report on the third programme management...
TRANSCRIPT
REPORT ON THE
THIRD PROGRAMME MANAGEMENT
COMMITTEE MEETING
Date: 03 June 2011
FAO Meeting Room
Phnom Penh
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Table of Contents Page Table of Contents ……………………………………………………………………….…..1 Acronyms……………………………………………………………………….………....…2 Programme Management Committee Component ………………………………...……3
I. Opening remarks by Ms. An Lund, Senior United Nations Coordination Specialist and Co-chairs of the PMC…………………………………...…………4
II. Opening remarks by H.E. Srun Darith, Deputy Secretary General of CARD and Co- chairs of the PMC……..…….…5
III. Presentation the progress updated activities of the joint progamme
by Mr. Ung Kim Heang, National Programme Coordinator…………................5 IV. Discussion .…………………………………………………………..…………..….7
V. Presentation of Complementary Feeding Campaign and 2nd Quarterly Bulletin, by Mr. Joel Conkle, Nutrition Specialist of UNICEF ...........................9
VI. Discussion ………………………………………………………………………...10
VII. Presentation Food Security Nutrition Media Hand Book for Journalists, by Ms. Marina Oro UNESCO ……………………………………………...….…10
VIII. Discussion ……………………………………………………………………....…11 IX. Presentation on the case study of the use of MNPs in Svay Rieng and
an individual story of a child under the management of acute malnutrition programme in Kampong Speu Province …...............................12
X. Discussion …………………………………………………………………...….…15
XI. Concluding remarks of the co-chairs……………………………………….....…16
XII. Next meeting date………………………………………………………………....16
XIII. Annexes…………………………………………………………………………….16
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Acronyms AECID Spanish International Cooperation Agency ANC Antenatal Care BCC Behavioral Change Communication CARD Council for Agricultural and Rural Development CMDG Cambodia Millennium Development Goals CSB++ Corn Soy Blend Plus Plus ECCD Early Childhood Care and Development FAO Food and Agriculture Organization of the United Nations FFS Farmer Field School FSF Food Security Forum FSN Food Security and Nutrition FSNIM TF Food Security and Nutrition Information Management Task Force FSNDAT Food Security and Nutrition Data Analysis Team HC Health Center H.E. His Excellency IPC Integrated Food Security Phase Classification ILO International Labour Organization IYCF Infant and Young Child Feeding IFA Iron Folic Acid JP Joint Programme JPCFSN Joint Programme for Children Food Security and Nutrition LOA Letter of Agreement MoLVT Ministry of Labour and Vocational Training MoH Ministry of Health MoEYS Ministry of Education, Youth and Sports MAFF Ministry of Agriculture, Forestry and Fisheries MAM Moderate Acute Malnutrition M&E Monitoring and Evaluation MNPs Multiple Micronutrient Powders MUAC Mid-Upper Aim Circumference MDG Millennium Development Goal NAP National Action Plan NMCHC National Maternal and Child Health Center NGO Non Governmental Organization NPC National Programme Coordinator NNP National Nutrition Programme PCC JP Provincial Coordination Committee PDA Provincial Department of Agriculture PMC Programme Management Committee PNC Postnatal Care RGC Royal Government of Cambodia TWG Technical Working Group UN United Nations UNRC United Nations Resident Coordinator UNICEF United Nations Children’s Fund UNESCO United Nations Educational, Scientific and Cultural Organization WHO World Health Organization WFP World Food Programme
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Programme Management Committee (PMC) Component: Co-chairs:
- H.E. Srun Darith, Deputy Secretary General of CARD - Ms. Ann Lund, Senior UN Coordination Specialist (First Half Session) - H.E. Mr. Douglas Broderick, United Nations Resident Coordinator (Second Half
Session) Secretariat:
- Mr. Ung Kim Heang, National Programme Coordinator - Mr. Ros Thoeun, Provincial Programme Coordinator for Kampong Speu Province - Mr. Savun Sam Ol, Provincial Programme Coordinator for Svay Reing Province
Members:
- Ministry of Health (MoH) - Ministry of Agriculture, Forestry and Fisheries (MAFF) - Ministry of Labour and Vocational Training (MoLVT) - Ministry of Education, Youth and Sports (MoEYS) - United Nations Children’s Fund (UNICEF) - World Health Organization (WHO) - Food and Agriculture Organization of the United Nations (FAO) - World Food Programme (WFP) - International Labour Organization (ILO) - United Nations Educational Scientific and Cultural Organization (UNESCO)
Honourable guests:
- Mr. Juan Pita, AECID General Coordinator, Spanish International Cooperation Agency (AECID)
Apology:
- H.E. Mr. Mariano Alonso Buron, Ambassador of Spain Documents distributed during the meeting:
- Minutes of PMC meeting in December 2010 - Report on the assessment of the initial implementation of Management of Acute
Malnutrition in Kampong Speu Province - Report on the maternity protection study of ILO - Drafted food security media guide of UNESCO
Photos exhibition displayed:
- Management of Acute Malnutrition in Kampong Speu Province (UNICEF, WHO & WFP)
- Multiple Micronutrient Powders (Sprinkles) programme in Svay Reing Province (UNICEF,WHO & WFP)
- National Communication Strategy to Promote the Use of Iron/Folic Acid (IFA) Supplementation for Pregnant and Postpartum Women (UNICEF, WHO & WFP)
- Photo Activities Description of FAO, ILO and UNESCO
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MINUTES OF THE MEETING
I. Opening remarks by Ms. Ann Lund, Senior UN Coordination Specialist, the Co-Chair of the PMC (First half session):
Due to Mr. Douglas Broderick, the United Nations Resident Coordinator and the Co-chair of
the PMC, was not available to attend at the first half session of the meeting, he, therefore,
requested Ms. Ann Lund, the Senior UN Coordination Specialist, to provide an opening
remarks on his behalf. Ms. Ann first welcomed Excellencies, Representatives of relevant line
Ministries of the Royal Government of Cambodia, especially from MoH, MAFF, MoLVT, and
MoEYS, the representatives of the six UN Agencies from UNICEF, WHO, WFP, FAO, ILO
and UNESCO for sharing good coordination and work as a ONE UN. She also expressed
her thanks to FAO for hosting the meeting today.
With the presence of the Mr. Juan Pita, Representative of the Spanish International
Cooperation Agency (EACID) who is also attended the meeting; Ms Ann took the opportunity
to reiterate her gratitude to the Spanish Government, which supports UN Joint Programmes
in Cambodia in addition to other development programmes. She reminded everyone that
Spanish Ambassador has sent his regret for not being able to participate in today meeting.
Ms. Ann recalled the nature of the joint programme that will contribute to the achievement of
national targets for Cambodia’s Millennium Development Goals 1, 4 and 5, namely to
eradicate extreme poverty and hunger, reduce child mortality and improve maternal health,
including those set out in the country’s first National Nutrition Strategy 2009 - 2015 and the
Strategic Framework for Food Security and Nutrition in Cambodia.
She also mentioned of some great achievements and progress which have been made over
the past year and requested all UN implementing and government agencies to carry out the
work for the coming years properly. At the end of her remarks, Ms. Ann invited all
participants to go through all the photos exhibition1, which have been exhibited here in the
meeting room, describing the activities from each UN implementing and government
agencies that have worked in the past year. She also encouraged all participants to actively
participate in the meeting.
1 The photo exhibition focused on some joint key activities of UNICEF, WHO and WFP such as the
implementation on management of acute malnutrition, National Communication Strategy to Promote the Use of Iron/Folic Acid (IFA) Supplementation for Pregnant and Postpartum Women, Multiple Micronutrient Powders (MNPs) for Children 6-24 Months and the key activities of UNESCO, FAO and ILO.
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II. Opening remarks by H.E. Srun Darith, Deputy Secretary General of CARD and the Co-Chair of the PMC:
H.E. Mr. Srun Darith reiterated his sincere thanks to PMC members from relevant line
ministries and government counterparts as well as the colleagues from UN implementing
agencies. He, on behalf of the Royal Government of Cambodia and the Council for
Agricultural and Rural Development (CARD), highlighted the importance of the involvement
of CARD for this joint programme. He also took this opportunity to thank the Spanish
government that provided funding for the joint programme. He recalled to the role and
responsibility of the PMC members to ensure successful implementation of the Joint
Programme for Children, Food Security and Nutrition in Cambodia through oversight and
coordination of the joint programme at a management level. He, therefore, encourage each
member to actively participate in the important meeting.
Before proceeding to the agenda, H.E. Srun Darith asked if there were any suggestions,
comments, or feedbacks on the agenda. There were no comments or feedbacks from the
floor. He then went through to each agenda items. His Excellency invited all participants to
do self-introduction by given name, role and responsibility and its institution. As next, he
invited Mr. Ung Kim Heang, National Programme Coordinator to present the update
implementation progress of the joint programme.
III. Presentation the progress updated activities of the joint progamme, by Mr. Ung Kim Heang, MDG National Programme Coordinator:
Mr. Kim Heang took this opportunity to express his sincere thanks to His Excellency the
PMC Co-chairs and the PMC representatives and members from relevant government line
ministries and UN agencies which spent their valuable time to attend the meeting today. He
recalled the four main overall objectives of the joint programme which is (1) to develop and
implement nationwide BCC plan in order to promote and improve breastfeeding,
complementary feeding and iron folic acid supplementation, (2) provide an integrated
comprehensive package of FSN interventions in order to increase food production and the
use of nutritious food at home, (3) review implementation and strengthen existing nutrition,
food security and agricultural policies, and develop new nutrition policies and (4) develop an
integrated national food security and nutrition monitoring system.
Mr. Kim Heang briefly update of the budget status for 2011 that each UN implementing
agencies just received funding from their Headquarters in early May 2011. The total fund
received for all UN implementing agencies are: USD 1,521,548
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Fund Received for 2011 by UN Implementing Agencies:
UN Implementing Agencies Fund Requested Fund Received
UNICEF USD 730,796 USD 730,796
WHO USD 197,950 USD 197,950
FAO USD 154,348 USD 154,348
WFP USD 249,738 USD 249,738
ILO USD 120,664 USD 120,664
UNESCO USD 68,052 USD 68,052
Total 6 UN Agencies USD 1,521,548 USD 1,521,548
In addition to this budget update, Mr. Kim Heang also presented the summary progress
update from each UN implementing agencies according to the three main outcomes as listed
below:
1. JP Outcome 1: The nutritional status of children aged 0-24 months and pregnant and
lactating women improved.
- Management of acute malnutrition
- Multiple Micronutrient Powders (MNPs) distribution in Svay Rieng Province
- Food Security and nutrition (FSN) training with CARD
- The development of nutrition handbook for family
- Workplan with provincial departments involved in the implementation of the joint
programme in both provinces
- National Action Plan (NAP) for Early Child Care Development (ECCD)
- The development of FSN media handbook
- Sharing experience workshops
2. JP Outcome 2: Existing nutrition, food security, and agricultural policies
strengthened, and new policies on nutrition developed and implemented:
- Policy review on Maternity leave and workplace policy
- Capacity building training Occupational Safety and Health (OSH) and Maternity
Protection at the workplace for Labour Officials
- Development of training and IEC/BCC materials on how to use mid-uper arm
circumference for malnutrition screening and how to prepare and use BP 100 and
CSB++
- The development of a master of science programme in nutrition
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- National policy and guidelines for micronutrient supplementation to prevent and
control deficiencies in Cambodia
- National communication strategy to promote the use of Iron/Folic Acid (IFA)
supplementation for pregnant and postpartum women: 2010-2013
3. JP Outcome 3: Integrated food security and nutrition monitoring system developed
- Food security bulletin
- Small area estimation of poverty and malnutrition
- Mid-term review of SFFSN
- FSNIS website
- Food consumption data analysis training
Please find the full presentation of the Update Implementation Progress of the Joint
Programme in Annex 1 of the report.
IV. Discussion:
His Excellency Srun Darith opened the floor to all participants for question and clarification of
the presentation made by Mr. Kim Heang. Initially H.E. Darith asked several question on the
assessment of management of acute malnutrition and multiple micronutrient powder (MNP):
- Why the defaulted rate amongst children under the management of acute
malnutrition in these health centers is high?
- What is the next step to bear with this high defaulted rate?
- He observed that the distribution of MNPs in Svay Rieng is high though it is just
started. Do children really eat this MNPs or not?
H.E. Darith added to the presentation made by Kim Heang on section review the Strategic
Framework for Food Security and Nutrition (SFFSN) in Cambodia 2008-2012. He said that
the review is confirmed and very cleared that it will start in September 2011. A consultant
was identified and ToR is finalized. He also mentioned about the Food Security and Nutrition
website which is supported by WFP and FAO and is under restructure and migration for a
better user friendly especially in searching for a particular document. This website is
considered as the first government website which contains all related food security and
nutrition information in Cambodia.
Ms. La-ong (WHO) responded that the high defaulter rate on the implementation of
management of acute malnutrition is due to many reasons, including travelling time and
waiting time at health centre and in appropriate discharge criteria and as a results many
children were not discharged even though when they looked better/healthier or when they
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have already reached MUAC discharge criteria. Some caretakers did not come back for
follow up when they saw their children got better or had no illness any more. The
discharged criteria for moderate acute malnutrition (MAM) and severe acute malnutrition
(SAM) is used either by MUAC (SAM >11.5 cm for 2 consecutive visits, MAM >12. 5 cm for 2
consecutive visits) or Weight gained (20% for 2 consecutive visits). Based on this, the
consultant suggested using MUAC as discharge criteria. The other problems identified from
the assessment that contributed to the high defaulter rate were the transportation (from
village to health center), long distance and some problems with acceptability of CSB++. Ms.
Ong added that this assessment found that the defaulter rate among SAM case was higher
than MAM cases this might be because for the SAM case health staff asks caretakers to
bring children for follow up at the health center every week. Weekly follow up might be too
frequent that some caretakers could not do. .
For MNPs distribution question, Ms. Ong said that we have just started the distribution of the
MNPs. What we should look in the future is the acceptability of the MNPs. Ms. Ong asked a
question with regards to small area estimation of poverty and malnutrition. Will this
estimation include data from the CDHS 2010? Mr. Joel Conkle, (UNICEF) said yes they can
include and the results from this assessment would probably be released in mid 2012.
Ms. Sun Lei (UNESCO): Were these children screened (6,157) from the initial assessment
were the same children included in the baseline survey of the joint programme. In response
to that Mr. Joel answered that some of them were because baseline survey randomly
selected children in the whole Kampong Speu province while this initial implementation of
the management of acute malnutrition have just started in only 5 selected health enters in
Kong Pisey Operational District with target children from 6 – 24 months.
Ms. Viorica (UNICEF) asked question to both Provincial Programme Coordinators: When
designing the programme at the beginning we were thinking to integrate services at the
ground level. Do you see now any integration of services at the community level? Mr. Ros
Thoeun, the Provincial Programme Coordinator in Kampong Speu responded that with JP
there is connection at sub-national level through Provincial Coordination Committee (PCC)
forum by involved core implementers and partners to join the forum with aims to link and
integrate between services delivery at the ground level such as health care, education
agriculture and labour protection at the workplace together. In addition, from agricultural
aspect, members of Village Health Support Groups (VHSGs) are being members of Farmer
Field Schools (FFS) and some family who have malnourished children were already selected
as members of FFS groups. For Provincial Labour Department they have provided education
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sessions for working mothers at the workplace and Provincial Education Department
integrated FSN message through formal and non-formal educations facilities.
Mr. Sam Ol, the Provincial Programme Coordinator in Svay Rieng added to Mr. Thoeun that
the PCC is used as a forum to meet, share and learn from the JP implementation activities.
Moreover, the provincial governors get information and learned of what happens in relation
with FSN in their provinces. Unlike before they didn't know about each other, every
department doing its own project and report separately, but through PCC, they can
consolidate all report related FSN regardless MDG-F JP partners. The other kinds of
integration at the community level including the complementary food cooking demonstration
prepared by Provincial Department of Agriculture (PDA) in collaboration with health center
staff.
H.E. Darith added that it is important that we should work with other projects at the provincial
levels in order to complement to each other and avoid overlapping.
V. Presentation of Complementary Feeding Campaign & Quarterly FSN Bulletin by Mr. Joel Conkle (UNCIEF):
Complementary Feeding Campaign: The campaign has not started officially but the
company has already been identifies and now is waiting for Ministry of Health to approve on
the proposal. The interpersonal communication is the ongoing campaign and reaching out to
mass media to deliver messages. The official mass media materials are currently in-
development. The campaign focuses on the complementary feeding to young children aged
from 6 – 24 months through national TVs and radios.
The 2nd Food Security and Nutrition (FSN) Bulletin: The 2nd FSN bulletin officially
disseminated through the Food Security Forum at the Council of Ministers in May 2011. It is
also available online at http://www.foodsecurity.gov.kh/ which is the only one government
website contains all information related to the FSN in Cambodia. Analytical works of this
bulletin has been presented to UN Country Team, Health Partners, and NGO’s associated
with MEDICAM. The main focus of the bulletin is focus on rainfall, harvest, prices, and
anthropometric indicators and current efforts to include wages and prices of additional food
items into the next bulletin. In the future plan disseminate via print media. The translation
and publication of the bulletin into Khmer language is also planned. Please find detail slide
presentation in annex 2 of the report.
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VI. Discussion:
Ms. Viorica (UNICEF): Under the MDG F, for example the complementary feeding campaign
is unofficially started and it attracted other donors to join the effort including USAID. For
instance, this year USAID will contribute to the complementary feeding campaign activities
with support over 400,000 USD. The other supporting agencies channeled their fund to
Health Sector Support Project Phase 2 (HSSP2) through the pool fund. Mr. Joel added that
the same as MNPs that attracted some development partners, e.g. NGOs are interested in
implementing this programme.
Ms. La-Ong (WHO): When is the midterm evaluation of the JP? Mr. Kim Heang responded
that the mid-term evaluation of the Joint Programme for Children, Food Security and
Nutrition in Cambodia is now due to begin, as the programme will have completed 18
months of implementation in 13 July 2011. This evaluation is independent and will be carried
out through a participatory process. The conclusions and recommendations of the
evaluation will be addressed to its main users -- the Programme Management Committee,
the National Steering Committee and the Secretariat of the MDG-Fund. The mid-term
evaluation process will also create a knowledge base and highlight best practices and
lessons learned that can ultimately be transferred to other programmes. Mr. Kim Heang in
consultation with UNRC office will follow up with HQ on this matter.
VII. Presentation of Food Security Nutrition Media Hand Book for Journalists by Ms. Marina Oro, UNESCO:
The purposes of this FSN Hand book are:
- Resource for Journalists who want to learn about FSN
- Encourage proactive reporting of positive news stories
- Raise awareness on media’s role through information and education
- Promote communication through media about FSN
- Promote social and behavior change through accurate and comprehensive news
Main contents outlined in the guide book:
- Part I: Understanding the Basics of Food Security and Nutrition
- Part II: Food Security and Nutrition in Cambodia Part III: The Role of the Media
- Part III: The Role of the Media
- Part IV: Reporting and Writing News on Food Security and Nutrition
- Part V: Feature Articles
- Part VI: Cambodia First Media Training Workshop on Food Security and Nutrition
- Part VII: Further Resources
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Ms. Marina requested to JP programme Officers to provide feedback to this FSN Guide
Book development with deadline by July 1, 2011. The delaine for submission of the final
draft is August 31, 2011. Please find detail slide presentation in annex 3 of the report.
VIII. Discussion:
H.E. Darith reiterated on the development of FSN Media Handbook. He thanked UNESCO
for their initiation and the development of the handbook. He added that the first draft of the
handbook was already submitted to the JPTWG early of year for comments and providing
feedback. For the finalized second draft, His Excellency suggested UNESCO to submit this
final draft to the Technical Working Group for Food Security and Nutrition (TWGFSN) for
final endorsement.
Mr. Douglas: UN has media session under the UN umbrella. So how we could make this
FSN media handbook useful and possible? In addition, Ms. Viorica asked is this media
handbook for Cambodia Journalist. And how is the dissemination strategy of this media
handbook? Ms. Butom (UNESCO’s consultant): The media guide book can be distributed to
the journalist student that UNESCO will support. H.E. Darith: For a better use of the book in
the future, His Excellency suggested that if the media handbook could be distributed to the
Faculty of Journalism at the Royal University of Phnom Penh. He wondered if this media
handbook can be translated into Khmer language.
Ms. La-Ong: Is there any plan in the later to update the statistical information in this book?
Ms. Marina said YES but it depends on the necessity of the book later on. We also can use
this book as reference book for the student as at the last chapter of the book talks about
further resource.
Mr. Douglas: Is there any media related handbook already available in the UN system here?
Ms. Marina responded that there is an HIV and AIDS Media Handbook developed by
UNESCO in collaboration with National AIDS Authority (NAA).
In conclusion for this discussion, Mr. Douglas concluded that (1) we should consider how to
disseminate this book. (2) Translation into Khmer version should also be considered. (3) if
possible update statistic and information of the guide book to in line with the present
situation (4) send comment and feedback of the book to UNESCO by 1st July and final draft
by 31st August 2011.
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IX. Presentation Case Study of the use of MNPs in Svay Rieng and an Individual story of a Child Under management of acute malnutrition in Kampong Speu Province
Case Study of the use of MNPs in Svay Rieng Province:
With MDG Joint Programme, the Multiple Micronutrient Powders (MNPs) started its
distribution in April 2011; and it is free of charge to children age 06-24 months in all villages
(690 villages) in Svay Rieng Province. After a month of distributing MNPs, there were 10,751
out of 18,807 children age 06-24 months received and used MNPs (57%) together with their
complementary feeding. As a result:
• Most mothers really want MNPs as they found that MNPs is good for their children to
eat and grow better.
• More mothers are eagerly waiting to receive MNPs when their children reach 6
months old.
Some mix with Borbor or Bay (cooked rice), others mix with special Borbor.
Case 1: Hin Chan Samnang
Hin Chansamnang, 22 months old, is
the son of Mr. Hin Chanmony and Mrs.
Sokhom Ratana. The family lives in
Russei Prey village, Kampong
Chamlorng commune, Svay Chrum
district. Since he was born Samnang
was fed by breast milk 8 times daily for
3 months even though his mother
resumed work as a teacher of a
primary school of Chamlorng. The mother gave 2-3 breast milks per day time and 4-5 times
during night time. During the first 3 months, Samnang was growing normally according to a
growth chart, but from 4th month Samnang began to grow less, and was only 8.5kg against
79cm height on May 11, 2011 (classified as moderate acute malnutrition). Samnang should
be 10-12kg with his age and height. However, before taking MNPs Samnang’s weight was
even worse than this (he was only 7kg last month when he was 21 months old.
• After taking MNPs, Samnang eats better and is clever as observed by his mother.
His weighs now 9kg (May 23, 2011) according to his mother.
• “I am very happy and appreciate that MNPs can help my child to eat and grow
better,” said the mother.
• Samnang’s mother is not only feeding her child, but she also helps other mothers by
teaching them how to mix MNPs with porridge and feed their children properly.
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Case 2: A day of waiting that works:
Moeum Sophorn, 18 months of
age is a son of Mrs. Sovath
Khemary, 27 years old and Mr.
Koy Mony, 27 years old, living
in Trapeang Kampeus village,
Khsetr commune, Kampong Ro
district of Svay Rieng province.
He is now 12 kg (normal
weight) and started eating
porridge with MNPs from April
2011 when he was only 11kg.
Sophorn was born with only 2.2kg (considered underweight), but his mother was taking care
of him by following the health workers’ advice, including regular visits to the health center – 4
times during pregnancy period – and regularly taking IFA (ANC & PNC). She breastfed her
son immediately after birth and provided complementary feeding when he was 6 months old,
and continues to breast feed. The family is very happy to receive free MNPs, and
immediately began cooking the porridge and mixing MNPs to feed their child every day, one
day one sachet of sprinkles. Until now he has taken 15 sachets already.
Observation by his mother is that before taking MNPs, Sophorn is slowly growing, 1/2kg per
month, but now from April to May he is 1kg different, according to his mother during
participation in complementary food demonstration day organized by the Provincial
Department of Agriculture (PDA) in cooperation with health center staff on May 23, 2011.
Sophorn’s mother mentions that the MNPs is good for her child, as proof her son becomes
better and eats more, which lead to fast growth. The complementary food demonstration has
participation from the Deputy Director of PDA, Deputy Chief of Commune, Chief of District
Agriculture Office, Village Chief, Commune Council Member, VHSG and Farmer Field
School Group Leader, who is guiding the food demonstration with assistance of HC staff.
24-year old mother with children expressed her strong motivation that she only knows how to
make such important porridge this time, especially the use of MNPs. They proposed that
complementary food demonstration should be conducted like this in every village, because
all mothers do not know about what they must know for the life for their children.
Observation:
1. Food Demonstration is really important to show mothers in every single village, if
possible
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2. MNPs have been mixed with porridge in front of mothers and children are well absorbing,
not having bitter taste or sour like rumor. I saw children are eating well. One mother
tastes porridge with and without sprinkles and recognizes that the one with sprinkles is
more delicious than the other one without sprinkles.
Individual story of a Child Under management of acute malnutrition in Kampong Speu Province
Case: A Safety Net that Works
A widowed father is residing in Thnout
village of Toul Sala commune living with
his two young sons, 3 years and another
14 months old. The mother left them
when the second son was two and half
months old; she returned to her native
village in Battambang province and
married a new husband there. In the
house of four, the grandmother is taking
full responsibility for day-to-day
household work, including caring for two
grandsons; the father works as a truck driver outside the province and only comes home
once a month. From birth, the two sons survived with formula milk and rice soup as they
never received breastfeeding from their mother; she learned from friends that giving breast
milk to children leads to loss her beauty. Huy Sok Chea is the youngest son who was
enrolled into the Management of Severe Acute Malnutrition (SAM) Program in October 2010
when the initial community screening campaign started. Before entering the program, Sok
Chea was a malnourished child who was often sick with respiratory infections, diarrhea and
fever. Sok Chea was ill since birth and received countless treatments at both public and
private health facilities around the commune, but his condition didn’t improve much. Early
bouts of illness were stabilized, but at a later age his condition became severe. Sok Chea
became so thin that he looked almost like a dead body and he became lethargic, with no
movement at all. Whenever his grandmother took him to local private clinics and the public
health center staff always rejected to offer treatment as they were scared he would die in
their facility; such rejections happened from the chief of Toul Sala Health Center, the same
health center that would later treat the child. Sok Chea was initially screened with a MUAC of
11.0 cm (<11.5 cm is the cut-off for severe) and a weight of 5.5 Kg (about ½ of normal
weight at this age); he was admitted into the programme and successfully completed
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treatment with BP100. He then moved on to treatment for moderate acute malnutrition and
was eating supplementary food (CSB++) during the time of a home visit in December 2010.
As a result, his new weight is 7.7 Kg. Sok Chea looks fresher and fatter, and is more active.
He received good care from his grandmother, who is also a member of the Village Health
Support Group (VHSG) in the same village. Now, he is on his last month of using
supplementary feeing product according to discharge criteria. “I gratefully thank health staff
and the products that helped my grandson survive until now; otherwise, he would have
already died,” said the grandmother.
X. Discussion: Ms. Viorica: We have to make sure that the complementary feeding has to happen together
with MNPs and mother should receive education by then. She added that improved process
and information for mothers/care takers on how to use the product is necessary. There are
already efforts that link closely with complementary feeding and the MNPs products.
Mr. Douglass: what is the distribution modality of MNPs? What is in the future if no more
freely distribution of MNPs? Is there any soft discussion or thinking about social marketing of
MNPs in Cambodia in the future? Mr. Sam Ol responded to the 1st question that health
centre staff is the distribution channel through outreach activities (OA) with the support of
VHSP and/or village chief in the provision of MNPs to mothers/care takers.
Mr. Nuth Sophorn (MoLVT): Suggested that MNPs should first target to the poorest children
and family. Mr. Sam Ol replied that the distribution targets to all children age 06-24 months.
None of the children are excluded in this project. Children from the rich family are also
suffered by malnourishment and anemia. In addition to this, Mr. Joel added that MDG-F JP
decides to distribute MNPs for free to all children in these target provinces because the
survey showed that more than half of children are under malnutrition and with high anemia.
Ms. La-Ong: How can we ensure mothers/care taker continue complementary feeding their
child after received BP100 and CSB++? Mr. Thoeun responded that start-up of MNPs will
help and add value to the complementary feeding once children discharged from the
management of acute malnutrition programme.
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XI. Concluding remarks of the co-chairs: Concluding remarks by H.E. Srun Darith, CARD, Co-chair of the PMC:
Mr. Douglas Broderick invited H.E. Srun Darith to wrap up the PMC meeting. H.E Darith
thanked Mr. Douglass for giving him a floor. He also thanked all honourable participants from
the Royal Government of Cambodia and the UN implementing agencies especially to FAO
who hosted this meeting. He highlighted and concluded the main points from the meeting as
bellow:
- Management of Acute Malnutrition Guidelines will be reviewed.
- Refresher training of management of acute malnutrition for health centers and scale
up the implementation
- Need to assess the acceptability of MNPs’ consumption
- Need to consider the commercialization/social marketing of MNPs
- Finalize the Food Security and Nutrition Guide for Journalists by 1st July and submit
to the TWG for FSN for full endorsement.
Mr. Douglass then announced the next PMC will be held in September 2011. Place to be
confirmed later by the MDG National Programme Coordinator.
XII. Next Meeting Date: September 2011. Place to be identified.
XIII. Annexes:
Annex 1: Presentation the progress updated activities of the joint progamme
Annex 2: Presentation complementary feeding campaign & quarterly FSN bulletin
Annex 3: Presentation of Food Security Nutrition Media Hand Book for Journalists
Annex 4: Agenda of the PMC meeting
Annex 5: List of participants
The meeting finished at 5.00 pm.
Annex 1
Presentation the progress updated activities of the joint progamme
1
The Joint Programme for Children,
Food Security and Nutrition in
Cambodia (2010 – 2012)
Presented by: Ung Kim Heang, National Programme Coordinator
Joint Programme for Children, Food Security and
Nutrition in Cambodia
Programme Management Committee (PMC) Meeting
FAO Meeting Room
Date: 03 June 2011
Outline of the Presentation
I. Budget status for 2011
II. Update implementation progress
2
I- Budget Status: Fund Transfer, Year 2011
Implementing
Agencies Fund requested Fund received
UNICEF USD 730,796 USD 730,796
WHO USD 197,950 USD 197,950
FAO USD 154,348 USD 154,348
WFP USD 249,738 USD 249,738
ILO USD 120,664 USD 120,664
UNESCO USD 68,052 USD 68,052
Total 6 UN Agencies USD 1,521,548 USD 1,521,548
The fund transferred for 2011 just arrived in Cambodia
Offices in the first week of May 2011.
II- Update on the Main
Implementation Progress:
3
Total children
in catchment
Total screened
by MUAC
Total acute
maln. (GAM)
Total
SAM
Total
MAM
6,555 6,157 578 91 487
94% 9.5% 1.5% 8%
Outcome 1: The nutritional status of children aged 0-24 months
and pregnant and lactating women improved
Note: Screening by MUAC, no oedema identified.
Management of Acute Malnutrition: (WHO, UNICEF & WFP)
An assessment conducted by the end Jan-Feb 2011: bellow are
the summary results of the assessment:
Screening results:
SAM MAM Total
Total admitted to programme 91 487 578
Total remaining in programme 50 391 441
Children in the programme by December 2011:
SAM MAM Sphere
Cured 15% (14) 3% (13) >75%
Died 1% (1) 0% (0) SAM<10%, MAM<3%
Defaulted 27% (25) 17% (81) <15%
Programme outcomes Oct-Dec 2010:
4
Total new cases children seen at
outpatient consultation (OPD)*
October Novem
ber
Decemb
er
January
(10/11)
2009 807 655 554 573
2010 1010 (53) 645 (6) 581 (6) 782 (2)
Implementation management of acute malnutrition lead to
increase uptake services at health centers (?):
* Source: Results from one HC. SAM/MAM cases in brackets. 2/5 health center staff stated
health center now busier.
Other Findings: Successes
o Appropriate screening, identifying, referring & admitting children: very active VHSGs and HC staff
o Sufficient supplies and appropriate equipment o Appropriate therapeutic and supplementary food o Integrated with existing HC services o Active follow up of absentees o Monthly meeting with VHSGs conducted o Visible improvement of children
o Some protocols not followed: use of antibiotics, appetite test, & oedema checks
o Confusion with discharge criteria: when to discharge & what category to use (MUAC vs weight gain)
o High absent and default rates o Poor communication & counselling with caretakers o Poor understanding of how to use CSB++ & BP 100. o Some problems with acceptability of CSB++ o Long distance from HC for some villages. o Long waiting time at HC
Other Findings: Weaknesses
Next Steps:
o Revise guidelines (including admission and discharge criteria and length f stay), forms, materials, and key messages
o Refresher training for trainers and HC staff o Conduct refresher training for existing 5 HCs
5
MNPs Indicators
Number children aged 6-24 months: 18,807
Number children aged 6-24 months rreceived MNPs
as of May 2011:
15,858 (84%)
Number of MNPs in stock of the 3 OD: 1,247,870 sachets
Number of MNPs distributed to children: 237,870 sachets (19%)
Multiple Micronutrient Powders (MNPs) Distribution
April 2011, Svay Rieng Province.
Outcome 1: The nutritional status of children (continue)
FSN Training with CARD: (FAO)
Supporting CARD to conduct FSN trainings in both
province. The LoA with CARD and FAO is finalized.
The training will start in July and August 2011.
Nutrition Handbook for Family: (FAO)
The hand book is being finalizing with technical
support from NNP. Expected to be finished by
the end of June.
AWP 2011 (FAO):
The AWP for both provinces planned. 20 new Farmer Field Schools (FFS)
from each province will be set up and supported. (1FFS/30members) for
2011. The new FFS training will start their activities in June 2011.
6
Outcome 1: The nutritional status of children (continue)
National Action Plan (NAP) for ECCD for ECCD: (UNESCO)
The NAP finalized and is awaiting for the establishment of the ECCD
National Committee by MOEYS (by Mid-June).
FSN Media Handbook: (UNESCO)
The 2nd draft of the hand book is being finalized
and will be shared with JPTWG for a 3rd comment
before submit to CARD for final endorsement.
Log frame and budget plan 2011 of both provinces: (UNESCO)
The Log frame and budget plan 2011 is being finalized with both
PoEYS. They focus on refresher training at all levels, follow up and
M&E.
Sharing Experience Workshop:(ILO)
The workshop conducted with stakeholders and
garment workers on maternal health (nutrition)
of working mother in the factories.
Service Agreement with PoLVTs: (ILO)
The agreement on the implementation of
2011 workplan mainly focused on the
training to garment worker and employers
on maternity protection, Occupational
Safety and Health, reproductive health,
and breast milk expressing…
Outcome 1: The nutritional status of children (continue)
7
AWP Workshop: For employers and
garment workers to review challenges and
achievements in 2010 and built 2011
workplan. (ILO)
Policy Review: Maternity leave and
workplace policy review. Expected
to be done by August 2011. (ILO)
Capacity Building Training: on
Occupational Safety and Health (OSH)
and Maternity Protection at the
workplace for Labour Officials. (ILO)
JP Outcome 2: Existing nutrition, food security, & agricultural
policies strengthened, and new policies on nutrition developed
and implemented
Development of training and IEC/BCC materials: (WHO, UNICEF
and WFP)
o How to use Mid-uper Arm Circumference for malnutrition screening
o How to prepare and use BP 100 and CSB++
Master of Science in Nutrition: (WHO)
o A Technical Working Group was established by the Ministry of Health
on 16 Dec 2010. It chaired by the National Institute of Public Health
(NIPH) with 13 members from relevant MoH’s Departments and
Centres.
o First consultative meeting was conducted on 22 February 2011, to
discuss programme design and curriculum development.
o An International Consultative Workshop is planned for 14-16 June
2011 to assist in the review of the draft curriculum. Suggestions will be
used to finalize the curriculum.
8
National Policy and Guidelines for Micronutrient Supplementation
to Prevent and Control Deficiencies in Cambodia: (WHO, UNICEF
and WFP)
o Development of the policy and guidelines started in September 2010
through a consultative and participatory process.
o The final draft shared with the Nutrition Working Group for final comments
in May 2011. The dissemination workshop will be conducted in 2012.
o A training package on micronutrient supplementations will be developed
in 2011.
National Communication Strategy to Promote the Use of Iron/Folic Acid
(IFA) Supplementation for Pregnant and Post Partum Women: 2010-
2013: (WHO, UNICEF and WFP)
o Media campaign will start again from June – August 2011:
o TV spots: on 4 national stations
o Radio spots: on Phnom Penh and 11 provincial stations
JP Outcome 3: Integrated food security and nutrition
monitoring system developed (WFP, UNICEF and FAO)
Food Security Bulletin: technical support to CARD for the
development of Food security and Nutrition Bulletin (two issues have
been published and added in the FSNIS website of CARD).
(http://www.foodsecurity.gov.kh/docs/ENG/Cambodia-EW-Report-
Finalized-and-endorsed-on25-01-11.Eng.pdf)
Small area estimation of poverty and malnutrition: NIS, WFP
and Massey University began secondary data analysis of CSES 2009,
CAS 2008, Census 2008 and CDB 2009 data sets to produce statistical
models for the small area estimation study. The GIS maps of poverty
and malnutrition will be produced. Results available in mid-2012.
Mid-term review of SFFSN: CARD has postponed the MTR until
September-October 2010. A consultant has been identified.
9
JP Outcome 3: Integrated food security and nutrition
monitoring system developed (WFP, UNICEF and FAO)
FSNIS website: Financial support to CARD on the redesigning of
FSNIS website. The website will be publically launched shortly in
the coming month.
Food Consumption Data Analysis Training:
The training has been done at the National Institute of Statistics in
March 2011 to relevant ministries and partners. The results of the
analysis has been presented in the last Food Security Forum at
CARD in May.
Thank you for your kind attention!
Your feedbacks and questions for clarification are welcomed!
Annex 2
Presentation complementary feeding campaign & quarterly FSN bulletin
07-Jul-11
1
Outputs from the Food Security and
Nutrition Bulletin
And
the Complementary Feeding Campaign
Programme Management Committee (PMC) Meeting
FAO Meeting Room
Date: 03 June 2011
Presented by: Joel Conkle, Nutrition Specialist
UNICEF
Complementary Feeding
Campaign
Campaign has not started officially.
Interpersonal communication
ongoing and reaching out to mass
media to deliver messages
Official mass media materials
currently in-development
07-Jul-11
2
07-Jul-11
3
Thank you !!
2nd FSN Bulletin
Officially disseminated via the
internet and through the Food
Security Forum
Available online at
http://www.foodsecurity.gov.kh/
Analytical work presented to UN
Country Team, Health Partners,
and NGO’s associated with
MEDICAM
07-Jul-11
4
Focus on rainfall, harvest, prices,
and anthropometric indicators
Current efforts to include wages
and prices of additional food items
Concepts further
disseminated via
print media
07-Jul-11
5
Thank you !!
Annex 3
Presentation of Food Security Nutrition Media Hand Book for Journalists
Version 2Version 2 Food Security and Nutrition Food Security and Nutrition
A Guide for JournalistsA Guide for JournalistsPrepared by Prepared by
UNESCOUNESCO
Publication DevelopmentPublication Development
• Resource for Journalists who want to learn about FSN
• Encourage proactive reporting of positive news stories
• Raise awareness on media’s role through information and education
• Promote communication through media about FSN
• Promote social and behavior change through accurate and comprehensive news
Purpose of the media handbook
Background of the HandbookBackground of the Handbook
Mass media play a crucial role in disseminating Mass media play a crucial role in disseminating information and creating awareness on issues to information and creating awareness on issues to food security and nutrition.food security and nutrition.
The media have an obligation to cover those The media have an obligation to cover those topics, journalists should take the initiative to topics, journalists should take the initiative to report accurate and upreport accurate and up--toto--date news and storiesdate news and stories
Media tend to focus more on issues on disaster Media tend to focus more on issues on disaster or population growthor population growth
Target BeneficiariesTarget BeneficiariesDirect beneficiaries:Direct beneficiaries:-- Journalists and all Journalists and all
persons involved in persons involved in mediamedia
InIn--direct:direct:-- Government Government
agencies/dept., agencies/dept., development partners, development partners, local NGOs.local NGOs.
Contents of Handbook Version 2Contents of Handbook Version 2
Part I: Understanding the Part I: Understanding the Basics of Food Security Basics of Food Security and Nutrition and Nutrition
Part II: Food Security and Part II: Food Security and Nutrition in CambodiaNutrition in Cambodia
Part III: The Role of the Part III: The Role of the Media Media
Part IV: Reporting and Part IV: Reporting and Writing News on Food Writing News on Food Security and NutritionSecurity and Nutrition
Part V: Feature ArticlesPart V: Feature Articles
Part VII: CambodiaPart VII: Cambodia’’s s First Media Training First Media Training Workshop on Food Workshop on Food Security and NutritionSecurity and Nutrition
Part VIII: Further Part VIII: Further ResourcesResources
FollowFollow--up to Final Version 3up to Final Version 3
• Recommendations from MDGs JP programme officers
Deadlines:• Receive comments by July 1, 2011• Submission of Final Draft by Aug.
31, 2011
THANK YOU.THANK YOU.
Annex 4
Agenda of the PMC meeting
Programme Management Committee Meeting
FAO Meeting Room Date: June 03rd, 2011
Time: 2.30 pm – 05.00 pm
Proposed Agenda
1- Welcome and introductory remarks (15 min) Co-chairs 2- Self-introduction of the PMC members (15 min) All
3- Update on implementation progress (15 min) NPC
4- Presentation of complementary feeding campaign (15 min) UNICEF 5- Presentation of 2nd quarterly FSN bulletin (15 min) UNICEF
6- Presentation draft media guide hand book` (15 min) UNESCO
7- Presentation on individual story of a child on sprinkle (15 min) PPC Svay Reing
8- Presentation on individual story of a child
under CMAM treatment in Kampong Speu (15 min) PPC Kg. Speu
9- Closure remarks (15 min) Co-chairs
Proposed documents distribute during the PMC meeting:
1. Minute of PMC meeting in December 2010 2. Report on the assessment of the initial implementation of Management of Acute Malnutrition in Kampong Speu Province 3. Report on the maternity protection study of ILO 4. Drafted food security media guide
Annex 5
List of participants
List of Participants for PMC Meeting, 03 June 2011
No Name Position/Organization
1 H.E. Srun Darith Deputy Secretary General , Co-chair of PMC Council for Agricultural and Rural Development (CARD)
2 H.E. Mr. Douglas Broderick UN Resident Coordinator, Co-chair of PMC Office of the UN Resident Coordinator
3 Ms. Ann Lund Senior UN Coordination Specialist Office of the UN Resident Coordinator
4 Mr. Juan Pita AECID General Coordinator Spanish International Cooperation Agency (AECID)
5 Ms. Mercedes San Roman Ruiz Coordination Officer Office of the UN Resident Coordinator
6 Mr. Nuth Sophon Deputy Director of Child Labor Department Ministry of Labor and Vocational Training (MoLVT)
7 H.E. Prof. Sea Huong Under Secretary of State Ministry of Health (MoH)
8 Mr. Puth Samith Deputy Director General for Education Ministry of Education, Youth and Sport (MoEYS)
9 Ms. Viorica Berdaga Head of Child Survival Unit United Nation Children’s Fund (UNICEF)
10 Mr. Joel Conkle Nutrition Specialist United Nation Children’s Fund (UNICEF)
11 Ms. La-Ong Tokmoh Technical Officer Nutrition World Health Organization (WHO)
12 Mr. Luc Hieu FAO-Project Coordinator Food and Agricultural Organization (FAO)
13 Mr. Chea Sophal National Project Coordinator International Labour Organization (ILO)
14 Ms. Heng Mory National Programme Officer The United Nations World Food Programme (WFP)
15 Ms. Sun Lei Head of Education Unit United Nations Educational Scientific and Cultural Organization (UNESCO)
16 Ms. Marina Oro Programme Coordinator United Nations Educational Scientific and Cultural Organization (UNESCO)
17 Ms. Tith Daravy Programme Assistant United Nations Educational Scientific and Cultural Organization (UNESCO)
18 Mr. Ung Kim Heang National Programme Coordinator Joint Programme for Children, Food Security and Nutrition
19 Mr. Ros Theoun Provincial Programme Coordinator-Kampong Speu Province Joint Programme for Children, Food Security and Nutrition
20 Mr. Savun Sam Ol Provincial Programme Coordinator-Svay Reing Province Joint Programme for Children, Food Security and Nutrition