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

Apr 01, 2015



  • Slide 1

Updates on IYCF- integrated with MNP & Child Grant, Vit A and GMP Programs 1 Pradiumna Dahal Nutrition Specialist, UNICEF Slide 2 Vitamin A Coverage 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. Slide 3 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 Slide 4 Anemia Prevalence High in Children: The Problem is serious among 6-23 months children Percent of children age 6-59 months with anemia Source: NDHS 2011 Slide 5 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% NDHS (2006)35%53%75% NDHS (2001)31%68%66% Trends on IYCF practices in Nepal: DHS 2001, 2006, 2011 Slide 6 IYCF Practices among Under 5 Children Breastfeeding Status Under 6 Months Percent of children 6-23 months Recommended IYCF Practices among 6-23 months children Slide 7 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 Slide 8 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 Slide 9 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) Slide 10 Distribution Models UNICEF/DOHS/LMD DHO/DPHO 6 to 24 months Children PHC/HP/SH P 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) Slide 11 Coverage Compliance Updates from External Survey: Preliminary Report New Era Slide 12 Updates from External Survey: Preliminary Report New Era Infant and Young Child Feeding Practices External Survey: Preliminary Report New Era Slide 13 Sub-Ecology Anemia (6-59) Ran k Anemia (6-23) Ran kDistricts No. of DistrictsScale up Plan* Far West Terai60.41 68.45 Kailali, Kanchanpur2 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 2013 75 by 2017 Mid-West Terai56.92 83.81 Bardiya, Banke, Dang3 (1) West Mountain52.73 80.32 Darchula, Bajhang, Bajura, Kalikot, Jumla, Dolpa, Mugu, Humla, Mustang, Manang10 East Mountain51.34 65.98 Solukhumbu, Sankhuwashaba, Taplejung3 (2) Eastern Terai49.55 74.83 Siraha, Saptari, Sunsari, Morang, Jhapa5 Western Terai48.86 659 Kapilvastu, Rupandehi, Nawalparashi3 (2) Central Terai46.77 67.76 Chitwan, Bara, Parsa, Rautahat, Sarlahi, Mahottari, Dhanusa7 (6) Western Hill43.68 6311 Palpa, Tanahun, Arghakhachi, Syanja, Parbat, Gulmi, Baglung, Myagdi, Kaski, Lamjung, Gorkha11 (9) Eastern Hill42.39 59.712 Okhaldhunga, Khotang, Udaypur, Bhojpur, Dhankuta, Terathum, Panchthar, Illam8 Far-West Hill40.910 70.44 Baitadi, Dadeldhura, Doti, Achham4 (2) Central Hill40.211 66.67 Dhading, Nuwakot, Makwanpur, Kathmandu, Lalitpur, Bhaktapur, Kavre, Sindhuli, Ramechhap9 (8) Mid-West Hill3612 58.513 Dailekh, Surkhet, Salyan, Rolpa, Pyuthan, Rukum, Jajarkot7 (6) Central Mountain33.113 63.710 Rasuwa, Sindhupalchok, Dolakha3 (1) Total Number of Districts75 6 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 Slide 14 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) Slide 15 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 Slide 16 Training Achievement SNDistrict FCHVHF Staffs VDC Influential People Traditional HealersMGM 1 Jumla 5141463472704711 2 Kalikot 264131 3532674590 3 Humla 2401o8 3102364655 4 Dolpa 15151 1881442440 Total1169436119891716396. Slide 17 Challenges/Future direction Challenges 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 mothers 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. Slide 18 Updates in Growth Monitoring Slide 19 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 Slide 20 Slide 21 Slide 22 Slide 23 Revised HMIS Formats for Feasibility..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 7-Revised.xls..\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 17-Revised.xls..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 31-Revised.xls..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 31-Revised.xls..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 32-Revised.xls..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 32-Revised.xls Slide 24 Dietary Pyramid for Nepal Slide 25 k|lt;o u|fddf ;|f]tM g]kfnL vfBkbfy{df kfOg] kf]ifs tTjx?, g]kfn ;/sf/ s[lif tyf ;xsf/L dGqfno vfB k|ljlw tyf u'0flgoGq0f ljefu, @)^! qm = ; + = vfBfGgk|f]l6 g - u|f d_ lrNn f] - u| f d _ Vlgh - ldln u|fd _ /]zf - ldln u|fd _ zlQmls =So fnf]/ L_ SoflN;o d - ldlnu |fd_ kmnfd - ldln u|fd _ !hf}!!=%!=#!=@#=(##^@^!=& @kmfk/!)=#@= $ @=#*=^#@#^$!%=% #sfu'gf]!@= # $=##=#*=)##!#!!@=( $ lrgf]&=#!=#@==^#@*!$#=( %Dfs}!!=!#=^!=%@=$@!)#=# ^h'g]nf]&=^@= $ !=))=^#%&!=^ &pjf sfnf]!)=$!=&@=#@=%#$)@)&=% *cfF6f!@= ! !=&@=&!=(#$!$*$=( (d}bf!!=))=()=^)=##$*@#@=& !)sf]bf]&=*!=@@=(#=@@@**$(=@ !!Rffdn^=*)=%)=^)=@#$%!))=& PLEASE DONT FEEL INFERIOR EATING INDIGENOUS FOOD..FEEL PROUD AND HEALTHY and PROMOTE THEM Slide 26