2019 grow great seminar · 3 micronutrient fortification (iron and salt iodization) malnutrition 4...
TRANSCRIPT
#GrowGreatSeminar2019
2
2019 GROW GREAT SEMINARZero Stunting by 2030- An opportunity for greatness!
18 October 2019 | Gauteng, South Africa
3
WELCOMEIman Rappetti
18 October 2019 | Gauteng, South Africa
DR KOPANO MATLWA MABASOExecutive Director, Grow Great Campaign
DR TSHEPO MOTSEPEKeynote address
#GrowGreatSeminar2019
DR RICHARD PENDAMERegional director, Nutrition International
9
STUNTING AND PROGRAMMATIC RESPONSES -
A REGIONAL OVERVIEW
GROW GREAT SEMINAR ON STUNTING
18TH OCTOBER 2019
Presentation by
Dr Richard Pendame
NI Regional Director, Africa
10
OUTLINE
Background
What is stunting and its burden
Programmatic response
Conclusion
Nutrition International
A global nutrition organization headquartered in Canada
27 years history
Operate in 10 core countries
Over 600 staff worldwide
Regional Offices in Kenya and India
Reach > 500m people/year
Nutrition International
Technical assistance in > 20 Sun Countries
Vitamin A programing in 55 countries
Reaching 150-180 M children a year.
Nutrition International
NI’s global programming has averted:
5 million child deaths
10 million cases of stunting
1.6 million permanent mental impairments
Half a million cases of anemia among women
What is Stunting?
14
15
Faces of Stunting
Photo credit: Tom Maguire/RESULT
16
Effects of stunting on a child’s brain
Stunted growth Never Stunted growth
What are the Impacts of Stunting?
17
Impact Stunting
Health
• Stunted children are sick more often and 4X more likely to die.
Poor immunity
Reduces effectiveness of vaccines
NCDs
Impact of Stunting
Education
• Reduced cognitive development combined with poor health impacts education outcomes.
Impact of Stunting
Earnings
• Reduced education outcomes combined with poor health impacts earning potential.
• This perpetuates the cycle of poverty and malnutrition.
• In women, this also impacts economic independence and choice.
Impact of Stunting
Economic Growth
• Reduced education outcomes and earning potential impacts the future of entire countries.
• Reduced tax revenue limits countries abilities to provide social services such as education and health care.
Impact of Stunting
Health System Costs
• DMS = increased burden
to health care system.
What is the Burden of Stunting?
23
Stunting: Global Burden
UNICEF, WHO, World Bank Group
Joint Child Malnutrition
Estimates
Key findings of 2018 edition
Stunting: Global Burden
UNICEF, WHO, World Bank Group
Joint Child Malnutrition
Estimates
Key findings of 2018 edition
26
Percentage of stunted children under 5
Source: UNICEF/WHO/WBG Joint Child Malnutrition estimates, 2019
27
Stunting numbers by region
Source: UNICEF/WHO/WBG Joint Child Malnutrition estimates, 2019
28
Trends in % of stunted children <5 in Africa
(2000 - 2018)
Source: UNICEF/WHO/WBG Joint Child Malnutrition estimates, 2019
2018 Global Nutrition Report
Global Nutrition Targets for 2025
TARGET 1:
40% reduction in the
number of children
under 5 who are stunted
TARGET 2:50% reduction of anaemia in women of reproductive age
TARGET 3:30% reduction in low birth weight
TARGET 4:No increase in childhood overweight
TARGET 5:Increase the rate of exclusive breastfeeding in the first 6 months to at least 50%
TARGET 6:Reduce and maintain childhood wasting to less than 5%
30
WHA Nutrition Targets - Progress
Countries on course:
1. Burkina Faso2. Egypt3. Ghana4. Kenya5. Eswatini6. Liberia7. Cote d’Ivoire
Source: Global Nutrition Report 2018
31
Ranking of solutions
Copenhagen consensus
Solution Challenge
1 Micronutrient supplements for children (A &
zinc)
Malnutrition
2 The Doha development agenda Trade
3 Micronutrient fortification (iron and salt
iodization)
Malnutrition
4 Expanded immunization coverage for children Diseases
5 Biofortification Malnutrition
6 Deworming, other nutrition programs in
school
Malnutrition
7 Lowering the price of schooling Education
8 Increase and improve girl’s schooling Women
9 Community-based nutrition programs Malnutrition
32
Critical steps to speed up progress
Conclusion Stunting is major public health problem for Africa
with health and non health long term effects.
Progress in reduction of stunting has been slow
Proven specific and sensitive nutrition interventions exist but need scaling up.
Tackling stunting requires bold multi-sectoral action, leadership and financing.
THANK YOU
#GrowGreatSeminar2019
36
TEA & POSTER PRESENTATIONS
18 October 2019 | Gauteng, South Africa
BEATING STUNTING-Case studies from developing country counterparts
DR THERESA SHAMAH
Deputy Director General,
National Institute of Public Health,
Mexico
39
Beating Stunting:
Case studies from
developing country
counterpartsDra. Teresa Shamah Levy
Deputy Director of the
Centre of Research of Evaluation and Surveys
National Public Health Institute
October, 18 2019
Public Policies in
Mexico to reduce
Stunting
40
ABOUT TODAY´S SESSION
Nutrition status in Mexico
PROSPERA EsIAN
Current Public Policies By the New Mexican Government
2019-2024
41
BEFORE BEGINNING………….
•I do not have any conflicts
of interest
42
EVOLUTION OF NUTRITION STATUS OF CHILDREN <5 Y
IN MEXICO
43
%
NATIONAL PREVALENCES OF MALNUTRITION IN CHILDREN <5 YEARS OLD FROM1988-2016. RESULTS FROM THE NATIONALHEALTH AND NUTRITION SURVEYS
10,8
26,9
6,27,8
5,6
21,5
2,1
8,8
3,4
15,5
2
8,3
2,8
13,6
1,6
9,7
3,9
10
1,9
5,86,0
27,0
3,0
13,0
0
5
10
15
20
25
30
Underweight Stunting Wasting Overweight and obesity
ENN 1988 ENN 1999 ENSANUT 2006 ENSANUT 2012 ENSANUT MC 2016 SOUTH AFRICA2016
44
National prevalence of low height for age in
children <5 y (1988-2016)
1988 1999 2006
2012 2016
More than 20% (2)
From 15% to 20% (0)
From 10% to 15% (2)
Less than 10% (0)
Categories of
Prevalence
45
NATIONAL PREVALENCES OF MALNUTRITION IN CHILDREN <5 YEARSOLD, 2016. RESULTS FROM THE NATIONAL HEALTH AND NUTRITION SURVEYS IN MEXICO-SOUTH AFRICA
3,9
10
1,9
5,86,0
27,0
3,0
13,0
0
5
10
15
20
25
30
Underweight Stunting Wasting Overweight and obesity
ENSANUT MC 2016 SOUTH AFRICA
Source: South African Demographic Survey (SADHS), 2016
2016
46
DROP OF THE NATIONAL PREVALENCE OF EBF
20
46
17
35
14
24
3
22
34
22
30
14
33
18
14,5
27
1316
13 13
22
0
5
10
15
20
25
30
35
40
45
50
Nacional Indígenas No Indígenas NSE más bajo NSE más alto Educaciónmaterna 1-<6a
Educaciónmaterna >14a
1999
2006
2012
Pre
vale
nce
5.6 pp
González de Cossío T et al.SPM. 2013;55 suppl 2:S170-S179.
National Indigenous Not indigenous Low
HWIHigh
HWI
Maternal
education 1-<YMaternal
Education >14Y
HWI: Household Wealth Index
47
Source: ENN 88 y 99, ENSANUT 2006 Y 2012, ENSANUT Medio Camino (half -way) 2016
18,6 20,8 19,5 15,4 20,0 19,6 18,5
40,9 42,5 42,6 41,79,6
16,6 17,418,3 13,0 14,5 15,0
18,524,2 26,8 27,7
28,2
37,4 36,933,7 33,0 34,1 33,5
59,4
66,7 69,4 69,4
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
1999 2006 2012 2016 2006 2012 2016 2000 2006 2012 2016
Niños escolares (5 a 11 años) Hombres Adolescentes (12-19 años) Hombres Adultos (20 y mas años)
Sobrepeso Obesidad
17,2 19,7 20,2 20,69,0
21,9 22,5 23,7 26,4 25,136,3 37,0 35,3 35,6
8,312,6 11,8 12,2
2,1
6,410,9 12,1
12,89,5
24,732,6 35,2 37,1
25,532,3 32,0 32,8
11,1
28,3
33,435,8
39,2
34,6
61,0
69,670,5 72,7
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
1999 2006 2012 2016 1988 1999 2006 2012 2016 1988 1999 2006 2012 2016
Niñas escolares (5 a 11 años) Mujeres adolescentes (12 a 19 años) Mujeres adultas (20-49 años)
Sobrepeso Obesidad
Female
Male
School-age girls (5-11 years) Female adolescents (12-19 years) Women adults (20-49 años)
School-age boys (5-11 years) Men adolescents (12-19 years) Men adults (20-49 years)
Overweight Obesity
Overweight Obesity
National Prevalences of overweight and obesity by age and sex groups
* Classification system proposed by WHO
48
National Prevalences of overweight by sex and age groups in Mexico- South Africa 2016
Source: ENSANUT Medio Camino, 2016 /South African Demographic Survey (SADHS), 2016 * Classification system proposed by WHO
20,6
15,4
26,4
18,5
28,1
12,0
27
8,6
0
5
10
15
20
25
30
Female Male Female Male
School Age (5-11 years) Adolescents (12-19 years)
ENSANUT MC 2016 South Africa 2016
49
Integral Actions
(General Population)
Education
Health
Social Protection
Job training
Housing
Focused Actions(Population in Poverty)
Human Capital Development
Education
Health
Feeding
Focused Actions(Population in Poverty)
Income opportunities
Financial, Productive and Labor market inclusion
Safe water, sanitation, rural highways, communications and housing
SOCIAL POLICY DEVELOPMENT
PROGRESA
1997OPORTUNIDADES
2006
PROSPERA
2013PROSPERA-2014
Modificado de: 1575-DS ASF“EVALUACIÓN DE LA POLÍTICA PÚBLICA DE PROSPERA PROGRAMA DE INCLUSIÓN SOCIAL”, p23.
50
51
• A conditional cash transfer program to improve public
service utilization.
• Mexican Social Development, Health and Education
Ministries.
• Covers over 6.1 million families and 26 million people.
PROSPERA (1997-2018)
52
PROSPERA PROGRAM SCHEME: LACTATION AND PREGNANT WOMEN.CO-RESPONSIBILITIES
• Pregnant women and in Lactation period: 30 USD/monthCash transfer
• Once a month at Medical Units
Antenatal care
• Pregnant women
• Lactation Period throughout 2 yearsSuplementation
• Attend workshops on different thematics: antenatal care; familar plannification; papanicolao, weight gainWomen
53
PROSPERA PROGRAMSCHEME: MOTHERS/CHILDRENCO-RESPONSIBILITIES
• Children <5 years, 30 USD/monthCash transfer
• Once a month at Medical UnitsNutrition monitoring
• All children < 2y and undernourished childrenfrom 2 to 5 y Supplementation
• Attend workshops on different thematics: EBF; complementary feeding; supplementationMothers
54
National Integrated Nutritional Strategy
Integral Strategy for Nutrition Attention
55
WHAT IS
A national strategy to strengthen the health and nutritional
component of Prospera to address the nutritional transition in
Mexico and to improve the health and nutrition of
beneficiaries.
?
56
ESIAN:• Strategies of proven efficacy and effectiveness
• Focused on the 1,000 days
• To address both under nutrition and obesity with a
life cycle approach
• Evidence based on external evaluation and efficacy
studies in the context of the program
• Systematic process
• Systematic thinking
57
Pregnancy 0-6 m 7-23 m 24-59 m
An integrated MIYCN strategy
• Promotion of healthy
eating and physical
activity.
• Appropriate weight gain.
• Anemia prevention
(Tablets).
• Promotion of
breastfeeding.
• Exclusive
breastfeeding.
• Nutrition
assessment.
• Complementary
feeding practices.
• Nutrition
assessment.
• Use of MNP and
other supplements.
• Healthy eating
and physical
activity.
• Nutrition
assessment.
• Use of MNP.
58
COMPONENTS
Health Units
Equipment
Behavior changecommunication
and training(BCC)
Supplementation
(MNP)
*BCC strategy based on Social Marketing
59
SuplementationU
rba
n
Pregnancy and
lactation 6-11 m 12-23 m 24-59 m
Ru
ral
+ +
60
BCC USES MUTUAL REINFORCING :ACTIVITIES, CHANNELS AND MATERIALS AT MANY LEVELS.
Physicians
26,146
Nurses
36,594Health promotors
10,709
CHWs
(Community Healthworkers)
22,922
• BCC materials distributed to 14,886 health clinics
• 94, 877 health workers trained (Dec 2018)
61
TASK DEFINITION - ESIAN
Physicians
•Antenatal care
•Well child visit
•Growth monitoring
•Simplified counseling: key messages.
Nurses
•Supplement distribution
•Breastfeeding workshop.
•Growth monitoring
•Key messages
Health promotors
•Healthy pregnancy workshop.
•Complementary feeding workshop (use of supplement)
CHWs
• Household visits to reinforce key messages:
• Use of supplement during pregnancy.
• EBF.
• Complementary feeding 6-24 m.
• Supplements.
62
SUPPORT MATERIAL - ESIAN
Physicians
•Desktop flipchart.
•Health Clinic Manual.
•Supplements.
Nurses
•Breastfeeding flipchart.
•Health Clinic Manual.
•Supplements.
Health promotors
•Healthy pregnancy flipchart.
•Complementary feeding flipchart.
•Health promotor manual.
CHWs
•Household visits material:
•Healthy pregnancy.
•EBF.
•Complementary feeding 6-24 m.
•Supplements.
63
ONLINE TRAINING
64
LOW HEIGHT PREVALENCE IN CHILDREN < 5 YEARS BENEFICIARIES OF PROSPERA PROGRAM BETWEEN 2012 AND 2018.
15,513,4
26
19,9
0
5
10
15
20
25
30
PROSPERA PROSPERA
2012 2018
Urbana Rural Total
17.8
20.7
65
AT THIS TIME THE PROGRAMGRANTS DIRECTLY TO THESCHOOL-CHILDREN A WELFARESCHOOLARSHIP “BENITOJUAREZ”: 80 USD/BIMONTHLY
PROSPERA IS A SCHOOLARSHIP PROGRAM AIMED AT PRESCHOOL,
ELEMETARY AND JUNIOR-HIGH STUDENTS
66
Current Public PoliciesBy the New Government
2019-2024
67
EARLY CHILDHOOD
HEALTH
LEARNING
OPPORTUNITIESSAFE AND
PROTECTION
NUTRITION
69
INTEGRAL ROUTE FOR THE ATTENTION OF FIRST CHILDHOOD
THE ROUTE OF CARE ESTABLISHES A SERIES OF MINIMUM ACTIONS AND DIFFERENTIATED SERVICES FOR THE
INTEGRAL DEVELOPMENT OF GIRLS AND BOYS FROM 0 TO 6 YEARS OF AGE, IN HEALTH AND NUTRITION;
EDUCATION AND CARE; SOCIAL PROTECTION, CHILDREN PROTECTION AND SOCIAL DEVELOPMENT
COMMISSION FOR FIRST CHILDHOOD
HEALTH
AND
NUTRITION
#GrowGreatSeminar2019
DR HELIA MOLINA
Former Minister of Health & current dean of the
Faculty of Health Sciences,
University of Santiago,
Chile
73
CHILEAN EXPERIENCE IN CHILD
UNDERNUTRITION AND STUNTINGHelia Molina MD.MPH
Dean of Medical Sciences Faculty
University of Santiago Chile
74
ANTECEDENTS
Optimal nutrition the
first 1000 days of life
• Associated with less Infant Mortality• Well nourish Children learn better at school• Well nourish adults and healthy are more
productive• A better nutrition is the entry point to end
poverty have a better quality of life andsustainable development of a country
Chronic
Malnourishment in
Children
Probably one of the best indicators to capturethe most important dimension of socialproblems of the country, including povertysocial exclusion and low coverage of social andhealth services.
75
CAUSES OF MALNOURISHMENT IN CHILDREN
BASIC CAUSES
UNDERLYING CAUSES
IMEDIATE CAUSES
INFANT
MALNOURISHMENT
POVERTY INEQUITUESLACK OF EDUCATION
OF THE MOTHER
LACK OF
ACCESS TO
FOODS
LACK OF HALTH
CARE
LACK OF WATER
AND SANITATION
INSUFICIENT
FOODINADECUARE CARE DISEASES
La desnutrición inafntil: causas, consecuencias y estrategias para su prevención y tratamiento, UNICEF, 2011
76
HISTORY OF CHRONIC MALNOURISHMENT IN CHILE
First half of
XX century
Food insecurity and highmalnourishment of motherand childrenInfant Mortality was over200 per 1000 newborn.
Economic situation of thecountry not veryencouraging with a grossinternal product ofUS$1.800year 1950, verysimilar to the average ofLAC
The state initiatesstrategies, plans andprograms in Health ,nutrition and otheractivities to increasethe level ofeducation, socialprotection andeconomicdevelopment of thecountry
77
NUTRITIONAL STATUS OF CHILE 2016
Informe de vigilancia del estado nutricional de la población bajo control y lactancia materna en el sistema público de salud de Chile, MINSAL, 2016
78
INFANT MALNOURISHMENT IN CHILE TODAY
• La prevalencia de desnutrición en los niños controlados en el sistema público de salud se
mantiene estable desde el año 2005 al año 2016, con valores bajo el 1%.
Informe de vigilancia del estado nutricional de la población bajo control y lactancia materna en el sistema público de salud de Chile, MINSAL, 2016
79
UNDERNUTRITION CHILE 1960-2009
.
YEAR Desnutrición
Leve %
-2DE a <-1 DE
Desnutrición
Moderada %
-3 DE a < -2 DE
Desnutrición Grave %
< -3DE
Total
%
1960 31,1 4,1 1,8 37,0
1970 15,8 2,5 1,0 19,3
1980 10,0 1,4 0,2 11,5
1990 7,7 0,2 0,1 8,0
2000 2,6 0,2 0,1 2,9
2009 2,4 0,4 - 2,8
Fuente: Monckeberg F, 2003; Jiménez de la Jara J, 2009, Minsal 2010.
1960 y 1970 Criterio de Gómez; 1980 y 1990 referencia Sempé; 2000 referencia NCHS; 2009 referencia OMS
80
INFANT AND MATERNAL MORTALITY
DEIS, MINSAL
81
DRINKING WATER AND SANITATION
Ministerio de Salud, elaborado por Monckeberg (2003).
82
MAIN STRATEGIES
SOCAIL
POLICIES
Priority to defat hunger and malnourishment as a policy ofthe StateContinuity of the intervention over different governmentsfrom different political parties.Strong participation of the Universities and the Scientificsocieties.Social Movement on favor of a quality of nutrition
CONCRETE
ACTIONS
Primary Health Care with a health TEAMCreation of the National Program of delivering nutritionalproducts linked to health control activities .Natality control
Increase in the educational level of the population
Increased availability of drinking water and sewerage
Public-private partnerships in search of technological
and productive
83
POLICIES DEVELOPMENT
Since the middle of XX century public policies were
developed focusing in ending malnourishment in
Children .
Supplementary
Feeding Program
(PNAC): Delivery of
food to all children
served in health
services (primary
prevention)
More frequent health controls and reinforced food deliver to children at risk of malnourishment or mild malnutrition (secondary prevention)
Hospitalization in rehabilitation centers of The Corporation of Child Nutrition (CONIN) for those infants with moderate to sever malnutrition (tertiary prevention)
84
HISTORY OF CHILEAN POLICIES
INFANTPATRONAGE
1901
Develoment of MILK DropdInitiative”
1906 1924 1934
Creation of the Ministry of Health , and Social Protection and National Council for Nutrition.
Legislation ofhealth controlof mother andchildren lesstan 2 years andfood deliver
1937
“NationalHealthSystem”
1952
LAW of mandatoryworkersinsurance/“Nationalprogram of milk deliver”
1954
Supplementary
Feeding
Program
(PNAC):.(PNAC)
1950-1060
NationalStrategyagainstdiarrhea
1971-1973
Half a literof milkcampaign
Corporation forChild Nutrition(CONIN)
1976
85
OTHER IMPORTANTMILESTONES
1. Family Planning programs and increase in the educational
level of the mother allowed significant reduction in fertility
rates a trend that was attenuated in the 90s
2. There was also a significant impact in maternal mortality
3. From the 602 school population feeding programs were
developed,
4. Vaccination programs .
5. Nursery networks developed
6. Breast feeding
7. Food fortification : iron , flour,
8. Food programs .
.
86
HUMAN RESOURCES , RESEARCH
AND KNOWLEDGE MANAGEMENT
The training of human resources (pre and postgraduate) related to food
and nutrition has been prioritized, achieving an adequate level of
knowledge and experience in professionals and technicians working I
n primary care (nurses, nutritionists, midwives, doctors, paramedics)
University Research focus on nutrition INTA
87
MONITORING AND EVALUATION
The efficient nutritional surveillance system has
allowed since 1975 a continuous record of the
nutritional status of 1.2 million children and pregnant
women controlled in the public health system In
addition, a system of information on the prevalence of
low birth weight was established in maternity
hospitals, which together with the information on infant
mortality recorded in Chile since 1904, allowed for very
strict monitoring of malnutrition in Chile
88
NATIONAL SUPPLEMENTARY
FEEDING PROGRAM (PNAC):
It is created in 1954
It presents an uninterrupted history of more than half a century
Its purpose is "to contribute to maintain and improve the nutritional
status of the population" It points to the control of malnutrition problems,
with an initial emphasis on deficit malnutrition, then incorporating
problems of excess malnutrition It is universal in nature and
considers a set of preventive and recovery nutritional support
activities, through which food is distributed to children under 6,
pregnant women and nurses
89
NATIONAL SUPPLEMENTARY
FEEDING PROGRAM (PNAC):
Hace 50 años Hoy
Food delivery is made through the establishments of the Primary
Health Care network Currently, the PNAC distributes a year close to
16 million kilos of various foods throughout the country, where dairy
products represent 98% of the total volume
90
NATIONAL SUPPLEMENTARY
FEEDING PROGRAM (PNAC):
Angelitos Salvados. Jiménez de la Jara, J. Uqbar Editores, Santiago 2009
91
PROGRAMA NACIONAL DE ALIMENTACION
COMPLEMENTARIA (PNAC)
Angelitos Salvados. Jiménez de la Jara, J. Uqbar Editores, Santiago 2009
92
LESSONS LEARNED
PUBLIC POLICIES OF THE STATE.
SUSTEINABILITY OF INTERVENTIONS.
STREGHTHENING OF PRIMARY HEALTH CARE AND HUMAN
RESOURCES DEVELOPMENT
COMMUNITY PARTICIPATIONA INVOLVING KEY
STAKE HOLDERS AND CIVIL SOCIETY.
PUBLIC PRIVATE PARTNERSHIPS IN THE SEARCH FOR
TECHNOLOGICAL AND PRODUCTIVE SOLUTIONS.
HEALTH: UNIVERSAL HEALTH CHECKS AND FAMILY PLANNING.
INCREASE THE EDUCATIONAL LEVEL OF THE POPULATION.
INCREASED AVAILABILITY OF DRINKING WATER AND SEWERAGE.
MONITORING SYSTEMS TO ASSESS COMPLIANCE WITH
THE PROPOSED GOALS
SUPPLEMENTARY FOOD PROGRAMS
93
¿IS IT POSSIBLE TO ERRADICATE
CHILD MALNUTRITION ?
Yes, but together, among several institutions , and with different
actions sustained over time.
The greatest impact is achieved in interventions aimed at pregnant
women,
lactation period and children under 3 years = damage reversibility stage.
(1000 days).
Promotion, primary and secondary prevention.
Actions to cure.
Virtuous circle of good nutrition
94
FINAL REFLECTION
The Chilean experience allows us to suggest that it is possible
to eradicate child malnutrition before reaching good levels of
economic development in the country, with state commitment,
alignment of public policies, strengthening of the health system,
political will and concrete actions to improve maternal and child health
#GrowGreatSeminar2019
DR RAJESH KUMAR
Former Mission Director, Poshan Abhiyaan
& current Principal Commissioner,
Delhi Development Authority,
Government of India
97
CHILDREN, NUTRITION &
VULNERABILITIES
98
151 Million Children Under 5 Years are Stunted across the World
Global Nutrition Report, 2018
99
Data Source: WDI 2016
0
20
40
60
1990 1995 2000 2005 2010 2015
Pre
vale
nce (
%)
GLOBAL
SOUTH ASIA
SUB-SAHARAN AFRICA
EAST ASIA & PACIFIC
MIDDLE EAST & NORTHAFRICA
LATIN AMERICA &CARIBBEAN
EUROPE & CENTRAL ASIA
Global and Regional Trends in Child Stunting
100
CHILD WITH STUNTED BRAIN
HEALTHY, CARED FOR CHILD
Source: Nelson, 2017
HEALTHY, CARED FOR CHILD
Significance of first 1000 Days
101
102
37,4
19
30,1
63
50,947,2
24,1
43,7
71,5
57,4
31
20
29,1
56
50,8
41,2
21
38,3
59,5
54,3
0
10
20
30
40
50
60
70
80
Stunting Wasting Underweight Anemia in Children Anemia in Women(15 to 49 Years)
Perc
en
tag
e
NFHS 3 Urban NFHS 3 Rural NFHS 4 Urban NFHS 4 Rural
Key Nutritional Indicators in India
103
Prevent and reduce stunting
Children (0- 6 years)
Prevent and reduce under-nutrition
Children (0-6 years)
Reduce Low Birth Weight
Reduce anemia
Young Children(6-59 months)
Women & Adolescent Girls – 15 to 49 years
Bring down stunting of children 0-6 years from 38.4% to 25% by the year 2022
@ 2% per annum
@ 3% per annum
Targets
104
Undernutrition – Manifestations, Consequences, and Impact
Problem Manifestation Consequences Impact
Undernourishment
Micronutrient
deficiency
Wasting
Stunting
Small for gestation
age
Suboptimal
breastfeeding
Under 5 and
maternal deaths
Impaired physical &
cognitive
development
Decreased economic
activity
Compromised adult
health
High risk of
intergenerational
transfer
45% of under 5
mortality
22% of adult income
loss
IQ loss through
stunting (5-11 points)
Annual GDP loss of
11%
Every rupee invested
in nutrition yields a
return of Rs. 34 in
India
105
Counselling
• During pregnancy
• Optimal breastfeeding
• Complementary feeding
Vitamin A supplementation
Iron-Folic Acid supplementation
Supplementary Rations
Complementary food for Children
6-36 months
Treatment of Diarrhoea Deworming
CCT During Pregnancy, delivery
& Post Delivery
Additional Food Rations for
SAM & MAM
Insecticide‐treated nets for
pregnant women
Counselling5%
Supplementary Nutirtion
39%
Micronutrient & Deworming
3%
Health 4%
Meternity Benefits
49%
Interventions and Cost impact
106
36 States/UTs
719 Districts
7,075 Projects
51,328 Sectors
100 Million Beneficiaries
1.4 MillionField Functionaries AWW
Implementation
107
Technology
Convergence
Behavioral Change Communication
Capacity Building
The Four Pillars
Aanganwadi App
(Data Entry on ground)
1First Level Supervision
(Lady Supervisor)
2Tech Support
(Issue Tracker)
3
Real Time Data Offline-Online Multilingual Multimedia Tools GPS Tagging User Centric
Design
Multi-Layer Supervision
Dashboard
4
What is ICDS-CAS?
ICDS-CAS | AWW Application
110AWW DM/DPO/CDPO
State ICDS Directorate
Supervisor
Centre
Helpdesk
Beneficiaries
DashboardsCentral servers – Cloud Provider
AWW interacts and provides
service to a beneficiary
5
3
1
2
6
7
8
9
Data Fed by AWW is synced to
the server
Supervisor interacts with AWW
Supervisor interacts with
beneficiary
Supervisor syncs data onto the
sever
Helpdesk interactions for issue
resolution
Helpdesk syncs troubleshooting
information
Generation of dashboard reports
using data entered
Stakeholders access reports at
various administrative levels
1
2
3
4
5
6
7
8
9
Interactions Data flow
Process Flow
4
6
ICDS-CAS | Workflow
<Name> is severely underweight. Please contact your AWW immediately for necessary advice.
~1 Mn SMS
sent to
AWW & LS
SMS to Workers
~5 Mn SMS
sent to
Mothers
SMS to Beneficiaries
Centralized ICDS-CAS Call Centre set up by the Ministry for:
Toll-free number feedback for grievance handling
Follow-up with beneficiaries
Follow-up with officials about action taken on ground for identified
cases
1.5 Mn Calls made
Messages and Alerts | Prompting Action
~ 500,000 AWWs
26 States in India
285 Districts
~73.2 Mn Registered Households
~13.1 Mn Registered for
AWC Services
~46.7 Mn Children (0-6
yrs)
~4.6 Mn Pregnant
Women and Lactating
Mothers
ICDS-CAS Rollout | What are we talking about?
113
National
State
District
Block
Village
National CouncilExecutive Council
Convergence Action Plan
VHSN Day, CBE, DAY-NRLM
14000 Meetings
held in 2018-19
Convergence Platforms
114
Platforms
CBE - MonthlyVHSN Day - MonthlyDAY NRLM - Weekly
Trans-Media Campaigns
Nutrition Assemblies Nukkad NataksFestivals
Specific Days Like -• Yoga day• Breastfeeding week • Poshan Maah
Aligning FFs AWWs+LS+ASHA+ANM+SBPs – 2.4 Mn DAY-NRLM – 4.7 Mn Swachhagrahis – 0.4 Mn
Community Mobilization and Behavioural Change (Jan Andolan)Driven by Convergence ( Centre / State / District / Block / Village)
Health and
Family Welfare
Women and
Child
Development
Housing and
Urban Affairs
Rural
Development
Panchayati
Raj
Drinking Water
and
Sanitation
Human
Resource
Development
Information
and
Broadcasting
Consumer
Affairs,
Food and
Public
Distribution
Non
Renewable
Energy
Tribal AffairsMinority
Affairs
Ministries
115
Multi Sectoral
Themes
Behaviours
Messages
Platforms
Activities
Material
Behavioural Change Communication & Community Mobilisation
116
5THEMEFOCUS
DiarrhoeaManagement
Diet DiversityComplementary
Food & Feeding
AnemiaPrevention
1,000 Days
Hygiene, Sanitation &
Safe Drinking Water
D2 Camp-
Defeat Diarrhea
T3 Camp-
Test, Treat, Talk Anemia
Focus Themes for Community Mobilisation and BCC
117
Social Movement - Building A Common Understanding
JAN ANDOLAN/
SOCIAL MOVEMENT
Macro Level Meso & Micro Level
SBCC System
Strengthening
118
Incremental Learning Approach (ILA)
Field Functionaries Supervisory Staff State Level Staff
21 ILA Modules & 21 e-ILA + ECCE Modules
Monthly or Quarterly Module based Training
Maternal Nutrition
Newborn care
Breastfeeding
Complementary Feeding
Management of undernourished children
1 Mn FLW Trained
Capacity Building
1
2
3
4
5
Key Themes
119
Nutrition – Key Strategies and Interventions
120
Promoting Safe Drinking Water
Promoting SanitationODF
Promoting Personal HygieneHandwash facility with Soap
• Households• Anganwadi Centres• Health Centres• Schools
Infrastructure
Across1
2
3
A
121
Growth Monitoring & Promotion
Management of Acute Malnutrition
Breastfeeding • Within 1 hour of delivery• Exclusive Breastfeeding till 6 months
Service Delivery & Interventions
Complementary Feeding
Home Visits & Antenatal Check-ups
Institutional Deliveries
4
• Children 0-6 years• Weight and Height
• SAM and MAM Children
Anaemia
• Initiated at 6 months of age
• Children• Adolescent Girls• Mothers
5
6
7
8
9
10
B
• By AWW, ASHA & ANM• Counselling, HBNC, HBYC
122
Deworming
Diarrhoea Management
Calcium Supplement
• Children from 6 to 59 months• Adolescent Girls• Women of reproductive Age• Pregnant Women
Service Delivery and Interventions
Immunisation
Vitamin A Supplementation
Iron and Folic Acid
11
• Children till 1 year of age
• Actions Taken at State & District LevelFood Fortification
• Children from 6 to 59 months
• Children 1 to 19 years• February & August every year
12
13
14
15
16
17
C
• Pregnant Women (360 Tablets)
• Oral rehydration Solution • Zinc Supplementation
123
• Stocks of SNP
• Functional GMDs
• Availability of MCP Card
• Monitoring through ICDS-CAS
Supply Chain Management and Monitoring
Linked to ICDS
• IFA• Vitamin A• Calcium• Deworming Tablets• ORS & Zinc Supplement
Linked to Pharmaceuticals
D
124
THANK YOU
#GrowGreatSeminar2019
126
LUNCH
18 October 2019 | Gauteng, South Africa
#GrowGreatSeminar2019
VIDEO
(Insert Lawrence Haddad
video here)
#GrowGreatSeminar2019
PANEL DISCUSSIONWhat we can do now, with what we have.
PANEL
#GrowGreatSeminar2019
132
GROW GREAT JOURNALISM AWARD
18 October 2019 | Gauteng, South Africa
VIDEO
(Insert Bill Gates video)
134
CLOSING REMARKS
18 October 2019 | Gauteng, South Africa
#GrowGreatSeminar2019