areas of interventions in national nutrition services (nns) by dr mustafiz rahman ppc, mohfw...
TRANSCRIPT
Areas of interventions in National Nutrition Services (NNS)
By
Dr Mustafiz Rahman PPC, MoHFWTraining on Assessment of Nutritional Status 18-22 December 2011
Date : 18 December 2011, Venue: FPMU Meeting Room
The Training is organized by the National National Food Policy Capacity Strengthening Programme (NFPCSP) . The NFPCSP is jointly implemented by the Food Planning and Monitoring Unit (FPMU), Ministry of Food and Disaster Management and Food and
Agriculture Organization of the United Nations (FAO) with the financial support of the EU and USAID.
Nutrition under MOHFW
• Due to it's multidisciplinary character nutrition is related with 13 different ministries.
• MOHFW is one of the important ministry which can address this problem up to certain level
• This issue incorporated in to constitution in 1972
• Institute of Public Health Nutrition (IPHN) established in 1972
Topics of my presentation
• Areas of interventions in National Nutrition Services (NNS)
• Scaling up proven direct and Indirect nutrition interventions
Major public health Nutrition problem :
1. Stunting2. Under weight 3. wasting4. Protein Energy Malnutrition 5. Iron deficiency Anemia, Iodine deficiency
disorders6. Vitamin A deficiency, zinc deficiency etc.7. Low Birth Weight8. Over nutrition & its complications (diet relatedNon- communicable Diseases-NCD)
Adolescent Girls 13-19 yrs
Newly Wed Women
ChildrenUnder Two
Lactating Mothers
PregnantWomen
ServicesThrough
Life-cycleIn BINP/NNP
NNS would follow life-cycle approach in community service
Services perform by a CNP at CNC
Post-partum Care Vitamin A iron folate Referral
Growth MonitoringCare for LBWFoodSupplementtionVitamin AReferral
Weight MonitoringIron FolateAntenatal careIron FolateFood supplementationCounselingReferral
Monthly ForumNutrition AssessmentIronFolateDe-wormingWeight promotionIGA, Fruits tree plantation
Lactating Women
Under 2 Children
Pregnant Women
Adolescent Girls/boys
NutritionAssessmentCounselingIronFolate
Newly wed Couple
Food Security Components Nutrition Garden
Poultry for NutritionVGD-NNP Collaboration
Household Survey followed by updateHome visit
Adolescent boysMother in lawFather in lawHusband of newly and pregnant women
Forums
BCC
Training
Family Welfare Assistant (FWA) for >5000 population
Community Nutrition Promoter (CNP) for 1250 population
Services in CCHealth Assistant (HA) for >5000 population
Other ministries/
NGOs/private /personal initiative
Eligible couple registration
Family planning counseling
Non-clinical contraceptive distribution & FU
Referral for ANC
Support during
NID & Vit A week
HH profile update GMP Micronutrient
Supplementation (Post partum Vit A, IFA for
PLW) Adolescent girt & newly wed women
Target food supplementation for PLW, U2 children
Referral for ANC BCC Food Security interv Support during NID & Vit A week
HPN Services Geographical reconnaissance
EPI Disease
surveillance Health education Epidemic control NID & Vit A week
………. ………… ……………
…
Job Analysis of Front Line Workers in HNPSP Comparative Matrix
Multi sectoral issues
Due to multisectoral issues many ministries would contribute to overcome these issues are important:
Food security at HH level Food safety Food quality Balance diet Healthy diet Diet culture Knowledge about nutrition Prevention ,control and management of malnutrition
( NNS-OP, MOHFW)
Intervention so far under MOHFW
• Through IPHN since 1974• Through IPHN & BINP (59 Uz): 1996-2001• Through IPHN & NNP(167Uz) : 2001-2011
What next in MOHFW ?
• National Nutrition Services (NNS) to mainstream the nutrition issue in all regular service delivery points of DGHS & DGFP
• GO-NGO model would be in practice to ensure nutrition service in urban slum, haor- baor -char, hard to reach, underserved and where Community Clinic (CC) is not available
• Inter-sectoral collaboration/coordinated collaboration among all stakeholders
General Objective
The overall objective of NNS OP is to reduce the prevalence of malnutrition particularly among children and women and also achieve sustainable improvements in the nutritional status of the population of Bangladesh.
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1. To implement a mainstreamed, comprehensive package of nutrition services to reduce maternal and child nutrition and ensure universal access
2. To develop and strengthen coordination mechanisms with key sectors (especially Ministry of Food and Disaster Management, Ministry of Agriculture, Ministry of Livestock and Fisheries, Ministry of Local Government and Rural Development and Cooperatives) to ensure a multi-sectoral response to malnutrition
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Cont.
3. To strengthen the human resource capacity to manage, supervise and deliver nutrition services at the different levels of the health system
4. To strengthen nutrition information systems and operations research to ensure an evidence-based response.
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Component of OP
Behavioural Change and Communication to Promote Good Nutritional Practices
Institutional capacity buildingHuman resource development (HRD)/
Training/Capacity BuildingFood security, quality & food safetyManagement of severe acute malnutrition (facility
and community)
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Cont.
• Monitoring and Evaluation / Nutrition Surveillance
• Mainstreaming Gender into Nutrition Program • Nutrition during Emergencies & climate change• Community Based Nutrition (CBN) as selected
area (urban, hard to reach)• Coordination of Nutrition Activities across
Different Sectors
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Cont.
• Procurement of equipments, micronutrients, and deworming tablets etc.
• School Nutritional education Program
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Service deliveryGrowth Monitoring and Promotion (GMP)Protection, Promotion and support of Breastfeeding/
Infant and Young Child Feeding (IYCF)Vitamin A supplementation of children 6-59 months &
lactating motherIron-folic acid supplementation for pregnant womenIron Supplementation and Deworming of Adolescent
GirlsIodine deficiency disorder & Salt IodizationZinc Supplementation during treatment of diarrhea
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Cross –cutting issuesGiven the nature of this , this OP is highly dependent with
other Ministry activities which are articulated in the Action Plan of the Strategic Document.
1. Effective Integration of priority nutrition Interventions in the field level at all service delivery points of DGHS and DGFP. OP-1,2,3,9.18,20
2. Strengthening HR resources necessary for provision of nutrition services. OP-11, 12, 29, 25
3. Establish effective facility and pop based nut surveillance. OP-1,2,3,14, 22, 6
4. Providing nutrition education OP-15, 23, 2,35. Strengthening sectoral collaboration regarding nutrition
and food safety. MODM, Food Div, MOFLS, MOWCA, MOI and other.
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Indicator
1. Prevalence of night blindness among <52. % of children 6-59 m receiving Vit-A3. % of vit-A supplementation in postpartum women4. Rate of EBF in infants under <6 months5. % of children 6-23 months fed with all infant and
Young Child Feeding (IYCF ) practices
6. Prevalence of iodine deficiency
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Cont.
7. Prevalence of anemia among pregnant women8. Prevalence of anemia among children 6-59m9. # of MOs trained in nutrition services delivery10. # of CC workers trained in nutrition services
delivery11. % of UHCs having a functional Nutrition Corner
established
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Budget for the following activities1. Behavior Change Communication (BCC)2. Human resource development (HRD) 3. Control of Vitamin-A deficiency disorder4. Control & prevention of Anemia5. Control of Iodine deficiency Disorders6. Other Micronutrient problems of Public Health
importance ( zinc, vitamin ‘D,’ calcium etc.)7. Community & facility based management of severe
acute malnutrition (SAM)8. Institutional Capacity Development
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Cont.
9. Protection, Promotion & Support of Breastfeeding/ Infant and Young Child Feeding (IYCF) including BFHI & BMS Code
10. Food fortification (Salt Iodization, fortification of oil/other food with Vitamin ‘A’, iron etc.)
11. School Nutritional education Program 12. Food security, Quality and Food Safety13. Monitoring, Evaluation, Operations Research,
Survey
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Cont.
14. Nutrition Surveillance Program15. Establishment of nutrition unit (NU) and
strengthening of existing NU 16. Community based Nutrition (CBN) ) as selected area
17. Multisectral Collaboration
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