nutrition sector by domitille kauffmann lrrd project
TRANSCRIPT
Nutrition sector
By Domitille Kauffmann
LRRD Project
Evolution of the « nutrition sector » in Afghanistan
20022001 2003 2004 20062005
« Development phase »:
acting on the underlying causes of malnutrition and on chronic malnutrition
« Transition phase»:
building a Public Nutrition strategy and policy
« Emergency phase»:
treatment of severe malnutrition and food aid
•Hand-over of TFU from NGOs to GoA
•Iodised salt campaign
•Breastfeeding campaign to be strengthened
•New task forces on nutrition education and flour fortification are been set up
•4 working group are still active
•Set-up of the PND within the MoPH
•Set up of 7 working groups on nutritional issues
•Design of a 3-year strategies
•Phasing-out of NGOs with SFC (gvnt decision)
•Implementation of the BPHS
•SFC and TFC run by NGOs
•Food distribution
•Vitamins distribution by NGOs
Nutrition
Women activities EducationAgricultureWater & Sanitation
A « cross-cutting sector » under the umbrella of the MoPH with an effort of ownership by the MAAHF
Health
Support of FAO and WFP (food supply)Support of UNICEF/WHO/…
PND MoPH (BPHS interventions and other Public Nutrition activities)
Programs implemented by NGO and UN-agencies
Support of UNICEF/WHO/WFP/FAO
Home economic Unit of MAAHF (guidance…) MRRD (training supports,ToT,..)
Shared responsibilities
• Leadership of the Public Nutrition Department (MoPH)
• Still limited involvement from Home economic Unit (MAAHF)
• A central role played by the UN-agencies: – Capacity building (trainings, etc.) – Strategic support– Technical support (laboratory, equipment and supply; protocols, development of guidelines,
communication support for USI campaign,etc.)– Building partnership with private sector– Donors
• Indirect roles played by NGOs in agriculture, water and sanitation, women programs and education
Nutrition
… under the umbrella of the MoPH …
HealthMoPH (BPHS interventions and other Public Nutrition activities)
Programs implemented by NGO and UN-agencies
Support of UNICEF/WHO/WFP/FAO
Production of iodised salt by a factory in Jalalabad
Mill in Kunduz (pilot project in flour fortification)
Women activities EducationAgricultureWater & Sanitation
Support of FAO and WFP (food supply)Support of UNICEF/WHO/…
Home economic Unit of MAAHF (guidance…) MRRD (training supports,ToT,..)
Public nutrition interventions
+ other interventions in the BPHS links to nutritional issues: food distribution in TB-programs, etc…
PUBLIC NUTRITION ACTIVITIES BPHS
TREATMENT OF MALNUTRITION
Growth monitoring
Diagnosis of malnutrition
Implementation of TFUs in district, provincial or regional hospitals
Treatment of malnutrition (?)
MICRONUTRIENT DEFICIENCY
Flour fortification Multi-micronutrient supplementation
Diagnosis of anaemia
Vit A supplementation
USI Iodised salt distribution in health facilities (?)
MATERNAL AND CHILD NUTRITION
Breastfeeding promotion on going (UNICEF support) Breastfeeding support
Iron supplementation in children and pregnant women
Vit A supplementation for children < 5 years during immunization campaign
Vit A supplementation (post-partum)
NUTRITIONAL EDUCATION
Initiatives on going with WFP, FAO IEC about nutrition and growth problem
Public nutrition strategy and policy 2003-2006: several achievements at provincial level …
• Provincial Nutrition Officers recruited through the PRR process are progressively appointed in each province (5 provinces visited, 4 PNO in position)
• Implementation of TFU in each province is on going ( 5 provinces visited, 3 TFU)
• Afghan factories are producing iodised salt more than 40% of the population already consume it
• Coordination bodies are running at national and provincial level
• PNO: Unclear budget allocationWhich ownership, support and means of interventions for PNO?
• TFU: Lack of financial and labour resources in running TFU, long distance from communities to the district or regional hospital
Where to implement and how to run TFU?
• USI: Top-down campaign, difficulty to access to communities in remote areas, regular salt still produced and available in bazaar, misunderstandings...
How to reach the 100% coverage?
• Flour fortification: relative failures of the small scale projects Which future?
• BPHS: lack of good screening and trained staff,… Is there sufficient human resources allocated to growth monitoring at health facilities level?
Public nutrition strategy and policy 2003-2006: … and still many uncovered issues
Nutrition
Women activities EducationAgricultureWater & Sanitation
Health MoPH (BPHS interventions and other Public Nutrition activities)
Programs implemented by NGO and UN-agencies
Support of UNICEF/WHO/WFP/FAO
« Prevention of diarrhoeal diseases » session for a women group in Jalalabad province
Greenhouses in BamyanFFW for vulnerable widows (GAIN) in Mazar-e-Sharif
... but also addressed through interventions in other sectors
Support of FAO and WFP (food supply)Support of UNICEF/WHO/…
Home economic Unit of MAAHF (guidance…) MRRD (training supports,ToT)
Sector Water and sanitation
Agriculture Women activities Education
Programs Hygiene promotion within water supply and sanitation programmes
- Kitchen garden,- Vegetables gardening- Greenhouses - School gardens- Tree nurseries
- WRC- Vocational training- Income generatingActivities
-Adult and mother Literacy courses-School for children
Activities related to nutrition issues
•Hygiene education sessions through 5 main topics such as •Food safety,•Prevention of diarrhoeal diseases, etc…
•Cooking lessons•Food preservation and processing lessons•Food distribution to vulnerable women
•Health /Hygiene education sessions•Breastfeeding education sessions•Food processing lessons•Etc…
•Training of teachers•Nutritional education at school•Food distribution to children at school
Nutritional issues addressed
•Decrease the risk of malnutrition due to diseases
•Diversification of the diet• Improvement of the quantity of food intakes
•Improvement of nutrition knowledge•Improvement of the quantity of food intakes•Decrease the risk of malnutrition due t diseases
•Improvement of nutrition knowledge•Improvement of the quantity of food intakes
Typology of nutritional interventions
What is the place of nutrition in the LRRD context?
• Nutrition is considered as a humanitarian sector in emergency phase (own donors, NGOs, nutrition programmes)
curative phase
• Nutrition is not anymore a sector in the development phase preventive phase: focus on the underlying causes of malnutrition through interventions in different sectors
Challenges in the LRRD context
• No « sectoring » nutrition into the health sector in order to keep the cross-cutting dimension of nutrition
• « Re-investing » NGOs in the conceptual framework of nutrition (raising awareness, developing monitoring on nutritional impact, capitalising on successful approaches)
• Difficulty to achieve a real long term impact on nutritional practices with short fund cycle programs
• Shifting too quickly from curative to preventive without ensuring that TFU structures are sustainable
Some issues for discussion (1)
• Lack of monitoring and evidence on nutritional impacts
• Lack of know-how on food receipt, processing and preservation
• Small scale projects in trainings teachers about nutrition (literacy courses and at school)
What strategy should be applied to improve nutritional practices within the communities?
Some issues for discussion (2)
• Limited and « hidden » role of donors in nutrition
• Reduction of funds allocated to Food Security
• No focus on nutrition required in the design of logical framework
How to maintain or even strengthen the focus on nutrition without donors support and influence?
Some issues for discussion (3)
• A conceptual framework demanding the commitment of several ministries (MoPH, MAAHF, MRRD, MoWA, …)
• Experience of MRRD in hygiene promotion (implementation, monitoring and evaluation)
How to ensure an inter-ministry collaboration? What mechanisms for lessons sharing and capitalization?