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
Nutrition Assessment and
Gap Analysis (2009-2010)
• Identified strengths,
weaknesses, and gaps;
• Need for a national
nutrition architecture;
and
• A multi-sectoral
approach through an
agreed nutrition
determinants model.
Build the National
“Nutrition Architecture”
(2011-2012):
• 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)
• 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 crosssectoral linkages
Costed Multi-sectoral
Nutrition Plan: Approved
by the Cabinet (2012)
 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 days
2 years: 365*2=730 days
LIFE COURSE CONSEQUENCES OF POOR MATERNAL AND
CHILD UNDERNUTRITION (MCU)
Short term
Brain
development
Poor nutrition
in uterus
and early
childhood
(STUNTING)
Death
Long term
Cognitive and
educational
performance
Growth and muscle mass
Body composition
Immunity
Work Capacity
Metabolic Syndrome:
programming of metabolism
of glucose, lipids, protein
Hormone/receptor/gene
Diabetes, Obesity
Heart Disease
High blood pressure
Cancer, stroke,
and ageing
(James et al 2000)
6
NEPAL IS ON TRACK TO REACH MDG4: REDUCING CHILD MORTALITY
200
160
Mortality Trend and MDG Goal
(Under 5, Infant and Neonatal)
153
120
IMR
61
48
33
54
NMR
118
102
80
40
U5MR
Improved Nutrition,
especially micronutrients
has contributed
79
45.9
50
91
64
39
46
33
54
34
15
Pneumonia
20%
Other
29%
0
1991
1996
2001
2006
2011
2015
MDG
Deaths associated with
under-nutrition
Diarrhoea
12%
At - min 35%
BUT, without Improvement in
Stunting, further Child Mortality
Reduction is very unlikely
Malaria
8%
Perinatal
22%
Sources:
HIV/AIDS
4%
Measles
5%
EIP/WHO. Black et al, 2008. The Lancet Series on Maternal and
Child Under-nutrition.
Stunting Remains High and Wasting Stagnant
Stunting
60
Percent
Wasting
57
50
40
Underweight
49
43
39
41
29
30
28
27
20
10
11
13
11
5
0
NDHS 2001
NDHS 2006
NDHS 2011
MDG Target 2015
• 18.2 per cent women are with a BMI <18.5
• 12.4 percent babies are LBW (<2500 grams)
Source: NDHS 2011
Stunting Remains High and Wasting Stagnant
Stunting
60
Percent
Wasting
57
50
40
Underweight
49
43
39
41
29
30
28
27
20
10
11
13
11
5
0
NDHS 2001
NDHS 2006
NDHS 2011
MDG Target 2015
• 18.2 per cent women are with a BMI <18.5
• 12.4 percent babies are LBW (<2500 grams)
Source: NDHS 2011
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
Cognitive function is benefitted across the life course,
and optimal birth weight is above the mean
Cognitive Function score (relative to 3-3.5kg)
0.15
0.10
Birth weight
0.05
0.00
<2.5(kg)
2.5-3
3-3.5
OPTIMAL
3.5-4 WEIGHT
4.0-5.0
-0.05
-0.10
-0.15
-0.20
-0.25
-0.30
-0.35
8
11
15
26
Years of age
Richards, M. Et al. 2001 Birth weight and cognitive function in the British 1946 birth cohort: longitudinal population
11
based study. BMJ. 322:199-203
Declining Prevalence of Stunting
Asian Refugee Children in the U.S.
Stunting = height-for-age < 5th percentile of Ref
12
Yip & Mei, 1996
Require MSN Approach To Tackle Stunting Sustainably
CHILD STUNTING
50%
Inadequate
Foetal Growth
Poor maternal
nutrient status
Poor maternal
nutrient intake
Inadequate
Household
Food Security
Inadequate IYC*
Growth
50%
Poor IYC nutrient
status
Maternal
Infections
Poor IYC
nutrient intake
Poor maternal
and child caring
practices
IYC
infections
Poor medical and
environmental
health services
BASIC CAUSES:
Resources, Institutions, Education, Infrastructure, Cultural Practices
Nutrition
Specific
IMMEDIATE
CAUSES
UNDERLYING
CAUSES
Nutrition
Sensitive
13
* IYC = Infant and young child
Multi-sectoral Operational Linkages & Accountabilities
Strategic Objective (SO) 1. National Planning Commission
Result (R) 1.1. Multi-sectoral commitment and resources for nutrition are increased
SO 4. Ministry of
Education
R 1.2. Nutritional information management and data analysis strengthened
•
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
R 1.3 Nutrition capacity of implementing agencies is strengthened
SO 2. Ministry of Health
and Population
R 2.1 MIYC micronutrient status
improved
The intergenerational transmission of growth
failure: When to intervene in the life cycle
R 2.2 MIYC feeding improved
Child growth
failure/ death
R 2.3 SAM better managed
R 2.4 Diarrhoea adequately treated
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
Low Birthweight
baby
Early pregnancy
Low weight &
height in teenagers
Small adult
woman
Small adult man
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
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
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
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
NHSP II
NEPAL FOOD SECURITY
ENHANCEMENT PROJECT
NEPAL WASH MASTER PLAN
&
MULTI-SECTORAL ECD PLAN
NEPAL
Mid-Western Region
Far-Western
Region
HUMLA
DARCHULA
BAJHANG
MUGU
BAITADI
DADELDHURA
BAJURA
JUMLA
DOTI
ACHHAM
DOLPA
KALIKOT
Western Region
MUSTANG
KANCHANPUR
DAILEKH
JAJARKOT
KAILALI
RUKUM
MANANG
Central Region
SURKHET
MYAGDI
BARDIYA
SALYAN
ROLPA
BANKE
DANG
PYUTHAN
KASKI
PARBAT
GORKHA
LAMJUNG
GULMI
ARGHAK
TANAHU
SYANGJA
HACHI
PALPA
KAPILRUPANNAWAL
BASTU
CHITWAN
DEHI
PARASI
NUWAKOT
DHADING
SINDHUPALCHOK
SULUKHUMBU
SINDHULI
BARA
DOLAKHA
KATHM
BHAK
MAKAWAN- LALIT KAVRE
PUR
PARSA
Initial MSNP Roll-Out Districts
Eastern Region
RASUWA
OKHALDHUNGA
RAUT- SARLAHI
AHAT
MAHOTARI
DHANUSA
SIRAHA
SANKHUWASABA
TAPLEJUNG
KHOTANG
TERHABHOJTHUM
PUR DHANKUTA
UDAYAPUR
SAPTARI
SUNSARI
MORANG
ILAM
JHAPA
Summary of Ongoing Nutrition Actions in the
Proposed MSNP Initial Districts
Districts
Development
Region
Geographical
Focus Level
Nutrition Related
Actions
Bajura
FW Hills
A
CFLG, Suaahara, FtF, WB/NASP,
HKI/Homestead food production,
Achhaam
MFW Hills
A
CFLG, UNICEF IYCF/MNPs,
CMAM, FtF, WB NASP,
Jumla
MW Mountains
A
CFLG, UNICEF/ADB IYCF/CG,
MI/UNICEF VAS, USAID FtF, WB
NASP, SCF/UNICEF GM
Parsa
Central Terrai
A
CFLG, UNICEF IYCF/MNPs, ECD,
Health
Kapilvastu
Western- Terrai
B
CFLG, UNICEF IYCF/MNP, CMAM,
WASH, ECD, Health, FtF
Nawalparasi
Western- Terrai
B
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
...basis for action
– 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 undernutrition on infant and young child mortality and
its largely irreversible long-term effects on
intellectual, physical and social development as
well as on health
3
endorsed by 100+ organizations
June 2010
– 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
The SUN framework
identifies two
complementary ways of
reducing under-nutrition:
The focus:
• Increased resource
mobilization through
advocacy & innovative
(a) direct, nutrition-specific
financing mechanisms
interventions: have nutritional
improvement as the primary
• Better alignment of
goal and should be accessible
donors' investments with
to all individuals and their
national priorities
households, especially in
pregnancy, in the first two years • Countries to identify their
of life and at times of illness or
capacity development
distress
needs to extend nutrition
interventions
• Plans need to be costed,
including financial
(b) a multisectoral approach aimed
resources for capacity
at promoting adequate
development,
nutrition as the goal of
strengthening the delivery
national development policies
of services
in agriculture, food supply,
social protection, WASH, health • Expected benefits should
and education programmes.
be quantified
The SUN Movement
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/
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 Leone
24. Tanzania
25. Uganda
26. Zambia
27. Zimbabwe
SUN Countries
The SUN Movement Stewardship Arrangements
THE SUN LEAD GROUP
Mr. Armando Emílio
Guebuza
Mr. Jakaya Mrisho Kikwete
President of Mozambique
Ms. Sheikh Hasina
Mr. Nahas Angula
Mr. Babu Ram Bhattarai
Ms. Ngozi Okonjo-Iweala
Ms. Nina Sardjunani
Prime Minister of Bangladesh
Prime Minister of Namibia
Prime Minister of Nepal
Minister of Finance of Nigeria
Deputy Minister of Development Planning of
Indonesia
First Lady of Peru
Ms. Nadine Heredia
President of Tanzania
Donors
Ms. Beverly Oda
Mr. Andris Piebalgs
Mr. Bruno Le Maire
Mr. Rajiv Shah
Minister of International Cooperation, Canada
Commissioner for Development Cooperation, EC
Minister of Food, Agriculture and Fishing, France
Administrator, US Agency for International
Development
Civil Society Organizations
Mr. Fazle Hasan Abed
Mr. Tom Arnold
Ms. Marie Pierre Allié
Founder and Chairperson, BRAC
Chief Executive Officer, Concern Worldwide
President, Médecins Sans Frontières France
Business
Ms. Vinita Bali
Mr. Paul Polman
Managing Director, Britannia Industries
Chief Executive Officer, Unilever
International Organizations
Ms. Ertharin Cousin
Ms. Tamar Manuelyan
Atinc
Executive Director, World Food Programme and
Representative of the United Nations Standing
Committee on Nutrition
Vice President, Human Development, The World
Bank
Foundations and Alliances
Mr. Chris Elias
Mr. Jay Naidoo
Ms. Mary Robinson
President, Global Development, Bill & Melinda Gates
Foundation
Chair of the Board, Global Alliance for Improved
Nutrition
Chair, Mary Robinson Foundation - Climate Justice
SUN Movement
Mr. Anthony Lake
Mr. David Nabarro
[1] At 4 April 2012
[2]
Effective 5 April 2012
Chair, Scaling Up Nutrition Movement Lead Group
and Executive Director, UNICEF
Coordinator, Scaling Up Nutrition Movement, and
Special Representative of the Secretary-General for
Food Security and Nutrition
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.
2.
3.
4.
5.
6.
Best practices, and which interventions have greatest potential to leverage results;
Gathering evidence of the cost-effectiveness of scaling up nutrition;
Tracking financing and investments in nutrition to identify key resource gaps;
Building a robust results and accountability framework, based on clear indicators and
targets (e.g. MDGs, post-2015 goals and the World Health Assembly);
Articulating the importance of empowering women to be at the centre of policies
and actions to Scale Up Nutrition;
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
Initiating Partners
The team
•REACH approach developed and
facilitated globally by Inter-Agency
team hosted by WFP in Rome
•Global REACH coordinator by
rotation from the four agencies
Further Participating Partners
Other UN agencies:
IFAD, SCN, WB
Governments:
• Mauritania, Lao PDR, Sierra Leone,
Bangladesh, Nepal, Mozambique,
Rwanda, Uganda, Mali, Ghana
• NGOs & Civil society:
• SC, WVI, Rotary, HKI, GAIN, MI, ACF,
CRS
Academia:
• Tufts, Wageningen, Cornell, Tulane,
George Washington, John Hopkins
University
Donors:
• ECHO, DFID, Bill & Melinda Gates
Foundation, USAID,++
Private sector:
• The Boston Consulting Group
REACH focuses on
scaling-up nutrition (SUN) actions
Vision &
Goals
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
Country action
planning and coordination
to support national capacity to scale up
evidence-based solutions
Action
areas
Knowledgesharing
Outcomes
1. Increased
awareness of the
problem and of
potential solutions
Financing and
resource
mobilization
2. Strengthened
national policies
and programmes
3. Increased
capacity at all
levels for action
Communications
and advocacy
4. Increased
efficiency and
accountability
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, 2012-2014
No
Outcome
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)
Strengthened
national policies
and programs
2.1 Nutrition is fully integrated in national and UN development strategies
2
Output
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
2.2 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:
–
–
–
–
–
–
•
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:
–
–
–
–
•
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.
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
INPUTS
PROJECT COMPONENTS / ACTIVITIES (A-E)
•
B. PRODUCTION
& SUPPLY
A. POLICIES AND PLANS
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)
•
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)
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 )
C. SERVICE DELIVERY
D. QUALITY
E. BCC
Management, staff, national micronutrient coalition, government &
international financial resources, health facility & community volunteer
infrastructure
Policies, Production, Delivery, Quality &
Behaviour Change Communication
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)
•
•
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)
OUTPUTS (O)
OUTCOMES (T)
IMPACTS (I)
Access & Coverage / Knowledge & Appropriate Use
• 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)
• 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)
• 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 )
• 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)
Effective Project Management & Monitoring and Evaluation
Impact on
intake, status
and function
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)
IYCF
(Complementary feeding)
• Introduction of solid, semisolid 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, 623.9 months (T.9)
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)
• Reduction in
Stunting in
children 0-23.9
months (I.1)
• Reduction in
Anaemia in
children 6-23.9
months (I.2)
• Reduction in
Anaemia in
women and
adolescent
girls - select
districts (I.3)
Logic Model for Nepal
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