1. 9TH IBFAN AFRICA REGIONAL CONFERENCE, 1-4 FEB 2016, KAMPALA, UGANDA Monitoring and Evaluation of MIYCN National Policies and Programs: Experiences from Eastern and Southern Africa Dr Geoffrey Bisoborwa WHO Regional Office for Africa

2. Global Monitoring Framework on Maternal, Infant and Young Child Nutrition

3. Introduction In 2012 the WHA 65 endorsed the comprehensive implementation plan for MIYCN Member states to put into practice the plan Principles include universal access and multi-sectoral approach Six global targets for nutrition Five strategic actions

4. Global Nutrition Targets 1.A 40% reduction of global number of children who are stunted 2.A 50% reduction of anemia in women of reproductive age 3.A 30% reduction in low birth weight 4.No increase in childhood overweight 5.Increase the rate of exclusive breast feeding in the first six months up to at least 50% 6.Reduce and maintain childhood wasting to less than 5%

5. Strategic Actions 1.Create supportive environment for the implementation of comprehensive food and nutrition policies 2.Include all required effective health interventions with an impact on nutrition in national nutrition plans 3.Stimulate development of policies and programs outside the health sector that recognize and include nutrition 4.Provide human and financial resources for implementaion of nutrition interventions 5.Monitor and evaluate implemention of policies and programs

6. Monitoring Framework premise National nutrition surveillance and monitoring systems, fragmented, few indicators tracked systematically accross countries Globally agreed framework with targets and indicators to serve as bench mark for countries and international community to measure achievemnts, identify gaps and triger actions and estimate resource requirements To capture multi-sectoral nature of nutrition as well as indicators relating to underlying causes of malnutrition and braoder policies and actions including those outside the outside the health sector

7. Indicators Core set of indicators for mandatory reporting and extended which are option and to address country specificities Four categories of indicators Primary outcome to measure progress towards the global the targets Intermediate outcome to monitor how specific diseases and conditions on causual pathway affects progress to targets Process indicators to monitor programs Policy, environment and capacity indicators to measure political economy and capacity within countries Primary outcome indicators were approved by the 66th WHA

8. Primary Outcome Indicators NoIndicator 1Prevalence of low height/age in children under-5 yrs of age 2aPrevalence of Hb less than 11 g/dl in pregnant women 2bPrevalence of Hb less than 12 g/dl in non pregnant women 3Prevalence of infants born less than 2500g 4Prevalence of weight/age > 2SD in children under-5 yrs of age 5Prevalence of exclusive braestfeeding in infants aged 6months and less 6Prevalence of low weight/hieght in children under-5 yrs of age

9. Intermediete Outcome Indicators NoIndicator 7Prevalence of dirrhoea in children under five years 8Proportion of women aged 15-49 years with low body mass index 9Number of births during a given reference period to women aged 15-19 yrs per 1000 females aged 15-19 years 10Proportion of overweight and obese women 18+ -19 years of age 11Proportion of overweight in school age children and adolescent 5-18 years

10. Proccess Indicators NoIndicator 12Proportion of children aged 6-23 months who receive a minimum acceptable diet 13Proportion of population using a safely manged drinking source 14Proportion of population using safely managed sanitation service 15Proportion of pregnant women receiving irn and folic acid supplements 16Percentage of births in baby friendly health facilities 17Proportion of mothers of children 0-23 months who have received counselling support mesages on optimal breast feeding at least once in the last year

11. Process (Policy and capacity) NoIndicator 18Number of trained nutritionist/1000 population 19Number of countries with legislation/regulation fully implementing the International code of marketing of breast milk substitutes WHA34.22 and the subsequent relevant WHA resolutions 20Number of countries with maternity protection laws or regulations in place EXTENDED SET OF INDICATORS 12 in number Mainly indicators of coverage of interventions Malaria, RH, diarrhoea, immunisation, iodine etc

12. Assessment of key actions for comprehensive infant and young child feeding programs in 65 countries: UNICEF 2010/11 IYCF actions at: national program, health services and community level. IYCF communications complementary feeding, HIV and Infant feeding, Infant feeding in emergencies, monitoring and evaluation and IYCF in exceptioanally difficult circumstances Very few countries were able to report on geographical scale, target population coverage and quality of IYCF interventions in the health services, and at community level.

13. Rapid assessment of national policy guidelines on HIV and Infant feeding; IBFAN 2015 A rapid review of national Infant and Young Child Feeding (IYCF) Policy Guidelines, in order to determine the extent to which they were aligned to the global WHO 2010 Guidelines on HIV and Infant feeding 11 countries from Anglophone sub-Saharan Africa region, namely: Ethiopia, the Gambia, Ghana, Kenya, Lesotho, Malawi, South Africa, Swaziland, Tanzania, Uganda and Zimbabwe. Was not intended to provide deeper understanding of the extent to which the practices by the health professional and caregivers/mothers have adapted the WHO guidance.

14. Challanges Determination of scope for M&E of policies Definition of what is to be monitored and evaluated Not well conceptualized or non existent plans on which to base a robust M&E Focus being more on impact and coverage indicators with less attention on inputs and proccess (which should be primary because the impact ones actually measure overall social economic development of a country) Monitoring integrated services Gaps in the logical result framework from direct nutrition interventions to outcome and impact Limited scope and coverage of interventions

15. Recommendation Improve planning capacity =plans with clear inputs, processes, outputs, outcome and impact incluiding key assumptions – M&E plan is based on implementation plans – M&E planned during the planning for implementation – A good plan will help in defining what is within the scope of being monitored and evaluated and what it is not Application of logical or result framework for M&E Multi-sectoral approach to M&E of nutrition interventions Mainstreaming nutrition indicators in all relevant sectors and programs information systems and at all levels

16. Thank you