Agnes Guyon, MD, MPH JSI Research and Training Victoria Quinn, PhD Helen Keller International CORE Group Fall Meeting Wash...
Countries  with ENA* … First generation (1997-2004) Second generation (2005-2006) Third generation (2007-2010) Indonesia I...
Some lessons learned … <ul><li>Rare to find examples of  full  ENA framework  (e.g. national level and at large scale) </l...
Some lessons learned … <ul><li>NGO field partners are enthusiastic about ENA as it improves their existing nutrition activ...
The Piglet Issue… I am only a small NGO with a little voice and no money to do a national program…
By the end of this session, you will have an understanding of… <ul><li>the difference between the 7 ENAs as compared to th...
Control of Anemia Optimal Breastfeeding Control of  Vitamin A deficiency Control of Iodine  Deficiency Disorders Women’s N...
<ul><li>nutrition of girls & women especially pregnant and lactating </li></ul><ul><li>infant & young children, especially...
History of ENA since its birth in 1997 Nutrition Minimum Package (MINPAK) 1997
Nutrition Essentials  1999 History of ENA since its birth in 1997 Essential Nutrition Actions  coined in the USAID support...
Today… consensus now exists on ‘what’ nutrition actions make a difference… The Lancet Series on Maternal and Child Undernu...
http://www.reach-partnership.org Lancet    UN supported ’REACH Approach’
Lancet     ‘Scaling Up Nutrition Framework  for Action’
Great similarity… Essential Nutrition Actions, The Lancet REACH and The SUN Framework for Action
Today… <ul><li>Agreement on the  ‘what’  (7 ENAs) </li></ul><ul><li>Challenge is now the  ‘how’: </li></ul><ul><ul><li>ope...
,  Many groups committed to move forwards take nutrition support to scale All these groups are aware, committed and mobili...
HKI research  study of ‘missed opportunities’ to provide nutrition support in existing health systems in three African cou...
HKI research  study of ‘missed opportunities’ to provide nutrition support in existing health systems in three African cou...
HKI research  study of ‘missed opportunities’ to provide nutrition support in existing health systems in three African cou...
Research study of using ‘multiple opportunities’ to provide nutrition support (IYCF) in child health programs in India
Research study of using ‘multiple opportunities’ to provide nutrition support (IYCF) in child health programs in India Fin...
These studies focused on existing services  inside  the health sector…. Imagine the huge number of  missed opportunities i...
<ul><li>How do we reduce the  ‘missed opportunities ’ to support nutrition in existing programs? </li></ul><ul><li>How do ...
The Eeyore mantra… Limited vision Too many missed opportunities
Small Group Work #1 -  From your experience, list the  three most common ‘missed opportunities ’  to support nutrition (10...
The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, pleas...
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CORE Group Fall Meeting 2010. The Essential Nutrition Actions Framework: More than Just Seven Actions. (Part 1 of 3) - Agnes Guyon, JSI Research and Training & Victoria Quinn, Helen Keller International

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  • We focused our efforts in these countries with the objective of showing behavior change impact at scale. In each country there was a sizeable catchment area population ranging in size from a million to over 6 million people across multiple districts and regions.
  • We focused our efforts in these countries with the objective of showing behavior change impact at scale. In each country there was a sizeable catchment area population ranging in size from a million to over 6 million people across multiple districts and regions.
  • We focused our efforts in these countries with the objective of showing behavior change impact at scale. In each country there was a sizeable catchment area population ranging in size from a million to over 6 million people across multiple districts and regions.
  • We focused our efforts in these countries with the objective of showing behavior change impact at scale. In each country there was a sizeable catchment area population ranging in size from a million to over 6 million people across multiple districts and regions.
  • The Framework is endorsed by nearly a hundred partners – from civil society, governments, academia, UN agencies, World Bank, Foundations &amp; private sector grps
  • Quinn ena 1

    1. 1. Agnes Guyon, MD, MPH JSI Research and Training Victoria Quinn, PhD Helen Keller International CORE Group Fall Meeting Washington DC 14 September 2010 The Essential Nutrition Actions Framework: More than Just Seven Actions
    2. 2. Countries with ENA* … First generation (1997-2004) Second generation (2005-2006) Third generation (2007-2010) Indonesia India Cambodia Bangladesh Nepal * Various levels of engagement from ENA at community level only to ENA at national level.
    3. 3. Some lessons learned … <ul><li>Rare to find examples of full ENA framework (e.g. national level and at large scale) </li></ul><ul><li>NGOs can play a leadership and catalytic role at the country level to advocate for the full ENA framework but this has been the exception rather than the rule </li></ul><ul><li>Need an ENA leader (a focal point) in each country to keep momentum going otherwise it fizzles out </li></ul>
    4. 4. Some lessons learned … <ul><li>NGO field partners are enthusiastic about ENA as it improves their existing nutrition activities especially breastfeeding practices </li></ul><ul><li>Past tendency of NGOs is to focus only on ENA at the community level and usually only one contact (e.g. GM/P or CMAM…) and only in a few selected districts (e.g. Child Survival Projects) </li></ul>
    5. 5. The Piglet Issue… I am only a small NGO with a little voice and no money to do a national program…
    6. 6. By the end of this session, you will have an understanding of… <ul><li>the difference between the 7 ENAs as compared to the ENA Framework? </li></ul><ul><li>what are the many missed opportunities for promoting the Essential Nutrition Actions? </li></ul><ul><li>what are the key steps for implementing the ENA framework at large-scale? </li></ul><ul><li>what role can NGOs play (but not according to Piglet!) </li></ul>
    7. 7. Control of Anemia Optimal Breastfeeding Control of Vitamin A deficiency Control of Iodine Deficiency Disorders Women’s Nutrition Complementary Feeding with BF Nutritional Care of the sick & Malnourished child The Seven Essential Nutrition Actions
    8. 8. <ul><li>nutrition of girls & women especially pregnant and lactating </li></ul><ul><li>infant & young children, especially 0-24 months </li></ul>Window of opportunity 1,000 days from conception to two years
    9. 9. History of ENA since its birth in 1997 Nutrition Minimum Package (MINPAK) 1997
    10. 10. Nutrition Essentials 1999 History of ENA since its birth in 1997 Essential Nutrition Actions coined in the USAID supported program in Madagascar
    11. 11. Today… consensus now exists on ‘what’ nutrition actions make a difference… The Lancet Series on Maternal and Child Undernutrition 2008
    12. 12. http://www.reach-partnership.org Lancet  UN supported ’REACH Approach’
    13. 13. Lancet  ‘Scaling Up Nutrition Framework for Action’
    14. 14. Great similarity… Essential Nutrition Actions, The Lancet REACH and The SUN Framework for Action
    15. 15. Today… <ul><li>Agreement on the ‘what’ (7 ENAs) </li></ul><ul><li>Challenge is now the ‘how’: </li></ul><ul><ul><li>operationalizing how to mainstream these 7 ENAs </li></ul></ul><ul><ul><li>‘ at large scale’ to achieve a public health impact </li></ul></ul><ul><ul><li>“ The ENA framework” </li></ul></ul>
    16. 16. , Many groups committed to move forwards take nutrition support to scale All these groups are aware, committed and mobilized, but where do we start? Also how do we address the huge problem of missed opportunities in each country?
    17. 17. HKI research study of ‘missed opportunities’ to provide nutrition support in existing health systems in three African countries
    18. 18. HKI research study of ‘missed opportunities’ to provide nutrition support in existing health systems in three African countries <ul><li>Findings </li></ul><ul><li>The three surveys revealed the extent of missed opportunities to deliver nutrition services during routine prenatal, postnatal and child-care consultations for the prevention and treatment of highly prevalent nutritional deficiencies. </li></ul><ul><li>Also highlighted issue of quality of nutrition services </li></ul>
    19. 19. HKI research study of ‘missed opportunities’ to provide nutrition support in existing health systems in three African countries <ul><li>Ante-Natal Contacts: </li></ul><ul><ul><li>In Niger and Burkina, only 38% and 14% of women observed at consultations received counseling on pregnancy related dietary improvement </li></ul></ul><ul><li>Well-child Contacts: </li></ul><ul><ul><li>In Niger, all children were weighed but only 62% of their caregivers were asked/or counselled about feeding practices </li></ul></ul><ul><ul><li>In Mozambique, while 87% of new mothers received counseling on breastfeeding, only 8% were advised to breastfeed exclusively </li></ul></ul><ul><ul><li>(HKI Tool for Quality Assessment of Nutrition Services in Health Systems) </li></ul></ul>
    20. 20. Research study of using ‘multiple opportunities’ to provide nutrition support (IYCF) in child health programs in India
    21. 21. Research study of using ‘multiple opportunities’ to provide nutrition support (IYCF) in child health programs in India Findings: Using multiple available opportunities and workers for counselling mothers and caregivers was feasible, resulted in high coverage and impact, and instead of disrupting ongoing services, resulted in their improvement.
    22. 22. These studies focused on existing services inside the health sector…. Imagine the huge number of missed opportunities in sectors outside of health: Agriculture Education Women in Development Emergency Water and Sanitation…
    23. 23. <ul><li>How do we reduce the ‘missed opportunities ’ to support nutrition in existing programs? </li></ul><ul><li>How do we mainstream into existing programs both inside and outside the health sector? </li></ul><ul><li>And, how do we roll out the ENA framework to achieve large scale? </li></ul>Operationalizing nutrition support at large scale
    24. 24. The Eeyore mantra… Limited vision Too many missed opportunities
    25. 25. Small Group Work #1 - From your experience, list the three most common ‘missed opportunities ’ to support nutrition (10 minutes) - Report back to plenary (2 minutes)
    26. 26. The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, please visit: www.coregroup.org/resources/meetingreports

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