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l targets has beeconsultations inates is required

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lity framewoof nutrition-rtunting, ma

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h weight byth a weight

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y Member Statef the Americas ave Board and th

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report on the w

s are needed idity and momia and low– is the largrs, and iron dch targets wation to redu

hood overwecondition. Tentions.

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ee on Nutritiyears (1998–

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s during regionand the Eastern rough electroni

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d for nutritioortality fromw birth wegest cause ofdeficiency cowould comp

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served 998 to

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Annex

where ontrol

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needsschoobirth

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47.

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s. Conditionaol, can have weight.

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keting and pro

Table 2 proonsidered.

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TION 4: Torition interv

Technical ascale and fold be an int

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tions on the .

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of cash to brtritional statu

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that engage

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A65/11

15

h centres andn height and

access andith adequated with social

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A65/11

16

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mber States

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World Bank, 201

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are workers ng in nutrit

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needed for

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luding worknal strengthe

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Annex

to the ion is

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58.

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Proposed a

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(b) makeefforts of M

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(b) set innutrition wand speciapractice (i.service and

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(d) explo

TION 5: To

A well-defhe comprehens implemenlative frameementation a

The propostained for astoring progre

blish a budge

nnel funds ob

activities for

port workforn Member Stion of trainin

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vide costing t

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nternational workforce, thaalists) and di.e. the doubd in-service t

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o monitor an

fined monitorensive implented, resourceworks and

and food secu

sed set of indssessment puess in interse

et line and na

btained from

r the Secreta

rce developmtates throughng materials;

refined tooles;

tools for nutr

r internation

iples of the Ponor support

competencyat recognize ifferent contle burden oraining of al

mic allianceer States;

ve financing

nd evaluate t

ring framewomentation pces and resud human rurity) and im

dicators needurposes at theectoral action

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excise taxes

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ment, leadeh workshops

ls for capaci

rition interve

nal partners

Paris Declarat at country l

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texts for polf malnutritio

ll levels of he

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tools for fun

the impleme

ork is needeplan. The fraults. Table 3resources),

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ds to be adape global leven.

cial targets f

s to nutrition

ership, techns, distance le

ity building,

entions.

s

ation on Aid evel;

specific to thers in the worlicy (i.e. capon), and supealth worker

at providing

nding the exp

entation of p

d to assess pamework ha lists proposoutput and

onal status an

pted to the coel. Additiona

for nutrition;

intervention

nical and marning and c

, and suppo

Effectivenes

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pacities for ipport revisios;

institutiona

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policies and

progress madas to providesed indicatord outcome nd mortality)

ountry contexl indicators s

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managerial ccommunities

ort the capac

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ment of the pntline workerintersectoral

ons of curric

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programme

de towards the accountabrs for input

(nutrition y).

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A65/11

17

capacities ins of practice,

city-building

ccra Agenda

public healthrs, managersaction) and

cula for pre-

to capacity

grammes.

es

he objectivesbility for the

(policy andprogramme

ties, but willonsidered for

1

7

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A65/11

18

Surve62.makers. Repbodies.1

Prop63.

(a) input

(b) popul

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(c) nutrit

(d)

Prop65.

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1 Repo

for in Article 1resolution WH

eillance systporting time

posed activit

develop or t, output/outc

implement lation levels

ensure thatmmended bydren’s Healthhs and that so

posed activit

provide mect indicators

establish a

report on tion plans, po

support Me

posed activit

adopt the plopment activ

support thesuring globa

orting implemen11.7 of the Inter

HA34.22.

tems should should be in

ies for Mem

r strengthen come and im

the WHO Cof stunting,

t nutrition iy the Commh in countrieocial differen

ies for the S

ethodologica, including p

database of

global progolicies and p

ember States

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proposed fravities;

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ntation of the prnational Code

be establishn line with na

mber States

surveillance mpact indicato

Child Growthwasting and

indicators armission on es with lowentials are ade

Secretariat

al support forprotocols and

selected inpu

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in implemen

rnational par

amework of

and exchangof the databas

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systems forors;

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re adequatelyInformation

est income aequately high

r the collectd design of su

ut, output/ou

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rtners

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ted input, ouystems;

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A

rmation to pts of the gove

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rowth pattern

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utput/outcom

ators;

ementing na

ards.

implementati

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alth Assembly ealth Assembly

Annex

policy-erning

lected

ns and

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ational

ion of

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called in

An

nex

A

65/11

19

Table 1a. Effective direct nutrition interventions that can be expanded for delivery through the health system1

All women of reproductive age Women in special circumstances All children aged 0 to 24 months Children in special circumstances

Iron and folic acid supplementation – daily for pregnant women – intermittent in non-anaemic pregnant

women – intermittent in menstruating women

living in settings where anaemia is a public health concern

Appropriate care of women with low body mass index

Counselling and support for optimal breastfeeding (early initiation, exclusive breastfeeding for the first six months and continued breastfeeding up to two years of age or beyond)

Integrated management of severe acute malnutrition through facility- and community-based interventions

Nutrition counselling through food-based dietary guidelines

Nutritional care and support for HIV-infected pregnant and lactating women

Counselling and support for appropriate complementary feeding

Treatment of moderate acute malnutrition

Calcium supplementation for the prevention and management of pre-eclampsia and eclampsia

Nutritional care and support in emergencies – multiple micronutrient

supplementation for pregnant women

Implementation of the Baby-friendly Hospital Initiative

Nutritional care and support for HIV-positive children

Iodine supplementation (in case iodized salt is unavailable)

Implementation of the International Code of Marketing of Breast-milk Substitutes and relevant resolutions of the World Health Assembly after resolution WHA34.22

Nutritional care and support in emergencies

Vitamin A supplementation for children from six months to five years of age in vitamin A-deficient populations

Counselling and support for appropriate infant feeding in the context of HIV infection

Iron supplementation for children aged under five years

Counselling and support for appropriate feeding of low-birth-weight infants

––––––––––––––––––––––––––– 1 Based on individual country needs.

A65/11

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ex 20

All women of reproductive age Women in special circumstances All children aged 0 to 24 months Children in special circumstances

Zinc supplementation for the management of diarrhoea

Nutrition counselling for the adequate care of sick children

Home fortification of foods intended for young children

Vitamin A administration as part of treatment for measles-related pneumonia for children older than six months

Table 1b. Effective health interventions with an impact on nutrition that can be expanded for delivery through the health system

Women of reproductive age Children aged 0 to 24 months

Prevention of adolescent pregnancy Properly-timed cord clamping at birth

Pregnancy spacing Deworming of children

Intermittent preventive treatment of malaria in pregnant women in high transmission areas

Provision of insecticide-treated bednets

Provision of insecticide-treated bednets Intermittent preventive treatment of malaria in infants, in areas of high transmission in sub-Saharan Africa where plasmodial resistance to sulfadoxine-pyrimethamine is not high

Prevention of exposure to second-hand smoke and cessation of direct tobacco use, alcohol and drug consumption by pregnant women

Hand washing with soap, and other hygienic interventions

Reduction of indoor air pollution

Prevention and control of occupational risks in pregnancy

Prevention and control of genitourinary infections in pregnancy

Deworming of pregnant women

Annex A65/11

21

Table 2. Non-health interventions with an impact on nutrition

Sector Intervention

Agriculture Agricultural activities that generate employment

Small-scale agriculture

Production of nutrient-rich foods and of staple foods of the poor1

Home gardening and large-scale fruit and vegetable production

Micronutrient-rich crop varieties (e.g. orange-flesh sweet potatoes)

Diversified food production, and improved storage and processing of food

Nutrition counselling integrated into agricultural extension programmes

Women’s role in agriculture supported

Food manufacturing

Local production of fortified foods, including fortified flour, oil, salt, sugar, soy and fish sauce, and fortified blended foods

Local production of high nutritional quality complementary food with provisions to allow access to all sectors of the population

Micronutrient fortification of complementary foods

Salt iodization

Improvement of the nutritional quality of foods (reduction of the content of salt, fats and sugars, and elimination of trans-fatty acids)

Water and sanitation

Improvement of water supply

Improvement of sanitation

Education Women’s primary and secondary education

Provision of healthy food in schools and pre-schools

Nutrition and physical activity education in school

Labour policies Employment-support policies

Healthy nutrition in the workplace

Maternity protection in the workplace (through adopting and enforcing the ILO Maternity Protection Convention, 2000 (No. 183) and Recommendation (No. 191))

Smoke-free workplaces

Social protection

Conditional cash transfers

Unconditional cash transfers

Support for socially disadvantaged groups to access healthy foods

Urban planning Healthy built environments

1 World development report 2008: agriculture for development. Washington, DC, World Bank, 2008.

Spielman DJ, Pandya-Lorch R. Millions fed: proven successes in agricultural development. Washington, DC, International Food Policy Research Institute, 2009. Agricultural production contributes to food security, and hence indirectly to redressing undernutrition, both by increasing food availability and by increasing livelihoods and incomes of poor people, so increasing their capacity to feed their families.

A65/11 Annex

22

Sector Intervention

Trade Food-price regulatory measures

Agricultural subsidies

Offer of food in public institutions and private food outlets

Food-labelling schemes

Regulation of advertising food and beverages to children

Implementation of International Code of Marketing of Breast-milk substitutes

Finance Use of excise taxes on tobacco and alcohol to finance expansion of nutrition programmes

Social mobilization

Social marketing for breastfeeding promotion, use of fortified foods, healthy diet and physical activity

Table 3. Indicators for monitoring the realization of the comprehensive implementation plan

Inputs Outputs/outcomes Impact

Policy/strategy environment for nutrition: nutrition governance score

Prevalence of children aged under six months who are exclusively breastfed

Incidence of low birth weight

Human resources: ratio of community health workers to total population

Proportion of children aged under five years who have received two doses of vitamin A supplements1

Proportion of stunted children below five years of age

Legal frameworks: adoption and effective implementation of International Code of Marketing of Breast-milk Substitutes

Proportion of households with consumption of iodized salt

Proportion of wasted children below five years of age

Proportion of population with sustainable access to an improved water source

Proportion of thin women2 of reproductive age

Individual food consumption score

Proportion of children below five years of age with haemoglobin concentration of <11 g/dl

Proportion of children receiving a minimum acceptable diet at 6–23 months of age

Proportion of women of reproductive age (15–49 years) with haemoglobin concentration of <12 g/dl

1 Children aged 6–59 months in settings where vitamin A deficiency is a public health problem. 2 Women with body mass index <18.5 kg/m2.

Annex A65/11

23

Inputs Outputs/outcomes Impact

Prevalence of children (aged 0–59 months) with diarrhoea who received oral rehydration therapy and therapeutic zinc

Median urinary iodine concentration (μg/l) in children aged 6–12 years

Proportion of pregnant women receiving iron and folic acid supplements

Maternal mortality ratio (per 100 000 live births)

Infant mortality rate (per 1000 live births)

Under-five year mortality rate (per 10 000/day)

= = =