Updates on IYCF- integrated with MNP & Child Grant, Vit A and GMP Programs 1 Pradiumna Dahal Nutrition Specialist, UNICEF.

1

Updates on IYCF- integrated with MNP & Child Grant, Vit A and GMP Programs

Pradiumna DahalNutrition Specialist, UNICEF

Vitamin A Coverage

NDHS2006 NDHS 20110

20

40

60

80

100

8890

Percentage Given Vitamin A Supplements in last 6 months among all eligible children age 6-59 months

Surveys

6-59

mon

ths

child

ren%

NDHS2006 NDHS 20110

20

40

60

80

100

44

70

Percentage Given Vitamin A Supplements in last 6 months among all eligible children age 6-8 months

Surveys

6-8

mon

ths

child

ren

%

NDHS2006 NDHS 20110

20

40

60

80

100

8186

Percentage Given Vitamin A Supplements in last 6 months among all eligible children age 6-59 months living in urban areas

Surveys

6-59

mon

ths

urba

n ch

ildre

n %

UNICEF will focus on under-reached and unreached children (children 6-11 months and children in given in urban areas)

VAS modeling for 6-11 months children is proposed in Jumla, Kavre and Chitwan districts for 2012- 2013 aiming to scale up this approach to rest of country by 2017.

Protocol for Vit A Modeling • The Routine Vit A Biannual Supplementation continued

with BCC focus on urban/Children 6-11 months.

• After 6 months the child receive 100,000 IU vitamin A supplement (In HF or through FCHV- Only the first dose)

• Integrated with routine measles vaccination - If the child is fails to receive routine Vit A biannual supplementation

• The time gap should be more than 30 days

Anemia Prevalence High in Children: The Problem is serious among 6-23 months children

6-8 9-11 12-17 18-23 24-35 36-47 48-59 Total0

102030405060708090

78 74 72

57

4438

25

46

Age in months

Perc

ent o

f chi

ldre

n ag

e 6-

59 m

onth

s w

ith

anem

ia

Source: NDHS 2011

Source (Year) Breastfeeding (BF) Complementary feeding (CF)

Early initiation (within 1 hour)

EBF among 0-6 months

CF (6-9 months)

NDHS (2011) 45% 70% 70%

NDHS (2006) 35% 53% 75%

NDHS (2001) 31% 68% 66%

Trends on IYCF practices in Nepal: DHS 2001, 2006, 2011

IYCF Practices among Under 5 Children

Exclusively breastfed

70%

Breast milk plus water

10%

Breast milk plus other

milk9%

Breast milk plus other non-milk

liquids<1%

Breast milk plus

complementary foods

10%

Not breastfed

1%

Breastfeeding Status Under 6 Months

Percent of children 6-23 months

Recommended IYCF Practices among 6-23 months children

National Programme

Feasibility study on MNP distribution in two districts, Makawanpur and Parsa

Piloting of the MNP program(6 districts: 2010 Onwards) and roll out

in 9 districts by 2012

Scale up of the MNP Programme by 2015

Phase I

Phase II

Phase III

To Improve Anemia, Other micronutrient deficiencies and timely introduction of Complementary food

IYCF Community Promotion linked with MNP

IYCF/MNP Program Goal

• To improve the nutritional status of children aged 6 to 24 months

by reducing prevalence of anemia and by improving

complementary feeding and care practices.

Pilot Objectives

To identify an effective delivery mechanism to distribute

MNPs integrated with IYCF counselling to children 6-24

months of age.

To use the findings of this pilot program to develop

national strategy for nationwide scale up

Program Districts for Piloting- 6 districts

Phase 1: Makwanpur (May, 2010);Palpa (June, 2010)

Phase 2: Rasuwa (Sept, 2010); Gorkha (Jan, 2011)

Phase 3: Rupandehi (May, 2011); Parsa (June, 2011)

DOLPA

MUGU

JUMLA

KAILALI

BARDIYA

HUMLA

DOTI

SURKHET

NAWALPARASIKAPILBASTURUPANDEHI

DANG

BANKE

ACHHAM KALIKOT

JHAPAMORANG

SIRAHA

SAPTARI

DARCHULA

BAJHANG

BAITADI

DADEL-DHURA

KANCHAN-PUR

BAJURA

PARSA

BARA RAUTA-

DHANUSAMAHO-TARI

SUNSARI

SARLAHI

DHADING

MAKAWANPURCHITWAN

KASKI

TANAHU

PALPA

SYANGJA

PARBAT

ARGHAKHACHI

GULMI

UDAYAPUR

SINDHULI

ILAM

BHOJ-PUR

DHANKUTA

TAPLEJUNG

OKHAL-DHUNGA

TERHA-THUM

KHOTANG

Patan

BKTM

SOLUK-HUMBU

DOLAKHA

SANKHUWA-SABA

NUWAKOTSINDHU-PALCHOK

KAVRE

RASUWALAMJUNG

GORKHA

PYUTHAN

ROLPASALYAN

MYAGDI

DAILEKHJAJARKOT

RUKUM

MUSTANG

MANANG

•Simikot•Darchula

•Baitadi

•Dadeldhura

•Mahendranagar

•Dhangadi

•Dipayal

•Chainpur •Martadi

•Magalsen

•Gularia

•Birendranagar

•Dailekh

•Manma

•Jumla

•Gamgadi

•Jajarkot

•Dunai

•Jumlikhalanda

•Salyan

•Nepalgunj

•Ghorahi

•Liwang

•Jomosom

•Beni

•Baglung

BAGLUNG

•Kusma

•Pyuthan

•Taulihawa

•Sandhikharka

•Tamghas

•Sidharthanagar

•Tansen

•Syangja

•Pokhara

•Chame

•Besisahar

•Damauli

•Parasi•Bharatpur

•Gorkha

•Dhadingbesi

•Dhunche

•Bidur

•Hetauda

•Birgunj•Kalaiya

•Gaur

HAT

•Dhulikhel

•Chautara

•Charikot

•Ramechhap

•Sindhulimadi

•Malangwa

Jaleshwor•Janakpur•Siraha

•Rajbiraj

•Ineruwa

•Gaighat

•Diktel

•Salleri

•Okhaldhunga•Bhojpur

•Khandbari •Taplejung

•Phidim•Ilam

•Biratnagar•Chandragadi

•Dhankuta

•Terhathum

EASTERNREGION

CENTRALREGION

WESTERNREGION

MID-WESTERNREGION

FAR-WESTERNREGION

CHINA

INDIA

Distribution Models

UNICEF/DOHS/LMD

DHO/DPHO

6 to 24 months Children

PHC/HP/SHP

FCHV

Procurement Department/UNICEF

DHO/DPHO

HP/SHP/PHC

6 to 24 months Children

HEALTH FACILITY (RURAL MODEL)

FEMALE COMMUNITY HEALTH VOLUNTEERS (RURAL MODEL)

Procurement Department/UNICEF

DHO/DPHO

Municipality Office

6 to 24 months Children

Ward Office

FCHV

MUNICIPALITY WARDS (URBAN MODEL)

5257

83

65

39

55

73

0

20

40

60

80

100

Makw anpur Parsa Palpa Rupandehi Urbanclusters

HealthFacility

FCHV

Pe

rce

nt

Districts Distribution ModalityFigure 3: Compliance of Baal-vita

40

56

39

53

4351 48

0

20

40

60

80

100

Makw anpur Parsa Palpa Rupandehi Urbanclusters

HealthFacility

FCHV

Pe

rce

nt

Districts Distribution Modality

Coverage

Compliance

Updates from External Survey: Preliminary Report New Era

Ever breastfed the child

Initiation of breastfeeding to the child within an hour of birth

Currently breastfeeding the child

Timely introduction of com-plementary food

Minimum dietary diversity

0 20 40 60 80 100 120

99.6

52.4

91.4

83.8

31.8

99.6

54.6

94.6

83.3

45.1

98.3

50.3

88.9

76.2

45.8

Urban

FCHV Modality

HF Modality

Updates from External Survey: Preliminary Report New EraInfant and Young Child Feeding Practices

External Survey: Preliminary Report New Era

Sub-EcologyAnemia (6-59)

Rank

Anemia (6-23) Ran

k Districts

No. of Districts Scale up Plan*

Far West Terai 60.4 1 68.4 5 Kailali, Kanchanpur 2

15 districts to be covered by 2012 (UNICEF). In case of additional funding from NAFSP – 8 Districts (Jumla, Kalikot, Dolpa, Mugu, Humla, Bajhang, Bajura and Jajarkot and WB Health Swap- 7 districts (Ramechhap, Jhapa, Chitwan, Tanahun, Pyuthan, Surkhet and Kavre, UNICEF 3 possible districts Dhanusha, Nawalparashi and Baitadi]

33 by 201375 by 2017

Mid-West Terai 56.9 2 83.8 1 Bardiya, Banke, Dang 3 (1)

West Mountain 52.7 380.3 2 Darchula, Bajhang, Bajura, Kalikot, Jumla,

Dolpa, Mugu, Humla, Mustang, Manang 10East Mountain 51.3 4 65.9 8 Solukhumbu, Sankhuwashaba, Taplejung 3 (2)Eastern Terai 49.5 5 74.8 3 Siraha, Saptari, Sunsari, Morang, Jhapa 5Western Terai 48.8 6 65 9 Kapilvastu, Rupandehi, Nawalparashi 3 (2)

Central Terai 46.7 767.7 6 Chitwan, Bara, Parsa, Rautahat, Sarlahi,

Mahottari, Dhanusa 7 (6)

Western Hill 43.6 8

63 11 Palpa, Tanahun, Arghakhachi, Syanja, Parbat, Gulmi, Baglung, Myagdi, Kaski, Lamjung, Gorkha 11 (9)

Eastern Hill 42.3 959.7 12 Okhaldhunga, Khotang, Udaypur, Bhojpur,

Dhankuta, Terathum, Panchthar, Illam 8Far-West Hill 40.9 10 70.4 4 Baitadi, Dadeldhura, Doti, Achham 4 (2)

Central Hill 40.2 11

66.6 7 Dhading, Nuwakot, Makwanpur, Kathmandu, Lalitpur, Bhaktapur, Kavre, Sindhuli, Ramechhap 9 (8)

Mid-West Hill 36 1258.5 13 Dailekh, Surkhet, Salyan, Rolpa, Pyuthan,

Rukum, Jajarkot 7 (6)Central Mountain 33.1 13

63.7 10Rasuwa, Sindhupalchok, Dolakha 3 (1)

Total Number of Districts 756 Districts in Orange IYCF/MNP Piloted, 9 districts in Blue IYCF MNP being expanded in 2012

Draft IYCF/MNP Scale up Plan by 2016/17

Background• Since 2009/10, - GoN- Child Cash Grant (CG) (NRs

200/child for maximum 2 children) is provided for each child in Karnali. Dalit families in rest of the country

• Disbursed through VDCs quarterly• Meant to be utilized for the improvement of nutritional

status of the targeted children.• UNICEF- complemented Infant & Young Child Feeding

(IYCF) training/Social mobilization in 4 districts

IYCF PROMOTION LINKED WITH CHILD GRANT (IYCF/CG)

Objectives

• Improve Child Grant beneficiaries’ knowledge on IYCF, Hygiene and Sanitation and other key nutritional behaviours

• Assist mothers and caretakers to identify the best possible locally available food - to improve the nutritional status of the children

• Build capacity of health workers and volunteers on IYCF

Strategies

• Advocacy: Capacity building • Orientation:• Process monitoring:• BCC• Evaluation

Training Achievement

SN District FCHV HF StaffsVDC

Influential People

Traditional Healers MGM

1Jumla

514 146 347 270 4711

2Kalikot

264 131 353 267 4590

3Humla

240 1o8 310 236 4655

4Dolpa

151 51 188 144 2440

Total 1169 436 1198 917 16396.

Challenges/Future directionChallenges• Optimum utilization of the Cash Grant in improvement of nutritional

status of targeted children.• Easy access to nutritious food for buying.

Focus for 2012• Monitoring of the IYCF/CG programme.• Midline Evaluation of IYCF/CG• Promotion of locally available foods.• Sustainability - functioning/revitalization of the mother’s group

meetings (MGM) and use of the VDC block grant.• Airing of IYCF messages, performance of street drama and advocacy

meetings at the ward level.

Updates in Growth Monitoring

Old Growth Monitoring Card New Growth Monitoring Card

•Unnecessarily covers under five children-not evidence based and also extra burden to health workers

•Uses -3SD for lower line-thus only identifies severe malnutrition, which defeats the purpose of GMP promotion and its too late for action

Revised HMIS Formats for Feasibility

• ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 7-Revised.xls

• ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 17-Revised.xls

• ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 31-Revised.xls

• ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 32-Revised.xls

Dietary Pyramid for Nepal

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PLEASE DON’T FEEL INFERIOR EATING INDIGENOUS FOOD…..FEEL PROUD AND HEALTHY and PROMOTE THEM

THANK YOU FOR YOUR ATTENTION!

Let us work together to make them smiling