Nutrition Program Management Some considerations
Nutrition Program Management
Some considerations
6/1/2012
Malnutrition exists
Malnutrition has serious implications
to individual & national development
Brain development
Cognitive and educational performance
Growth and muscle mass Body composition
Immunity Work capacity
Metabolic programming of glucose, lipids, protein hormones/ receptors/genes
Early nutrition utero and childhood Diabetes
Obesity Heart disease High blood pressure, cancer, stroke, and ageing
Short-term
effects
Long-term
effects
Violation of
human
rights
Consequences of
malnutrition
Malnourished
children
Inability to concentrate
in school
School
drop-out
Lack skill/
low literacy
Under/unemployed
malnourished adults
Low
productivity
Poverty
Weak resistance
Infections
Early death
Poor health status
Faulty food habits & practices
Lack of education
Large-sized family
Poor environmental conditions
Inadequate food intake
Causes of malnutrition
The program management cycle
Assess the situation
Set objectives
Decide on course of
action
Draw up details of
implementation
Evaluate plan
Implement and
monitor
Importance of nutrition
planning
Allows efficient use of resources
Preventing overlap
Integrating, synchronizing, and
coordinating efforts
Importance of nutrition
planning
Serves as a guide for
Implementing actions for nutrition
improvement
Assessing and evaluating efforts
Generating resources
Advocating for meaningful
participation
What is planning
Setting
objectives
Selecting
course of
action
Identifying
problems
Deciding in advance What, who, when, where,
how long, how often
Planning is
a decision-
making
process
Present to approving
body
Estimate budget
Plan monitoring &
evaluation
Determine the details
Select interventions
Set objectives
Assess the situation
Organize planning
team
Steps in
planning
Assess the situation
Nutrition problems
Nutrition programs
Resources
Constraints
Assess the situation ---
objectives
Identify nutrition problems, groups
affected, areas affected, and causes
Assess past experiences in
implementing nutrition programs and
projects
Assess available resources and
constraints
Assess the situation --- uses
Decide on Objectives Mix of interventions to pursue and their
design Priority target groups Priority target areas
Sets the basis for monitoring & evaluation
Provide information to motivate politicians, the community and the public
Guide Questions For the
Situational Analysis WHAT are the nutritional problems in
the area?
WHAT is the trend in the nutrition
situation over the years?
HOW many are affected?
WHO are affected?
WHERE are they located?
WHAT FACTORS cause or give rise
to the nutrition situation?
Guide Questions (cont…)
WHAT PROGRAMS and PROJECTS
have been implemented in the past
years? And what lessons can be
learned from their implementation?
WHAT RESOURCES are available to
address these problems?
WHAT CONSTRAINTS can prevent
action for nutrition improvement?
Causal model of
malnutrition
Representation of the factors that lead
to malnutrition
Shows how factors interact with each
other to cause malnutrition
Identifies immediate, intermediate,
and root causes of malnutrition
Causal Model of Malnutrition
Leads to better understanding of the
malnutrition problem
Facilitates increased participation and
opinion-sharing among team members
Allows thorough discussion of malnutrition
and its causes
Results to identification of data to be
gathered and relevant interventions
Uses
Building a causal model of
malnutrition
Identify the problem and affected
groups
Underweight among children 0 – 5
years old
Stunting among children 0 – 5 years
old
Vitamin A deficiency among children 0
– 5 years old
etc
Building a causal model of
malnutrition
Brainstorm or list possible causes
Inadequate food in the household
Poor environmental sanitation
Low family income
Unsafe water supply
Declining breastfeeding
Poor complementary feeding practices
Lack of money to buy food
Poor soil for growing food
Building a causal model of
malnutrition
Branch out to at least two immediate
causes
Underweight children,
0-5 years old
Low food
intake
Poor health
status
Building a causal model of
malnutrition For each immediate cause, identify
factors that lead to it by asking a series
of WHYs Underweight children,
0-5 years old
Low food intake Poor health status
Decline in
breastfeeding
Lack of food in
the family
Poor environ-mental
sanitation
Low use of health
services
Building a causal model of
malnutrition When to stop
When an activity or project to address the
problem has been identified
When action is beyond the decision-
making capability of the planning group
Some tips
Keep it simple --- no horizontal lines, no
feedback loops, if needed repeat a cause
Be specific
Stick to the local situation
Situational Analysis --- Data
collection
QUANTITATIVE: Numerical
Census
Surveys
Special studies
Routine administrative
monitoring reports
Situational Analysis --- Data
collection
QUALITATIVE: Descriptive
Coping mechanisms
Food habits
Perception on nutrition and
government programs and
projects
Situational Analysis --- Data
collection
QUALITATIVE: Descriptive
Key informant interviews
Focused/focus group discussion
In-depth interview
Ocular inspection
Observation
Situational Analysis --- Data
collection
Factors Data/Indicator
Malnutrition among
preschool children
Prevalence of
Underweight-for-age
Stunting
Wasting
Frequent illnesses Morbidity rate
Diarrhea
Acute respiratory infections
Inadequate health services Ratio of health personnel to
population
Situational Analysis --- Data
collection
Factors Data/Indicator
Poor environmental
sanitation
% of households with
sanitary toilet
% of households with
potable water
Low household income Average household income
Low wages Minimum daily wage rate
Inadequate livelihood
opportunities
Unemployment and
underemployment rate
•
Data Analysis Gives MEANING to data collected by
applying statistical tools
Simple counting (frequencies)
Rates
Percent
Data are analyzed/interpreted based on
OBJECTIVES of nutritional assessment
Plan on how to analyze data is done at
START of project planning
Helpful to refer to CAUSAL MODEL`
Data Analysis
Prevalence, rates, averages, proportions
Trends
Comparison with known standards
Rank and set cut-offs
Mapping
Cross-tabulations
Use of statistical treatments
Data analysis WHAT ARE THE NUTRITION PROBLEMS?
Get prevalence, proportions or averages Prevalence
(No. of severely and moderately underweight/preschoolers x 100 No. of children weighed
Compare with standards
Example
National prevalence 8.4%
Regional prevalence 9.8%
Municipal prevalence 10.3%
Data analysis
YEAR BGY 1 BGY 4
1995 18.2 4.4
1996 17.5 5.0
1997 16.5 6.5
1998 14.9 7.2
1999 13.3 8.0
WHAT IS THE TREND?
Calculate percent change
BEFORE-AFTER X 100
BEFORE
Data analysis
WHO ARE AFFECTED?
Get prevalence by age group/
physiologic group
Preschool children
School children
Pregnant women
Get prevalence by socio-economic
group or functional classification
Data analysis
WHERE ARE THEY LOCATED?
Identify clustering of areas with high
levels of malnutrition
Identify common characteristics
Coastal areas
Upland
Lowland
Urban poor area
Data analysis
HOW MANY ARE AFFECTED?
Get number of malnourished
Barangay Prevalence No.
Malnourished
A 20% 20
B 5% 5
Assuming a population of 100
Data analysis
WHAT FACTORS AFFECT
MALNUTRITION?
Describe population groups and areas
more affected
Data analysis
WHAT PROGRAMS AND PROJECTS
HAVE BEEN IMPLEMENTED IN THE
PAST?
Consider efficiency Coverage
Targeting
Timeliness of service delivery
Timeliness and adequacy of supplies
and other resources
Beneficiary participation and acceptance
Data analysis
WHAT PROGRAMS AND PROJECTS
HAVE BEEN IMPLEMENTED IN THE
PAST?
Consider effectiveness in reducing
levels of malnutrition
Data analysis
WHAT RESOURCES ARE AVAILABLE
TO ADDRESS THE PROBLEM?
Human --- type, number, expertise
Physical facilities/equipment --- markets,
health center, schools, means of
transportation and communication
Natural --- source of water, fuel, land
Financial
Political
A little more on assessment
Start with the causal model to guide
data collection and analysis
Collect and analyze data
Review the causal model and update
if needed, based on the analysis
Objective Tree
Uses
describe a situation that would exist
after solving the problems
Identify means-ends relationships
between the objectives
Visualize these means-ends
relationships in a diagram
Objectives
Statements of what one wishes to
achieve
Characteristics of a good objective
• Specific
• Measurable
• Attainable
• Realistic
• Time-bound
Types or levels of objectives
Goal - a general statement of vision
Outcome – an effect
• Input objective – resources used to
produce
• Output objective – goods or services to
create
Setting Objectives
Setting Objectives
agree on nutrition problems to be given
priority
agree on priority target groups
review national, regional and local policies
on nutrition which may have bearing on
objectives to be set
review trends in the nutrition situation
assess available resources
How to set objectives
Selecting Interventions
1. Relevance – potential of the
intervention to correct the nutrition
problems in the area
Criteria in selecting interventions
Selecting Interventions
2. Feasibility – extent to which an
intervention may be implemented
with success
Criteria in selecting interventions
Selecting Interventions
3. Integrated into a similar existing
program • allows integration of intervention with
existing infrastructure and sectoral
programs which does not require
setting-up of new structures
Criteria in selecting interventions
Selecting Interventions
4. Effectiveness – extent to which
objectives can be attained e.g.,
nutritional impact, socio-economic
impact, stimulation of participation
and increased self-reliance
Criteria in selecting interventions
Selecting Interventions
5. Ease in targeting – consider ease
in defining, identifying, and
actually reaching the target
groups
Criteria in selecting interventions
Selecting Interventions
5. Cost-effectiveness – allows one
to value the total cost or cost per
beneficiary relative to the output
Criteria in selecting interventions
Selecting Interventions
7. Ease in evaluation – possibility of
evaluating the impact of the
intervention
Criteria in selecting interventions
Selecting Interventions
8. Likelihood of becoming a long-
term ongoing program – potential
for the intervention to be
sustained and become self-
propelling
Criteria in selecting interventions
Planning Programs
What type of programs and projects shall be
implemented to meet the plan objectives?
What will be the core service?
Who will be the project targets and
beneficiaries? What will be their
participation?
Where will the project be implemented?
When? How long? How often?
Planning Programs
What type of programs and projects shall be
implemented to meet the plan objectives?
Who will implement?
What resources will be needed? Where will
these come from?
How monitor and evaluate?
How organize?
Monitoring – regular and timely collection
of information on progress of program,
project, or activity
Evaluation – systematic
appraisal of success or
extent to which objectives
were met
Monitoring and Evaluation
Monitoring and Evaluation
determine how well objectives were met
determine reasons for success and failure
decide if will continue, modify, or stop
levels of evaluation
effort
efficiency
effectiveness of performance
adequacy of performance
process
Monitoring and Evaluation
Preparation of periodic accomplishment
reports
Field visits to project sites
Periodic meetings to track progress of
implementation
Special studies
1. Planning
2. Organizing
3. Staffing
4. Directing
5. Controlling
Functions of Management
Functions of Management
Planning
Define roles and missions
Determine key results areas
Identify and specify indicators of
effectiveness
Select and set objectives
Prepare action plans
Policy making
Establish procedures
Organizing
• Structuring
• Integrating
Staffing
• Determining personnel needs
• Selecting personnel
• Developing personnel
Functions of Management
Directing
• Assigning
• Motivating
• Communicating
• Coordinating
Functions of Management
Controlling
• Establishing standards
• Measuring performance
• Taking corrective action
Functions of Management