Understanding the Essential Nutrition Actions Framework_Victoria Quinn_5.5.14
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  • But, over the last year or so, a new global movement has started… that has led to a common call to action
  • The Framework is endorsed by nearly a hundred partners – from civil society, governments, academia, UN agencies, World Bank, Foundations & private sector grps
  • We have today two key references from renown institutions (World Health organizations and the Lancet series) to guide donors, governments, and program managers in scaling up high impact nutrition interventions
  • We have today two key references from renown institutions (World Health organizations and the Lancet series) to guide donors, governments, and program managers in scaling up high impact nutrition interventions
  • This year the Lancet series and the WHO agreed on using the live cycle to deliver nutrition specific interventions; For some we have experienced to take them to scale such as consumption of iodized salt, exclusive breastfeeding, vitamin A supplementation.For others such as complementary feeding to breastfeeding, calcium supplementation as example will require program implementers to build field experience and evidence how it can be done at scale.

Transcript

  • 1. Essential Nutrition Actions Framework Potential for the SUN Movement Victoria Quinn, PhD Helen Keller International Core Group Spring meeting 5 May 2014
  • 2. Essential Nutrition Actions Relevance to global nutrition movements “new opportunities for ENA”
  • 3. Scaling Up Nutrition –SUN Movement SUN is a unique Movement founded on the principle that all people have a right to food & good nutrition.
  • 4. 4 Lancet Nutrition Series February 2008 These data had an immense impact on subsequent nutrition strategies and global development events Funded by BMGF
  • 5. 5 Increased focus on the ‘Global Nutrition Architecture’ Lancet 2008 Nutrition Series “The international nutrition system—made up of international and donor organisations, academia, civil society, and the private sector— is fragmented and dysfunctional…” Morris et.al, 2008 Lancet Nutrition Series Paper 5
  • 6. 6 Sparked series of consultations in nutrition community to rally around the new 2008 Lancet nutrition findings which provided evidence on ‘what worked’.
  • 7. Publication of ‘Scaling Up Nutrition: Framework for Action’ (Feb. 2010) released by coalition of nutrition partners representing many different constituencies
  • 8. Endorsed by nearly a hundred partners – from civil society, governments, academia, UN agencies, World Bank, Foundations & private sector groups National Nutrition Institute, MOH Egypt Cornell University Division of Nutritional Sciences Cornell University, USA THE WORLD BANK Public-Private Partnerships The International Life Science Institute Focal Point in China ,
  • 9. Exceptionally unique point in time for nutrition! SUN is a unique Movement founded on the principle that all people have a right to food & good nutrition.
  • 10. Over 165 million children under 5 are stunted as a result of malnutrition. • 52 million children are too thin and require special treatment. • At the same time, 43 million children are overweight - some as a result of poverty, when families are unable to afford a balanced, nutritious diet. • 2 billion people are deficient in key vitamins & minerals A reminder - why nutrition? The facts
  • 11. ROOTED IN Poverty Disempowerment of women Political & Cultural Environment Insufficient access to affordable, nutritious FOOD throughout the year Lack of good CARE for mothers & children & support for parents on appropriate child feeding practices Inadequate access to HEALTH sanitation & clean water services SUN recognizes the causes of malnutrition are interconnected Environmental Degradation
  • 12. Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment Agriculture: Making nutritious food more accessible to everyone, and supporting small farms as a source of income for women and families Clean Water & Sanitation: Improving access to reduce infection and disease Education & Employment: Making sure children have the nutrition needed to learn and earn a decent income as adults Health Care: Access to services that enable women & children to be healthy Support for Resilience: Establishing a stronger, healthier population and sustained prosperity to better endure emergencies and conflicts Nutrition-Sensitive StrategiesSpecific Actions for Nutrition Nutrition strategies increase the impact of specific actions for nutrition
  • 13. Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment Agriculture: Making nutritious food more accessible to everyone, and supporting small farms as a source of income for women and families Clean Water & Sanitation: Improving access to reduce infection and disease Education & Employment: Making sure children have the nutrition needed to learn and earn a decent income as adults Health Care: Access to services that enable women & children to be healthy Support for Resilience: Establishing a stronger, healthier population and sustained prosperity to better endure emergencies and conflicts Nutrition-Sensitive StrategiesSpecific Actions for Nutrition Nutrition strategies increase the impact of specific actions for nutrition
  • 14. Countries around the world have committed to making nutrition a priority & global partners are working together to support the efforts of SUN countries. Countries are at the center of scaling up nutrition
  • 15. The SUN approach – starting in 2010 • The Scaling up Nutrition Movement relies on national leaders taking ownership and responsibility for delivering sustainable solutions to improve nutrition in their countries. • Through country-led efforts that focus on equity and realization of rights, SUN countries are enabling women, families & communities to create stronger foundations for their people & transforming the future of our world. • SUN enables countries to take a collaborative approach bringing together the people & resources needed to rapidly scale up nutrition-specific interventions as well as implement cross-sector strategies that are nutrition-sensitive.
  • 16. The SUN approach –Country level Country governments lead national efforts to scale up nutrition. Within each country a SUN Focal Point is identified
  • 17. The SUN approach – Country level The Focal Point brings people together in a multi-stakeholder platform Technical Community United Nations Government Partners Civil Society Donors Business
  • 18. The SUN approach – Country level The multi-stakeholder platform Works to align and coordinate action across sectors. Women’s Empowerment Health Development & Poverty Reduction Agriculture Education Social Protection
  • 19. The SUN approach – Global level Using a unique approach that works for each country. These efforts are underway in all SUN countries Multi-sector, multi- stakeholder platform Together the combined efforts of all countries make up the core of the Movement - The SUN Country Network
  • 20. With overall support and coordination provided by the SUN Secretariat and SUN Lead Group Country Network Donor Network Civil Society Network Business Network United Nations Network Global Networks of stakeholders shift resources & align actions to support country efforts. The SUN approachn – Global level
  • 21. Making progress – Country level Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition. Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies Align Actions Across Sectors around high quality and well- costed country plans, with an agreed results framework and mutual accountability. Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact. 1 2 3 4 Within each country, SUN Movement stakeholders are brought together around 4 key processes: progress is reviewed every six weeks
  • 22. Tracking and reporting impact Establishing targets to measure impact: Countries are encouraged to establish their own ‘costed plans’ with targets for nutrition goals in the following areas: Annual SUN Movement Progress Report: Released in September each year by the SUN Movement Secretariat, the report provides updates on progress in achieving the Movement’s goals and strategic objectives.
  • 23. Supporting global impact Together, countries and supporting stakeholders are collectively working to reach the global targets by 2025 set out by the World Health Assembly 2012 Resolution: Reducing and maintaining childhood wasting to less than 5% Target 1: Target 2: Target 3: Target 4: Target 5: Target 6: 40% reduction of the global number of children under 5 who are stunted 50% reduction of anemia in women of reproductive age 30% reduction of low birth weight No increase in childhood overweight Increase exclusive breastfeeding rates in the first 6 months up to at least 50%
  • 24. Today the SUN Movement is growing in numbers & strength 100+ global stakeholders are providing support to 46 countries with the opportunity to reach 82 million stunted children
  • 25. How does the ENA framework fit in? Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition. Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies Align Actions Across Sectors around high quality and well- costed country plans, with an agreed results framework and mutual accountability. Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact. 1 2 3 4 Within each country, SUN Movement stakeholders are brought together around 4 key processes: progress is reviewed every six weeks
  • 26. Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition. Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies Align Actions Across Sectors around high quality and well- costed country plans, with an agreed results framework and mutual accountability. Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact. 1 2 3 4 Within each country, SUN Movement stakeholders are brought together around 4 key processes: progress is reviewed every six weeks Country Level - how does the ENA framework fit in?
  • 27. Nutrition specific actions
  • 28. Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment Specific Actions for Nutrition Nutrition specific actions
  • 29. Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment Specific Actions for Nutrition Nutrition specific actions
  • 30. Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment Specific Actions for Nutrition Nutrition specific actions Essential Nutrition Actions
  • 31. The ‘what’ of ENA…
  • 32. Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition. Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies Align Actions Across Sectors around high quality and well- costed country plans, with an agreed results framework and mutual accountability. Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact. 1 2 3 4 Within each country, SUN Movement stakeholders are brought together around 4 key processes: progress is reviewed every six weeks How does the ENA framework fit in?
  • 33. So… “how” do we do it?
  • 34. The ENA Framework may provide a nice fit for what is needed to scale up proven nutrition actions under the SUN movement
  • 35. 35 1st task… Reach women and children at broad scale with the Essential Nutrition Actions to make a public health impact
  • 36. 36 2nd task…. Provide the right nutrition support at the right time to the right person (e.g. children, women and … adolescent girls)?
  • 37. Critical Life-Cycle Contact Points for the Nutrition of Women, Infants and Young Children? pre-pregancy and adolescence during pregnancy & lactation at birth during post-natal period from 0-6 months from 6-24 months
  • 38. Source: adapted from Lancet Nutrition Series 2013 Providing the right support at the right time:
  • 39. 3rd task… Reduce the many ‘missed opportunities’ in existing health programs to provide nutrition support
  • 40. 40 •Nutrition Programs •Child survival programs •Neonatal •Reproductive health •Infectious diseases •Agriculture •Education •Micro-credit •Emergency •Social Protection •WatSAN Outside the health sector Within the health sector Potential to integrate ENA into health sector and non-health sector programs
  • 41. 41 •Nutrition Programs •Child survival programs •Neonatal •Reproductive health •Infectious diseases •Agriculture •Education •Micro-credit •Emergency •Social Protection •WatSAN Outside the health sector Within the health sector Potential to integrate ENA into health sector and non-health sector programs
  • 42. 42 •Nutrition Programs •Child survival programs •Neonatal •Reproductive health •Infectious diseases •Agriculture •Education •Micro-credit •Emergency •Social Protection •WatSAN Outside the health sector Within the health sector Potential to integrate ENA into health sector and non-health sector programs
  • 43. 43 •Nutrition Programs •Child survival programs •Neonatal •Reproductive health •Infectious diseases •Agriculture •Education •Micro-credit •Emergency •Social Protection •WatSAN Outside the health sector Within the health sector Potential to integrate ENA into health sector and non-health sector programs
  • 44. 44 4th task… Lots of partners! Need to align ourselves in each country
  • 45. 45 National Nutrition Institute, MOH Egypt Cornell University Division of Nutritional Sciences Cornell University, USA THE WORLD BANK Public-Private Partnerships The International Life Science Institute Focal Point in China
  • 46. 46 All these groups are aware, committed and mobilized!!
  • 47. 47 Under USAID funded LINKAGES Project (1996-2006) • Ethiopia: >60 ENA partner groups • Ghana: ~ 15 nutrition partners groups (regional & district networks) • Madagascar: >50 ENA partners groups (national & regional networks) Create broad partner networks to increase coverage, allow fast-tracking and and leverage of resources
  • 48. 48 5th task… Choosing a starting point.
  • 49. 49 Where to start - harmonize and strengthen existing field programs Fine-tune existing programs to make them better Focus on capacity development of government & NGO staff, key community members, etc… especially in behavior change and counseling Strive for same nutrition messages, BCC strategy, IEC materials, training materials...
  • 50. 50 Where to start - harmonize and strengthen existing field programs Fine-tune existing programs to make them better Focus on capacity development of government & NGO staff, key community members, etc… especially in behavior change and counseling Strive for same nutrition messages, BCC strategy, IEC materials, training materials...
  • 51. Different customized training targeted to: Health workers (government and CSO staff, etc..) Community members & volunteers • Short-term, skills-based ENA training • Heavy on interpersonal communication skills (e.g. counseling/negotiation) • Lots of practice with real mothers Capacity building in ENA for health workers and community members
  • 52. The Core Group http://www.coregroup.org/resources/core-tools New Generic ENA Behavior Change Training for Health Workers and Community Level: English & French
  • 53. The ENA Framework may provide a nice fit for what is needed to scale up proven nutrition actions under the SUN movement
  • 54. • SUN Secretariat Powerpoint (December 2013) downloaded from SUN Website (adapted for this presentation) • Why Nutrition The Facts: UNICEF-WHO-The World Bank: Joint child malnutrition estimates - Levels and trends. Global Database on Child Growth and Malnutrition • A Smart Investment: Lawrence Haddad. Child Growth=Sustainable Economic Growth: Why we should invest in Nutrition. May 2013 • Experts Agree: Copenhagen Consensus: Solving the world’s challenges. May 2012 • SUN Countries’ success in reducing stunting: The number of countries with AARRs greater than 2% is calculated based on historical data from 2000 to mid-2013. This figure is currently under review, and the new number will be reported once the reanalysis of latest available data is finished. The SUN Movement Secretariat is supported by Canada, France, Germany, Ireland, the Netherlands, the United Kingdom and the European Union, together with the Micronutrient Initiative. How has stunting been reduced?References and Technical NotesReferences & technical notes from SUN website
  • 55. 55