Updates on IYCF- integrated with MNP & Child Grant, Vit A and GMP Programs

1. Updates on IYCF- integrated with MNP & Child Grant, Vit A and GMP Programs Pradiumna Dahal Nutrition Specialist, UNICEF

2. Vitamin A Coverage UNICEF will focus on under-reached and unreached children (children 6-11 months and children in given in urban areas) VAS modeling for 6-11 months children is proposed in Jumla, Kavre and Chitwan districts for 2012- 2013 aiming to scale up this approach to rest of country by 2017.

3. Protocol for Vit A Modeling • The Routine Vit A Biannual Supplementation continuedwith BCC focus on urban/Children 6-11 months. • After 6 months the child receive 100,000 IU vitamin A supplement (In HF or through FCHV- Only the first dose) • Integrated with routine measles vaccination - If the child is fails to receive routine Vit A biannual supplementation • The time gap should be more than 30 days

4. Anemia Prevalence High in Children: The Problem is serious among 6-23 months children Percent of children age 6-59 months with anemia Source: NDHS 2011

5. Trends on IYCF practices in Nepal: DHS 2001, 2006, 2011

6. IYCF Practices among Under 5 Children Percent of children 6-23 months Breastfeeding Status Under 6 Months Recommended IYCF Practices among 6-23 months children

7. IYCF Community Promotion linked with MNP National Programme To Improve Anemia, Other micronutrient deficiencies and timely introduction of Complementary food Feasibility study on MNP distribution in two districts, Makawanpur and Parsa Phase I Piloting of the MNP program (6 districts: 2010 Onwards) and roll out in 9 districts by 2012 Phase II Scale up of the MNP Programme by 2015 Phase III

8. IYCF/MNP Program Goal • To improve the nutritional status of children aged 6 to 24 months by reducing prevalence of anemia and by improving complementary feeding and care practices. Pilot Objectives • To identify an effective delivery mechanism to distribute MNPs integrated with IYCF counselling to children 6-24 months of age. • To use the findings of this pilot program to develop national strategy for nationwide scale up

9. Program Districts for Piloting- 6 districts Phase 1: Makwanpur (May, 2010); Palpa (June, 2010) Phase 2: Rasuwa (Sept, 2010); Gorkha (Jan, 2011) Phase 3: Rupandehi (May, 2011); Parsa (June, 2011)

10. UNICEF/DOHS/LMD DHO/DPHO Procurement Department/UNICEF Procurement Department/UNICEF PHC/HP/SHP DHO/DPHO DHO/DPHO FCHV HP/SHP/PHC Municipality Office 6 to 24 months Children Ward Office 6 to 24 months Children FCHV 6 to 24 months Children Distribution Models HEALTH FACILITY (RURAL MODEL) FEMALE COMMUNITY HEALTH VOLUNTEERS (RURAL MODEL) MUNICIPALITY WARDS (URBAN MODEL)

11. Updates from External Survey: Preliminary Report New Era Coverage Compliance

12. Updates from External Survey: Preliminary Report New EraInfant and Young Child Feeding Practices External Survey: Preliminary Report New Era

13. Draft IYCF/MNP Scale up Plan by 2016/17

14. IYCF PROMOTION LINKED WITH CHILD GRANT (IYCF/CG) Background • Since 2009/10, - GoN- Child Cash Grant (CG) (NRs 200/child for maximum 2 children) is provided for each child in Karnali. Dalit families in rest of the country • Disbursed through VDCs quarterly • Meant to be utilized for the improvement of nutritional status of the targeted children. • UNICEF- complemented Infant & Young Child Feeding (IYCF) training/Social mobilization in 4 districts

15. Objectives • Improve Child Grant beneficiaries’ knowledge on IYCF, Hygiene and Sanitation and other key nutritional behaviours • Assist mothers and caretakers to identify the best possible locally available food - to improve the nutritional status of the children • Build capacity of health workers and volunteers on IYCF Strategies • Advocacy:Capacity building • Orientation: • Process monitoring: • BCC • Evaluation

16. Training Achievement .

17. Challenges/Future direction Challenges • Optimum utilization of the Cash Grant in improvement of nutritional status of targeted children. • Easy access to nutritious food for buying. Focus for 2012 • Monitoring of the IYCF/CG programme. • Midline Evaluation of IYCF/CG • Promotion of locally available foods. • Sustainability - functioning/revitalization of the mother’s group meetings (MGM) and use of the VDC block grant. • Airing of IYCF messages, performance of street drama and advocacy meetings at the ward level.

18. Updates in Growth Monitoring

19. Old Growth Monitoring Card New Growth Monitoring Card • Unnecessarily covers under five children-not evidence based and also extra burden to health workers • Uses -3SD for lower line-thus only identifies severe malnutrition, which defeats the purpose of GMP promotion and its too late for action

23. Revised HMIS Formats for Feasibility • ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 7-Revised.xls • ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 17-Revised.xls • ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 31-Revised.xls • ..\Growth Monitoring\New card\HMIS Revised Formats\HMIS 32-Revised.xls

24. Dietary Pyramid for Nepal

25. k|lt;o u|fddf ;|f]tM g]kfnLvfBkbfy{dfkfOg] kf]ifs tTjx?, g]kfn ;/sf/ s[liftyf ;xsf/L dGqfnovfBk|ljlwtyf u'0flgoGq0f ljefu, @)^! PLEASE DON’T FEEL INFERIOR EATING INDIGENOUS FOOD…..FEEL PROUD AND HEALTHY and PROMOTE THEM

26. THANK YOU FOR YOUR ATTENTION! Let us work together to make them smiling