Nutrition Specialist, UNICEF Updates on IYCF- integrated with MNP & Child Grant, Vit A and GMP Programs Pradiumna Dahal Nutrition Specialist, UNICEF

Vitamin A Coverage 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 2012- 2013 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

Anemia Prevalence High in Children: The Problem is serious among 6-23 months children Percent of children age 6-59 months with anemia Source: NDHS 2011

Trends on IYCF practices in Nepal: Complementary feeding (CF) 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% NDHS (2006) 35% 53% 75% NDHS (2001) 31% 68% 66%

IYCF Practices among Under 5 Children Percent of children 6-23 months 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 Feasibility study on MNP distribution in two districts, Makawanpur and Parsa Phase I Piloting of the MNP program (6 districts: 2010 Onwards) and roll out in 9 districts by 2012 Phase II Scale up of the MNP Programme by 2015 Phase III

IYCF/MNP Program Goal Pilot Objectives 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 Phase 1: Makwanpur (May, 2010); Palpa (June, 2010) Phase 2: Rasuwa (Sept, 2010); Gorkha (Jan, 2011) Phase 3: Rupandehi (May, 2011); Parsa (June, 2011)

HEALTH FACILITY (RURAL MODEL) FEMALE COMMUNITY HEALTH VOLUNTEERS Distribution Models UNICEF/DOHS/LMD DHO/DPHO 6 to 24 months Children PHC/HP/SH P FCHV Procurement Department/UNICEF DHO/DPHO Municipality Office 6 to 24 months Children Ward Office FCHV Procurement Department/UNICEF DHO/DPHO HP/SHP/PHC 6 to 24 months Children HEALTH FACILITY (RURAL MODEL) FEMALE COMMUNITY HEALTH VOLUNTEERS (RURAL MODEL) MUNICIPALITY WARDS (URBAN MODEL)

Updates from External Survey: Preliminary Report New Era Coverage Compliance

Updates from External Survey: Preliminary Report New Era Infant and Young Child Feeding Practices

Draft IYCF/MNP Scale up Plan by 2016/17 Sub-Ecology Anemia (6-59) Rank Anemia (6-23) Districts No. of Districts Scale up Plan* Far West Terai 60.4 1 68.4 5 Kailali, Kanchanpur 2 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 Swap- 7 districts (Ramechhap, Jhapa, Chitwan, Tanahun, Pyuthan, Surkhet and Kavre, UNICEF 3 possible districts Dhanusha, Nawalparashi and Baitadi] 33 by 2013 75 by 2017 Mid-West Terai 56.9 83.8 Bardiya, Banke, Dang 3 (1) West Mountain 52.7 3 80.3 Darchula, Bajhang, Bajura, Kalikot, Jumla, Dolpa, Mugu, Humla, Mustang, Manang 10 East Mountain 51.3 4 65.9 8 Solukhumbu, Sankhuwashaba, Taplejung 3 (2) Eastern Terai 49.5 74.8 Siraha, Saptari, Sunsari, Morang, Jhapa Western Terai 48.8 6 65 9 Kapilvastu, Rupandehi, Nawalparashi Central Terai 46.7 7 67.7 Chitwan, Bara, Parsa, Rautahat, Sarlahi, Mahottari, Dhanusa 7 (6) Western Hill 43.6 63 11 Palpa, Tanahun, Arghakhachi, Syanja, Parbat, Gulmi, Baglung, Myagdi, Kaski, Lamjung, Gorkha 11 (9) Eastern Hill 42.3 59.7 12 Okhaldhunga, Khotang, Udaypur, Bhojpur, Dhankuta, Terathum, Panchthar, Illam Far-West Hill 40.9 70.4 Baitadi, Dadeldhura, Doti, Achham 4 (2) Central Hill 40.2 66.6 Dhading, Nuwakot, Makwanpur, Kathmandu, Lalitpur, Bhaktapur, Kavre, Sindhuli, Ramechhap 9 (8) Mid-West Hill 36 58.5 13 Dailekh, Surkhet, Salyan, Rolpa, Pyuthan, Rukum, Jajarkot Central Mountain 33.1 63.7 Rasuwa, Sindhupalchok, Dolakha   Total Number of Districts 75 6 Districts in Orange IYCF/MNP Piloted, 9 districts in Blue IYCF MNP being expanded in 2012

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 Strategies 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

VDC Influential People Training Achievement SN District FCHV HF Staffs VDC Influential People Traditional Healers MGM 1 Jumla 514 146 347 270 4711 2 Kalikot 264 131 353 267 4590 3 Humla 240 1o8 310 236 4655 4 Dolpa 151 51 188 144 2440   Total 1169 436 1198 917 16396 .

Challenges/Future direction 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 19

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

! hf} !!=% !=# !=@ #=( ##^ @^ !=& @ kmfk/ !)=# @=$ @=# *=^ #@# ^$ !%=% qm=;+= vfBfGg k|f]l6g -u|fd_ lrNnf] Vlgh -ldlnu|fd_ /]zf zlQmls=Sofnf]/L_ SoflN;od kmnfd ! hf} !!=% !=# !=@ #=( ##^ @^ !=& @ kmfk/ !)=# @=$ @=# *=^ #@# ^$ !%=% # sfu'gf] !@=# $=# #=# *=) ##! #! !@=( $ lrgf] &=# @=& #=^ #@* !$ % Dfs} !!=! !=% #$@ !) ^ h'g]nf] &=^ !=) )=^ #%& !& & pjf –sfnf] !)=$ @=% #$) @) &=% * cfF6f !@=! !=( #$! $* $=( ( d}bf !!=) )=( )=# #$* @# sf]bf] &=* @=( #=& #@@ @** $(=@ !! Rffdn ^=* )=% )=@ #$% )=& k|lt;o u|fddf ;|f]tM g]kfnL vfBkbfy{df kfOg] kf]ifs tTjx?, g]kfn ;/sf/ s[lif tyf ;xsf/L dGqfno vfB k|ljlw tyf u'0flgoGq0f ljefu, @)^! 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