The document summarizes the evolution of nutrition policies and programs in Ethiopia. It discusses the establishment of the Ethiopian Nutrition Institute in 1962 as marking the beginning of focused nutrition efforts. It then outlines several national nutrition strategies, policies, and programs that have been developed over the decades to address issues like infant and young child feeding, micronutrient deficiencies, emergency nutrition, and food security. Key programs mentioned include the Health Extension Program, Community-Based Nutrition, Integrated Management of Childhood Illness, and the Productive Safety Net Program.

1. PPT Prepared for community nutrition course

2. Evolution of nutrition in Ethiopia
 The establishment of Ethiopian Nutrition Institute in
1962 can be considered as a hallmark in the history of
nutrition
 Advocacy
 Awareness creation and promotion
 Various interventions
 Researches, surveys and IEC/BCC material production
 Extensive engagements in disaster prevention and
response activities

3. Food and nutrition related policies,
strategies and guidelines in Ethiopia
 Comprehensive socioeconomic development
plans/programs
 Health policy
 Health sector development plans
 National nutrition strategy
 Disaster management and emergency nutrition
policies and strategies
 Child survival strategy

4. Food and nutrition related policies,
strategies and guidelines in Ethiopia
 National guideline on control and prevention of
micronutrient deficiencies was issued by MoH in 2004.
 National strategy for infant and young child feeding was
developed in 2004 by MoH.
 Essential Nutrition Actions was endorsed and included
in nutrition programs

5. Health extension program
 HEP was formulated around 2000. It was piloted in
2002/2003 and implemented in 2004/2005 during
HSDPII.
 The main aim of HEP was to accelerate access to
primary health care service to the communities at
grassroots
 Activities in rolling out the program, included
construction of health posts at all kebeles, training
and deploying two health extension workers in each
health post and delivering preventive and promotive
services on sixteen health issues

6. Health extension program
 Nutrition is included as one of the sixteen activities that are
included in the health extension program
 The primary goal of the nutrition package is to prevent
malnutrition by empowering communities through sensitization
and awareness creation efforts.
 Delivering appropriate nutrition messages and demonstrating
appropriate ways of food preparation to communities, by
organizing community meeting or making use of any community
gathering as well as going from house to house.
 It is also emphasized that enabling families as model families and
engaging them in the overall health activities as a major strategy in
implementing the nutritional activities

7. NNS & NNP
 Ethiopia did not have policy and strategic framework
and directives up to 2008.
 In 2008 national nutrition strategy was endorsed
and a five year national nutrition program was
initiated in 2009.
 The national nutrition program had two major
objectives, namely enhancing nutrition service
delivery and institutional capacity building.

8. NNS & NNP
 The service delivery component has four segments
 a) Sustaining Enhanced Outreach Strategy (EOS) with
Targeted Supplementary Food (TSF) and transitioning
of EOS into the Health Extension Package (HEP),
 b) Health Facility Nutrition Services,
 c) Community Based Nutrition (CBN)
 d) Micronutrient Interventions.

9. NNS & NNP
 The community based nutrition program includes, vitamin
A supplementation, deworming, monthly anthropometric
measurements, delivering messages and counseling, food
preparation demonstrations.
 The CBN component of NNP focuses on growth
monitoring and promotion –
 Consists of measuring children monthly, analyze the
information and decide on appropriate actions. Triple A
cycle (assess, analyze and act) approach is used in growth
monitoring and promotion activity.
 The aim is to identify children experiencing growth
faltering and intervene in time before the problems gets
serious

10. NNS & NNP
 Measures actions include
 Appreciate and encourage mothers of children who are
doing well to keep on
 Discuss about the causes and actions to be taken with
the mothers of children who are not doing well and
counsel them
 Admit the children whose situation appears to be
serious to various feeding modalities.

11. NNS & NNP
 The CBN component of NNP is designed to be
implemented mainly through HEP, where nutrition is
already one of the 16 packages of HEW activities.
 CBN is being implemented in drought prone woredas in
phases in Amhara, Oromiya, SNNPR and Tigray regions
 The first phase was initiated in 2008 in 54 woredas; the
second phase was initiated in 2009 in 77 woredas and the
third phase was initiated in 2011 in 40 woredas.
 On top of prone to drought, the presence of EOS, feeding
programs and PSNP are considered to be included in the
CBN program

12. NNS & NNP
 With the aim consolidating and accelerating the
promotion of nutritional status, and hence meet the
MDG goals 4 and 5, a new and ambitious three year
second phase national nutrition program was
launched in June 2013.
 Assignment
 In groups, review
 National nutrition strategy and present a concise
summary
 first and second NNP and present your findings
regarding the differences and similarities

13. Essential Nutrition Actions
 National strategy for infant and young children
feeding practices was developed in 2004 by FMoH.
 The strategy adopted the essential nutrition actions,
developed by AED/LINKAGES that include seven low
cost, high impact and feasible actions in improving
maternal and child health outcomes.

14. Essential Nutrition Actions
 These include
1. promotion of optimal breast feeding,
2. promotion of optimal complementary feeding,
3. nutritional care of sick children during and after
illness,
4. improving women’s nutrition,
5. preventing/controlling anemia, Vitamin-A and iodine
deficiencies.

15. Essential Nutrition Actions
6. Essential nutrition actions are intended to improve
infant and young child feeding practices through
behavior change communication
7. Six contact points are envisaged to provide appropriate
messages and counseling
NB: prenatal visits, delivery care, postpartum care for
mothers and infants, immunization, sick‐child visits and
well child visits (including counseling and growth
monitoring and promotion [GMP]).

16. Micronutrient supplementation
 Vitamin A supplementation to lactating mothers and
children under five years of age is being undertaken
beginning from 1990th
 The doses, the schedule and the strategies have been
laid out in the guideline issued by FMOH
 Iron/folate supplementation for pregnant women is
also being implemented through ANC services
 Zinc supplementation has recently been included in
the protocol of treating children with diarrhea

17. Fortification
 Fortification of salt with iodine has already begun a
few years back
 Households are advised to consume salt fortified with
iodine
 The import of unfortified salt is legally banned

18. Extended Outreach Strategy (EOS),
 A number of food and nutrition interventions are provided
to the communities in the drought prone woredas.
 Extended Outreach Strategy (EOS), was developed and
implemented in drought prone areas beginning from 2006
 Interventions include
 Bi-annual provision of vitamin A supplements, deworming
and screening of children for malnutrition and providing
supplementary foods for uncomplicated malnourished
children and referrals for complicated cases.

19. IMNCI
 Pneumonia, diarrhea, malaria, measles and malnutrition
account for much of child deaths in developing countries.
 These conditions often occur in combinations requiring a
holistic approach of assessment, treatment and caretaker
counseling.
 The Integrated management of Childhood Illness (IMCI)
strategy was been developed to address these conditions
effectively.
 Ethiopia contributed immensely to the development of
IMCI
 Officially adopted it in 1997 and included in health sector
development plans

20. IMNCI
 The strategy required rigorous capacity building and
provision of necessary materials/medicines to health
facilities
 Plans to increase the number health facilities that
provide IMNCI has been included in all HSDPs
 Evaluation documents indicate that the achievements
have always been lower than the planed targets
 In HSDP4 the target has been set to increase the
number of health institutions providing IMNCI
services from 62% to 100%

21. CMAM
 Community management of acute malnutrition, is
treatment of acute malnutrition in the community by
the HEW.
 It begun in 2008 in SNNPR and Oromyia and rolled
out to Amhara and Tigray in 2009
 Children are weighed and medically uncomplicated
severely malnourished children receive therapeutic
foods at community
 Complicated cases are referred to health centers

22. ICCM
 Integrated community case management (ICCM) was
initiated/scaled up in 2010.
 General objective is improving Community-based
Case Management of Common Childhood Illnesses
including pneumonia using the Health Extension
Program as a major vehicle
• ICCM is intended to reinforce ongoing CCM of malaria,
diarrhea, malnutrition and introducing CCM of
pneumonia by HEWs

23. ICCM
 Apart from Preventive/promotive measures, HEWs are
expected to provide curative services for the following
childhood illnesses
 Pneumonia (antibiotic treatment)
 Diarrhea (ORT/ORS, Antibiotics for dysentery, Zinc
treatment),
 Malaria (Anti-malarial drugs),
 Malnutrition (Therapeutic feeding; treatment with RUTF,
Systematic antibiotic treatment and deworming, Measles
vaccination) and
 Newborn health problems (Resuscitation of newborn,
Management of hypothermia, Antibiotics for sepsis)

24. Food security programs
 Among a number of programs aimed at addressing
food insecurity, the most important program believed
to have contributed to improved nutrition is the food
security program implemented in rural areas since
1996.
 The program embraces four components implemented
in all drought prone woredas, among which productive
safety net program is the main one.

25. Food security programs
 Households identified as chronically food insecure are
provided with cash or food, until, their conditions is
evaluated to have improved.
 To date about 8,000000 people have been receiving the
support
 Recently, food security program focusing in urban
areas is underway in selected urban centers

26. Emergency nutrition interventions
 Ethiopia has been affected by repeated episodes of
drought and famine that required emergency nutrition
interventions
 The emergency nutrition interventions included
 Food provision to the entire affected population (general
food ration)
 Provision of enriched foods for vulnerable groups
(supplementary feeding)
 Treatment of malnourished children (therapeutic
feeding)