behaviors – they are sustained over life and passed from one generation to another
NERS not only changes the behaviors of individual families, but also changes how a community perceives malnutrition and their ability to change the situation.

15. Conclusions
NERS focuses on the treatment of under weight, MAM and its prevention.
Promotes long-term self-sustaining solutions to malnutrition (solutions are within the community)
Can demonstrate achieving results in a very short amount of time.
NERS can be linked to facility based GMP and CMAM especially as a way to address MAM appropriately and comprehensively.

16. Thank You
Any Questions?