Transcript 7. IYCF MNP-CG, GM, Vit A Updates _ MOHP_PD 13

Updates on IYCF- integrated with MNP &
Child Grant, Vit A and GMP Programs
Pradiumna Dahal
Nutrition Specialist, UNICEF
1
Vitamin A Coverage
Percentage Given Vitamin A Supplements
in last 6 months among all eligible
children age 6-59 months
Percentage Given Vitamin A Supplements
in last 6 months among all eligible
children age 6-8 months
100
100
90
88
100
86
6-8 months children %
80
60
40
20
70
60
44
40
20
0
0
NDHS2006
NDHS 2011
Surveys
6-59 months urban children %
81
80
6-59 months children%
Percentage Given Vitamin A
Supplements in last 6 months among
all eligible children age 6-59 months
living in urban areas
80
60
40
20
0
NDHS2006
NDHS 2011
Surveys
NDHS2006
NDHS 2011
Surveys
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 20122013 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
Percent of children age 6-59 months with
anemia
Anemia Prevalence High in Children:
The Problem is serious among 6-23 months children
90
80
70
60
50
40
30
20
10
0
78
74
72
57
44
46
38
25
6-8
9-11
12-17
18-23
24-35
36-47
48-59
Total
Age in months
Source: NDHS 2011
Trends on IYCF practices in Nepal:
DHS 2001, 2006, 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%
IYCF Practices among Under 5 Children
Percent of children 6-23 months
Breast milk
Not
plus
Breast milk
breastfed
plus other compleme
1%
non-milk ntary foods
10%
liquids
<1%
Breast milk
plus other
milk
9%
Breast milk
plus water
10%
Exclusively
breastfed
70%
Breastfeeding Status Under 6
Months
Recommended IYCF Practices among 6-23 months
children
IYCF Community Promotion linked with MNP
National Programme
To Improve Anemia, Other micronutrient deficiencies and timely
introduction of Complementary food
Phase I
Phase II
Phase III
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
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
FAR-WESTERN
REGION
MID-WESTERN
REGION
HUMLA
•Simikot
•Darchula
DARCHULA
CHINA
BAJHANG
•Chainpur
BAITADI
•Baitadi
•Martadi
MUGU
•Gamgadi
BAJURA
•Dadeldhura
DADEL•Dipayal
DHURA
DOTI
•Jumla
JUMLA
ACHHAM
•Magalsen
KALIKOT
•Manma
DOLPA
•Dailekh
KANCHANPUR
•Dunai
DAILEKH
•Mahendranagar
•Dhangadi
MYAGDI
•Nepalgunj
•Chame
CENTRAL
REGION
•Ben
ROLPA
i
GORKHA
•Liwang
•Kusma KASKI
LAMJUNG
•Baglung
•Pokhara
PARBAT
RASUWA
•Besisahar •Gorkha
PYUTHAN
GULMI
•Syangja
•Dhunche
•Pyuthan
•Tamghas
TANAHU
DHADING
DANG
SYANGJA
SINDHU•Sandhikharka
•Damauli
NUWAKOT
PALCHOK
•Ghorahi
ARGHAKHACHI
•Tansen
•Bidur
PALPA
•Dhadingbesi
•Chautara DOLAKHA
KTM
KAPILBASTU
NAWALPARASI
SOLUKB
•Taulihawa RUPANDEHI
•Bharatpur
•Charikot
HUMBU
SANKHUWA•Sidharthanagar •Parasi
•Hetauda
TAPLEJUNG
Patan
KAVRE
SABA
CHITWAN
•Ramechhap
•Salleri
MAKAWANPUR
•Dhulikhel
OKHAL•Khandbari
•Taplejung
DHUNGA
PARSA
•Sindhulimadi
•Okhaldhunga •Diktel
•Bhojpur
•Terhathum
SINDHULI
KHOTANG
BARA RAUTATERHABHOJ•Birgunj
HAT
THUM
PUR
•Kalaiya
•Dhankuta
UDAYAPUR
•Gaur SARLAHIMAHO- DHANUSA
DHANKUTA•Phidim
TARI
•Malangwa
•Ilam
ILAM
•Gaighat
Jaleshwor•Janakpur SIRAHA
•Siraha
•Ineruwa
SUNSARI MORANG
JHAPA
SAPTARI
•Rajbiraj
•Chandragadi
•Biratnagar
SALYAN
•Salyan
BANKE
INDIA
MANANG
•Jumlikhalanda
•Gularia
WESTERN
REGION
RUKUM
•Birendranagar
SURKHET
BARDIYA
Phase 1:
•Jomosom
JAJARKOT
•Jajarkot
KAILALI
MUSTANG
BAGLUNG
EASTERN
REGION
Makwanpur (May, 2010);
Palpa (June, 2010)
Phase 2:
Rasuwa (Sept, 2010);
Gorkha (Jan, 2011)
Phase 3:
Rupandehi (May, 2011);
Parsa (June, 2011)
Distribution Models
Procurement
UNICEF/DOHS/LMD
Procurement
Department/UNICEF
Department/UNICEF
DHO/DPHO
DHO/DPHO
DHO/DPHO
PHC/HP/SH
P
HP/SHP/PHC
Municipality
Office
6 to 24 months
Children
Ward Office
FCHV
6 to 24 months
Children
FEMALE COMMUNITY HEALTH VOLUNTEERS
(RURAL MODEL)
FCHV
HEALTH FACILITY (RURAL MODEL)
6 to 24 months
Children
MUNICIPALITY WARDS (URBAN MODEL)
Updates from External Survey: Preliminary Report New Era
Figure 2: Coverage of Baal-vita
100
83
80
73
Percent
65
60
52
57
55
Coverage
39
40
20
0
Makw anpur
Parsa
Palpa
Rupandehi
Urban
clusters
Districts3: Compliance of Baal-vita
Figure
Health
Facility
FCHV
Distribution Modality
100
Percent
80
56
60
40
53
43
39
40
51
48
Compliance
20
0
Makw anpur
Parsa
Palpa
Districts
Rupandehi
Urban
clusters
Health
Facility
FCHV
Distribution Modality
Updates from External Survey: Preliminary Report New Era
Infant and Young Child Feeding Practices
45.8
45.1
Minimum dietary diversity
31.8
76.2
83.3
83.8
Timely introduction of
complementary food
Urban
88.9
94.6
91.4
Currently breastfeeding the child
HF Modality
50.3
54.6
52.4
Initiation of breastfeeding to the
child within an hour of birth
FCHV Modality
98.3
99.6
99.6
Ever breastfed the child
0
20
40
60
80
100
120
External Survey: Preliminary Report New Era
Draft IYCF/MNP Scale up Plan by 2016/17
Sub-Ecology
Anemia Ran Anemia
k
(6-23)
(6-59)
Far West Terai 60.4
Mid-West Terai 56.9
1
2
West Mountain
East Mountain
Eastern Terai
Western Terai
52.7
51.3
49.5
48.8
3
4
5
6
Central Terai
46.7
7
68.4
83.8
80.3
65.9
74.8
65
67.7
63
Western Hill
43.6
Eastern Hill
Far-West Hill
42.3
40.9
9
10
Central Hill
40.2
11
70.4
66.6
58.5
36
5
1
2
2
3 (1)
8
3
9
6
11
12
4
7
13
12
63.7
33.1
No. of
Districts Scale up Plan*
8
59.7
Mid-West Hill
Central
Mountain
Ran
k
Districts
13
Kailali, Kanchanpur
Bardiya, Banke, Dang
Darchula, Bajhang, Bajura, Kalikot, Jumla,
Dolpa, Mugu, Humla, Mustang, Manang
Solukhumbu, Sankhuwashaba, Taplejung
Siraha, Saptari, Sunsari, Morang, Jhapa
Kapilvastu, Rupandehi, Nawalparashi
Chitwan, Bara, Parsa, Rautahat, Sarlahi,
Mahottari, Dhanusa
Palpa, Tanahun, Arghakhachi, Syanja,
Parbat, Gulmi, Baglung, Myagdi, Kaski,
Lamjung, Gorkha
Okhaldhunga, Khotang, Udaypur, Bhojpur,
Dhankuta, Terathum, Panchthar, Illam
Baitadi, Dadeldhura, Doti, Achham
Dhading, Nuwakot, Makwanpur,
Kathmandu, Lalitpur, Bhaktapur, Kavre,
Sindhuli, Ramechhap
Dailekh, Surkhet, Salyan, Rolpa, Pyuthan,
Rukum, Jajarkot
10
3 (2)
5
3 (2)
7 (6)
11 (9)
8
4 (2)
9 (8)
7 (6)
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 Swap7 districts (Ramechhap,
Jhapa, Chitwan, Tanahun,
Pyuthan, Surkhet and
Kavre,
UNICEF 3 possible
districts Dhanusha,
Nawalparashi and Baitadi]
10
Rasuwa, Sindhupalchok, Dolakha
3 (1)
Total Number of Districts
75
6 Districts in Orange IYCF/MNP Piloted, 9 districts in Blue IYCF MNP being expanded in 2012
33 by 2013
75 by 2017
IYCF PROMOTION LINKED WITH
CHILD GRANT (IYCF/CG)
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
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
Jumla
1
Kalikot
2
Humla
3
HF Staffs
VDC
Influential
People
Traditional
Healers
MGM
514
146
347
270
4711
264
131
353
267
4590
240
1o8
310
236
4655
151
51
188
144
2440
1169
436
1198
917
16396
FCHV
Dolpa
4
.
Total
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 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