updates on msnp
DESCRIPTION
Updates on MSNP, SUN/REACH , Initiatives and MYCNISA Saba Mebrahtu , PhD Nutrition Section Chief UNICEF Nepal Nutrition Central Level Advocacy Grand Hotel, Soalteemode , Kalimati Kathmandu, Nepal 15 July 2012. UPDATES ON MSNP. - PowerPoint PPT PresentationTRANSCRIPT
Updates on MSNP, SUN/REACH, Initiatives and MYCNISA
Saba Mebrahtu, PhDNutrition Section Chief
UNICEF Nepal
Nutrition Central Level AdvocacyGrand Hotel, Soalteemode, Kalimati
Kathmandu, Nepal15 July 2012
UPDATES ON MSNP
Nutrition Assessment and Gap Analysis (2009-2010)
Build the National “Nutrition Architecture”
(2011-2012):
• Identified strengths, weaknesses, and gaps;
• Need for a national nutrition architecture; and
• A multi-sectoral approach through an agreed nutrition determinants model.
• NPC led High Level Nutrition and Food Security Steering Committee chaired by the Vice Chair of the NPC in place and National Nutrition and Food Security Coordination Committee;
• Technical working group to guide multi-sectoral nutrition review, and planning; and
• Nutrition and Food Secretariat being established at the NPC – with links to NNC of the MoHP and MoAD
Nutrition Multi-Sectoral Reviews: A consultative
Process (2011)
Costed Multi-sectoral Nutrition Plan: Approved
by the Cabinet (2012)• Nutrition reviews by sector:
Health; Agriculture, Education, Physical Planning and Works, and Local development
• Defined scope: Global and national evidences for ‘what works’: essential nutrition specific interventions through the Health sector & nutrition sensitive interventions through other sectors
• Systematic consultation: through Reference Group Meetings by sector at key stages and All Reference Group Meetings to identify the cross-sectoral linkages
Clear leadership: the NPC and actively involving health & other key sectors
Focused: the first 1,000 days of life and stunting reduction
Addressing the immediate, underlying and basic factors:
• women and children’s access to health and nutrition;
• safe water & sanitation; and • education and inequity.
Emphasis on decentralized implementation: initially in selected districts (2013-2014)
Vision to gradually scale up: to all other districts by 2017 (A new approach: learning by doing)
Stunting is preventable : BUT Need to act before the child is 2 years
Source: Victora et al 2010
The Critical “Window of Opportunity”: 1000 DAYS
Pregnancy: 9*30= 270 days2 years: 365*2=730 days
6
Growth and muscle massBody composition
Metabolic Syndrome:programming of metabolism
of glucose, lipids, protein Hormone/receptor/gene
Brain development
Cognitive andeducational performance
ImmunityWork Capacity
Diabetes, ObesityHeart DiseaseHigh blood pressureCancer, stroke, and ageing
Poor nutrition in uterus and early childhood
(STUNTING)
Short term Long term
Death
LIFE COURSE CONSEQUENCES OF POOR MATERNAL AND CHILD UNDERNUTRITION (MCU)
(James et al 2000)
NEPAL IS ON TRACK TO REACH MDG4: REDUCING CHILD MORTALITY
BUT, without Improvement in Stunting, further Child Mortality Reduction is very unlikely
153
118
91
54
10279
6448 46
3445.9 50
39 3315
5461
330
40
80
120
160
200
1991 1996 2001 2006 2011 2015MDG
U5MR IMR NMR
Mortality Trend and MDG Goal(Under 5, Infant and Neonatal)
Diarrhoea12%
Other29%
Pneumonia20%
Malaria8%
Measles5%HIV/AIDS
4%
Perinatal22%
Deaths associated with under-nutrition
At - min 35%
Sources:EIP/WHO. Black et al, 2008. The Lancet Series on Maternal and Child Under-nutrition.
Improved Nutrition, especially micronutrients has contributed
Stunting Remains High and Wasting Stagnant
Source: NDHS 2011
NDHS 2001 NDHS 2006 NDHS 2011 MDG Target 20150
10
20
30
40
50
6057
4941
28
4339
2927
11 13 115
Stunting Underweight Wasting
Perc
ent
• 18.2 per cent women are with a BMI <18.5• 12.4 percent babies are LBW (<2500 grams)
Stunting Remains High and Wasting Stagnant
Source: NDHS 2011
NDHS 2001 NDHS 2006 NDHS 2011 MDG Target 20150
10
20
30
40
50
6057
4941
28
4339
2927
11 13 115
Stunting Underweight Wasting
Perc
ent
• 18.2 per cent women are with a BMI <18.5• 12.4 percent babies are LBW (<2500 grams)
Nepal Numbers of Children Affected by Chronic and Acute Under-nutrition
• With a current under five population of 3.5 million, some 1.61 million children are suffering from stunting – The long-term consequences of stunting, include
slower cognitive and mental development, educability and economic potential cannot be overestimated.
• Similarly, some 585,000 children under five years of age are suffering from wasting – Consequences include heightened risk of morbidity
and mortality
11
Cognitive function is benefitted across the life course, and optimal birth weight is above the mean
-0.35
-0.30
-0.25
-0.20
-0.15
-0.10
-0.05
0.00
0.05
0.10
0.15
8 11 15 26
<2.52.5-33-3.53.5-44.0-5.0
Birth weight
Years of age
Cognitive Function score (relative to 3-3.5kg)
(kg)
Richards, M. Et al. 2001 Birth weight and cognitive function in the British 1946 birth cohort: longitudinal population based study. BMJ. 322:199-203
OPTIMAL WEIGHT
12
Declining Prevalence of StuntingAsian Refugee Children in the U.S.
Stunting = height-for-age < 5th percentile of Ref
Yip & Mei, 1996
13
Poor maternal nutrient status
Inadequate IYC* Growth
Inadequate Foetal Growth
Poor IYC nutrient status
IYC infections
Poor IYC nutrient intake
Maternal Infections
Poor maternal nutrient intake
Poor medical and environmental health services
Inadequate Household Food Security
Poor maternal and child caring practices
CHILD STUNTING
IMMEDIATE CAUSES
UNDERLYING CAUSES
BASIC CAUSES: Resources, Institutions, Education, Infrastructure, Cultural Practices
Require MSN Approach To Tackle Stunting Sustainably
50% 50%
* IYC = Infant and young child
Nutrition Specific
Nutrition Sensitive
Multi-sectoral Operational Linkages & Accountabilities
Child growthfailure/ death
Low Birthweightbaby
Low weight & height in teenagersEarly pregnancy
Small adultwoman
Small adult man
The intergenerational transmission of growth failure: When to intervene in the life cycle
SO 2. Ministry of Health and Population
R 2.1 MIYC micronutrient status improved
R 2.2 MIYC feeding improved
R 2.3 SAM better managed
R 2.4 Diarrhoea adequately treated
SO 4. Ministry of Education
• R 3.1 Adolescent girl’s awareness and behaviours in relation to protecting foetal, infant and young child growth improved
• R 3.2 Parents better informed with regard to avoiding growth faltering
• R 3.3 Nutritional status of adolescent girls improved
• R 3.4 Primary and secondary school completion rates for girls increased
SO 5. Ministry Local Development/ Social Protection
R 4.1 Nutritional content of local development plans better articulated
R 4.2 Collaboration between local bodies’ health, agriculture, and education sector strengthened at DDC and VDC level
R 4.3 Social transfer programmes corroborated for reducing chronic under nutrition
R 4.4 Local resources increasingly mobilized to accelerate the reduction of MCU
SO 6. Ministry of Agriculture and Cooperatives
R4.1 Increased availability of animal foods at the household level
R 4.2 Increased income amongst young mothers and adolescent girls from lowest wealth quintile
R 4.3 Increased consumption of animal foods by adolescent girls, young mothers and young children
R 4.4 Reduced workload of women and better home and work environment
Strategic Objective (SO) 1. National Planning Commission
Result (R) 1.1. Multi-sectoral commitment and resources for nutrition are increased
R 1.2. Nutritional information management and data analysis strengthened
R 1.3 Nutrition capacity of implementing agencies is strengthened
SO 3. Ministry of Physical Planning and Works
R3.1 All young mothers and adolescent girls use improved sanitation facilities
R 3.2 All young mothers and adolescent girls use soap to wash hands
R 3.3 All young mothers and adolescent girls as well as children under 2 use treated drinking water
Ongoing Activities to Prepare the Grounds for MSNP district level implementation
1. MNIS review and a strategic plan to strengthen the existing system, ongoing 2012
NPCPMAS
MoACAIS
MoPWNMIP
MoEEMIS
MoHPHMIS MoLD
DEO• 100s Resource
Centers• 1000s schools
DHO• 1000s facilities
NeKSAP DSFN• (make IPC
Class)DADO
• 100s Service Centers
DoWS• Village Wat/san
committees
DDC-DPMAS
CENTRAL
DISTRICT
80 Impact indicators
2. Nutrition capacity assessment and a strategic plan, ongoing 2012
• Comprehensive mapping of community workers across the key sectors involved in the MSNP: – Health – Agriculture – Education– WASH– Local Development
• Review of individual, organization and institutional capacities – and identify the gaps– Review of Job descriptions– Training curriculum– Supervision and mentoring mechanisms– Reporting mechanisms – Policy and legal systems
3. Operational Guidelines, Materials and Tools for Modelling of MSNP in Six Districts of Nepal, 2012-2014
REACH ENDING CHILD HUNGER AND UNDERNUTRITION
NEPAL FOOD SECURITY ENHANCEMENT PROJECT
NHSP II
NEPAL WASH MASTER PLAN &
MULTI-SECTORAL ECD PLAN
NEPALFar-WesternRegion
Mid-Western Region
Western Region
Central Region
Eastern Region
Initial MSNP Roll-Out Districts
DOLPA
MUGU
JUMLA
KAILALI
BARDIYA
HUMLA
DOTI
SURKHET
NAWALPARASI
KAPIL-BASTU RUPAN-
DEHI
DANG
BANKE
ACHHAMKALIKOT
JHAPAMORANG
SIRAHA
SAPTARI
DARCHULA
BAJHANG
BAITADI
DADEL-DHURA
KANCHAN-PUR
BAJURA
PARSABARA
RAUT-AHAT
DHANUSA
MAHO-TARI
SUNSARI
SARLAHI
DHADING
MAKAWAN-PUR
CHITWAN
KASKIBAG LUNG
TANAHU
PALPA
SYANGJA
PARBAT
ARGHAKHACHI
GULMI
UDAYAPUR
SINDHULI
ILAM
BHOJ-PUR PA CH E THA R
DHAN-KUTA
TAPLEJUNG
RAME CHHAP
OKHAL-DHUNGA
TERHA-THUM
KHOTANG
LALIT
BHAKKATHM SULUK-
HUMBU
DOLAKHA
SANKHUWA-SABA
NUWAKOTSINDHU-PALCHOK
KAVRE
RASUWALAMJUNG
GORKHA
PYUT-HAN
ROLPASALYANMYAGDI
DAILEKHJAJARKOT
RUKUM
MUSTANG
MANANG
Summary of Ongoing Nutrition Actions in the Proposed MSNP Initial Districts
Districts Development Region Geographical Focus Level
Nutrition Related Actions
Bajura
Achhaam
Jumla
Parsa
Kapilvastu
Nawalparasi
FW Hills
MFW Hills
MW Mountains
Central Terrai
Western- Terrai
Western- Terrai
A
A
A
A
B
B
CFLG, Suaahara, FtF, WB/NASP,HKI/Homestead food production,
CFLG, UNICEF IYCF/MNPs, CMAM, FtF, WB NASP,
CFLG, UNICEF/ADB IYCF/CG, MI/UNICEF VAS, USAID FtF, WB NASP, SCF/UNICEF GM
CFLG, UNICEF IYCF/MNPs, ECD, Health
CFLG, UNICEF IYCF/MNP, CMAM, WASH, ECD, Health, FtF
CFLG, Suaahara, WASH, Health, ECD
Work Plan: Six Model Districts • Sensitization of key stakeholders at the regional, district and
community levels on MSNP - ongoing• Baseline impact evaluation – prepwork ongoing • Detailed Operational Guideline – July 2012
– MSN Monitoring and reporting formats– MSN Supervisory mechanisms and checklists
• Training materials and tools (REACH/WB) for community workers - August/September 2012– District MSN profiles– VDC mapping of nutrition situation, activities & stakeholders (inventory) – Existing resources and gaps (mobilization to meet these)– MSN database management (DPMAS)– Verification survey guideline (every six months – as part of national MN)– MSNP adoption to the district context– MIYCN integrated package (nutrition sepecific interventions)– Package of nutrition sensitive interventions (Education, WASH, Agriculture,
Local Development/Social Protection)• Process evaluation – August/September 2013• Endline impact evaluation – 2014
SUN/REACH INITIATIVES
The Goal of SUN
“To reduce hunger and under-nutrition and contribute to the realization of all the Millennium Development Goals, with particular emphasis on MDG 1 - halving poverty and hunger by the year
2015”
.
The SUN Framework calls for scaling up efforts against under-nutrition in a coordinated multi-stakeholder approach
– human rights focus as a basis for economic, social and human development, and on addressing food and nutrition security within that framework
– abundant evidence on the impact of under-nutrition on infant and young child mortality and its largely irreversible long-term effects on intellectual, physical and social development as well as on health
– recognition of a series of well-tested and low-cost interventions can protect the nutrition of vulnerable individuals and communities and benefit millions of individuals if incorporated into agriculture, social protection, health and educational programmes
1
3
June 2010
endorsed by 100+ organizations
...basis for action
2
The SUN framework identifies two complementary ways of reducing under-nutrition:
(a) direct, nutrition-specific interventions: have nutritional improvement as the primary goal and should be accessible to all individuals and their households, especially in pregnancy, in the first two years of life and at times of illness or distress
(b) a multisectoral approach aimed at promoting adequate nutrition as the goal of national development policies in agriculture, food supply, social protection, WASH, health and education programmes.
The focus:• Increased resource
mobilization through advocacy & innovative financing mechanisms
• Better alignment of donors' investments with national priorities
• Countries to identify their capacity development needs to extend nutrition interventions
• Plans need to be costed, including financial resources for capacity development, strengthening the delivery of services
• Expected benefits should be quantified
The SUN Movement SUN Countries: As of April 2012 the following countries have committed to Scaling up Nutrition:
1. Bangladesh, 2. Benin,
3. Burkina Faso, 4. Ethiopia, 5. Gambia, 6. Ghana,
7. Guatemala, 8. Indonesia,
9. Kyrgyz Republic,10. Laos PDR,
11. Madagascar,12. Malawi,
13. Mali, 14. Mauritania,
15. Mozambique, 16. Namibia,
17. Nepal,18. Niger,
19. Nigeria 20. Peru
21. Rwanda 22. Senegal
23. Sierra Leone24. Tanzania 25. Uganda 26. Zambia
27. Zimbabwe
The Scale Up Nutrition Movement (SUN) was initiated in September 2010 – NY UN Assembly.
The SUN Movement focuses on the 1000 day window of opportunity between the start of pregnancy and the child’s second birthday. Stakeholders in the Movement are increasing the resources made available to SUN countries and better aligning their financial and technical support to national nutrition priorities, momentum increased in the last months with 27 countries having made commitment to scale up nutrition. The UN Secretary General appointed a high-level, multi-stakeholder Lead Group to provide overall strategic leadership of the SUN Movement. A SUN Movement Secretariat, with budget is estimated at around $3.5million/year
http://www.scalingupnutrition.org/key-documents/
The SUN Movement Stewardship Arrangements SUN Countries THE SUN LEAD GROUP1. Mr. Armando Emílio
GuebuzaPresident of Mozambique
1. Mr. Jakaya Mrisho Kikwete President of Tanzania1. Ms. Sheikh Hasina Prime Minister of Bangladesh1. Mr. Nahas Angula Prime Minister of Namibia 1. Mr. Babu Ram Bhattarai Prime Minister of Nepal 1. Ms. Ngozi Okonjo-Iweala Minister of Finance of Nigeria1. Ms. Nina Sardjunani Deputy Minister of Development Planning of
Indonesia1. Ms. Nadine Heredia First Lady of Peru
Donors
1. Ms. Beverly Oda Minister of International Cooperation, Canada1. Mr. Andris Piebalgs Commissioner for Development Cooperation, EC1. Mr. Bruno Le Maire Minister of Food, Agriculture and Fishing, France1. Mr. Rajiv Shah Administrator, US Agency for International
Development
Civil Society Organizations 1. Mr. Fazle Hasan Abed Founder and Chairperson, BRAC1. Mr. Tom Arnold Chief Executive Officer, Concern Worldwide1. Ms. Marie Pierre Allié President, Médecins Sans Frontières France
Business
1. Ms. Vinita Bali Managing Director, Britannia Industries1. Mr. Paul Polman Chief Executive Officer, Unilever
International Organizations1. Ms. Ertharin Cousin Executive Director, World Food Programme and
Representative of the United Nations Standing Committee on Nutrition
1. Ms. Tamar Manuelyan Atinc
Vice President, Human Development, The World Bank
Foundations and Alliances1. Mr. Chris Elias President, Global Development, Bill & Melinda Gates
Foundation1. Mr. Jay Naidoo Chair of the Board, Global Alliance for Improved
Nutrition1. Ms. Mary Robinson Chair, Mary Robinson Foundation - Climate Justice
SUN Movement
1. Mr. Anthony Lake Chair, Scaling Up Nutrition Movement Lead Group and Executive Director, UNICEF
1. Mr. David Nabarro Coordinator, Scaling Up Nutrition Movement, and Special Representative of the Secretary-General for Food Security and Nutrition
[1] At 4 April 2012[2] Effective 5 April 2012
From Mobilization to Results: Priorities for the Movement and future areas of focus for the Lead Group
• Focus on work to be undertaken before the next meeting of the Lead Group (in late September 2012).
• Take part in the development of an updated Strategy (revised Road Map) for the SUN Movement. These will include ways to ensure that results are monitored and analyzed, that advocacy around the results is intensified, and that the Lead Group continues to facilitate the growth of the Movement driven by SUN countries.
Lead Group Members were invited to form sub-groups to work on six key areas: 1. Best practices, and which interventions have greatest potential to leverage results; 2. Gathering evidence of the cost-effectiveness of scaling up nutrition; 3. Tracking financing and investments in nutrition to identify key resource gaps; 4. Building a robust results and accountability framework, based on clear indicators and
targets (e.g. MDGs, post-2015 goals and the World Health Assembly); 5. Articulating the importance of empowering women to be at the centre of policies
and actions to Scale Up Nutrition; 6. Improved advocacy and mobilization of national and international resources for
nutrition (NEPAL).
Nepal’s SUN Architecture • The Honorable Member of the NPC, (Social Sector) acts as the chair of the National
Nutrition and Food Security Coordination Committee. This coordination committee will act as a country coordination mechanism for SUN Initiative under the NPC leadership.
• The SUN Country Focal Point is the Secretary, Ministry of Health (MOHP). MOHP will contribute towards the technical aspects.
• NPC, MoHP, and MOFA took part in the UN SUN tele-conference on Thursday 14 June 2012 at 12:45 KTM time, on the thematic area: Improved advocacy and mobilization of national and international resources for nutrition.
• Teleconference on 5 July at 14:15 KTM time involving MoHP and NPC: Country SUN progress report – prepared through consultative process and submitted on 15 July by the MoHP.
• NPC, MOHP with multi-stakeholders consultations will identify personnel for The Selected Thematic Task Team, to contribute to the SUN Strategy development plus continued consultation to finalize SUN Country Progress Report required for September 2012 UN Meeting.
From Mobilization to Results: Priorities for the Movement and future areas of focus for the Lead Group
• Under the guidance of the SUN Movement Lead Group Chair, the Secretariat and its Networks will support Lead Group members as they establish the elements of a SUN Movement Strategy (revised Road Map).
• The Strategy will be debated and finalized in the next Lead Group meeting in New York over a half-day in the week starting 24 September.
• The meeting will focus on substantive issues, on action items and on measuring the impact of the Movement.
• Coordinated advocacy to maintain the focus on scaling up nutrition remains a priority .
• To help sustain this momentum, and to showcase the impact of the Movement, Canada has offered to co-host a SUN side event at the UN General Assembly in September 2012.
REACH partnership aims to accelerate reduction in child undernutrition
• REACH approach developed and facilitated globally by Inter-Agency team hosted by WFP in Rome
• Global REACH coordinator by rotation from the four agencies
Initiating Partners Further Participating Partners
Other UN agencies: IFAD, SCN, WBGovernments:• Mauritania, Lao PDR, Sierra Leone,
Bangladesh, Nepal, Mozambique, Rwanda, Uganda, Mali, Ghana
• NGOs & Civil society: • SC, WVI, Rotary, HKI, GAIN, MI, ACF,
CRSAcademia:• Tufts, Wageningen, Cornell, Tulane,
George Washington, John Hopkins University
Donors:• ECHO, DFID, Bill & Melinda Gates
Foundation, USAID,++Private sector:• The Boston Consulting Group
The team
Ending 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
Outcomes4. Increased efficiency and accountability
2. Strengthened national policies and programmes
3. Increased capacity at all levels for action
1. Increased awareness of the problem and of potential solutions
Communications and advocacyFinancing and
resource mobilization
Country action planning and coordinationto support national capacity to scale up evidence-based solutions
Knowledge-sharing
Action areas
REACH focuses on scaling-up nutrition (SUN) actions
The REACH Facilitator(s): ‘Embodiment’ of REACH in-country
• The REACH Facilitator serves as a catalyst for scaling up agreed essential nutrition actions with quality and capacity to sustain
• REACH facilitator profile:• - Inclusive, Participatory development practitioner• - Change management skills• - Excellent communication skills• - Knowledge of good nutrition programming practices
• Position of the REACH Facilitator(s) strategically within: • Government structures – e.g. at the NPC in Nepal• Partnerships (NGOs, Private sector, Donors, Academia)• The UN System
Nepal Update: International facilitator expected in mid September and national facilitator in mid August – interim support between mid July to 10th August
Proposed REACH Nepal Work Plan, 2012-2014No Outcome Output
1 Increased awareness of the problem and of potential solutions
1.1 Multi-sectoral nutrition & multi-stakeholder activities maps developed (national and district level – MSNP districts)
1.2 MSNP districts priority nutrition actions for expected results identified
1.3 Investment case developed using harmonized one budget tool (MBB, REACH)
1.4 Joint communications and advocacy strategy developed and implemented in the priority districts
2 Strengthened national policies and programs
2.1 Nutrition is fully integrated in national and UN development strategies
2.2 National Nutrition Policy and Strategy of the MoHP is updated in line with the MSNP
2.3 Multi-sector National Nutrition is fully integrated into sectoral action plans based on reviews using nutrition lens
2.4 Priority MSN priority actions are fully integrated into relevant sub-national development plans in the MSN districts
3 Increased capacity at all levels for action
3.1 Multi-sector nutrition coordination mechanisms at national and sub-national level are fully established and functional
3.2 Institutional and human capacity for MSN in government (relevant ministries, regional and district level) are strengthened
3.3 Capacity for MSN action at community level is strengthened
3.4 MSN good programming practices are documented and shared through MSN district exchange-visits and via the web
4 Increased efficiency and accountability
4.1 MSN responsibilities and accountability matrix for nutrition security at national and district levels is available
4.2 MSN monitoring system and linkages to accountability in place and is used for program policy decisions
4.3 Government and REACH UN partner agencies nutrition commitments, including budgetary allocations are consolidated and reviewed to ensure compliance
4.4 MSN is established as a key area for the UN delivering as one
MYCNSIA IN NEPAL
Outline of MYCNSIA Contribution to Nutrition in Nepal: 2011- Q2 of 2012
• Pillar 1: – High level advocacy to at the PM level to raise nutrition in the national development agenda– Technical assistance to streamline nutrition governance under the lead of the NPC and involving all the key Ministries– Support development of evidence based MSNP + Operational guidelines, MNIS review and MSN capacity needs
assessment – Support to NUTEC - development of national comprehensive IYCF strategy and costed plan, maternal nutrition
strategy and costed plan – with an overarching strategy framework on MYCN integrated and harmonized package – Support NNC establishment– Partnership and coordination – NNG, FSWG, EDPs, SUN/REACH, Nutrition cluster, Nutrition and Food Security Steering
and Coordination Committees, and Secretariat, Reference Groups. • Pillar 2:
– Community training related to key interventions – IYCF/MNPs and CMAM/NiE– Plans to undertake nutrition capacity needs assessment - in collaboration with the Bank and the RO, and on this basis
comprehensive CB with a focus on the community level• Pillar 3:
– IYCF/MNPs internal process monitoring, external coverage surveys three and fifteen-month – final draft report– CMAM evaluation – phase one formative, and phase two – impact evaluation– Plans for implementing IYCF/MNPs baseline survey– Initiated MNIS Review – as the basis for developing a strategy and costed plan to strengthen the existing system with
links to existing early warning systems – NeKSAP, IPC • Pillar 4:
– IYCF/MNPs pilot in six districts completed, with MoHP policy decision to expand in additional nine– CMAM pilot in five districts completed, plans ongoing to expand in five districts– IYCF/CCG in five districts, with process monitoring and evaluation design – MSNP: Identification of initial 6 districts to model MSNP, with a plan to gradually scale-up (learning by doing)– IFA with de-worming to adolescent girls integrated with the school health and nutrition strategy / FHD
• Advocacy events held at national and district level to maintain commitment for multi-sector program (E.1)
• BCC Strategy and Plan of Action harmonized with community MIYCN (E.2)
E. B
CC
INPUTS PROJECT COMPONENTS / ACTIVITIES (A-E) OUTPUTS (O) OUTCOMES (T) IMPACTS (I)
Effective Project Management & Monitoring and Evaluation
• Refresher training and supervision provided to all health workers (O.10)
• Functional multi-sector coordination in place at District level (O.11 )
• Nutrition focal points from all sectors in place at district level and oriented in multi-sector approach (O.12 )
• Data available and used from surveys - baseline, endline, coverage surveys, etc. (O.13 )
IYCF (Breastfeeding)• Early Initiation of BF (T.1)• Exclusive breastfeeding
under 6 months (T.2)• Continued breastfeeding
to 1 year (T.3)• Continued breastfeeding
to 2 years (T.4)
Results Area 1: Upstream Policy• Comprehensive National MSNP Costed Plan of
Action developed (A.1)• National coordinating mechanism established
for multi-sector nutrition program -MSNP (A.2)• Commitment to allocate budget and ensure
implementation of MSNP (A.3)• Protocol established for nutrition profiles (as
basis for planning) at district level (A.4)• Comprehensive MIYCN strategy and costed
plan developed (A.5)
A. P
OLI
CIES
AN
D PL
ANS
• Guidelines developed for implementation of integrated MIYCN , including counselling as part of Cash grants and CMAM in target districts (O.1)
• Costed plan for National MSNP endorsed (O.2)
• Multi-sector nutrition profiles developed at district level (O.3)
• Commitment at district level to support MSNP with resources allocated (O.4)
• District-level MSNP plans in place (O.5)
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• Planned advocacy events held (O.14)
• Planned media implemented (O.15)• Targeted caregivers reached with
mass messages on MIYCN/MNP, linked with hygiene, CMAM and cash grant interventions (O.16)
MIYCN Services• Coverage of IYCF
counselling increased among mothers and children (O.17)
• MoH delivery system functions effectively and adequate supply (MNP/IFA/RUTF) is available where expected and needed (O.18)
• MIYCN Focal points, providers & volunteers have knowledge to adequately distribute MNP, deliver MIYCN with mothers & caretakers (O.19)
• Mothers & caretakers know, demand, accept, & have ability to appropriately use MIYCN services (O.20)
CMAM Services• Health workers know how
to identify and treat children with SAM in target districts (O.21)
• Qualified children enrolled and treated in CMAM program(O.22 )
Complementary Services• Place for Hand washing
(O.23)• Availability of soap
(O.24)• Safe disposal of faeces
(O.25)• Hand washing/ hygiene
coverage, knowledge of caregivers of U2’s (O.26)
• Qualified HHs enrolled in cash grant program (O.27)
• Reduction in Stunting in children 0-23.9 months (I.1)
• Reduction in Anaemia in children 6-23.9 months (I.2)
Policies, Production, Delivery, Quality & Behaviour Change Communication
C. S
ERVI
CE D
ELIV
ERY
Results Area 2: Capacity Building• Development of ToRs for nutrition focal points
from all sectors at district level (C.1)• District-capacity enhanced to guide
preparation of profiles, plans and implementation (C.2 )
• Key stakeholders and service providers sensitized and trained on MIYCN (C.3)
• Provide IYCF counselling as part of CMAM program in ten districts (C.4 )
• Provide IYCF counselling as part of MNPs (C5) • Provide IYCF counselling as part of child cash
grants in target districts (C.6 )
D. Q
UALI
TY
Results Area 3: Data and Knowledge Sharing• Refresher training and Supervision provided at
all levels of MIYCN implementation (D.1)• Data available to monitor coverage of MIYCN
interventions (D.2)• Data available to evaluate impact of MIYCN
interventions (D.3)• Capacity enhanced for M&E (D.4)
IYCF(Complementary feeding)• Introduction of solid, semi-
solid and soft foods, 6-8 months (T.5)
• Minimum dietary diversity, 6-23.9 months (T.6)
• Minimum meal frequency 6-23.9 months (T.7)
• Minimum acceptable diet, 6-23.9 months (T.8)
• Consumption of iron-rich (or iron-fortified) foods, 6-23.9 months (T.9)
Access & Coverage / Knowledge & Appropriate Use Impact on intake, status and function
• Consolidated MIYCN training materials adapted and rolled-out (O.6)
• Nutrition (ANC) integrated with Family Health Division (O.7)
• Supply and recording systems for MIYCN/CMAM products (O.8)
• Timely and adequate supply of MIYCN/CMAM products(O.9)
B. P
RODU
CTIO
N
& S
UPP
LY
• Training packages (Facility ANC Package) revised for MIYCN to guide training across sectors (B.1 )
• Procurement management system in place for MIYCN/CMAM products, e.g. MNP, IFA, RUTF (B.2)
Logic Model for Nepal
• Reduction in Anaemia in women and adolescent girls - select districts (I.3)
Improved Iron/MN Intake/Deworming• Coverage of IFAs among
adolescent girls, women (T.10)
• Utilization of IFAs among adolescent girls/women (T.11)
• MNP coverage of children 6-23.9 months (T.12)
• MNP utilization of children 6-23.9 months (T.13)
• VAS coverage of children (T.14)
• Deworming coverage of different age groups (T.15)
Priority MYCNISIA Supported Interventions for 2012
Scale-up Community IYCF Integrated with MNPs in Nine Districts
Scale Up Community Management Of Acute
Malnutrition (CMAM/IMAM) in Five Districts
Pilot IYCF promotion linked with Child Grant (IYCF/CG) in Karnali
MODEL MULTI-SECTORAL NUTRITION PLAN IN SIX DISTRICTS
Under the lead of the National Planning Commission (NPC) and involving 5 key sectors – MoHP, MoAC, MoE, MoLD, and MPPW
Lead Technical Support: UNICEF, funded by the EU in close collaboration with the World Bank, HKI, and WFP
Thank You