Areas of interventions in National
Nutrition Services (NNS)
By
Dr Mustafiz Rahman PPC, MoHFW
Training 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.
2.
3.
4.
5.
Stunting
Under weight
wasting
Protein Energy Malnutrition
Iron deficiency Anemia, Iodine deficiency
disorders
6. Vitamin A deficiency, zinc deficiency etc.
7. Low Birth Weight
8. Over nutrition & its complications (diet related
Non- communicable Diseases-NCD)
Children
Under Two
Adolescent Girls
13-19 yrs
Services
Through
Life-cycle
Lactating
Mothers
In BINP/NNP
Newly Wed
Women
Pregnant
Women
NNS would follow life-cycle approach in community service
Lactating
Women
Post-partum Care
Vitamin A
iron folate
Referral
Forums
Adolescent boys
Mother in law
Father in law
Husband
of
newly
and
pregnant women
Under 2
Children
Growth Monitoring
Care for LBW
FoodSupplementtionVi
tamin A
Referral
Household Survey
followed by update
Home visit
BCC
Training
Pregnant
Women
Weight Monitoring
Iron Folate
Antenatal care
Iron Folate
Food supplementation
Counseling
Referral
Services
perform
by a CNP
at CNC
Newly wed
Couple
Nutrition
Assessment
Counseling
IronFolate
Food Security Components
Nutrition Garden
Poultry for Nutrition
VGD-NNP Collaboration
Adolescent
Girls/boys
Monthly Forum
Nutrition Assessment
IronFolate
De-worming
Weight promotion
IGA, Fruits tree
plantation
Job Analysis of Front Line Workers in HNPSP Comparative Matrix
Family Welfare
Assistant (FWA) for
>5000 population






Eligible couple
registration
Family
planning
counseling
Non-clinical
contraceptive
distribution &
FU
Referral for
ANC
Support
during
NID & Vit A
week
Community Nutrition Promoter
(CNP) for 1250 population









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
Health Assistant (HA)
for >5000 population
Services in CC

HPN Services






Geographical
reconnaissance
EPI
Disease
surveillance
Health education
Epidemic control
NID & Vit A week
Other
ministries/
NGOs/private
/personal
initiative



……….
…………
……………
…
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.
11
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
12
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 evidencebased response.
13
Component of OP
Behavioural Change and Communication to Promote
Good Nutritional Practices
Institutional capacity building
Human resource development (HRD)/
Training/Capacity Building
Food security, quality & food safety
Management of severe acute malnutrition (facility
and community)
14
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
15
Cont.
• Procurement of equipments, micronutrients, and
deworming tablets etc.
• School Nutritional education Program
16
Service delivery
Growth 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 mother
Iron-folic acid supplementation for pregnant women
Iron Supplementation and Deworming of Adolescent
Girls
Iodine deficiency disorder & Salt Iodization
Zinc Supplementation during treatment of diarrhea
17
Cross –cutting issues
Given 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, 2,3
5. Strengthening sectoral collaboration regarding nutrition
and food safety. MODM, Food Div, MOFLS, MOWCA,
MOI and other.
18
Indicator
1.
2.
3.
4.
5.
Prevalence of night blindness among <5
% of children 6-59 m receiving Vit-A
% of vit-A supplementation in postpartum women
Rate of EBF in infants under <6 months
% of children 6-23 months fed with all infant and
Young Child Feeding (IYCF ) practices
6. Prevalence of iodine deficiency
19
Cont.
7. Prevalence of anemia among pregnant women
8. Prevalence of anemia among children 6-59m
9. # of MOs trained in nutrition services delivery
10. # of CC workers trained in nutrition services
delivery
11. % of UHCs having a functional Nutrition Corner
established
20
Budget for the following activities
1.
2.
3.
4.
5.
6.
Behavior Change Communication (BCC)
Human resource development (HRD)
Control of Vitamin-A deficiency disorder
Control & prevention of Anemia
Control of Iodine deficiency Disorders
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
21
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 Safety
13. Monitoring, Evaluation, Operations Research,
Survey
22
Cont.
14. Nutrition Surveillance Program
15. Establishment of nutrition unit (NU) and
strengthening of existing NU
16. Community based Nutrition (CBN) ) as selected area
17. Multisectral Collaboration
23
Thanks
24