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

2. 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 aiming to scale up this approach to rest of country by 2017.

3. 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

4. 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

5. 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%

6. 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

7. 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

8. 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

9. 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)

10. 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)

11. Updates from External Survey: Preliminary Report New Era
Coverage
Compliance

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

13. 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

14. 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

15. 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

16. 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 .

17. 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.

18. Updates in
Growth Monitoring

19. 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

23. 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

24. Dietary Pyramid for Nepal

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PLEASE DON’T FEEL INFERIOR EATING INDIGENOUS FOOD…..FEEL PROUD AND HEALTHY and PROMOTE THEM

26. THANK YOU FOR YOUR ATTENTION!
Let us work together to make them smiling