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Nutrition sector

Nutrition sector . By Domitille Kauffmann LRRD Project. Evolution of the « nutrition sector » in Afghanistan. 2001. 2002. 2003. 2004. 2005. 2006. « Emergency phase»: treatment of severe malnutrition and food aid. « Transition  phase»: building a Public Nutrition strategy and policy.

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Nutrition sector

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  1. Nutrition sector By Domitille Kauffmann LRRD Project

  2. Evolution of the « nutrition sector » in Afghanistan 2001 2002 2003 2004 2005 2006 « Emergency phase»: treatment of severe malnutrition and food aid « Transition  phase»: building a Public Nutrition strategy and policy • SFC and TFC run by NGOs • Food distribution • Vitamins distribution by NGOs « Development phase »: acting on the underlying causes of malnutrition and on chronic malnutrition • 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 • 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

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

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

  6. Public nutrition interventions +other interventions in the BPHS links to nutritional issues: food distribution in TB-programs, etc…

  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. Public nutrition strategy and policy 2003-2006: … and still many uncovered issues • PNO: Unclear budget allocation • Whichownership, 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?

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

  10. 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?

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