Nutrition Education and Rehabilitation Sessions (NERS) Ministry of Public Health Afghanistan Nutrition Education and Rehabilitation Sessions (NERS) Dr. M. Homayoun Ludin December 10, 2014

What is NERS? Nutrition Education Rehabilitation Session is a community-based approach to successful and sustainable reduction of malnutrition in resource- poor settings. It is based on positive deviance model. This approach is combined with CMAM for the treatment of children with moderate acute malnutrition (MAM) and prevent further deterioration of nutritional status.

NERS Objectives To raise awareness of optimal IYCF (Exc. breastfeeding and complementary feeding) practices in the community; To sustainably prevent malnutrition and common diseases in children in the community; To Promote healthy feeding, cooking, health- seeking and hygiene practices; To Rehabilitate malnourished children especially MAM

NERS Approach In this approach the community will be mobilized volunteers from the community will be trained to conduct (NERS) in which caregivers and volunteer facilitators meet to learn and practice cooking energy dense meals and feeding them to their malnourished children; Caregivers at these sessions also learn about breastfeeding, danger signs in ill children, health seeking and maternal health;

NERS Approach Caretakers of identified malnourished children are invited to participate in NERS for a duration of 12 days. NERS is implemented by volunteer – they help mothers prepare/cook and feed energy rich/calorie dense meals to their children. Caregivers bring a fist full of food to the sessions and a piece of wood.

How does 12 day-NERS look like? Days 1 Every child is weighed on the first day Preparing energy dense meals based on menus Education (one topic each day) Feeding children Days 2 to 6: Feeding Education

Cont’d… Day 7: Home Alone Day Participants stay home and practice the new behaviors. CHW/volunteers visits families and counsel Day 8: Feedback Preparing energy dense meals based on menus Feeding children Education Discussion around the experiences the caregivers faced at home and assist them

Cont’d… Day 9 and 10: at home Day 11: Next-to-last day of the Session Preparing energy dense meals based on menus Feeding children Education Discussion – problems faced at home Day 12: Last day of the Session All children will be weighed again Caregivers counseled

Advantages of NERS The approach provides a solution that can quickly address an immediate problem. Supervised feeding is held during the session. Caregivers learn and implement the same practices at home and report on their experiences at the sessions. NERS is the source of learning about what positive and unique behaviors people themselves practice in the community Knowledge and doing something empowers community

Lessons Learnt building the capacity of Community Health Workers (CHW) and Family Health Action Group (FHAG) strengthens feeding babies and breastfeeding practices and participatory cooking sessions in the community level Establishment and training of FHAG reduce load of working at community level and improved maternal and newborn care services Close supervision of Female CHWs and FHAG has great affect on follow up of pregnant and lactating women by CHWs and FHAG

Challenges Some parts of community not ready to accept women as volunteers some areas do not have CHWs, making it difficult to reach lactating mothers Gaining approval from IRB takes too much time

Recommendations Expansion to other ethnic areas and in rural areas Integration of community-based NERS approach into BPHS Integration of pictorial materials and guidelines of the project into MoPH MNC guidelines Expansion of FHAGs establishment national wide Inclusion of one Female staff for supervision and support of Female CHWs and FHAG is essential for effective and successful implementation of community based maternal and newborn care

Advantages of NERS Affordable NERS is affordable and families are not dependent on outside help or resources to practice the new behaviors. NERS is much more cost effective Sustainable The positive behaviors continue after the NERS sessions end. The skills practiced at the session become habitual behaviors – they are sustained over life and passed from one generation to another NERS not only changes the behaviors of individual families, but also changes how a community perceives malnutrition and their ability to change the situation.

Conclusions NERS focuses on the treatment of under weight, MAM and its prevention. Promotes long-term self-sustaining solutions to malnutrition (solutions are within the community) Can demonstrate achieving results in a very short amount of time. NERS can be linked to facility based GMP and CMAM especially as a way to address MAM appropriately and comprehensively.

Thank You Any Questions?