2.00 denise costa coitinho.ppt [modo de...
TRANSCRIPT
REACHREACHAn inter-agency renewed effort to end child hunger and undernutritiong y gWFP WHO UNICEF FAO
REACH : um modelo para fortalecer o l j t t i i l?planejamento nutricional?
Seminario Internacional sobre Nutricao na Atencao PrimariaPainel 4 Planejamento Monitoramento e A aliacaoPainel 4 – Planejamento, Monitoramento e Avaliacao
A Epidemiologia nutricional mostra umA Epidemiologia nutricional mostra ummundo em transição
1REACH Progress Report I_August 2008_v1.ppt
Carga de doenças segundo 10 principais causas (2000)Países em desenvolvimento renda abaixo da média
84564
124398
461833-Unsafe water
2-Unsafe sex
1-Underweight
30393
26781
46183
5-Zinc deficiency
4-Indoor smoke
3-Unsafe water
20627
25137
26170
8-Blood pressure
7- Vit A deficiency
6-Iron deficiency
16683
640817 Overweight
9-Tobacco
2REACH Progress Report I_August 2008_v1.ppt
6408
0 20000 40000 60000 80000 100000 120000 140000
17-Overweight
Thousands of DALY'sSource: WHO 2002
Carga de doenças segundo 10 principais causas (2000)Países em desenvolvimento renda acima da média
16294
25520
20278
3-Tobacco
2- Blood pressure
1-Alcohol
12596
111155-Overweight
4-Underweight
7595
7869
8609
8 Indoor smoke
7-Low f&v
6-Cholesterol
7595
7292
715010-Unsafe water
9-Iron deficiency
8-Indoor smoke
3REACH Progress Report I_August 2008_v1.ppt
0 5000 10000 15000 20000 25000 30000
Thousands of DALY'sSource: WHO 2002
Carga de doenças segundo 10 principais causas (2000)Países desenvolvidos
19638
26104
20278
3-Alcohol
2- Blood pressure
1-Tobacco
16227
158935-Overweight
4-Cholesterol
3872
6986
8324
8 Illicit drugs
7-Physical inactivity
6-Low f&v
1626
3872
715010-Iron deficiency
9-Unsafe sex
8-Illicit drugs
4REACH Progress Report I_August 2008_v1.ppt
0 5000 10000 15000 20000 25000 30000
Thousands of DALY'sSource: WHO 2002
11 mihões de crianças morrem todos os anos antes dos 5 anos: 1 em cada 3 estava desnutrida.1 em cada 6 recém-nascidos nos países em desenvolvimento tem baixo peso ao nascer comprometendo sua saúde futura;peso ao nascer comprometendo sua saúde futura;1 em cada 4 pre-escolares tem baixo peso para a idade e um número ainda maior baixa estatura para a idade, com efeitos em seu desenvolvimento 1 em cada 3 pessoas no mundo tem alguma carência de micronutrienteAs 40 milhões de pessoas vivendo com HIV/AIDS estão expostas a um alto risco de desnutriçãorisco de desnutriçãoNos países que enfrentam situações de emergência, a desnutrição afeta quase 40 milhoões de pessoas e é uma das principais causas de morte e doençasdoenças.
5REACH Progress Report I_August 2008_v1.ppt
Mas este é apenas um lado do problema…
DCnT são responsáveis por 60% das mortes globalmente e por quase 50% de toda a carga de doença. 66% destas mortes ocorrem em países desenvolvidos.em países desenvolvidos.A maior parte das DCnTs são associadas a dieta.Mais de um 1 bilhão e meio de adultos no mundo tem sobrepeso, destes, meio milhão são obesos.
A desnutrição e o sobrepeso e a obesidade já ocorrem nas mesmas comunidades, as vezes até nas mesmas famílias.
6REACH Progress Report I_August 2008_v1.ppt
Um assunto chave: a hipótese de BarkerUm assunto chave: a hipótese de Barker
O retardo do crescimento fetal e durante a primeira infancia são relacionados com o estado de saúde na vida adulta. Pessoas previamente desnutridas tem maior risco dePessoas previamente desnutridas tem maior risco de desenvolverem doenças crônicas ´metabólicas quando expostas a dietas inadequadas. A eficiencia metabólica que foi útil nas condições de desnutrição (fetal ou na infancia) torna-se maladaptativa sob estas exposições, levando ao desenvolvimento de um perfil lipídico anormal, metabolismos de glicose e insulina alterados e obesidade. A nutrição no início da vida tem um impacto substancial ao longo do curso da vida principalmente quanto ao risco para DCnTsdo curso da vida, principalmente quanto ao risco para DCnTs.
7REACH Progress Report I_August 2008_v1.ppt
Baixo peso ao nascer
Falta de aleitamento materno
Alimentação complementar inadequada
Baixa estatura para idade (stunting) Solucoes comuns e
Inatividade física
Baixo consumo de frutas e vegetais;
comuns e acoes
Alto consumo de sal;
Alto consumo de gorduras saturadas e trans;integradas
Hipertensão arterial;
Hipercolesterolemia;
8REACH Progress Report I_August 2008_v1.ppt
Sobrepeso e obesidade.
S lh d dSe melhoras de renda ocorrerem (MDG 1) sem a redução da desnutrição e a melhora da
qualidade das dietas a saúde da população vai deteriorarqualidade das dietas, a saúde da população vai deteriorar ainda mais, com um custo elevado para todos os países.
9REACH Progress Report I_August 2008_v1.ppt
Aprovada pelos E t d M bEstados Membros na
55th World Health Assembly 2002Assembly, 2002
(WHA55.)
10REACH Progress Report I_August 2008_v1.ppt10
Aprovada pelos Estados M b 57th W ldMembros na 57th World Health Assembly, 2004
(WHA57 17)(WHA57.17)
11REACH Progress Report I_August 2008_v1.ppt
O DESAFIO : fazer as coisas certas e nao fazer as erradas
- renovar esforços conjuntos de forma coordenada e com- renovar esforços conjuntos de forma coordenada e com foco para o combate prioritario a desnutrição materna e infantil com abordagem do ciclo vital e da promocao da g palimentacao saudavel
- apoiar os paises para identificar e implementar solucoes efetivas respaldadas por politicas adequadas, dirigidas
t i i li t d i / d / id dao trinomio – alimentos saudaveis/saude/cuidados –
- implementar em larga escala
12REACH Progress Report I_August 2008_v1.ppt
Alimentos : demanda e oferta igualmente críticas
• Uma questão de escolha individual?
• Urbanização e industrializacao• Novos padrões de emprego • Demanda por "conveniência" • Propaganda cria desejo por alimentos associados a um status
social mais alto
• Afeta disponibilidade, preços e estratégias de marketingg g• Define o ambiente no qual a demanda é estabelecida• A escolha saudável tem que ser a escolha disponível,
acessível e desejada.
13REACH Progress Report I_August 2008_v1.ppt
As grande 5 areas de solucoes-chave que podem ser operacionalmente integradas e efetivasoperacionalmente integradas e efetivas ….
Seguranca alimentar do domicilio
Suplementacao com micronutrientes para maes e
Promocao do aleitamento materno e alimentacao micronutrientes para maes e
criancas <5 anos e fortificacao de alimentos
complementar
Tratamento da desnutricao severa
Promocao da higiene e controle de parasitas severa p
14REACH Progress Report I_August 2008_v1.ppt
Promocao da alimentacao saudavel e fortelecimento da mulher
… quando respaldadas por politicas adequadas… quando respaldadas por politicas adequadas
Tecnologia• Mudanças tecnológicas na produção de alimentos, processamento e
distribuição reduzem custos
Globalização• Liberalização do setor financeiro facilita as mudanças na produção e
comercialização dos alimentos• Marketing promocional encoraja a convergência de culturas de
consumo• Aparato regulatório (qualidade sanitária e nutricional) encoraja a
ê i d d õ d id tid d lid d d li tconvergência de padrões de identidade e qualidade de alimentos
Políticas agrícolas• Políticas de comercialização (e.g. bolsas de commodities)• Políticas de suporte de preços (e.g.subsidios)• Políticas tarifárias (e.g. sobretaxas, incentivos para exportação)
15REACH Progress Report I_August 2008_v1.ppt
( g )• Crédito diferenciado
Fortalecendo o planejamento em nutricao : REACHFortalecendo o planejamento em nutricao : REACH
Uma parceria em formacao entre WFP , UNICEF , WHO and FAO
Outras agencias UN - SCN, IFAD, UNVSociedade civil - SCF, WVI, Rotary International, GAIN, Helen Keller Intl, CRS, JAM, Africare, MSF, ACFAcademia: Tufts, George Washington Univ, outrasSetor privado : Boston Consulting Group, Governos (Mauritania, Laos, etc …& alguns doadores)
REACH tem sido procurada continuamente por novos potenciais parceiros
REACH e facilitada por uma pequena equipe inter agencial baseada no PMA em Roma paraREACH e facilitada por uma pequena equipe inter-agencial, baseada no PMA em Roma para promover o apoio coordenado :
- A processos nacionais de planejamento operacional de solucoes intergradas para p p j p g po combate a desnutricao e identificacao de brechas e oportunidades,
- A processos “supra-nacionais” identificados como necessarios pelos paises participantes (ex. Advocacia, networking, mobilizacao de recursos) Ao fortalecimento dos setores de nutricao das organizacoes parceiras
16REACH Progress Report I_August 2008_v1.ppt
- Ao fortalecimento dos setores de nutricao das organizacoes parceiras
REACH Overview
Ending child hunger and undernutritionEnding child hunger and undernutrition By 2015: REACH MDG 1, Target 3 (half the proportion of underweight children under 5)
Beyond 2015: Achieve sustainable acceleration of the rate of reduction in child underweight
Vision &Goals
Country actionplanning and coordination
to support national capacity to scale up evidence-based solutions
Communications and advocacy
Financing and resource
evidence based solutions
Knowledge-sharing
Action areas
yresource mobilization
Outcomes Increased efficiency and accountability
Strengthened national policies and
programmes
Increased capacity at all levels for action
Increased awareness of the problem and of
potential solutions
17REACH Progress Report I_August 2008_v1.ppt
REACH promove a acao coordenada de parceiros sob a lideranca dos governos nacionaislideranca dos governos nacionais
UN Agencies/IFIs Government(lead) Bilaterals
Reach MDG 1 and end maternal and child undernutritionReach MDG 1 and end maternal and child undernutritionThrough a coordinated, “solution focused” approach to
scale-up activities in nutrition in the life-cycle
Private Sector/ NGO A d iPrivate Sector/Corporations NGOs Academia
18REACH Progress Report I_August 2008_v1.ppt
REACH oferece apoio aos paises em dois niveisREACH oferece apoio aos paises em dois niveis
T d iT d iTroca de informacoes e “networking” Todos os paisesTodos os paises
• Troca de know-how sobre como atuar em escala
1 1
escala • Networking• Compilacao e disseminacao de informacoes
sobre os progressos alcancados
Assess,mobilize,
set upworking
• Laos/Mauretania• WHO landscaping
countries1
structure
D t il d Pilots in:
Apoio ao planejamento
22 Paises prioritariosPaises prioritarios
• Analise de situacao, competencias e compromisso para atuar em escala
• Apoio a gestao estrategica e mapeamento de demandas e ofertas
Detailedaction
planning & coordination
Pilots in:• Lao PDR• Mauritania
operaconal e mobilizacao de recursos
demandas e ofertas• Identificacao de necessidades nao
preenchidas e mobilizacao de apoio e recursos locais e globais
• Apoio para o monitoramento dos processos e
19REACH Progress Report I_August 2008_v1.ppt
Apoio para o monitoramento dos processos e avaliacao de impacto
1. Burkina Faso, Ghana, Guatemala, Madagascar, Peru, South Africa and Timor Leste
atividades sao mobilizadas em 4 areas fundamentais capacitando paises para implantacao de solucoes em escalacapacitando paises para implantacao de solucoes em escala
Gestao Troca de Advocacia e comunicacao
Mobilizacao de recursos
Gestao estrategica e coordenacao
Troca de informacoes e
networking
A li d Compilar e Monitorar fontes D l• Analise de situacao, competencias e compromisso
Compilar e disseminar informacaoes
P i
Monitorar fontes de recursos
Prover apoio
Desenvolver ferramentas e capacidades para advocacia co p o sso
• Priorizar acoes • Estimar custos• Mapear
demandas/oferta e
Prover servicos e ferramentas para networking
para desenvolvimento de propostas para mobilizacao
pvisando promover investimentos governamentaisdemandas/oferta e
necessidades• M&A
Lid t
Facilitar contatos entre ciencia e pratica
pde recursos
Mobilizar recursos globais
governamentais e de doadores em solucoes integradas efetivasLideranca e gestao
estrategicarecursos globais efetivas
20REACH Progress Report I_August 2008_v1.ppt
Testes- piloto iniciados em Julho na Mauritania e no LaosProposed “typical” REACH country process:
Testes piloto iniciados em Julho na Mauritania e no Laos
Detailed action planningOngoing REACH
activitiesAssess, mobilize, set-up working
structurePrepare
1-3 months 3 months 9-12 months Ongoing
Detailed country analysis & action
planning
Resourceplanning
& matching
Implementation and
monitoring
Country preparati
on
Exploratory
interviews &
mobilization (country
First assessment
Set-up of working
Regional information/ mobilization
Country request for REACH support
gn (country phase)
working modusREACH support
Global REACH involve-ment:
Laos1 Mauritania
ment:Inform and sequence
Initiate an mobilizeProvide process
experience and know how
Provide best practices, coach country processRaise local needs to global partnership
Support "match making", monitor results
21REACH Progress Report I_August 2008_v1.ppt
1. Laos process may or may not be completed in 1 year, based on need to perform mobilize phase activitiesSource: BCG, REACH analysis
Facilitators support national teams to do the following
Detailed action planningOngoing REACH
activitiesAssess, mobilize, set-up working
structurePrepare
Mobilize resources Plan delivery Q antif cost
Advocacy and funding
Set-up operational planDefine
Finalizestock-taking
Assess readiness, willingness and ability to act at scale
Identify locally required set of interventions
Define appropriate delivery
Estimate costs and resource gaps
Define advocacy and fundraising
Mobilize resources locally
& commitmenty
channels Quantify cost funding strategyinterventionsstock-taking
act at scale
Situational and current response analysis, identify intervention gaps
interventionsand targets
delivery channels and operational mechanism
gaps fundraising strategy
locally, regionally and globally
Metrics, and information system
Develop tracking system, including indicators, sources, and processes
Ongoing communication & advocacy
Develop communication processes and content
22REACH Progress Report I_August 2008_v1.ppt
Progress in each area to be reported via key “sentinel” indicators complemented by a broader set of M&E indicators
Backup
complemented by a broader set of M&E indicators
Action areaAction area Sentinel indicatorSentinel indicator 19901990 20062006 20112011 20152015Action areaAction area
Improve breastfeeding and complementary feeding
Sentinel indicatorSentinel indicator
% of <6 month olds that are exclusively breastfed1
19901990
33
20062006
37
20112011
45
20152015
601
Increase micronutrientintake
% of 6 to 59 month olds fully covered with 2 doses of VAS in the last year2
16 72 80 802
Improve diarrhea andparasite control
% of preschool children at risk treated with deworming tablets in the last year3
TBD 21.3 50 753
Increase treatment of severe acute malnutrition
y
# of countries with severe wasting rates > 10%4
TBD 25 18 124
Improve household food security
Proportion of population below minimum level of dietary energy consumption5
20%(823M)
17%(820M)
15%(800M)
10%(582M)
5
23REACH Progress Report I_August 2008_v1.ppt
y gy p
1. Data available from WHO Global Databank on Infant and Young Child Feeding. 2. Data available from WHO 3. Data available from WHO Partners for Parasite Control; reflects % of preschool children receiving preventive chemotherapy against soil-transmitted helminthiasis in a given year; note that provisional 2007 data reflects only 10.7%; Note that the global target established at the World Health Assembly 2001 is to achieve 75% coverage of school-aged children at risk of STH and/or SS by 2010. 4. Data available from WHO. 5. Official indicator of MDG1 target 1C
Building on existing processes in Laos Laos
20092008
11 109872 51 412 310 69 MilestonesM th 11 109872 51 412 310 69
Feedback on NPAN compiledfrom dissemination workshop
MilestonesNNS/NPAN WorkplanNNP dissemination workshops
Sector/agency consultations 1 Sector workplans complete
Month
Sector/agency consultations 1. Sector workplans complete2. Technical approval of workplans3. Sector workplans integrated into FY2010 budgets in each ministryTBD
E t bli h t t tProvincial/district consultations
W ki t t fi li d
Toda
Dissemination workshops completeDissemination of NNS/NPAN
NNS/NPAN documents finalizedFinalize strategy and plan of action
Establish management structureTBDEstablish nutrition surveillance system
Working structure finalized
ay
REACH workplan
RTM pre-session
High-level action plan completeHigh level action planning
Stock-taking analysis completeCurrent country situation stock-taking
Consultation conducted prior to RTM
Detailed action plan complete
Advocacy & funding strategy 1. Advocacy/funding strategy draft2. Detailed advocacy/funding strategy
Other key events
RTM pre session Consultation conducted prior to RTM
Detailed action planning
24REACH Progress Report I_August 2008_v1.ppt
Other key eventsRound Table MeetingEC Food Security RFP
Mauritania is taking stock of "who does what …" Example UN agency activities
Preliminary
Example UN agency activities
InterventionsInterventions OMSOMSUNICEFUNICEF PAMPAMFAOFAO PASNPASN GouvernementGouvernement
Treat severeacute malnutrition Therapeutic feeding
Improve breastfeeding and
complementary
Exclusive breastfeeding
C l t
S l t f di
complementary feeding Complementary
feeding
Increase micronutrient
intakeMicronutrient suppl.
and fortificationOnly Vitamin A, and Iodized Salt
Improve household food
security1
Conditional cash transfers
Local homestead food production
Supplementary feeding
2
Covers Vitamin A, and Iron
Handwashing with soapImprove diarrhea
and parasite control
Household water treatment
HWT not covered by any
3
Bednets and IPTp
Deworming
control
Diet diversification
covered by any UN agency?
25REACH Progress Report I_August 2008_v1.ppt
1. WFP also intervenes in Food Security throgh SAVS2. VCT – cooperation with NGOs;3. Small pilot for monitoring water quality;
Need to detail Government-direct and FAO interventions
...along with a picture of "where they do it"......along with a picture of where they do it ...
LegendLegend
OrganizationOrganization SymbolSymbol
UNICEF1
PAM
CRI/CPSSAPASN
PASN
26REACH Progress Report I_August 2008_v1.ppt
1. Couverture sur la carte pour la Alim. Thérapeutique; pour AME etAlim Complémentaire et Vitamine A la couverture est Nationale; pour lesAliments enrichis mêmes 8 régions sauf Tagant
Tracking progress in Mauritania
Taux de Insécurité Alimentaire
Score de diversification alimentaireTaux de diversification agricole
% ménages producteurs agricoles
P té
% population consommant en dessous du minimum quotidienne % Allaitement immédiate
% Allaitement exclusif
27
27
Pauvreté
Préval. palu. chez Mères enceintes
Couverture Vitam. A Mères PPCouverture Fer Mères E&A% 6-24 mois encore mise au sein
% 6-24 mois reçoivent alim. compl.
% 6-24 mois reçoivent 2 repas/ j +
4 42
3
3
% Mères E qui utilisent MIIPrévalence anémie chez Mères E&A
Faible poids a naissance
Carence Iode <5 ans
Prévalence MAM chez Mères E&A
Couverture Zinc < 5 ans
% de Mères qui reçoit TPIç p j
Utilisation sel iodé
44
3
10
10
% ménages qui dispose de MII
P é l é i h l <5
Carence Vitamine A <5 ans
Carence Zinc < 5 ansCouverture Vitamine A <5 ans
Couverture Fer enfants < 5ans
Couverture déparasitage
4
11
4
10
Mortalité <5ans pour paludismePrévalence paludisme <5 ans
% enfants < 5ans utilisant MII
% popn. avec eau amélioré à boire
Prévalence anémie chez les <5 ansPrévalence parasites
8
10
% enfants MAM admis CRENAMs
Taux de guérison CRENAMs 5
Prévalence MAM < 5 ans
5
% ménages traitant d'eau
% population avec assainissement
% de mères lavent mains correct.
98
9 % enfants MAS admis CRENIs
Taux de guérison CRENAMs 5
Taux de guérison CRENIs 1
Prévalence MAS < 5 ans
1
27REACH Progress Report I_August 2008_v1.ppt
Mortalité à cause de mal. diarr.
Prévalence mal. diarrhéiquesNon - existant
Existant
# = # interventionMortalité chez les enfants < 5ans
Mortalité pour MAS
Taux de guérison CRENIs 1
“Know-how” operacional tem sido sistematicamente compilado Serie “Atuando em Escala”Serie Atuando em Escala
Physical component
Public health
UN facilities
Mass campaign
InterventionIntervention
Delivery overview: Deworming
• Drugs against soil-transmitted helminthsDrugs against water-borne schistosomiasis
Deworming
NGOs, UNICEF
Ministry of H lth
NGOs, UNICEF,
WFP
Ministry of Health
NGOs, UNICEF,
WFP
Ministry of Health
NGOs, UNICEF,
Ministry of Health
Other1Government
Deliverable to mother/child
Deliverable to mother/child Key delivery channelsKey delivery channels Key/typical implementersKey/typical implementers
Education component
Beneficiaries:• Children 1 – 5 in high worm
burden areas• P&L women in high worm
Deworming
Community mobilization and participation creates awareness Examples from large-scale HWT programs
The "Blue Bus"The "Blue Bus" Water testing daysWater testing days Promotion at health-eventsPromotion at health-events
Nicaragua Indonesia Indonesia
Implement
Atuando em escala : i ti
Nam e O rg anization and title Area of expertise C ontact deta ils
Charles Adam s R otary Internationa l Im p lem ent charles@ taer ia.comAm paro A raujo PPPH W C olum bia Im p lem ent lavam araujo@ ho tm ail.comAngela A rm strong W orld Bank Im p lem ent aarm strong@ worldbank .o rgAbdul Badru W SP-T anzan ia Im p lem ent abad ru@ worldbank .orgNancy Bock Soap & D ete rgent Assoc iation Im p lem ent nbock@ sdahq .orgJohn Borrazzo U SAID Im p lem ent JBorrazzo@ usaid.govSandy C allier AED Im p lem ent scallier@ aed .orgJason C ardosi W SP-A frica Im p lem ent jcardosi@ worldbank .orgCar los Augusto C laux M ora PPPH W Peru Im p lem ent caclaux@ worldbank .orgVal Cu rtis LSH TM R esearch val.curtis@ lshtm .ac.ukSylvie D ebom y W orld Bank Im p lem ent sdebom y@ worldbank .o rgCha rles Adam s R otary Internationa l Im p lem ent charles@ taer ia.comAm paro A raujo PPPH W C olum bia Im p lem ent lavam araujo@ ho tm ail.comAngela A rm strong W orld Bank Im p lem ent aarm strong@ worldbank .o rgAbdul Badru W SP-T anzan ia Im p lem ent abad ru@ worldbank .orgNancy Bock Soap & D ete rgent Assoc iation Im p lem ent nbock@ sdahq .org
Biblioteca completa
• Normas tecnicas
REACHEnding Child Hunger and Undernutrition
Version 1
Acting at Scale: Intervention Guide
76REACH_SP_Summary_v1.ppt
Schools2 UNICEF, WFP
Health, Education
1. W HO responsible for normative guidance on deworming. 2. Most common channel, but typically focused on 5+ children. Potentially can be expanded to reach <5s and P&L women if used as a community center.Source: Expert interviews; literature review; REACH analysis
• Hygiene education to induce behavior change to avoid reinfection
P&L women in high worm burden areas
23REACH_SP_Handbook_HWT_v1.ppt
Source: "Understanding Behavior Change for Safe W ater: Lessons from the Field." W ater Network W orking Meeting at Johns Hopkins Bloomberg School of Public Health, 2007.
• An entertaining vehicle for mobilizing communities for healthy behavior
• Visited 120 communities in 12 months
• Children learnt about water cleanness through experiments
• Entertainment-education
• Demonstration of water cleaning technology and benefits during an immunization campaign
guias programaticos
Draft – Work in progress
Direct consumer activities and mass media advertisement comprise the bulk of the program costs
Case study: Ghana
Draft – Work in progress
Successful practice case study (I)
Case study: Ghana
y p g p @ q gJohn Borrazzo U SAID Im p lem ent JBorrazzo@ usaid.govSandy C allier AED Im p lem ent scallier@ aed .orgJason C ardosi W SP-A frica Im p lem ent jcardosi@ worldbank .orgCar los Augusto C laux M ora PPPH W Peru Im p lem ent caclaux@ worldbank .orgVal Cu rtis LSH TM R esearch val.curtis@ lshtm .ac.ukSylvie D ebom y W orld Bank Im p lem ent sdebom y@ worldbank .o rgKatri Kontio W SP Im p lem ent Kkontio@ worldbank .orgT im Long P roc ter & G am ble Im p lem ent long .tj@ pg.comJack M olyneaux W SP-H Q Im p lem ent jm o lyneaux@ worldbank .orgKaposo M wam buli W SP-T anzan ia Im p lem ent km wam buli@ w orldbank .orgHarriet N attab i W SP-U ganda Im p lem ent hnattabi@ w orldbank .orgNga Nguyen PPPH W V ietnam Im p lem ent N nguyen4@ w orldbank .orgChr is N subuga -M ugga PPHW U ganda Im p lem ent ch rism ugga@ yahoo .co .ukEduardo Perez W SP Im p lem ent eperez1 @ worldbank .o rgPatricia Poppe JHU C ente r for Com m . P rogram m s R esearch ppoppe@ huccp.orgIda R afiqah W SP-Indones i Im p lem ent iraf iqah@ worldbank .orgEshuchi R ufus W SP-Kenya Im p lem ent reshuchi@ w orldbank .orgBas il Safi JHU C C P C en ter fo r C om m . P rogram m s R esearch bsafi@ huccp.o rgOrissa Sam aroo W SP-H Q Im p lem ent osam aroo@ worldbank .orgM yriam S idibe U nilever Im p lem ent M yriam .S idibe @ U nileve r.comTim T obery P roc ter & G am ble Im p lem ent tobery.t@ pg.comKate Tu lenko W SP Im p lem ent k tulenko@ worldbank .orgM erri W einger U SAID Im p lem ent m weinger@ usaid .gov
O rg an iza tio n W eb lin k C ateg ory D escrip tio n K ey activ ititesW a ter and San itation P ro gra m
w w w.w sp .org M ultila tera l Intern ational p artn ers hip ho sted by th e W orld B ank to im prove w ate r su pply
C o -ad m in is ters and pro vid es te chnica l prog ram lea dershipA dm iniste rs g lo bal se cre tariat of P P P-H W
U N IC E F w w w.u nicef .org M ultila tera l U N N atio ns C hildrens' Fu nd Im p lem ents pro gra m sIm p lem ents supp ort
W o rld B an k w w w.w orldban k.o rg M ultila tera l Intern ational d evelopm e nt ba nk F inan ces p rog ram s- A ls o throug h loan sP rovid es m an age m e nt su pport to PP P -H W
B an k/N eth erlan ds W a ter P artnership
w w w-esd. wo rldba nk.org /bnw pp/ B ila teral E stab lish ed by gove rnm e nt of N eth erlan ds a nd W o rld B ank to im pro ve w ater sec urity by pro m o ting inno vative ap proa ches to In tegrated W ater R e sources M ana gem en t
P rovid es f inancia l a ssistan ce to progra m s
F inan ces g lo bal co ordin a-tion and kno wled ge s har in g of PP P -H W
U S A ID w w w.u said.g ov B ila teral U nited States develop m e nt a gency F inan ces p rog ram s in several cou ntrie sC o -funds PP P -H W se cre tariat
D A N ID A w w w.d anida -dcc d.dk B ila teral D en m a rk 's de velopm en t age ncy F inan ces p rog ram sE H P En vironm e ntal H ea lth P ro ject
w w w.e hproject .org B ila teral U S AID pro gra m P rovid es a ccess to a bro ad range of capa bilities for m issio ns an d bu rea us w ishing to includ e hea lth p reve ntive com p onen ts in p rog ram sR e searche s state-o f-th e-a rt p reve ntive co m p onen ts
H ygiene Im pro vem ent P ro ject
w w w.h ip .w atsan .net B ila teral U S AID pro gra m Im p lem ents hyg ie ne program s a t sca le
P rovid es p ublication s, too ls , project pre senta tions, W E LL w w w.lbo ro.ac.uk /orgs/w ell/inde x.
htmB ila teral R eso urc e cen tre fun ded b y th e U K
D ep artm e nt fo r In ternationa l D evelo pm ent (D FID ), p rom ot in g en vironm en tal hea lth in de veloping
C o ord in ates and provide s services for wa ter, s anitation and enviro nm ental health pro gra m s to D F ID an d oth er agen cies
O rgan iza tio n des cription
• Normas tecnicas, guias operacionais, treinamentos, artigos
• Organizacoes-chave
Acting at Scale: Intervention GuideSupplementary feeding
August 2008
FundingFunding ExpensesExpenses
1
1
24
Public sector/ CWSA
Industry External support
agencies
Total
50%73 %
25%
0.200.50
0.05
0.40
Develop-mentcosts
(agency)
0.10
PR
0.20
M&E
0.40
Mgmt. of DCC
program
0.30
Overall program mgmt.
4.00
Total
0.25
1.00
District activities
0.60
0.30
0.90
Mass media
0.60
Direct community contact
(DCC) program
TV
RadioDistrict
SchoolsHealth units
Soap
Expenses for 3-year program (US$M)Funding for 3-year program (US$M)27 %
Successful practice case study (I)
Ghana, whole country
September 2003
• 2.5 M women with children under five• 3.5 M children in primary schools and junior secondary schools• Target to reach 80% of the target group within 3 years through mass media and direct community contacts
X Yes No
$ 4 M over 3 years
• Percentage of mothers and care-givers of children under five years that wash their hands with soap, especially after cleaning up a child (16% in 2002) and after using a toilet (24% in 2002 and 89% in 2005), before and after eating and before feeding babies
• Percentage of school children aged 6-15 years who wash their hands with soap, especially after using the toilet and before eating
Ghana Public-Private Partnership for Handwashing Physical component; Education
Ongoing
N/A
• Lead implementer: Community Water and Sanitation Agency (CWSA) at the ministry of Works and Housing• Public implementing partners: MoH (provision of existing health staff), MoE (contribution to school program)• Implementation assistance: UNICEF (assistance for the school program), LSHTM (consumer and market studies)• External funding: World Bank, DFID, CIDA • Private sector: Unilever Ghana, PZ-Cussons (technical assistance for campaign design, testing and implementation)
Handwashing with soap
X xRural Urban
Program name:
Location:
Start year: Ongoing?
Target group:
Total costs:
Metrics:
Type:
Duration:
Other resources used:
Lead & partner organizations:
Intervention:
Setting:
Atuando em escala:Estudos de caso
en vironm en tal hea lth in de veloping an d transitiona l coun triesM a nage d by LS H T M an d IR C in W eb site is a focal po in t of inform ation abou t w ater
L ondo n S choo l of H ygiene a nd T ropical M edicine
w w w.ls htm .ac.uk A cad em ia Le ading rese arc h institute in hygiene re search
P rovid es to ols fo r c onsum e r resea rch
R e searche s eff icacy and effectiven ess o f H W p rog ram sR e searche s psycholog y of hygiene beha vio ur c hang eP rovid es te chnica l in put to produc tsA dvoc ates
A E D /H ygien e Im provem en t P ro ject
w w w.h ip .w atsan .net A cad em ia U S AID -fu nded pro gra m that wo rks at sca le to im prove a nd su stain h ygien e
P rovid es te chnica l assista nce
P rovid es te chnica l in puts to produ ctsA dvoc ates
C e nter for D isea se C on trol w w w.cdc.g ov A cad em ia U nited States public h ealth a genc y P rovid es te chnica l assista nce for M & E R e searche s effectiven ess o f H WP rovid es te chnica l in puts to produ ctsA dvoc ates
U n ive rsity of L eeds w w w.lee ds.a c.uk A cad em ia Le ading rese arc h institute in hygiene R e searche s and tra in s on health educ ationH e alth E duc ation D a taba se
U n ive rsity of S ou thham p ton w w w.e ng4d ev.soton.ac .uk /res earch.htm l
A cad em ia Le ading rese arc h institute in hygiene re search
R e searche s gen der is sues in the pro m otion o f h ygien e an d san itation a m ongst the u rba n po or
G lo bal P ublic-Pr iva te w w w.g lo balha ndw ashin g.org N G O G lob al initiative of pr iva te an d pub lic A dvoc acyG lobal M &ED e velopm en t of stand ard toolsK no wled ge ex chan geIm p lem enta tio n in s evera l coun tries
IR C Internation al W ate r a nd S an ita tion C en tre
w w w.irc.nl N G O Ind epen dent, non -profit o rga niza tion sup ported b y a nd linke d w ith the
F acilitate s the shar ing, p rom o tio n an d use of k now ledg e to bette r su pport be nef ic ia ries to obtain A dvoc ates chan ge an d aim s to im pro ve the inform a tion a nd k now ledge bas e of the s ector via its w eb site, d ocum e ntation , pub lica tions
In ternation al Sc ie ntific F orum of H om e H ygiene
w w w.ifh-ho m ehyg iene.o rg/2003 /2new slette r/lette r.h tm
N G O N G O com prising sc ie ntists and h ealth care p rofession als w ho p la y an active ro le in hygiene policy and s cientific re search
P ub lish es a new slette r (H om e H ygiene a nd H e alth N e ws ) on latest new s, rese arch , even ts an d libra ry u pdates in th e fie ld of h om e h ygiene
N E T W A S– Ne tw ork fo r W a ter and San itation
w w w.n etw as.o rg N G O A cap acity b uilding an d inform at io n ne two rk for A frica foc using on w ate r, san itation a nd h ygien e
P rovid es a tra in in g cou rse
• Lista de experts
38REACH_Success Practices_Handwashing_v9.ppt
Note: The data is from the Ghana handwashing business plan, not actual dataSource: "Ghana washes her hands: A public-private-partnership." CWSA, 2002.; "Your health in your hands. Ghana public-private partnership for handwashing.", CWSA presentation
1REACH_Success Practices_Handwashing_v9.ppt
• In 2002 9 M annual episodes of diarrhea and 15% of children had diarrhea in the past two weeks prior to survey• In Ghana an estimated 84 K children die each year from diarrheal diseases
– about 25% of deaths in children <5 are attribute to diarrhea
Description of specific country situation & social context:
Source: "Ghana washes her hands: A public-private-partnership." CWSA, 2002.; "Your health in your hands. Ghana public-private partnership for handwashing.", CWSA presentation
Draft – work in progress
Intervention description: deworming (II)
• Cambodia school deworming program (MoH)• Nepal school deworming program (WFP) and integration of
deworming in national Vitamin A supplementation (UNICEF)
Examples of successful implement-ations:
• Advocacy: Partners for Parasite Control (hosted at WHO)• Funding: Gates Foundation; Pan American Health and Education
Foundation, Japan, CIDA• Tablet donation / sales: MedPharm, Bayer, other pharmacos
• Ministry of Health, Education (if school program)• UN: UNICEF, WFP• NGOs Schistosomiasis Control Initiative (SCI); The
CORE Group; Project HOPE; International Save the Children Alliance; Save the Children; OXFAM; The Partnership for Child Development
• Need to select tablets based on local prevalence patterns, e.g. schistosomiasis primarily present in Sub-Saharan Africa; intestinal worms in sub-Saharan Africa, India, China and East Asia
Localization issues:
• National programs by PPC in Nepal, Guinea, Mexico, Egypt• Schistosomiasis Control Initiative (SCI): Burkina Faso, Mali, Niger,
Tanzania, Uganda, Zambia (at-scale)
Typical funding sources & advocates:
Coverage• # (or %) of children and P&L women
i i d i d (PPC d t b k
Outcome• Prevalence of STH/schistosomiasis
(PPC d t b k d di t )
Impact• DALYs/deaths associated with intestinal
t d i f ti / hi t i i
Metrics(italics=not
Typical implementers:
Draft – work in progress
Intervention description: deworming (I)
Intervention: Deworming
Children under 5; P&L women
Description of intervention (incl. goals & rationale/ potential impact):
~2 bn people (30% of world population) carry two varieties of helminths, or parasitic worms: soil-transmitted helminths (STH or intestinal worms such as hookworm, roundworm, and whipworm) and water-borne schistosomiasis. The intestinal obstruction deprives children of micronutrients, creating undernutrition, which leads to stunting, learning deficiencies and learning deficiencies. STH are mostly treated with either albendazole or mebendazole (alternatives: levamisole or pyrantel). Praziquantel is used for treatment against schistosomiasis(bilharzia). The treatment is safe (even when given to uninfected children) and helps to prevent undernutrition as it eliminates the parasites from the childrens' intestinal system. Albendazole treatment can be very cost effective with $2-9 per DALY averted (DCP 2).
Type: Physical component; education
• Deliver tablets to <5s via– Public health: health center, hospitals – UN facilities: distribute tablets at feeding centers
$ 0.05-1.00 per child per yearCosts perperson/hh:
REACH target group:Detail of delivery channels and
Atuando em escala :
4REACH_Successful practices_deworming_v11.ppt
1. PPC 2005 attendants with potentially practical implementation knowledge; Email addresses available in document 2. WHO Global burden of disease database
receiving deworming drugs (PPC databank depending on country)
• Quantity of drugs distributed (program data)
(PPC databank depending on country)• % of highly/moderately infected individuals
(PPC databank depending on country)
nematode infections/schistosomiasis(WHO2)
• % children<5/ P&L mothers with mild, mod-erate, severe anemia (MICS2)
• Dr Henrietta Allen, WHO, Partners for Parasite Control, [email protected]• Dr Antonio Montresor, WHO, Focal point for helminth control WPRO, [email protected]• Dr Donald Bundy, World Bank, Lead Specialist for School Health and Nutrition, [email protected]• Dr Andrew Hall, Centre for Public Health Nutrition, School of Integrated Health, University of Westminster, [email protected]• Ms Rita Bhatia, WFP, Public Health Nutrition, [email protected]
Key implementation experts:
available):
3REACH_Successful practices_deworming_v11.ppt
g– Mass campaign: National/regional (child) health days; national/regional micronutrient days
• Often delivered along with immunization, antenatal care, general health
Required materials:
• Tablets: – for intestinal worms: treatment 1-3 times per year (depending on the worm burden in the area) with one tablet of albendazole (400mg) or
mebendazole (500mg) per child/year (cost per tablet $0.02); dosage regardless of children's size or age– for schistosomiasis: single dose of Praziquantel (600mg) once a year ($0.08 per tablet; $0.20-0.30 per treatment); number of pills has to be
adjusted to the weight/size of the child for which a dose pole is usually used– heat-stable and require no cold chain; shelf life of up to 4 years
• Training materials for those delivering tablets (e.g. teachers, community workers, healthcare providers)• Educational materials to promote awareness and (if employed) hygiene behavior for mothers and children• Registration forms to track overall and individual multi-year coverage
• Deworming can potentially reduce anaemia by 5-10% in populations with high rates of intestinal helminthiasis4
• One dose of deworming tablets is associated with 0.24kg weight increase and 0.14cm in height (review of 25 studies of children aged 1-16)4
• Infant mortality for children of mothers who received 2 doses albendazole at 6 months fell by 41% in Nepal study5
• Deworming also increases micronutrient status for pregnant women: The mean decline in haemoglobin concentration between first and third trimester in women who received albendazole was 6·6 g/L less than in women who received placebo4
channels and methods:
1. WHO Factsheet Nr. 115. 2. "School Deworming." World Bank, 2003. 3. WHO. 4. "What works? Interventions for maternal and child undernutrition and survival." Bhutta et. al., 2008. 5. "Antenatal anthelmintic treatment, birthweight, and infant survival in rural Nepal." Christian et. al., 2004.
Scientific evidence of effectiveness & efficacy:
resumos
28REACH Progress Report I_August 2008_v1.ppt
Abordagem do ciclo vital enfatizada
Ferramenta e modelo para calculo de custo foi desenvolvido
Cost per beneficiary (USD)
Cost per beneficiary (USD)
Reflecting direct costsReflecting
direct costs Allocation basisAllocation basisReflecting full program costsReflecting full program costs
Cost/child <5 (USD)
Increase micro-
nutrient intake
Micronutrient supp.
Micronutrient fort.
$9.26 per child <5
$0.36 per capita
9.26
0.36
• N/A
• Assumes 10% of population are children <5
9.26
3.55
Improve BF and CF BF / CF $2.50 per P&L woman 1.25 • N/A1.25
Improve diarrhea and
parasite
HH water treatment
Handwashing
Malaria: bednets
$4.00 per household
$1 per woman
$4.97 per child <5
0.80
0.50
4.97
• Assumes households include 5 ppl, including two <5s
• N/A
• N/A
2.00
0.50
4.97
Therapeutic feeding $283 per SAM child 9.91Increase
treatment of • N/A29.91
pcontrol
Malaria: IPT
Deworming
$1.36 per P&L woman
$0.38 per child <5
0.68
0.38
• N/A
• N/A
0.68
0.38
Therapeutic feeding $283 per SAM child 9.91SAM1
N/A9.91
Increase household
food security
Supp. feeding
Homestead food prod.
$50 per MAM3 child
$22 per household
3.25
4.40
• N/A
• Assumes households include 5 ppl, including two <5s
3.25
11.00
Total cost w/o CCT
Total cost including CCT
yCond. cash transfer (CCT)5
$56-339 per household 11 - 68
$36
$47 - 104
• Assumes households include 5 ppl, including two <5s28–170
$47
$75–217
29REACH Progress Report I_August 2008_v1.ppt
1. SAM = severely acute malnourished. 2. No change, as <5s are the only beneficiaries. 3. MAM = moderately acute malnourished. 5. CCT costs are highly variable, based on local economic conditions, and often include conditions for behaviors beyond nutrition, e.g. education. Figures used include both administrative costs and the value of the transfer. Ranges include data on programs excluding relatively prosperous middle-income countries, e.g. Brazil and Mexico, which provide higher-value transfers. Costs do not include nutrition services deliveredNote: All cost / child <5 calculations assume 2 <5 children / household and per P&L woman. Average household size assumed to be 5, including 2 <5 children
Ferramenta pode ser utilizada para orcamentacaoFerramenta pode ser utilizada para orcamentacao
Select which interventions1 Review the initial estimates
5
Determine the number of
Select which interventions should be included in cost
calculation
2
of the demographic data and enter custom
estimates for your country, if available
Determine the number of beneficiaries in need for
each intervention (column Q): Who the beneficiaries are is shown in column O
to the left
Select the target coverage level in relation to the
3
level in relation to the number of beneficiaries in need for each intervention
(column S)
Select whether cost savings arising from
integrating interventions should be included in the
4
30REACH Progress Report I_August 2008_v1.ppt
calculations
Algumas licoes aprendidas
1. As ferramentas de planejamento estrategico e1. As ferramentas de planejamento estrategico e “gestores/facilitadores” qualificados deve ser mais empregados no campo da nutricao
2. Uma abordagem abrangente requer foco e priorizacao
3. Profissionais nutricionistas devem assumir o papel central na facilitacao de processos de planejamento conjunto, resolucao de conflitos e promocao de mudancas gerenciais e operacionaisconflitos e promocao de mudancas gerenciais e operacionais, comunicacao e advocacia.
4. Os gestores em nutricao devem buscar uma maior interacao e “networking” para empoderamento individual e coletivo.
31REACH Progress Report I_August 2008_v1.ppt
Algumas licoes aprendidas
5. A articulacao entre acoes de nutricao e de desenvolvimento agricola5. A articulacao entre acoes de nutricao e de desenvolvimento agricola deve ser buscada no livel local e operacional.
6. O uso da abordagem do ciclo vital e fundamental:
• E intuitiva e oferece uma boa estrutura analitica (situacional de• E intuitiva e oferece uma boa estrutura analitica (situacional, de capacidades e compromisso – ready, willing and able analysis)
• Facilita o processo de identificacao de solucoes-chave e o processo de definicao de prioridades
• Facilita a discussao sobre integracao operacional • Pode se traduzir em reducao de custos operacionais (a ser testado)• Pode se traduzir em reducao de custos operacionais (a ser testado)
32REACH Progress Report I_August 2008_v1.ppt
…. To REACH those in need …. Juntem-se ao network…. To REACH those in need …. Juntem se ao network
www.reach-partnership.org
Obrigada
33REACH Progress Report I_August 2008_v1.ppt