4 th National Seminar on Food Security and Nutrition Under the theme “Child and Maternal Nutrition” National Maternal and Child Health Centre, MoH Dr. Prak Sophonneary Needs and challenges for scaling up evidence-based nutrition interventions in Cambodia

1. Success at scale Breastfeeding Vitamin A supplementation, immunization and deworming Iron/Folic Acid supplementation for pregnant & postpartum women Antenatal care, delivery & Postnatal care Household use of iodized salt

2. Specific Problems/Challenges Many women are entering pregnancy thin and anemic Iron supplementation for women of reproductive age expensive Promoting dietary intake and weight gain during pregnancy not previously emphasized Despite improvement in Iron/ Folic Acid, pregnant/ postpartum women still anemic

2. Problems/Challenges (cont) Many young children receive inappropriate diet Formula use is increasing and mothers are stopping breastfeeding earlier No intervention for child multiple micronutrient deficiency until recently Resources allocated to identifying and treating child malnutrition insufficient

2. Overall Problems/Challenges Nutrition improvement relies on behavior change, which is expensive and takes time Financial allocation for nutrition low No structure to support community based nutrition program Limited number of Cambodian nutrition experts with formal training Limited multi-sectoral program based approach

3. Solutions For anemia and low weight gain during pregnancy: Emphasize nutrition counseling and promotion and monitoring of weight gain during Antenatal care (ANC) Improve early ANC and compliance to Iron/Folic Acid supplementation Identification and treatment of anemia

3. Solutions (con’t) For anemia & thin women of reproductive age: Iron fortification of food Targeted iron supplementation to high risk women Social marketing of iron supplementation Scale up nutrition promotion with homestead food production

3. Solutions (con’t) For inappropriate feeding of children: Implement behavior change communication campaign for complementary feeding Strengthen enforcement of Sub-Decree 133 to stop marketing of breastmilk substitutes Scale up multiple micronutrient powder supplementation

3. Solutions (con’t) For identifying and treating child malnutrition: Connect identification and treatment of malnutrition to the Health Equity Fund and other social protection mechanisms MoH and local government financing for Village Health Support Group (VHSG) screening and referral of malnutrition Create structure to support community based nutrition program to prevent malnutrition

4. Way forward - Immediate Improve quality of nutrition counselling during ANC/PNC Health Information System includes indicator for weight gain during pregnancy Gain better understanding of lack of response to Iron/Folic Acid supplementation during pregnancy Develop plan for iron supplementation of women of reproductive age Review homestead food production programs and connect to nutrition activities

4. Way forward - Immediate Evaluate complementary feeding campaign and secure financing for scaling up Scale up treatment of diarrhea using ORS + zinc Identify advocate/champion for enforcement of sub decree 133 Cost-sharing arrangement between partners and MoH for procurement of Multiple Micronutrient Powders Identify appropriate structure for community based program Start using Health Equity Fund for treatment of malnutrition in hospitals

4. Way forward (medium & long term) Moving from visual to biochemical test for anaemia during pregnancy Private sector engagement for social marketing of iron supplementation for women of reproductive age and fortification Test new structure for community based program Human resource development for nutrition professional