Rahman 2a areas of interventions in national nutrition services

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 RoomThe Training is organized by the National National Food Policy Capacity Strengthening Programme (NFPCSP) . The NFPCSPis 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 its 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. Stunting2. Under weight3. wasting4. Protein Energy Malnutrition5. Iron deficiency Anemia, Iodine deficiency disorders6. Vitamin A deficiency, zinc deficiency etc.7. Low Birth Weight8. Over nutrition & its complications (diet relatedNon- communicable Diseases-NCD)

Children Adolescent Girls Under Two 13-19 yrs Services Through Life-cycle Newly Wed In BINP/NNPLactating Women Mothers Pregnant WomenNNS would follow life-cycle approach in community service

Lactating Forums Under 2 Women Children Adolescent boys Mother in lawPost-partum Care Father in lawVitamin A Growth Monitoring Husband ofiron folate Care for LBW newly andReferral FoodSupplementtionVit pregnant women amin A Referral Household Survey followed by update Home visit Food Security Components Nutrition GardenBCC Services Poultry for Nutrition perform VGD-NNP Collaboration Training by a CNP at CNC Adolescent Newly wed Girls/boys Pregnant Women Couple Monthly Forum Nutrition Nutrition AssessmentWeight Monitoring Assessment IronFolateIron Folate Counseling De-wormingAntenatal care IronFolate Weight promotionIron Folate IGA, Fruits treeFood supplementation plantationCounselingReferral

Job Analysis of Front Line Workers in HNPSP Comparative Matrix Other Family Welfare ministries/ Community Nutrition Promoter Health Assistant (HA)Assistant (FWA) for Services in CC NGOs/private (CNP) for 1250 population for >5000 population >5000 population /personal initiative Eligible couple  HH profile update  HPN Services  Geographical  ………. registration  GMP reconnaissance  ………… Family  Micronutrient  EPI  …………… planning Supplementation  Disease … counseling (Post partum Vit A, IFA for surveillance Non-clinical PLW) Adolescent girt &  Health education contraceptive newly wed women  Epidemic control distribution &  NID & Vit A week  Target food FU supplementation for PLW, Referral for U2 children ANC  Referral for ANC Support  BCC during  Food Security interv NID & Vit A  Support during week  NID & Vit A week

Multi sectoral issuesDue 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 ObjectiveThe 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 access2. 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 system4. To strengthen nutrition information systems and operations research to ensure an evidence- based 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 issuesGiven the nature of this , this OP is highly dependent with other Ministry activities which are articulated in the Action Plan of the Strategic Document.• 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• Strengthening HR resources necessary for provision of nutrition services. OP-11, 12, 29, 25• Establish effective facility and pop based nut surveillance. OP-1,2,3,14, 22, 6• Providing nutrition education OP-15, 23, 2,3• Strengthening sectoral collaboration regarding nutrition and food safety. MODM, Food Div, MOFLS, MOWCA, MOI and other. 18

Indicator1. Prevalence of night blindness among <52. % of children 6-59 m receiving Vit-A3. % of vit-A supplementation in postpartum women4. Rate of EBF in infants under <6 months5. % of children 6-23 months fed with all infant and Young Child Feeding (IYCF ) practices6. Prevalence of iodine deficiency 19

Cont.7. Prevalence of anemia among pregnant women8. Prevalence of anemia among children 6-59m9. # of MOs trained in nutrition services delivery10. # of CC workers trained in nutrition services delivery11. % of UHCs having a functional Nutrition Corner established 20

Budget for the following activities1. Behavior Change Communication (BCC)2. Human resource development (HRD)3. Control of Vitamin-A deficiency disorder4. Control & prevention of Anemia5. Control of Iodine deficiency Disorders6. 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 Code10. Food fortification (Salt Iodization, fortification of oil/other food with Vitamin ‘A’, iron etc.)11. School Nutritional education Program12. Food security, Quality and Food Safety13. Monitoring, Evaluation, Operations Research, Survey 22

Cont.14. Nutrition Surveillance Program15. Establishment of nutrition unit (NU) and strengthening of existing NU16. Community based Nutrition (CBN) ) as selected area17. Multisectral Collaboration 23

Thanks 24

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Rahman 2a areas of interventions in national nutrition services Presentation Transcript