1. Nutrition sector By Domitille Kauffmann LRRD Project

2. Evolution of the « nutrition sector » in Afghanistan 200220012003200420062005 « Development phase »: acting on the underlying causes of malnutrition and on chronic malnutrition « Transition phase»: building a Public Nutrition strategy and policy « Emergency phase»: treatment of severe malnutrition and food aid Hand-over of TFU from NGOs to GoA Iodised salt campaign Breastfeeding campaign to be strengthened New task forces on nutrition education and flour fortification are been set up 4 working group are still active Set-up of the PND within the MoPH Set up of 7 working groups on nutritional issues Design of a 3-year strategies Phasing-out of NGOs with SFC (gvnt decision) Implementation of the BPHS SFC and TFC run by NGOs Food distribution Vitamins distribution by NGOs

3. Nutrition Women activitiesEducationAgricultureWater & Sanitation A « cross-cutting sector » under the umbrella of the MoPH with an effort of ownership by the MAAHF Health Support of FAO and WFP (food supply)Support of UNICEF/WHO/… PND MoPH (BPHS interventions and other Public Nutrition activities) Programs implemented by NGO and UN-agencies Support of UNICEF/WHO/WFP/FAO Home economic Unit of MAAHF (guidance…) MRRD (training supports,ToT,..)

4. Shared responsibilities Leadership of the Public Nutrition Department (MoPH) Still limited involvement from Home economic Unit (MAAHF) A central role played by the UN-agencies : –Capacity building (trainings, etc.) –Strategic support –Technical support (laboratory, equipment and supply; protocols, development of guidelines, communication support for USI campaign,etc.) –Building partnership with private sector –Donors Indirect roles played by NGOs in agriculture, water and sanitation, women programs and education

5. Nutrition … under the umbrella of the MoPH … Health MoPH (BPHS interventions and other Public Nutrition activities) Programs implemented by NGO and UN-agencies Support of UNICEF/WHO/WFP/FAO Production of iodised salt by a factory in Jalalabad Mill in Kunduz (pilot project in flour fortification) Women activities EducationAgricultureWater & Sanitation Support of FAO and WFP (food supply)Support of UNICEF/WHO/… Home economic Unit of MAAHF (guidance…) MRRD (training supports,ToT,..)

6. Public nutrition interventions + other interventions in the BPHS links to nutritional issues: food distribution in TB-programs, etc… PUBLIC NUTRITION ACTIVITIESBPHS TREATMENT OF MALNUTRITION Growth monitoring Diagnosis of malnutrition Implementation of TFUs in district, provincial or regional hospitals Treatment of malnutrition (?) MICRONUTRIENT DEFICIENCY Flour fortificationMulti-micronutrient supplementation Diagnosis of anaemia Vit A supplementation USIIodised salt distribution in health facilities (?) MATERNAL AND CHILD NUTRITION Breastfeeding promotion on going (UNICEF support)Breastfeeding support Iron supplementation in children and pregnant women Vit A supplementation for children < 5 years during immunization campaign Vit A supplementation (post-partum) NUTRITIONAL EDUCATION Initiatives on going with WFP, FAOIEC about nutrition and growth problem

7. Public nutrition strategy and policy 2003-2006: several achievements at provincial level … Provincial Nutrition Officers recruited through the PRR process are progressively appointed in each province (5 provinces visited, 4 PNO in position) Implementation of TFU in each province is on going ( 5 provinces visited, 3 TFU) Afghan factories are producing iodised salt  more than 40% of the population already consume it Coordination bodies are running at national and provincial level

8. PNO: Unclear budget allocation  Which ownership, support and means of interventions for PNO? TFU: Lack of financial and labour resources in running TFU, long distance from communities to the district or regional hospital  Where to implement and how to run TFU? USI: Top-down campaign, difficulty to access to communities in remote areas, regular salt still produced and available in bazaar, misunderstandings...  How to reach the 100% coverage? Flour fortification: relative failures of the small scale projects  Which future? BPHS: lack of good screening and trained staff,…  Is there sufficient human resources allocated to growth monitoring at health facilities level? Public nutrition strategy and policy 2003-2006: … and still many uncovered issues

9. Nutrition Women activities EducationAgriculture Water & Sanitation Health MoPH (BPHS interventions and other Public Nutrition activities) Programs implemented by NGO and UN-agencies Support of UNICEF/WHO/WFP/FAO « Prevention of diarrhoeal diseases » session for a women group in Jalalabad province Greenhouses in Bamyan FFW for vulnerable widows (GAIN) in Mazar-e-Sharif... but also addressed through interventions in other sectors Support of FAO and WFP (food supply)Support of UNICEF/WHO/… Home economic Unit of MAAHF (guidance…) MRRD (training supports,ToT)

10. SectorWater and sanitation AgricultureWomen activitiesEducation ProgramsHygiene promotion within water supply and sanitation programmes - Kitchen garden, - Vegetables gardening - Greenhouses - School gardens - Tree nurseries - WRC - Vocational training - Income generating Activities -Adult and mother Literacy courses -School for children Activities related to nutrition issues Hygiene education sessions through 5 main topics such as Food safety, Prevention of diarrhoeal diseases, etc… Cooking lessons Food preservation and processing lessons Food distribution to vulnerable women Health /Hygiene education sessions Breastfeeding education sessions Food processing lessons Etc… Training of teachers Nutritional education at school Food distribution to children at school Nutritional issues addressed Decrease the risk of malnutrition due to diseases Diversification of the diet Improvement of the quantity of food intakes Improvement of nutrition knowledge Improvement of the quantity of food intakes Decrease the risk of malnutrition due t diseases Improvement of nutrition knowledge Improvement of the quantity of food intakes Typology of nutritional interventions

11. What is the place of nutrition in the LRRD context? Nutrition is considered as a humanitarian sector in emergency phase (own donors, NGOs, nutrition programmes)  curative phase Nutrition is not anymore a sector in the development phase  preventive phase: focus on the underlying causes of malnutrition through interventions in different sectors

12. Challenges in the LRRD context No « sectoring » nutrition into the health sector in order to keep the cross-cutting dimension of nutrition « Re-investing » NGOs in the conceptual framework of nutrition (raising awareness, developing monitoring on nutritional impact, capitalising on successful approaches) Difficulty to achieve a real long term impact on nutritional practices with short fund cycle programs Shifting too quickly from curative to preventive without ensuring that TFU structures are sustainable

13. Some issues for discussion (1) Lack of monitoring and evidence on nutritional impacts Lack of know-how on food receipt, processing and preservation Small scale projects in trainings teachers about nutrition (literacy courses and at school) What strategy should be applied to improve nutritional practices within the communities?

14. Some issues for discussion (2) Limited and « hidden » role of donors in nutrition Reduction of funds allocated to Food Security No focus on nutrition required in the design of logical framework How to maintain or even strengthen the focus on nutrition without donors support and influence?

15. Some issues for discussion (3) A conceptual framework demanding the commitment of several ministries (MoPH, MAAHF, MRRD, MoWA, …) Experience of MRRD in hygiene promotion (implementation, monitoring and evaluation) How to ensure an inter-ministry collaboration? What mechanisms for lessons sharing and capitalization?