KENYA ON COURSE PRESENTER: GLADYS MUGAMBI HEAD OF NUTRITION AND DIETETICS MINISTRY OF HEALTH KENYA

Outline WHA Targets Why should countries invest in improving nutrition? Nutrition situation in Kenya What we can do to accelerate malnutrition reduction

World Health Assembly Targets 2025

Why invest in improving nutrition? Human Rights Alive and thriving Economic Benefits Intergenerational equity

of all child deaths from poor nutrition Malnutrition –single greatest contributor to child mortality. It accounts for more than a half of deaths among under-fives None BF infants and children have a 7 fold and 5 fold greater risk of death from diarrhea diseases and RTI respectively www.globalnutritionreport.org

Progress on Nutrition Status in Kenya

Nutritional Status of Children 26 4 11 *Based on the 2006 WHO Child Growth Standards

Progress in addressing malnutrition The country has made progress towards reduction of malnutrition among children under five years Stunting (short for age) has decreased from 35 to 26 percent Wasting (low weight for height) has decreased from 7 to 4 percent in 2014 Underweight has reduced from 16 to 11 percent We have achieved Millennium Development Goal target of 11 percent for underweight Proportion of children less than 6 months who are exclusively breastfeeding (that is breastfeeding without being given anything else not even water) has increased from 32 to 61 percent *Source KDHS 2014

Trends in Nutritional Status of Children *Based on the 2006 WHO Child Growth Standards

Nutrition situation at county level West Pokot and Turkana have the highest proportions of underweight children West Pokot and Kitui counties have the highest proportions of stunted children Turkana, Marsabit and Mandera have the highest proportion of wasted children *Source KDHS 2014

Breastfeeding Status for Children Under 6 Months *Source KDHS 2014

Exclusive Breastfeeding trends Proportion of children younger than age 6 months who are exclusively breastfed has markedly increased over the years 2003 KDHS 2008-09 KDHS 2014 KDHS 13% 32% 61% The proportion of children less than 6 months using a bottle with a nipple has decreased from 25 to 11 percent Only 21 percent of children age 6-23 months consume an acceptable diet

Kenya on course to meet WHA targets WHA target 2008 2014 U5 stunting 35.3 26.0 Anaemia 15-49yrs 48% 25.0 LBW 10 5.6 U5 overweight 4.1 EBF rates 32 61.4 U5 wasting 6.7 4.0

Prevalence of under-5 stunting (%) Progress on reducing Stunting, but only one country on course to meet all the 5 WHA Targets for 2025 Prevalence of under-5 stunting (%) On course Off course, some progress Off course, no progress Not enough data to make assessment

Some progress on reducing Wasting: 4 countries on course to meet World Health Assembly Targets for 2025

Some progress on increasing Exclusive Breastfeeding Rates: 2 countries off course to meet World Health Assembly Targets for 2025 On course Off course, some progress Off course, no progress Not enough data to make assessment

What has been our priority 1. Policy direction and positioning Guided by the New Kenyan Constitution (2010) Article 43 (1 c) - every person has the right to be free from hunger and article 53 – (1c) every child has the right to basic nutrition – much progress has been made in the policy environment for nutrition in Kenya in the last 5 years Maternal and Infant Young Child Nutrition Policy Guidance: Food and Nutrition Security Policy (2012) Breastmilk Substitutes (Regulation and Control) Act . 2012 Maternal, Infant and Young Child Nutrition Policy & Strategy 2013 National Nutrition Action Plan Maternity Protection (14 weeks) and paternity leave (2 weeks) through Employment Act (2004 /2007) National Guidelines for Prevention of Mother to Child Transmission of HIV

What Has Been Our Priority? 2. Giving effect to the international code of marketing breast milk substitute through enactment of national legislations (BMS) Act- this has seen improvement of breastfeeding rates

What Have We Done? 3.Successful implementation of the national nutrition action plan to combat malnutrition: elements Improve the nutritional status of women of reproductive age (15-49 years), children and vulnerable groups To improve the quality of diets of the Kenyan population Improve access to quality curative nutrition services including TB, HIV, diabetes, hypertension etc Strengthen coordination and partnerships among the key nutrition actors

We implement high impact nutrition intervention that seek to: What Have We Done? We implement high impact nutrition intervention that seek to: Integration of nutrition services in MCH, health facilities and outreaches including: IFAS supplementation, Vitamin A, MNPs Implementing of baby Friendly Hospital and Community Initiative Use of Community health Volunteers and mother to mother support groups Capacity building of health workers to provide nutrition services including NCD support Fortification of salt, maize, wheat flour, fats and oils with micronutrients Provision of the nutrition commodities e.g. Vitamin A supplements Capacity building of ECD teachers on de-worming and Vitamin A supplementation Nutrition messaging through use of media especially local radios and social platforms such as facebook and twitter

What Have We Done? Establishment of strong government leadership and coordination: Kenya has well-coordinated structures for implementation of nutrition actions, Nutrition Inter-agency Coordinating Committee (NICC)-multi-stakeholder and multi-agency platform that coordinates nutrition in Kenya. Kenya’s engagement (since 2012) in the global Scaling Up Nutrition (SUN) Movement Strong support from donors Good monitoring and research Enhanced human resources for health

Next Steps Continue to provide nutrition services through platforms such as beyond zero campaign Promotion of healthy diets and lifestyles to prevent diseases malnutrition Implementation of National and County action plan Continued resource mobilization & advocacy Community engagement to create demand for nutrition services Use of media to share nutrition messages

Working Together Addressing malnutrition in Kenya requires a multi-stakeholder approach & Government is leading national efforts to scale up nutrition Civil Society Technical Community United Nations Donors Government Partners Business

What can Governments & other stakeholders do about it?

1. Show Commitment

2. Measure Coverage of Nutrition Programs Avula et al., forthcoming

3. Strive for Policy Coherence

4. Cash: Invest More in Nutrition Actions

x x Donors More resources are needed for nutrition to meet WHA undernutrition targets Spending on nutrition specific interventions, 2015-2025 Governments Donors x x R4D and World Bank estimates for stunting reduction

5. Community: Delivery and accountability

6. Count: Invest in Data to Monitor Success

Calls to Action Commitment Coverage Coherence Cash Community 6. Count Set national targets for malnutrition reduction Make a Nutrition for Growth commitment at Rio 2016 Coverage Increase coverage of nutrition programmes & measure coverage Coherence Think multi-sectorally Build alliances between nutrition & other communities Cash Find more funding for nutrition action Community Strengthen front line delivery 6. Count Identify the data gaps that hinder action—and fill them