Areas of interventions in National Nutrition Services (NNS) By Dr Mustafiz Rahman PPC, MoHFW Training on Assessment of Nutritional Status December 2011 Date : 18 December 2011, Venue: FPMU Meeting Room The Training is organized by the National National Food Policy Capacity Strengthening Programme (NFPCSP). The NFPCSP is jointly implemented by the Food Planning and Monitoring Unit (FPMU), Ministry of Food and Disaster Management and Food and Agriculture Organization of the United Nations (FAO) with the financial support of the EU and USAID.

Nutrition under MOHFW Due to it's multidisciplinary character nutrition is related with 13 different ministries. MOHFW is one of the important ministry which can address this problem up to certain level This issue incorporated in to constitution in 1972 Institute of Public Health Nutrition (IPHN) established in 1972

Topics of my presentation Areas of interventions in National Nutrition Services (NNS) Scaling up proven direct and Indirect nutrition interventions

Major public health Nutrition problem : 1.Stunting 2.Under weight 3.wasting 4.Protein Energy Malnutrition 5.Iron deficiency Anemia, Iodine deficiency disorders 6.Vitamin A deficiency, zinc deficiency etc. 7.Low Birth Weight 8.Over nutrition & its complications (diet related Non- communicable Diseases-NCD)

Adolescent Girls yrs Newly Wed Women Children Under Two Lactating Mothers Pregnant Women Services Through Life-cycle In BINP/NNP NNS would follow life-cycle approach in community service

Services perform by a CNP at CNC Post-partum Care Vitamin A iron folate Referral Growth Monitoring Care for LBW FoodSupplementtionVi tamin A Referral Weight Monitoring Iron Folate Antenatal care Iron Folate Food supplementation Counseling Referral Monthly Forum Nutrition Assessment IronFolate De-worming Weight promotion IGA, Fruits tree plantation Lactating Women Under 2 Children Pregnant Women Adolescent Girls/boys Nutrition Assessment Counseling IronFolate Newly wed Couple Food Security Components Nutrition Garden Poultry for Nutrition VGD-NNP Collaboration Household Survey followed by update Home visit Adolescent boys Mother in law Father in law Husband of newly and pregnant women Forums BCC Training

Family Welfare Assistant (FWA) for >5000 population Community Nutrition Promoter (CNP) for 1250 population Services in CC Health Assistant (HA) for >5000 population Other ministries/ NGOs/private /personal initiative  Eligible couple registration  Family planning counseling  Non-clinical contraceptive distribution & FU  Referral for ANC  Support during  NID & Vit A week  HH profile update  GMP  Micronutrient Supplementation (Post partum Vit A, IFA for PLW) Adolescent girt & newly wed women  Target food supplementation for PLW, U2 children  Referral for ANC  BCC  Food Security interv  Support during  NID & Vit A week  HPN Services  Geographical reconnaissance  EPI  Disease surveillance  Health education  Epidemic control  NID & Vit A week  ……….  …………  …………… … Job Analysis of Front Line Workers in HNPSP Comparative Matrix

Multi sectoral issues Due to multisectoral issues many ministries would contribute to overcome these issues are important: Food security at HH level Food safety Food quality Balance diet Healthy diet Diet culture Knowledge about nutrition Prevention,control and management of malnutrition ( NNS-OP, MOHFW)

Intervention so far under MOHFW Through IPHN since 1974 Through IPHN & BINP (59 Uz): Through IPHN & NNP(167Uz) :

What next in MOHFW ? National Nutrition Services (NNS) to mainstream the nutrition issue in all regular service delivery points of DGHS & DGFP GO-NGO model would be in practice to ensure nutrition service in urban slum, haor- baor - char, hard to reach, underserved and where Community Clinic (CC) is not available Inter-sectoral collaboration/coordinated collaboration among all stakeholders

General Objective The overall objective of NNS OP is to reduce the prevalence of malnutrition particularly among children and women and also achieve sustainable improvements in the nutritional status of the population of Bangladesh. 11

1.To implement a mainstreamed, comprehensive package of nutrition services to reduce maternal and child nutrition and ensure universal access 2.To develop and strengthen coordination mechanisms with key sectors (especially Ministry of Food and Disaster Management, Ministry of Agriculture, Ministry of Livestock and Fisheries, Ministry of Local Government and Rural Development and Cooperatives) to ensure a multi-sectoral response to malnutrition 12

Cont. 3. To strengthen the human resource capacity to manage, supervise and deliver nutrition services at the different levels of the health system 4. To strengthen nutrition information systems and operations research to ensure an evidence- based response. 13

Component of OP  Behavioural Change and Communication to Promote Good Nutritional Practices  Institutional capacity building  Human resource development (HRD)/ Training/Capacity Building  Food security, quality & food safety  Management of severe acute malnutrition (facility and community) 14

Cont. Monitoring and Evaluation / Nutrition Surveillance Mainstreaming Gender into Nutrition Program Nutrition during Emergencies & climate change Community Based Nutrition (CBN) as selected area (urban, hard to reach) Coordination of Nutrition Activities across Different Sectors 15

Cont. Procurement of equipments, micronutrients, and deworming tablets etc. School Nutritional education Program 16

Service delivery  Growth Monitoring and Promotion (GMP)  Protection, Promotion and support of Breastfeeding/ Infant and Young Child Feeding (IYCF)  Vitamin A supplementation of children 6-59 months & lactating mother  Iron-folic acid supplementation for pregnant women  Iron Supplementation and Deworming of Adolescent Girls  Iodine deficiency disorder & Salt Iodization  Zinc Supplementation during treatment of diarrhea 17

Cross –cutting issues Given the nature of this, this OP is highly dependent with other Ministry activities which are articulated in the Action Plan of the Strategic Document. 1.Effective Integration of priority nutrition Interventions in the field level at all service delivery points of DGHS and DGFP. OP-1,2,3,9.18,20 2.Strengthening HR resources necessary for provision of nutrition services. OP-11, 12, 29, 25 3.Establish effective facility and pop based nut surveillance. OP-1,2,3,14, 22, 6 4.Providing nutrition education OP-15, 23, 2,3 5.Strengthening sectoral collaboration regarding nutrition and food safety. MODM, Food Div, MOFLS, MOWCA, MOI and other. 18

Indicator 1.Prevalence of night blindness among <5 2.% of children 6-59 m receiving Vit-A 3.% of vit-A supplementation in postpartum women 4. Rate of EBF in infants under <6 months 5.% of children 6-23 months fed with all infant and Young Child Feeding (IYCF ) practices 6.Prevalence of iodine deficiency 19

Cont. 7. Prevalence of anemia among pregnant women 8. Prevalence of anemia among children 6-59m 9. # of MOs trained in nutrition services delivery 10. # of CC workers trained in nutrition services delivery 11. % of UHCs having a functional Nutrition Corner established 20

Budget for the following activities 1.Behavior Change Communication (BCC) 2.Human resource development (HRD) 3.Control of Vitamin-A deficiency disorder 4.Control & prevention of Anemia 5.Control of Iodine deficiency Disorders 6.Other Micronutrient problems of Public Health importance ( zinc, vitamin ‘D,’ calcium etc.) 7.Community & facility based management of severe acute malnutrition (SAM) 8.Institutional Capacity Development 21

Cont. 9. Protection, Promotion & Support of Breastfeeding/ Infant and Young Child Feeding (IYCF) including BFHI & BMS Code 10. Food fortification (Salt Iodization, fortification of oil/other food with Vitamin ‘A’, iron etc.) 11. School Nutritional education Program 12. Food security, Quality and Food Safety 13. Monitoring, Evaluation, Operations Research, Survey 22

Cont. 14. Nutrition Surveillance Program 15. Establishment of nutrition unit (NU) and strengthening of existing NU 16. Community based Nutrition (CBN) ) as selected area 17. Multisectral Collaboration 23

Thanks 24