Progress Report on Nutrition Component of CMDG 1

1. Progress Report on Nutrition Component of CMDG 1 Prepared for Health Partners Meeting May 2011 UNICEF, WHO, WFP

2. The Cambodia Millennium Development Goals Gap Analysis in 2009 stated that it is still possible to reach CMDG1, ifchanges occur…

3. Positive Change Early breastfeeding and exclusive breastfeeding show great progress (CDHS 2010) Coverage of deworming and micronutrient supplementation for pregnant/postpartum women and children climbing to above 50% (CDHS 2010) Eight out of ten households consume iodized salt (CDHS 2010) Household dietary diversity is improving with a higher percentage of calories from animal sources, especially in urban areas (CSES 2009) The poorest households are consuming 13% more calories (CSES 2009) and spending a lower percent of overall expenditure on food

5. On Track? CMDG 2010 Target=24.5% CMDG 2015 Target=19%

6. The (2007-2011) 2008 Food Price Crisis • Rice prices more than doubled in 2008 • In 2011 rice prices remain 35% higher, inflation adjusted, and wages have not kept pace • 2011 international spike in other food prices also affecting Cambodia

7. Share of Food Consumption to total consumption in monetary value (%)

8. Negative Developments 30% of children 6-9 months use a bottle; this is triple the 2005 percent 34% of children 1-2 years old are not breastfeeding, up from 26% in 2005 Estimated annual cases of severe acute malnutrition increased to 70,000; only 2% currently receive therapeutic feeding Improvement in stunting has stagnated at 40%

9. These children are cousins living in the same house in Kampong Speu Province. One child is 5 months old and the other is nearly twice that age. The child on the left is 9 months old; the mother is working in a garment factory and the child is enrolled in the only HC outpatient therapeutic feeding programme in the country.

10. Ongoing and Recent Efforts at Scale • Behavior change communication on VA, IFA compliance, complementary feeding, and continued breastfeeding • Hospital based treatment of acute malnutrition • Salt iodization • Training of HC staff on MPA 10, volunteers on BFCI, and hospital staff on BFHI

11. Localized Ongoing and Recent Efforts • Initial implementation of HC management of acute malnutrition • Initial implementation of MNP • Iron fortification of fish/soy sauce • Rice fortification effectiveness study (school children) • Incentivized GMP • Private sector distribution of ORS and zinc • Locally produced complementary food • Pilot on cash transfers linked to nutrition

12. Programmatic priorities

13. Immediate Priority for Health Sector • Micronutrient policy including MNP for children nearly finalized • Cambodia pilot on MNP already carried out with positive results • MNP can be scaled up quickly through monthly outreach if prioritized by government and partners

14. MNP Policy Consideration 55% child anaemia calls for universal supplementation and the NNP draft policy stipulates public sector distribution… What is a feasible funding arrangement for MNP supply for government and partners? Will universal coverage be possible without private sector engagement?

15. Immediate Priority for Health Sector (more difficult to implement) Zinc for treatment of diarrhea policy in place Stock is available at all levels Memo sent to implementing units from MoH to distribute during outreach

16. Zinc Policy Consideration If health sector distribution will not reach high coverage and there is no concern over toxicity or resistance, Should partners focus on a private sector distribution system for zinc that utilizes community workers?

17. Immediate Priorities for Health Sector (more difficult to implement) • Identification and treatment of acute malnutrition policy nearly finalized and IMCI currently being revised • System relies on consistent screening by volunteers and proper implementation of IMCI by HC staff • Complicated cases rely on expertise/commitment at hospital level

18. MAM Policy Considerations MAM requires a substantial amount of work from HC and volunteers… Should MAM be incentivized independently or is there potential to strengthen IMCI as a whole? Is there a need to formalize community volunteers under a single compensation framework?

19. Medium-term Priorities • Expanded food fortification • Improve ANC/PNC to monitor weight gain and provide IPC on key issues such as IFA compliance • Focus on pre-pregnancy nutrition, including targeted distribution of WIF • Connect social protection priorities to nutrition

20. Immediate Strategic Priorities • Increased attention to urban poor • Better integration of nutrition into health systems strengthening • Commitment from government • Strategy for dealing with moderate acute malnutrition in a targeted manner • More targeted approach to breastmilk substitutes

21. Discussion- Policy Questions Repeated • What is a feasible funding arrangement for MNP supply for government and partners? • Should partners focus on a private sector distribution system for zinc that utilizes community workers? • Should MAM be incentivized independently or is there potential to strengthen IMCI as a whole? • Is there a need to formalize community volunteers under a single compensation framework?