Updates on MSNP, SUN/REACH, Initiatives and MYCNISA

Saba Mebrahtu, PhDNutrition Section Chief

UNICEF Nepal

Nutrition Central Level AdvocacyGrand Hotel, Soalteemode, Kalimati

Kathmandu, Nepal15 July 2012

UPDATES ON MSNP

Nutrition Assessment and Gap Analysis (2009-2010)

Build the National “Nutrition Architecture”

(2011-2012):

• Identified strengths, weaknesses, and gaps;

• Need for a national nutrition architecture; and

• A multi-sectoral approach through an agreed nutrition determinants model.

• NPC led High Level Nutrition and Food Security Steering Committee chaired by the Vice Chair of the NPC in place and National Nutrition and Food Security Coordination Committee;

• Technical working group to guide multi-sectoral nutrition review, and planning; and

• Nutrition and Food Secretariat being established at the NPC – with links to NNC of the MoHP and MoAD

Nutrition Multi-Sectoral Reviews: A consultative

Process (2011)

Costed Multi-sectoral Nutrition Plan: Approved

by the Cabinet (2012)• Nutrition reviews by sector:

Health; Agriculture, Education, Physical Planning and Works, and Local development

• Defined scope: Global and national evidences for ‘what works’: essential nutrition specific interventions through the Health sector & nutrition sensitive interventions through other sectors

• Systematic consultation: through Reference Group Meetings by sector at key stages and All Reference Group Meetings to identify the cross-sectoral linkages

Clear leadership: the NPC and actively involving health & other key sectors

Focused: the first 1,000 days of life and stunting reduction

Addressing the immediate, underlying and basic factors:

• women and children’s access to health and nutrition;

• safe water & sanitation; and • education and inequity.

Emphasis on decentralized implementation: initially in selected districts (2013-2014)

Vision to gradually scale up: to all other districts by 2017 (A new approach: learning by doing)

Stunting is preventable : BUT Need to act before the child is 2 years

Source: Victora et al 2010

The Critical “Window of Opportunity”: 1000 DAYS

Pregnancy: 9*30= 270 days2 years: 365*2=730 days

6

Growth and muscle massBody composition

Metabolic Syndrome:programming of metabolism

of glucose, lipids, protein Hormone/receptor/gene

Brain development

Cognitive andeducational performance

ImmunityWork Capacity

Diabetes, ObesityHeart DiseaseHigh blood pressureCancer, stroke, and ageing

Poor nutrition in uterus and early childhood

(STUNTING)

Short term Long term

Death

LIFE COURSE CONSEQUENCES OF POOR MATERNAL AND CHILD UNDERNUTRITION (MCU)

(James et al 2000)

NEPAL IS ON TRACK TO REACH MDG4: REDUCING CHILD MORTALITY

BUT, without Improvement in Stunting, further Child Mortality Reduction is very unlikely

153

118

91

54

10279

6448 46

3445.9 50

39 3315

5461

330

40

80

120

160

200

1991 1996 2001 2006 2011 2015MDG

U5MR IMR NMR

Mortality Trend and MDG Goal(Under 5, Infant and Neonatal)

Diarrhoea12%

Other29%

Pneumonia20%

Malaria8%

Measles5%HIV/AIDS

4%

Perinatal22%

Deaths associated with under-nutrition

At - min 35%

Sources:EIP/WHO. Black et al, 2008. The Lancet Series on Maternal and Child Under-nutrition.

Improved Nutrition, especially micronutrients has contributed

Stunting Remains High and Wasting Stagnant

Source: NDHS 2011

NDHS 2001 NDHS 2006 NDHS 2011 MDG Target 20150

10

20

30

40

50

6057

4941

28

4339

2927

11 13 115

Stunting Underweight Wasting

Perc

ent

• 18.2 per cent women are with a BMI <18.5• 12.4 percent babies are LBW (<2500 grams)

Stunting Remains High and Wasting Stagnant

Source: NDHS 2011

NDHS 2001 NDHS 2006 NDHS 2011 MDG Target 20150

10

20

30

40

50

6057

4941

28

4339

2927

11 13 115

Stunting Underweight Wasting

Perc

ent

• 18.2 per cent women are with a BMI <18.5• 12.4 percent babies are LBW (<2500 grams)

Nepal Numbers of Children Affected by Chronic and Acute Under-nutrition

• With a current under five population of 3.5 million, some 1.61 million children are suffering from stunting – The long-term consequences of stunting, include

slower cognitive and mental development, educability and economic potential cannot be overestimated.

• Similarly, some 585,000 children under five years of age are suffering from wasting – Consequences include heightened risk of morbidity

and mortality

11

Cognitive function is benefitted across the life course, and optimal birth weight is above the mean

-0.35

-0.30

-0.25

-0.20

-0.15

-0.10

-0.05

0.00

0.05

0.10

0.15

8 11 15 26

<2.52.5-33-3.53.5-44.0-5.0

Birth weight

Years of age

Cognitive Function score (relative to 3-3.5kg)

(kg)

Richards, M. Et al. 2001 Birth weight and cognitive function in the British 1946 birth cohort: longitudinal population based study. BMJ. 322:199-203

OPTIMAL WEIGHT

12

Declining Prevalence of StuntingAsian Refugee Children in the U.S.

Stunting = height-for-age < 5th percentile of Ref

Yip & Mei, 1996

13

Poor maternal nutrient status

Inadequate IYC* Growth

Inadequate Foetal Growth

Poor IYC nutrient status

IYC infections

Poor IYC nutrient intake

Maternal Infections

Poor maternal nutrient intake

Poor medical and environmental health services

Inadequate Household Food Security

Poor maternal and child caring practices

CHILD STUNTING

IMMEDIATE CAUSES

UNDERLYING CAUSES

BASIC CAUSES: Resources, Institutions, Education, Infrastructure, Cultural Practices

Require MSN Approach To Tackle Stunting Sustainably

50% 50%

* IYC = Infant and young child

Nutrition Specific

Nutrition Sensitive

Multi-sectoral Operational Linkages & Accountabilities

Child growthfailure/ death

Low Birthweightbaby

Low weight & height in teenagersEarly pregnancy

Small adultwoman

Small adult man

The intergenerational transmission of growth failure: When to intervene in the life cycle

SO 2. Ministry of Health and Population

R 2.1 MIYC micronutrient status improved

R 2.2 MIYC feeding improved

R 2.3 SAM better managed

R 2.4 Diarrhoea adequately treated

SO 4. Ministry of Education

• R 3.1 Adolescent girl’s awareness and behaviours in relation to protecting foetal, infant and young child growth improved

• R 3.2 Parents better informed with regard to avoiding growth faltering

• R 3.3 Nutritional status of adolescent girls improved

• R 3.4 Primary and secondary school completion rates for girls increased

SO 5. Ministry Local Development/ Social Protection

R 4.1 Nutritional content of local development plans better articulated

R 4.2 Collaboration between local bodies’ health, agriculture, and education sector strengthened at DDC and VDC level

R 4.3 Social transfer programmes corroborated for reducing chronic under nutrition

R 4.4 Local resources increasingly mobilized to accelerate the reduction of MCU

SO 6. Ministry of Agriculture and Cooperatives

R4.1 Increased availability of animal foods at the household level

R 4.2 Increased income amongst young mothers and adolescent girls from lowest wealth quintile

R 4.3 Increased consumption of animal foods by adolescent girls, young mothers and young children

R 4.4 Reduced workload of women and better home and work environment

Strategic Objective (SO) 1. National Planning Commission

Result (R) 1.1. Multi-sectoral commitment and resources for nutrition are increased

R 1.2. Nutritional information management and data analysis strengthened

R 1.3 Nutrition capacity of implementing agencies is strengthened

SO 3. Ministry of Physical Planning and Works

R3.1 All young mothers and adolescent girls use improved sanitation facilities

R 3.2 All young mothers and adolescent girls use soap to wash hands

R 3.3 All young mothers and adolescent girls as well as children under 2 use treated drinking water

Ongoing Activities to Prepare the Grounds for MSNP district level implementation

1. MNIS review and a strategic plan to strengthen the existing system, ongoing 2012

NPCPMAS

MoACAIS

MoPWNMIP

MoEEMIS

MoHPHMIS MoLD

DEO• 100s Resource

Centers• 1000s schools

DHO• 1000s facilities

NeKSAP DSFN• (make IPC

Class)DADO

• 100s Service Centers

DoWS• Village Wat/san

committees

DDC-DPMAS

CENTRAL

DISTRICT

80 Impact indicators

2. Nutrition capacity assessment and a strategic plan, ongoing 2012

• Comprehensive mapping of community workers across the key sectors involved in the MSNP: – Health – Agriculture – Education– WASH– Local Development

• Review of individual, organization and institutional capacities – and identify the gaps– Review of Job descriptions– Training curriculum– Supervision and mentoring mechanisms– Reporting mechanisms – Policy and legal systems

3. Operational Guidelines, Materials and Tools for Modelling of MSNP in Six Districts of Nepal, 2012-2014

REACH ENDING CHILD HUNGER AND UNDERNUTRITION

NEPAL FOOD SECURITY ENHANCEMENT PROJECT

NHSP II

NEPAL WASH MASTER PLAN &

MULTI-SECTORAL ECD PLAN

NEPALFar-WesternRegion

Mid-Western Region

Western Region

Central Region

Eastern Region

Initial MSNP Roll-Out Districts

DOLPA

MUGU

JUMLA

KAILALI

BARDIYA

HUMLA

DOTI

SURKHET

NAWALPARASI

KAPIL-BASTU RUPAN-

DEHI

DANG

BANKE

ACHHAMKALIKOT

JHAPAMORANG

SIRAHA

SAPTARI

DARCHULA

BAJHANG

BAITADI

DADEL-DHURA

KANCHAN-PUR

BAJURA

PARSABARA

RAUT-AHAT

DHANUSA

MAHO-TARI

SUNSARI

SARLAHI

DHADING

MAKAWAN-PUR

CHITWAN

KASKIBAG LUNG

TANAHU

PALPA

SYANGJA

PARBAT

ARGHAKHACHI

GULMI

UDAYAPUR

SINDHULI

ILAM

BHOJ-PUR PA CH E THA R

DHAN-KUTA

TAPLEJUNG

RAME CHHAP

OKHAL-DHUNGA

TERHA-THUM

KHOTANG

LALIT

BHAKKATHM SULUK-

HUMBU

DOLAKHA

SANKHUWA-SABA

NUWAKOTSINDHU-PALCHOK

KAVRE

RASUWALAMJUNG

GORKHA

PYUT-HAN

ROLPASALYANMYAGDI

DAILEKHJAJARKOT

RUKUM

MUSTANG

MANANG

Summary of Ongoing Nutrition Actions in the Proposed MSNP Initial Districts

Districts Development Region Geographical Focus Level

Nutrition Related Actions

Bajura

Achhaam

Jumla

Parsa

Kapilvastu

Nawalparasi

FW Hills

MFW Hills

MW Mountains

Central Terrai

Western- Terrai

Western- Terrai

A

A

A

A

B

B

CFLG, Suaahara, FtF, WB/NASP,HKI/Homestead food production,

CFLG, UNICEF IYCF/MNPs, CMAM, FtF, WB NASP,

CFLG, UNICEF/ADB IYCF/CG, MI/UNICEF VAS, USAID FtF, WB NASP, SCF/UNICEF GM

CFLG, UNICEF IYCF/MNPs, ECD, Health

CFLG, UNICEF IYCF/MNP, CMAM, WASH, ECD, Health, FtF

CFLG, Suaahara, WASH, Health, ECD

Work Plan: Six Model Districts • Sensitization of key stakeholders at the regional, district and

community levels on MSNP - ongoing• Baseline impact evaluation – prepwork ongoing • Detailed Operational Guideline – July 2012

– MSN Monitoring and reporting formats– MSN Supervisory mechanisms and checklists

• Training materials and tools (REACH/WB) for community workers - August/September 2012– District MSN profiles– VDC mapping of nutrition situation, activities & stakeholders (inventory) – Existing resources and gaps (mobilization to meet these)– MSN database management (DPMAS)– Verification survey guideline (every six months – as part of national MN)– MSNP adoption to the district context– MIYCN integrated package (nutrition sepecific interventions)– Package of nutrition sensitive interventions (Education, WASH, Agriculture,

Local Development/Social Protection)• Process evaluation – August/September 2013• Endline impact evaluation – 2014

SUN/REACH INITIATIVES

The Goal of SUN

“To reduce hunger and under-nutrition and contribute to the realization of all the Millennium Development Goals, with particular emphasis on MDG 1 - halving poverty and hunger by the year

2015”

.

The SUN Framework calls for scaling up efforts against under-nutrition in a coordinated multi-stakeholder approach

– human rights focus as a basis for economic, social and human development, and on addressing food and nutrition security within that framework

– abundant evidence on the impact of under-nutrition on infant and young child mortality and its largely irreversible long-term effects on intellectual, physical and social development as well as on health

– recognition of a series of well-tested and low-cost interventions can protect the nutrition of vulnerable individuals and communities and benefit millions of individuals if incorporated into agriculture, social protection, health and educational programmes

1

3

June 2010

endorsed by 100+ organizations

...basis for action

2

The SUN framework identifies two complementary ways of reducing under-nutrition:

(a) direct, nutrition-specific interventions: have nutritional improvement as the primary goal and should be accessible to all individuals and their households, especially in pregnancy, in the first two years of life and at times of illness or distress

(b) a multisectoral approach aimed at promoting adequate nutrition as the goal of national development policies in agriculture, food supply, social protection, WASH, health and education programmes.

The focus:• Increased resource

mobilization through advocacy & innovative financing mechanisms

• Better alignment of donors' investments with national priorities

• Countries to identify their capacity development needs to extend nutrition interventions

• Plans need to be costed, including financial resources for capacity development, strengthening the delivery of services

• Expected benefits should be quantified

The SUN Movement SUN Countries: As of April 2012 the following countries have committed to Scaling up Nutrition:

1. Bangladesh, 2. Benin,

3. Burkina Faso, 4. Ethiopia, 5. Gambia, 6. Ghana,

7. Guatemala, 8. Indonesia,

9. Kyrgyz Republic,10. Laos PDR,

11. Madagascar,12. Malawi,

13. Mali, 14. Mauritania,

15. Mozambique, 16. Namibia,

17. Nepal,18. Niger,

19. Nigeria 20. Peru

21. Rwanda 22. Senegal

23. Sierra Leone24. Tanzania 25. Uganda 26. Zambia

27. Zimbabwe

The Scale Up Nutrition Movement (SUN) was initiated in September 2010 – NY UN Assembly.

The SUN Movement focuses on the 1000 day window of opportunity between the start of pregnancy and the child’s second birthday. Stakeholders in the Movement are increasing the resources made available to SUN countries and better aligning their financial and technical support to national nutrition priorities, momentum increased in the last months with 27 countries having made commitment to scale up nutrition. The UN Secretary General appointed a high-level, multi-stakeholder Lead Group to provide overall strategic leadership of the SUN Movement. A SUN Movement Secretariat, with budget is estimated at around $3.5million/year

http://www.scalingupnutrition.org/key-documents/

The SUN Movement Stewardship Arrangements SUN Countries THE SUN LEAD GROUP1. Mr. Armando Emílio

GuebuzaPresident of Mozambique

1. Mr. Jakaya Mrisho Kikwete President of Tanzania1. Ms. Sheikh Hasina Prime Minister of Bangladesh1. Mr. Nahas Angula Prime Minister of Namibia 1. Mr. Babu Ram Bhattarai Prime Minister of Nepal 1. Ms. Ngozi Okonjo-Iweala Minister of Finance of Nigeria1. Ms. Nina Sardjunani Deputy Minister of Development Planning of

Indonesia1. Ms. Nadine Heredia First Lady of Peru

Donors

1. Ms. Beverly Oda Minister of International Cooperation, Canada1. Mr. Andris Piebalgs Commissioner for Development Cooperation, EC1. Mr. Bruno Le Maire Minister of Food, Agriculture and Fishing, France1. Mr. Rajiv Shah Administrator, US Agency for International

Development

Civil Society Organizations 1. Mr. Fazle Hasan Abed Founder and Chairperson, BRAC1. Mr. Tom Arnold Chief Executive Officer, Concern Worldwide1. Ms. Marie Pierre Allié President, Médecins Sans Frontières France

Business

1. Ms. Vinita Bali Managing Director, Britannia Industries1. Mr. Paul Polman Chief Executive Officer, Unilever

International Organizations1. Ms. Ertharin Cousin Executive Director, World Food Programme and

Representative of the United Nations Standing Committee on Nutrition

1. Ms. Tamar Manuelyan Atinc

Vice President, Human Development, The World Bank

Foundations and Alliances1. Mr. Chris Elias President, Global Development, Bill & Melinda Gates

Foundation1. Mr. Jay Naidoo Chair of the Board, Global Alliance for Improved

Nutrition1. Ms. Mary Robinson Chair, Mary Robinson Foundation - Climate Justice

SUN Movement

1. Mr. Anthony Lake Chair, Scaling Up Nutrition Movement Lead Group and Executive Director, UNICEF

1. Mr. David Nabarro Coordinator, Scaling Up Nutrition Movement, and Special Representative of the Secretary-General for Food Security and Nutrition

[1] At 4 April 2012[2] Effective 5 April 2012

From Mobilization to Results: Priorities for the Movement and future areas of focus for the Lead Group

• Focus on work to be undertaken before the next meeting of the Lead Group (in late September 2012).

• Take part in the development of an updated Strategy (revised Road Map) for the SUN Movement. These will include ways to ensure that results are monitored and analyzed, that advocacy around the results is intensified, and that the Lead Group continues to facilitate the growth of the Movement driven by SUN countries.

Lead Group Members were invited to form sub-groups to work on six key areas: 1. Best practices, and which interventions have greatest potential to leverage results; 2. Gathering evidence of the cost-effectiveness of scaling up nutrition; 3. Tracking financing and investments in nutrition to identify key resource gaps; 4. Building a robust results and accountability framework, based on clear indicators and

targets (e.g. MDGs, post-2015 goals and the World Health Assembly); 5. Articulating the importance of empowering women to be at the centre of policies

and actions to Scale Up Nutrition; 6. Improved advocacy and mobilization of national and international resources for

nutrition (NEPAL).

Nepal’s SUN Architecture • The Honorable Member of the NPC, (Social Sector) acts as the chair of the National

Nutrition and Food Security Coordination Committee. This coordination committee will act as a country coordination mechanism for SUN Initiative under the NPC leadership.

• The SUN Country Focal Point is the Secretary, Ministry of Health (MOHP). MOHP will contribute towards the technical aspects.

• NPC, MoHP, and MOFA took part in the UN SUN tele-conference on Thursday 14 June 2012 at 12:45 KTM time, on the thematic area: Improved advocacy and mobilization of national and international resources for nutrition.

• Teleconference on 5 July at 14:15 KTM time involving MoHP and NPC: Country SUN progress report – prepared through consultative process and submitted on 15 July by the MoHP.

• NPC, MOHP with multi-stakeholders consultations will identify personnel for The Selected Thematic Task Team, to contribute to the SUN Strategy development plus continued consultation to finalize SUN Country Progress Report required for September 2012 UN Meeting.

From Mobilization to Results: Priorities for the Movement and future areas of focus for the Lead Group

• Under the guidance of the SUN Movement Lead Group Chair, the Secretariat and its Networks will support Lead Group members as they establish the elements of a SUN Movement Strategy (revised Road Map).

• The Strategy will be debated and finalized in the next Lead Group meeting in New York over a half-day in the week starting 24 September.

• The meeting will focus on substantive issues, on action items and on measuring the impact of the Movement.

• Coordinated advocacy to maintain the focus on scaling up nutrition remains a priority .

• To help sustain this momentum, and to showcase the impact of the Movement, Canada has offered to co-host a SUN side event at the UN General Assembly in September 2012.

REACH partnership aims to accelerate reduction in child undernutrition

• REACH approach developed and facilitated globally by Inter-Agency team hosted by WFP in Rome

• Global REACH coordinator by rotation from the four agencies

Initiating Partners Further Participating Partners

Other UN agencies: IFAD, SCN, WBGovernments:• Mauritania, Lao PDR, Sierra Leone,

Bangladesh, Nepal, Mozambique, Rwanda, Uganda, Mali, Ghana

• NGOs & Civil society: • SC, WVI, Rotary, HKI, GAIN, MI, ACF,

CRSAcademia:• Tufts, Wageningen, Cornell, Tulane,

George Washington, John Hopkins University

Donors:• ECHO, DFID, Bill & Melinda Gates

Foundation, USAID,++Private sector:• The Boston Consulting Group

The team

Ending child hunger and undernutrition

By 2015: REACH MDG 1, Target 3 (half the proportion of underweight children under 5)Beyond 2015: Achieve sustainable acceleration of the rate of reduction in child underweight

Vision &Goals

Outcomes4. Increased efficiency and accountability

2. Strengthened national policies and programmes

3. Increased capacity at all levels for action

1. Increased awareness of the problem and of potential solutions

Communications and advocacyFinancing and

resource mobilization

Country action planning and coordinationto support national capacity to scale up evidence-based solutions

Knowledge-sharing

Action areas

REACH focuses on scaling-up nutrition (SUN) actions

The REACH Facilitator(s): ‘Embodiment’ of REACH in-country

• The REACH Facilitator serves as a catalyst for scaling up agreed essential nutrition actions with quality and capacity to sustain

• REACH facilitator profile:• - Inclusive, Participatory development practitioner• - Change management skills• - Excellent communication skills• - Knowledge of good nutrition programming practices

• Position of the REACH Facilitator(s) strategically within: • Government structures – e.g. at the NPC in Nepal• Partnerships (NGOs, Private sector, Donors, Academia)• The UN System

Nepal Update: International facilitator expected in mid September and national facilitator in mid August – interim support between mid July to 10th August

Proposed REACH Nepal Work Plan, 2012-2014No Outcome Output

1 Increased awareness of the problem and of potential solutions

1.1 Multi-sectoral nutrition & multi-stakeholder activities maps developed (national and district level – MSNP districts)

1.2 MSNP districts priority nutrition actions for expected results identified

1.3 Investment case developed using harmonized one budget tool (MBB, REACH)

1.4 Joint communications and advocacy strategy developed and implemented in the priority districts

2 Strengthened national policies and programs

2.1 Nutrition is fully integrated in national and UN development strategies

2.2 National Nutrition Policy and Strategy of the MoHP is updated in line with the MSNP

2.3 Multi-sector National Nutrition is fully integrated into sectoral action plans based on reviews using nutrition lens

2.4 Priority MSN priority actions are fully integrated into relevant sub-national development plans in the MSN districts

3 Increased capacity at all levels for action

3.1 Multi-sector nutrition coordination mechanisms at national and sub-national level are fully established and functional

3.2 Institutional and human capacity for MSN in government (relevant ministries, regional and district level) are strengthened

3.3 Capacity for MSN action at community level is strengthened

3.4 MSN good programming practices are documented and shared through MSN district exchange-visits and via the web

4 Increased efficiency and accountability

4.1 MSN responsibilities and accountability matrix for nutrition security at national and district levels is available

4.2 MSN monitoring system and linkages to accountability in place and is used for program policy decisions

4.3 Government and REACH UN partner agencies nutrition commitments, including budgetary allocations are consolidated and reviewed to ensure compliance

4.4 MSN is established as a key area for the UN delivering as one

MYCNSIA IN NEPAL

Outline of MYCNSIA Contribution to Nutrition in Nepal: 2011- Q2 of 2012

• Pillar 1: – High level advocacy to at the PM level to raise nutrition in the national development agenda– Technical assistance to streamline nutrition governance under the lead of the NPC and involving all the key Ministries– Support development of evidence based MSNP + Operational guidelines, MNIS review and MSN capacity needs

assessment – Support to NUTEC - development of national comprehensive IYCF strategy and costed plan, maternal nutrition

strategy and costed plan – with an overarching strategy framework on MYCN integrated and harmonized package – Support NNC establishment– Partnership and coordination – NNG, FSWG, EDPs, SUN/REACH, Nutrition cluster, Nutrition and Food Security Steering

and Coordination Committees, and Secretariat, Reference Groups. • Pillar 2:

– Community training related to key interventions – IYCF/MNPs and CMAM/NiE– Plans to undertake nutrition capacity needs assessment - in collaboration with the Bank and the RO, and on this basis

comprehensive CB with a focus on the community level• Pillar 3:

– IYCF/MNPs internal process monitoring, external coverage surveys three and fifteen-month – final draft report– CMAM evaluation – phase one formative, and phase two – impact evaluation– Plans for implementing IYCF/MNPs baseline survey– Initiated MNIS Review – as the basis for developing a strategy and costed plan to strengthen the existing system with

links to existing early warning systems – NeKSAP, IPC • Pillar 4:

– IYCF/MNPs pilot in six districts completed, with MoHP policy decision to expand in additional nine– CMAM pilot in five districts completed, plans ongoing to expand in five districts– IYCF/CCG in five districts, with process monitoring and evaluation design – MSNP: Identification of initial 6 districts to model MSNP, with a plan to gradually scale-up (learning by doing)– IFA with de-worming to adolescent girls integrated with the school health and nutrition strategy / FHD

• Advocacy events held at national and district level to maintain commitment for multi-sector program (E.1)

• BCC Strategy and Plan of Action harmonized with community MIYCN (E.2)

E. B

CC

INPUTS PROJECT COMPONENTS / ACTIVITIES (A-E) OUTPUTS (O) OUTCOMES (T) IMPACTS (I)

Effective Project Management & Monitoring and Evaluation

• Refresher training and supervision provided to all health workers (O.10)

• Functional multi-sector coordination in place at District level (O.11 )

• Nutrition focal points from all sectors in place at district level and oriented in multi-sector approach (O.12 )

• Data available and used from surveys - baseline, endline, coverage surveys, etc. (O.13 )

IYCF (Breastfeeding)• Early Initiation of BF (T.1)• Exclusive breastfeeding

under 6 months (T.2)• Continued breastfeeding

to 1 year (T.3)• Continued breastfeeding

to 2 years (T.4)

Results Area 1: Upstream Policy• Comprehensive National MSNP Costed Plan of

Action developed (A.1)• National coordinating mechanism established

for multi-sector nutrition program -MSNP (A.2)• Commitment to allocate budget and ensure

implementation of MSNP (A.3)• Protocol established for nutrition profiles (as

basis for planning) at district level (A.4)• Comprehensive MIYCN strategy and costed

plan developed (A.5)

A. P

OLI

CIES

AN

D PL

ANS

• Guidelines developed for implementation of integrated MIYCN , including counselling as part of Cash grants and CMAM in target districts (O.1)

• Costed plan for National MSNP endorsed (O.2)

• Multi-sector nutrition profiles developed at district level (O.3)

• Commitment at district level to support MSNP with resources allocated (O.4)

• District-level MSNP plans in place (O.5)

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• Planned advocacy events held (O.14)

• Planned media implemented (O.15)• Targeted caregivers reached with

mass messages on MIYCN/MNP, linked with hygiene, CMAM and cash grant interventions (O.16)

MIYCN Services• Coverage of IYCF

counselling increased among mothers and children (O.17)

• MoH delivery system functions effectively and adequate supply (MNP/IFA/RUTF) is available where expected and needed (O.18)

• MIYCN Focal points, providers & volunteers have knowledge to adequately distribute MNP, deliver MIYCN with mothers & caretakers (O.19)

• Mothers & caretakers know, demand, accept, & have ability to appropriately use MIYCN services (O.20)

CMAM Services• Health workers know how

to identify and treat children with SAM in target districts (O.21)

• Qualified children enrolled and treated in CMAM program(O.22 )

Complementary Services• Place for Hand washing

(O.23)• Availability of soap

(O.24)• Safe disposal of faeces

(O.25)• Hand washing/ hygiene

coverage, knowledge of caregivers of U2’s (O.26)

• Qualified HHs enrolled in cash grant program (O.27)

• Reduction in Stunting in children 0-23.9 months (I.1)

• Reduction in Anaemia in children 6-23.9 months (I.2)

Policies, Production, Delivery, Quality & Behaviour Change Communication

C. S

ERVI

CE D

ELIV

ERY

Results Area 2: Capacity Building• Development of ToRs for nutrition focal points

from all sectors at district level (C.1)• District-capacity enhanced to guide

preparation of profiles, plans and implementation (C.2 )

• Key stakeholders and service providers sensitized and trained on MIYCN (C.3)

• Provide IYCF counselling as part of CMAM program in ten districts (C.4 )

• Provide IYCF counselling as part of MNPs (C5) • Provide IYCF counselling as part of child cash

grants in target districts (C.6 )

D. Q

UALI

TY

Results Area 3: Data and Knowledge Sharing• Refresher training and Supervision provided at

all levels of MIYCN implementation (D.1)• Data available to monitor coverage of MIYCN

interventions (D.2)• Data available to evaluate impact of MIYCN

interventions (D.3)• Capacity enhanced for M&E (D.4)

IYCF(Complementary feeding)• Introduction of solid, semi-

solid and soft foods, 6-8 months (T.5)

• Minimum dietary diversity, 6-23.9 months (T.6)

• Minimum meal frequency 6-23.9 months (T.7)

• Minimum acceptable diet, 6-23.9 months (T.8)

• Consumption of iron-rich (or iron-fortified) foods, 6-23.9 months (T.9)

Access & Coverage / Knowledge & Appropriate Use Impact on intake, status and function

• Consolidated MIYCN training materials adapted and rolled-out (O.6)

• Nutrition (ANC) integrated with Family Health Division (O.7)

• Supply and recording systems for MIYCN/CMAM products (O.8)

• Timely and adequate supply of MIYCN/CMAM products(O.9)

B. P

RODU

CTIO

N

& S

UPP

LY

• Training packages (Facility ANC Package) revised for MIYCN to guide training across sectors (B.1 )

• Procurement management system in place for MIYCN/CMAM products, e.g. MNP, IFA, RUTF (B.2)

Logic Model for Nepal

• Reduction in Anaemia in women and adolescent girls - select districts (I.3)

Improved Iron/MN Intake/Deworming• Coverage of IFAs among

adolescent girls, women (T.10)

• Utilization of IFAs among adolescent girls/women (T.11)

• MNP coverage of children 6-23.9 months (T.12)

• MNP utilization of children 6-23.9 months (T.13)

• VAS coverage of children (T.14)

• Deworming coverage of different age groups (T.15)

Priority MYCNISIA Supported Interventions for 2012

Scale-up Community IYCF Integrated with MNPs in Nine Districts

Scale Up Community Management Of Acute

Malnutrition (CMAM/IMAM) in Five Districts

Pilot IYCF promotion linked with Child Grant (IYCF/CG) in Karnali

MODEL MULTI-SECTORAL NUTRITION PLAN IN SIX DISTRICTS

Under the lead of the National Planning Commission (NPC) and involving 5 key sectors – MoHP, MoAC, MoE, MoLD, and MPPW

Lead Technical Support: UNICEF, funded by the EU in close collaboration with the World Bank, HKI, and WFP

Thank You