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Essential Nutrition Actions_Agnes and Nielson_10.10.12


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Essential Nutrition Actions_Agnes and Nielson_10.10.12

  1. 1. How to translate the nutrition momentum into countries? Lessons Learned from previous program on implementing the ENA framework Jennifer Nielsen HKI Agnes Guyon SPRING/JSI Core Group – Fall meeting 2012
  2. 2. What is the difference between ENA and IYCF?What is the difference between ENA and Lancet High Impact Nutrition Interventions?
  3. 3. The Essential Nutrition Actions Nutritional Care Optimal ComplementaryWomen’s Nutrition Breastfeeding of the sick & Feeding with BF Malnourished child Control of Vitamin A deficiency Control of Control of Iodine Anemia Deficiency Disorders
  4. 4. Window of opportunity1,000 days from conception to two years nutrition of girls & women especially pregnant and lactating  infant & young children, especially 0-24 months 4
  5. 5. What is the history of ENA?
  6. 6. History of ENA since its birth in 1997 Nutrition Minimum Package (MINPAK) 1997
  7. 7. History of ENANutrition Essentials 1999Essential Nutrition Actions coined in the USAID supported program in Madagascar
  8. 8. Today… consensus now exists on ‘what’ nutrition actions make a difference… The Lancet Series on Maternal and Child Undernutrition 2008 8
  9. 9. Lancet  ‘Scaling Up Nutrition Framework for Action’ 9
  10. 10. Great similarity… Essential Nutrition Actions, The Lancet and The SUN Framework for Action Optimal Nutritional Care Complementary of the sick &Breastfeeding Feeding with BF Malnourished child Women’s Nutrition Control of Vitamin A deficiency Control of Control of Iodine Anemia Deficiency Disorders 10
  11. 11. Today… Agreement on the ‘what’ Challenge is now the ‘how’:operationalizing how to mainstream these 7 ENAs ‘at large scale’ to achieve a public health impact “The ENA framework” 11
  12. 12. Countries with ENA* … Indonesia India Cambodia Bangladesh Nepal* Various levels of engagement from ENA at community level only to ENA at national level. 12
  13. 13. What are the objectives of the ENA framework? What is the framework?
  14. 14. Consider the huge number of missed opportunities Source: World Bank, HNP
  15. 15. Operationalize nutrition support at large scale How do we reduce the ‘missed opportunities’ to support nutrition in existing programs? How do we mainstream into existing programs both inside and outside the health sector? And, how do we roll out the ENA framework to achieve large scale?
  16. 16. ENA framework extends nutrition coverage within the health sector… Child Health Nutrition programs Newborn health Reproductive HealthFrom policy to delivery EPI Lactation Amenorrhea Method Community IMNCI/CCM with Family Planning Health facilities IMNCI Maternal Health CMAM Infectious Diseases Control of Malaria (Insecticide Treated Nets & Treatment) Tuberculosis HIV/AIDS (PMTCT) 16
  17. 17. Critical health contacts for infant feeding, micronutrients & women’s nutritionPREGNANCY: diet, iodized DELIVERY: Cord clamping,salt, iron/folic acid, de- Initiation BF, vitamin A,worming, anti-malarial, iron/folic acid, dietprep to BF.POSTNATAL AND FAMILY IMMUNIZATION: BF & CF,PLANNING: LAM & BF, vitamin A, de-worming,diet, iron/folic acid, treat assess and treat anemiaanemia WELL CHILD & GMP monitor growth, assess and SICK CHILD & SAM/MAM:, counsel on IYCF feeding, counsel on IYCF, iodized assess and treat for anemia, check and complete 17 salt vitamin A, de-worming,
  18. 18. ENA framework extends nutrition coverage outside the health sector… Food Production Food SecurityFrom policy to delivery Pre-Service Water and Education Climate Change Sanitation Women in Schools Development Mass Media
  19. 19. ENA framework create the buzz at community level…Agriculture Education Community Health Workers Savings groups Local Development & Planning
  20. 20. BCC the backbone for the ENA framework Promote small do-able actions to demystify nutrition Harmonization through various toolsPoopy and Counseling cardsradio/TV Posters Newsletters Job aids Health booklet Formative Research to help over-come family and community obstacles
  21. 21. BCC: build on partners what already exists 1. Inter-personal counseling Health provider with mother Community worker with mother Mother-to-mother Peer counseling 2. Group discussions Breastfeeding support groups Savings & credit groups Homestead food production groups Listening clubs (cassettes and radio) 3. Informal settings Market days Fetching water or wood 4. Mass media Radio 21 Village theatre groups
  22. 22. Ultimate goal: saturate the environment with nutrition practices Enroll a large number of volunteers across sectors Health workersCommunity volunteers supporting Community assisting at health mothers volunteer making clinic home visits Community volunteers supporting women at chanceCommunity health encounters (market, fields, festivals Agricultural extension collecting firewood) workers supporting mothers
  23. 23. Small Group WorkEach group discuss a case study (20 minutes)Report back (5 minutes) Question: If you were Country Director…