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Moataz Saleh (UNICEF)• 2018 IFPRI Egypt Seminar: “High quality evidence is critical for high quality nutrition policy”

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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.

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Moataz Saleh (UNICEF)• 2018 IFPRI Egypt Seminar: “High quality evidence is critical for high quality nutrition policy”

  1. 1. 1 Adequate Nutrition Dr. Moataz Saleh IFPRI EGYPT SEMINAR : SEPTEMBER 2018 HIGH QUALITY EVIDENCE IS CRITICAL FOR HIGH QUALITY NUTRITION POLICY
  2. 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. 3 Policy & Directions
  4. 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. 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. 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. 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. 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. 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. 10 Supporting supply side services: Interim Solutions For High Quality Data 2. Supply chain support tools for Micronutrients and Lab supplies
  11. 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. 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. 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. 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. 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

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