Director for Nutrition, MOH/RSS South Sudan Maternal Infant and Young Child Nutrition (MIYCN) Strategy and Guidelines Rebecca Alum William Director for Nutrition, MOH/RSS December 12, 2016 Johannesburg 9/19/2018

Outline of the presentation Introduction to South Sudan: Demographics, Administrative divisions and Map. Country Situation and efforts Purpose, Goal and objectives of the MIYCN Strategy Strategic action of the MIYCN Next steps Challenges

South Sudan overview South Sudan attained her independence on the 9th July 2011 Area coverage 644,329 KM2 Population of 8.3 m (2008 Census) Male 4.29 m Female 3.97 m Population density: 15.8 KM2 Capital city: Juba

South Sudan overview Cont… The country has a decentralized system of Governance with a national government and a decentralized system of four levels – National States -10 Counties - 80 Payams -578 Boma -2092

Health facilities in Country Total of four Teaching Hospital (National Hospitals) 7 state Hospital 27 county hospital 358 Primary health Care centers 1010 Primary health Care Units

Country Situation 40.3% 17.3% 19.4% Health Status indicators SSHHS(2006) SSHHS(2010) Maternal Mortality Ratio (per 100,000 live births) 2,054 789 Under Five Mortality Rate (per 1,000 live births) 105 99 Infant Mortality Rate(per 1,000 live births) 67 64 Stunting (% of under five children) 34.4 31.1 Underweight (% of under five children) 32.9 27.6 Under five Wasting 22.7 Contraceptive prevalence rate(%) 4.7 Antenatal attendance 1st visit(%) 46.7 40.3% Antenatal attendance 4th visit(%) 9.3% 17.3% Births attended by skilled H/Ws(%) 14.7 19.4% Caesarean section rate(%) 0.5

Country Situation Cont….. Selected Service coverage indicators SSHSS (2010) DPT3 Coverage(%) 59 Measles(MCV %) 62 Selected Health System Indicators Deliveries attended by a skilled attendant 19.4% Institutional deliveries 11.5% Mother-to-child-transmission (women living with HIV) 135,000 Children living HIV 18,000 Neonatal Mortality rate (/1000 births) 39

Infant and Young Child Feeding practices in South Sudan % SHHS 2006 and 2010

Current Efforts Services for treatment and prevention of nutrition are on-going pls mention scale and numbers to show the reach Increased access to quality nutrition data; SMART and IPC Analysis Development of guidelines for Nutrition - CMAM guidelines and training Packages, - MIYCN strategy, guidelines and Training Packages are developed as a road map for sustainable development for South Sudan

MIYCN strategy and Guidelines: the purpose, Goal and Objective It serves as a guide for the government and all stakeholders involved in the conceptualization, planning, implementation, supportive supervision, and monitoring of MIYCN and related preventive interventions GOAL: To strengthen the health status of the population by improving the health and nutritional status of mothers, infants, and young children and their wellbeing through an effective delivery of the basic package of health and nutrition services (BPHNS). Objective: To reduce the burden of malnutrition in pregnant and lactating mothers by 20%, and stunting in children under five years of age by 10% by year 2025

MIYCN strategy development process 1 Desk review, meetings, interviews, group discussions (March-April 2016) 2 Consultation, setting goals and objectives to review a 1st draft of the strategy (May 8 to 10,2016) 3 Consultation to review a 2nd draft of the strategy and the 1st draft of the guidelines (June 14 to 16,2016) 4 Consultation to Review the third draft of the strategy and guidelines (July to August,2016) 5 Finalization process: with inputs and suggestions from all partners (July to September,2016) 6 Developing of Training Package (September to November,2016) 7 Validation Workshop (November 2016) Planning and costing of the MIYCN strategy 6th -8th December 8 Endorsement by the Senior Management Committee (6th December 2016)

MIYCN MIYCN strategy: components Endorse key policies and regulations Improve maternal nutrition Optimal Infant and Young Child Feeding practices Intesectoral integration Multisectoral integration Capacity Building and Service Strengthening Advocacy and SBCC Research, information, monitoring and evaluation Resources Mobilization and support

MATERNAL, INFANT AND YOUNG CHILD NUTRITION STRATEGIC ACTIONS - 2016 to 2025 Develop and disseminate key policies and regulations Improve maternal nutrition Promote, and support optimal Infant and Young Child Feeding practices Support optimal Infant and Young Child Feeding in difficult circumstances (HIV/AIDS, emergencies e.t.c) intra-sectoral integration (Health and Nutrition 

MATERNAL, INFANT AND YOUNG CHILD NUTRITION STRATEGIC ACTIONS - 2016 to 2025 cont…. Multi-sectoral integration (Food Security and Livelihood, WASH, Protection, Education and Shelter) Inter-sectoral: Maternal and Child Health, Immunization, Reproductive Health, HIV/AIDS. Capacity Building and Service Strengthening Advocacy and Social Behavioural Change Communication Research, information, monitoring and evaluation Mobilise resources and technical support

MIYCN strategy: expected outcomes by 2025 Indicators Baseline (%) (2016) Target (%) (2025) Increase the rate of early initiation of breastfeeding within the first hour of life from 48 75 Increase the rate of exclusive breastfeeding in the first six months 45 70 Increase continued breastfeeding up to two years from 38 60 Increase the timely introduction of complementary foods 21 50 Increase the Minimum Dietary Diversity (children six to 23 months) 18 40 Decrease the low birth weight 5 2 Reduce childhood stunting by 10% 31 Reduce childhood wasting to less than 13% 23 13 Zero percent increase in childhood obesity in urban areas - Five percent reduction from baseline anaemia in women of reproductive age (There is no baseline for anaemia in women)* Twenty percent reduction in the Proportion of women aged 15 to 49 years with low body mass index (<18.5 kg/m2) (-) means we have no baseline, and we need to immediately conduct a national Why 2015: Align with the national health policy and the global targets for MIYCN (WHO is tracking progress)

MIYCN strategy aligned with international and national recommendations…like International Code of Marketing and WHAs,1981 to 2016 The Baby Friendly Hospital Initiative,1991 The ILO Maternity Convention,2000 The Global Strategy for Infant and Young Child Feeding,2002 WHO Essential Nutrition Actions, 2013 The Sustainable Development Goals,2015 GOSS National Health Policy, and the GOSS Boma Health Initiative,2016 World Health Assembly Resolution (65.6) on the development of a comprehensive plan for MIYCN,2012 WHO comprehensive implementation plan for MIYCN,2012 WHO Essential Nutrition Actions evidence and guidelines,2013 World Health Assembly recommended MIYCN global indicators, 2014 GOSS National Health Policy,2016 GOSS Boma Health Initiative,2016

MIYCN strategy: Next steps… Launch of the MIYCN strategy Printing and dissemination Advocacy and promotion with donors and other agencies Capacity building (master training, training of trainers, cascade training) Integrate MIYCN into the Boma Health initiative for community ownership Reporting, Monitoring and evaluation

Lessons learned in development of the MIYCN strategy Advocacy to the MoH senior management for leadership and ownership. Consultative process especially with the various government line ministries and communities and also involvement of all implementing partners and the UN agencies was key in the development of the strategy Formation of the MIYCN TWG as a core group which expedite review process and technical inputs

Challenges Policy environment: No nutrition policy to re-enforce implementation of international regulations No county wide nutrition data Male engagement Data and analytics: lack of good baseline data for guiding the strategy Programming environment: political instability and insufficient HR capacity , limited funding to support scale up

Commitment statement from the Honorable Minister of Health Republic of South Sudan, Dr. Riak Gai Kok “ Yes, we are in emergency, but we must balance the situation with development to give a future for the young generation” 9/19/2018

Thank you for listening ! 9/19/2018