as part of the IFPRI-Egypt Seminar Series- funded by the United States Agency for International Development (USAID) project called “Evaluating Impact and Building Capacity” (EIBC) that is implemented by IFPRI.

1. 1
Adequate Nutrition
Dr. Moataz Saleh
IFPRI EGYPT SEMINAR : SEPTEMBER 2018
HIGH QUALITY EVIDENCE IS CRITICAL FOR
HIGH QUALITY NUTRITION POLICY

2. 2
23
3
4
23
5 5
29
7
6
27
21
15
8
6
Anemia Stunting Overweight Wasting Underweight
%OFUNDER-FIVECHILDREN
2000 2005 2008 2014
Percentage of Children Under the Age of Five who are
Malnourished, DHS Trend
78
36
21
85
25
overweight Anemia overweight Anemia
Females 5-19 years Ever-married women 15-49 years
PERCENTAGE
2008 2014
Percentage of females aged 5-19 years and ever-married
women aged 15-49 years who are malnourished, DHS Trend
Available Data

3. 3
Policy & Directions

4. 4
Deprivations in nutrition and health are a
significant contributor to multidimensional
poverty of under-five children.
Integrated response and policies are needed to fully address these
multidimensional poverties.
In addition, the main contributors to child poverty (deprivations in
health, nutrition, and child protection), need to be addressed through
linkages between interventions that promote early childhood
development
The three largest contributors to child poverty
are the same in urban and rural areas
Nutrition is the second largest cause of
poverty for children under-five

5. 5
Unicef interventions
UNICEF is working on 2 levels to address nutritional challenges in the Egypt
1. Policy level (advocacy, generation of policy briefs, supporting the government to create the
conditionality of the Takafol and Karama program with consideration of the Multidimensional
Poverty, update of the national nutrition strategy with a budgeted action plan.
2. On the ground level through designing and implementation of the 1000 days program with the
MOHP
The 1000 days Program
Enhancing Capacity of
providers to convey
adequate counselling to
induce behaviour change
Building Capacity of
providers to provide high
quality Nutrition services
at the public facilities
Supporting supply side
services to ensure
enabling environment to
providing services
Supporting data
management and
creation of a data driven
decision support system

6. 6
Adequate counselling to induce behaviour change
• UNICEF is finalizing with the MOHP the 3 new national counselling
manuals on nutrition for health care workers at the PHC level.
1. Nutrition specific counselling skills
2. Nutrition of women in the perinatal period
3. Complementary feeding guidelines
• UNICEF support to the national Breast Feeding Program
is continuous and aims to accredit all trained facilities as
Baby Friendly Facilities
• Supporting the MOHP to create a micronutrient manual
and system which includes inventory and supply chain
management.

7. 7
Adequate counselling to induce behaviour change
Based on the nurturing care framework
UNICEF has assisted the MOHP to update the “well baby
health cards” with new messages addressing both growth and
development as well as early stimulation positive parenting,
family planning and other important messages.

8. 8
High quality Nutrition services at the PHC level
Anthropometry Training manual
for health care providers
Supporting the supply chain
reform initiative
Lab services protocols update

9. 9
Supporting supply side services: Interim Solutions For High Quality Data
1. MORES implementation for quality data at the PHC
facility level
0
20
40
60
80
100
120
61
48
40
70
90 91
85 80
85 85
93
84
73
47
8
31
65 61
87
88
72
50
82
70
100 97 96 97
103
92
110
76
33
7
36
27
59
97
%coverage
Percentage Coverage of Mother & Child with Vit A Capsules
In All Participating Districts
proportion of coverage of mothers with Vit A capsules post delivery proportion of coverage with Vit A capsules for infants aged 9 month
8.40 11.60
16.00 15.70
23.3
20.57
25.86
19.52
23.03 23.37
0
10
20
30
Quarter 1
2013
Quarter 3
2013
Quarter 1
2014
Quarter 3
2014
Quarter 1
2015
Quarter 3
2015
Quarter 1
2016
Quarter 3
2016
Quarter 1
2017
Quarter 3
2017
Demand for ANC services before 13 weeks pregnancy in Participating Districts
Proportion of
women registering
in ANC clinic before
the 13th week of…
Determinants Definitions
Enabling
Environment
Social Norms
Widely followed social rules of
behaviour
Legislation/Policy Adequacy of laws and policies
Budget/Expenditure
Allocation & disbursement of
required resources
Management
/Coordination
Roles and Accountability/
Coordination/ Partnership
Supply
Availability of Essential
Commodities/Inputs
Essential commodities/ inputs
required to deliver a service or
adopt a practice
Access to Adequately
Staffed Services,
Facilities and
Information
Physical access (services,
facilities, information)
Demand
Financial Access
Direct and indirect costs for
services/practices
Social and Cultural
Practices and Beliefs
Individual/ community beliefs,
awareness, behaviors, practices,
attitudes

10. 10
Supporting supply side services: Interim Solutions For High Quality Data
2. Supply chain support tools for Micronutrients and Lab supplies

11. 11
Data management & data driven decision support
Generating high-quality nutrition evidence from
The National health information systems
Institutionalizing the change
Challenges:
• Data from MoHP HIS was under-utilized due to problems in timeliness and
quality
• Difficulty in interpreting raw data
• Very large volume of data monthly
• Rarely used to improve performance at the peripheral levels

12. 12
Data management & data driven decision support
Strengthening routine Health Information System
UNICEF support to MoHP
• Refine and update maternal and child health registries
• Streamlining and updating indicators
• Indicators can be disaggregated up to PHC unit level
• Providing benchmarks and decision support for each indicator
• Currently developing training package for governorate and district
level teams on using data for decision making
• Advocating to rolling out to the facility level

13. 13
Data management & data driven decision support
Strengthening routine Health Information System
HIS provides indicators on:
• Health status: anaemia, stunting, underweight and overweight, low
birth weight, prematurity
• Coverage: ANC, hospital delivery, PNC, growth monitoring
• Coverage with iron, folate and Vit A supplementation
• Coverage with screening services e.g. anaemia, hypertension and
proteinuria and glucosuria for pregnant women
• Breastfeeding and infant and young child feeding: early initiation of
breastfeeding, exclusive breastfeeding, continued breastfeeding

14. • No recent, representative, national data on nutrition status of women
and children
• National surveys do not provide adequate disaggregation at
governorate and district levels  difficult to pinpoint high-need areas
• Supply chain management system at present does not identify FHUs
with stock-outs or overstock or expiring stocks of micronutrient
supplements or other medications
14
Data gaps

15. • Data use
• Data quality (since most data entered at district, not PHC level)
• Timeliness: no online data entry
• Reach: not all population utilizes MOHP services
• Aggregation: individual data not available
• Quality of growth monitoring: under-detection of stunting and
underweight
• Quality of other services: under-detection of pregnancy-associated
nutrient related risk factors
15
Data gaps
Health Information System