Areas of interventions in National Nutrition Services (NNS)

By

Dr Mustafiz Rahman PPC, MoHFWTraining on Assessment of Nutritional Status 18-22 December 2011

Date : 18 December 2011, Venue: FPMU Meeting Room

The Training is organized by the National National Food Policy Capacity Strengthening Programme (NFPCSP) . The NFPCSP is 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 it's 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 weight 3. wasting4. Protein Energy Malnutrition 5. 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)

Adolescent Girls 13-19 yrs

Newly Wed Women

ChildrenUnder Two

Lactating Mothers

PregnantWomen

ServicesThrough

Life-cycleIn BINP/NNP

NNS would follow life-cycle approach in community service

Services perform by a CNP at CNC

Post-partum Care Vitamin A iron folate Referral

Growth MonitoringCare for LBWFoodSupplementtionVitamin AReferral

Weight MonitoringIron FolateAntenatal careIron FolateFood supplementationCounselingReferral

Monthly ForumNutrition AssessmentIronFolateDe-wormingWeight promotionIGA, Fruits tree plantation

Lactating Women

Under 2 Children

Pregnant Women

Adolescent Girls/boys

NutritionAssessmentCounselingIronFolate

Newly wed Couple

Food Security Components Nutrition Garden

Poultry for NutritionVGD-NNP Collaboration

Household Survey followed by updateHome visit

Adolescent boysMother in lawFather in lawHusband of newly and pregnant women

Forums

BCC

Training

Family Welfare Assistant (FWA) for >5000 population

Community Nutrition Promoter (CNP) for 1250 population

Services in CCHealth Assistant (HA) for >5000 population

Other ministries/

NGOs/private /personal initiative

Eligible couple registration

Family planning counseling

Non-clinical contraceptive distribution & FU

Referral for ANC

Support during

NID & Vit A week

HH profile update GMP Micronutrient

Supplementation (Post partum Vit A, IFA for

PLW) Adolescent girt & newly wed women

Target food supplementation for PLW, U2 children

Referral for ANC BCC Food Security interv Support during NID & Vit A week

HPN Services Geographical reconnaissance

EPI Disease

surveillance Health education Epidemic control NID & Vit A week

………. ………… ……………

…

Job Analysis of Front Line Workers in HNPSP Comparative Matrix

Multi sectoral issues

Due 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 Objective

The 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 access

2. 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 system

4. 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 buildingHuman resource development (HRD)/

Training/Capacity BuildingFood security, quality & food safetyManagement 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 deliveryGrowth 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 motherIron-folic acid supplementation for pregnant womenIron Supplementation and Deworming of Adolescent

GirlsIodine deficiency disorder & Salt IodizationZinc 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.

1. 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

2. Strengthening HR resources necessary for provision of nutrition services. OP-11, 12, 29, 25

3. Establish effective facility and pop based nut surveillance. OP-1,2,3,14, 22, 6

4. Providing nutrition education OP-15, 23, 2,35. Strengthening sectoral collaboration regarding nutrition

and food safety. MODM, Food Div, MOFLS, MOWCA, MOI and other.

18

Indicator

1. 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 ) practices

6. 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 Code

10. Food fortification (Salt Iodization, fortification of oil/other food with Vitamin ‘A’, iron etc.)

11. School Nutritional education Program 12. 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 NU 16. Community based Nutrition (CBN) ) as selected area

17. Multisectral Collaboration

23

Thanks

24