understanding the essential nutrition actions framework_victoria quinn_5.5.14
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Essential Nutrition Actions Framework
Potential for the SUN Movement Victoria Quinn, PhD Helen Keller International Core Group Spring meeting 5 May 2014
Essential Nutrition Actions
Relevance to global nutrition
movements
“new opportunities for ENA”
Scaling Up Nutrition –SUN Movement
SUN is a unique Movement founded on the principle that all people have a
right to food & good nutrition.
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Lancet Nutrition Series
February 2008
These data had an immense impact on
subsequent nutrition strategies and global development events
Funded by BMGF
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Increased focus on the ‘Global Nutrition
Architecture’
Lancet 2008 Nutrition Series
“The international nutrition system—made up of international
and donor organisations, academia, civil society, and the private sector— is fragmented and
dysfunctional…”
Morris et.al, 2008 Lancet Nutrition Series Paper 5
6
Sparked series of
consultations in nutrition community to rally around
the new 2008 Lancet nutrition findings which
provided evidence on ‘what worked’.
Publication of
‘Scaling Up Nutrition:
Framework for Action’ (Feb. 2010)
released by coalition of nutrition partners
representing many different
constituencies
Endorsed by nearly a hundred partners – from civil society, governments, academia, UN agencies, World Bank, Foundations & private sector groups
National Nutrition Institute, MOH Egypt
Cornell University Division
of Nutritional SciencesCornell University, USA
THE WORLD BANK
Public-Private Partnerships
The International Life Science Institute Focal Point in China
,
Exceptionally unique point in time for nutrition!
SUN is a unique Movement founded on the principle that all people have a
right to food & good nutrition.
Over 165 million children under 5 are stunted as a result of malnutrition. • 52 million children are too thin and require special
treatment.
• At the same time, 43 million children are overweight - some as a result of poverty, when families are unable to afford a balanced, nutritious diet.
• 2 billion people are deficient in key vitamins & minerals
A reminder - why nutrition? The facts
ROOTED IN
Poverty Disempowerment of women
Political & Cultural Environment
Insufficient access to affordable, nutritious
FOOD throughout the year
Lack of good
CARE
for mothers & children & support for parents on appropriate child feeding
practices
Inadequate access to
HEALTH
sanitation & clean water services
SUN recognizes the causes of malnutrition are interconnected
Environmental Degradation
Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment
Agriculture: Making nutritious food more accessible to everyone, and supporting small farms as a source of income for women and families Clean Water & Sanitation: Improving access to reduce infection and disease Education & Employment: Making sure children have the nutrition needed to learn and earn a decent income as adults Health Care: Access to services that enable women & children to be healthy Support for Resilience: Establishing a stronger, healthier population and sustained prosperity to better endure emergencies and conflicts
Nutrition-Sensitive Strategies Specific Actions for Nutrition
Nutrition strategies increase the impact of specific actions for nutrition
Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment
Agriculture: Making nutritious food more accessible to everyone, and supporting small farms as a source of income for women and families Clean Water & Sanitation: Improving access to reduce infection and disease Education & Employment: Making sure children have the nutrition needed to learn and earn a decent income as adults Health Care: Access to services that enable women & children to be healthy Support for Resilience: Establishing a stronger, healthier population and sustained prosperity to better endure emergencies and conflicts
Nutrition-Sensitive Strategies Specific Actions for Nutrition
Nutrition strategies increase the impact of specific actions for nutrition
Countries around the world have committed
to making nutrition a priority
& global partners
are working together to support the
efforts of SUN countries.
Countries are at the center of scaling up nutrition
The SUN approach – starting in 2010
• The Scaling up Nutrition Movement relies on national leaders taking ownership and responsibility for delivering sustainable solutions to improve nutrition in their countries.
• Through country-led efforts that focus on equity and realization of rights,
SUN countries are enabling women, families & communities to create stronger foundations for their people & transforming the
future of our world.
• SUN enables countries to take a collaborative approach
bringing together the people & resources needed to rapidly scale up nutrition-specific interventions as well as implement cross-sector strategies that are nutrition-sensitive.
The SUN approach –Country level
Country governments lead national efforts to scale up nutrition.
Within each country a
SUN Focal Point is identified
The SUN approach – Country level
The Focal Point brings people together in a multi-stakeholder platform
Technical Community
United Nations
Government Partners
Civil Society
Donors
Business
The SUN approach – Country level
The multi-stakeholder platform
Works to align and coordinate action
across sectors.
Women’s Empowerment
Health
Development & Poverty Reduction
Agriculture
Education
Social Protection
The SUN approach – Global level
Using a unique approach that
works for each country. These efforts are underway
in all SUN countries
Multi-sector, multi-stakeholder platform
Together the combined efforts of all countries make up the core of the
Movement - The SUN Country Network
With overall support and coordination provided by the
SUN Secretariat and
SUN Lead Group
Country Network
Donor Network
Civil Society Network
Business Network
United Nations Network
Global Networks of stakeholders shift
resources & align actions to support
country efforts.
The SUN approachn – Global level
Making progress – Country level
Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition.
Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies
Align Actions Across Sectors around high quality and well-costed country plans, with an agreed results framework and mutual accountability.
Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact.
1 2
3 4
Within each country, SUN Movement stakeholders are brought together around
4 key processes: progress is reviewed every six weeks
Tracking and reporting impact
Establishing targets to measure impact: Countries are encouraged to establish their own ‘costed plans’ with targets for nutrition goals in the following areas:
Annual SUN Movement Progress Report: Released in September each year by the SUN Movement Secretariat, the report provides updates on progress in achieving the Movement’s goals and strategic objectives.
Supporting global impact
Together, countries and supporting stakeholders are collectively working to reach the global targets by 2025 set out by the
World Health Assembly 2012 Resolution:
Reducing and maintaining childhood wasting to less than 5%
Target 1:
Target 2:
Target 3:
Target 4:
Target 5:
Target 6:
40% reduction of the global number of children under 5 who are stunted
50% reduction of anemia in women of reproductive age
30% reduction of low birth weight
No increase in childhood overweight
Increase exclusive breastfeeding rates in the first 6 months up to at least 50%
Today the SUN Movement is growing in numbers & strength
100+ global stakeholders are providing support to
46 countries with the opportunity to reach
82 million stunted children
How does the ENA framework fit in?
Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition.
Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies
Align Actions Across Sectors around high quality and well-costed country plans, with an agreed results framework and mutual accountability.
Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact.
1 2
3 4
Within each country, SUN Movement stakeholders are brought together around
4 key processes: progress is reviewed every six weeks
Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition.
Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies
Align Actions Across Sectors around high quality and well-costed country plans, with an agreed results framework and mutual accountability.
Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact.
1 2
3 4
Within each country, SUN Movement stakeholders are brought together around
4 key processes: progress is reviewed every six weeks
Country Level - how does the ENA framework fit in?
Nutrition specific actions
Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment
Specific Actions for Nutrition
Nutrition specific actions
Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment
Specific Actions for Nutrition
Nutrition specific actions
Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment
Specific Actions for Nutrition
Nutrition specific actions
Essential Nutrition Actions
The ‘what’ of ENA…
Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition.
Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies
Align Actions Across Sectors around high quality and well-costed country plans, with an agreed results framework and mutual accountability.
Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact.
1 2
3 4
Within each country, SUN Movement stakeholders are brought together around
4 key processes: progress is reviewed every six weeks
How does the ENA framework fit in?
So… “how” do we do it?
The ENA Framework may provide a nice fit for what is needed to scale
up proven nutrition actions under the SUN
movement
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1st task… Reach women and children at
broad scale with the Essential Nutrition Actions
to make a public health impact
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2nd task…. Provide the right nutrition
support at the right time to the right person
(e.g. children, women and …
adolescent girls)?
Critical Life-Cycle Contact Points for the Nutrition of Women, Infants and Young
Children? pre-pregancy and adolescence
during pregnancy & lactation
at birth
during post-natal period
from 0-6 months
from 6-24 months
Source: adapted from Lancet Nutrition Series 2013
Providing the right support at the right time:
3rd task… Reduce the many ‘missed opportunities’ in existing
health programs to provide nutrition support
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•Nutrition Programs
•Child survival programs
•Neonatal
•Reproductive health
•Infectious diseases
•Agriculture
•Education
•Micro-credit
•Emergency
•Social
Protection
•WatSAN
Outside
the health
sector
Within the
health
sector
Potential to integrate ENA into health sector and non-health sector programs
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•Nutrition Programs
•Child survival programs
•Neonatal
•Reproductive health
•Infectious diseases
•Agriculture
•Education
•Micro-credit
•Emergency
•Social
Protection
•WatSAN
Outside
the health
sector
Within the
health
sector
Potential to integrate ENA into health sector and non-health sector programs
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•Nutrition Programs
•Child survival
programs
•Neonatal
•Reproductive health
•Infectious diseases
•Agriculture
•Education
•Micro-credit
•Emergency
•Social
Protection
•WatSAN
Outside
the health
sector
Within the
health
sector
Potential to integrate ENA into health sector and non-health sector programs
43
•Nutrition Programs
•Child survival
programs
•Neonatal
•Reproductive health
•Infectious diseases
•Agriculture
•Education
•Micro-credit
•Emergency
•Social
Protection
•WatSAN
Outside
the health
sector
Within the
health
sector
Potential to integrate ENA into health sector and non-health sector programs
44
4th task…
Lots of partners!
Need to align ourselves in each country
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National Nutrition Institute, MOH Egypt
Cornell University Division
of Nutritional SciencesCornell University, USA
THE WORLD BANK
Public-Private Partnerships
The International Life Science Institute Focal Point in China
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All these groups are aware, committed and mobilized!!
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Under USAID funded LINKAGES Project (1996-2006)
• Ethiopia: >60 ENA partner groups
• Ghana: ~ 15 nutrition partners groups (regional & district networks)
• Madagascar: >50 ENA partners groups (national & regional networks)
Create broad partner networks to increase coverage, allow fast-tracking and
and leverage of resources
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5th task…
Choosing a starting point.
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Where to start - harmonize and strengthen existing field programs
Fine-tune existing programs to make them
better
Focus on capacity development of government & NGO staff, key community members, etc…
especially in behavior change and counseling
Strive for same nutrition messages, BCC strategy, IEC materials, training materials...
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Where to start - harmonize and strengthen existing field programs
Fine-tune existing programs to make them
better
Focus on capacity development of government & NGO staff, key community members, etc…
especially in behavior change and counseling
Strive for same nutrition messages, BCC strategy, IEC materials, training materials...
Different customized training targeted to:
Health workers (government
and CSO staff, etc..) Community members &
volunteers
• Short-term, skills-based ENA training • Heavy on interpersonal communication skills (e.g.
counseling/negotiation) • Lots of practice with real mothers
Capacity building in ENA for health workers and community members
The Core Group
http://www.coregroup.org/resources/core-tools
New Generic ENA Behavior Change Training for Health Workers and Community Level: English & French
The ENA Framework may provide a nice fit for what is needed to scale
up proven nutrition actions under the SUN
movement
• SUN Secretariat Powerpoint (December 2013) downloaded from SUN Website (adapted for this presentation)
• Why Nutrition The Facts: UNICEF-WHO-The World Bank: Joint child malnutrition estimates - Levels and trends. Global Database on Child Growth and Malnutrition
• A Smart Investment: Lawrence Haddad. Child Growth=Sustainable Economic Growth: Why we should invest in Nutrition. May 2013
• Experts Agree: Copenhagen Consensus: Solving the world’s challenges. May 2012
• SUN Countries’ success in reducing stunting: The number of countries with AARRs greater than 2% is calculated based on historical data from 2000 to mid-2013. This figure is currently under review, and the new number will be reported once the reanalysis of latest available data is finished.
The SUN Movement Secretariat is supported by Canada, France, Germany, Ireland, the Netherlands, the United Kingdom and the European Union, together with the Micronutrient Initiative.
How has stunting been reduced? References and Technical Notes References & technical notes from SUN website
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