Community Nutritionnnnnnnn Porgram .pptx

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1. National Nutrition Programs in Pakistan 3 ) Topic: Community nutrition programs: national and international ,

2. INTRODUCTION Malnutrition is a serious health concern. For a developing country like Pakistan, poverty, lack of governmental support, and illiteracy contribute toward the widespread malnutrition ▶ Although there has been a general increase in awareness and concern regarding nutrition in Pakistan ▶ Pakistan desperately needs nutritional programs for surveillance, awareness, food fortification, and integration of nutritional counseling as a part of regular medical checkups and outreach programs  Jeukendrup & Gleeson. Champaign, IL. Human Kinetics. 2018

3. Conti… The need of the time is to use a multi-disciplinary, all- handson -deck approach employing professionals from a broad range of fields such as economists, nutritionists, doctors, nurses, community health workers, and agriculturists ▶ There is a discussion of the various nutritional programs being run in Pakistan by the government and nongovernmental organizations,their successes, failures, room for improvement, and way forward

4. Nutrition International Programs in Pakistan Key Priorities: Enhancing Access to Micronutrients Implementing large-scale micronutrient supplementation and food fortification programs to combat deficiencies. Strengthening supply chains to ensure consistent availability of essential nutrients. Policy Advocacy and Reform Promoting evidence-based policy changes to improve nutritional outcomes. Advocating for stronger regulatory frameworks to support fortification and supplementation initiatives. Government Collaboration Partnering with federal and provincial governments to enhance national nutrition policies. Encouraging multi- sectoral coordination to integrate nutrition strategies across health, education, and social welfare sector s.

5. Micronutrient Initiatives Together with national and provincial governments, we focus on improving access to much needed micronutrients through supplementation and fortification to improve health of women and children ▶ The Micronutrient Initiative (MI ) is dedicated to ensuring that the world's most vulnerable- especially women and children in developing countries- get the vitamins and minerals they need to survive and thrive   Jeukendrup & Gleeson. Champaign, IL. Human Kinetics. 2018 Powers & Howley. McGraw-Hill Education. 2017

6. Mission Our mission is to be a global leader in advancing integrated, innovative and sustainable solutions to reduce vitamin and mineral deficiencies through advocacy, technical and programmatic support, in collaboration with others For every 10 children born in Pakistan, one will die before the age of five Close to half of all children under five are moderately or severely stunted 54% of children under five are vitamin A deficient 62% of children are anaemic Some regions show up to 86% prevalence of childhood anaemia   Jeukendrup & Gleeson. Champaign, IL. Human Kinetics. 2018 Powers & Howley. McGraw-Hill Education. 2017

7. Current Projects: Nutrition International (NI) 1) Maternal and Newborn Health & Nutrition NI supports provincial and district governments in the provinces of Balochistan , KPK, Sindh, and Punjab to strengthen maternal and newborn health and nutrition services. Strategies were designed based on internal and external consultations, focusing on: Ensuring pregnant women receive Iron and Folic Acid (IFA) supplementation to reduce anemia. Strengthening the follow-up system for improved adherence to supplementation. Addressing barriers to utilization and compliance with IFA supplementation . Enhancing newborn survival through Kangaroo Mother Care services and building the capacity of government health employees on IFA supplementation adherence.

8. COVID-19 Emergency Response (2020-2021): During the COVID-19 pandemic, NI implemented a project in 7 tribal districts of KPK to combat maternal anemia . The initiative benefited 79,000 pregnant women through: IFA supplementation, Safe delivery practices, and Training of healthcare providers and frontline workers on maternal, newborn, and child health-focused interpersonal counseling skills . 2) Multiple Micronutrient Supplementation (MMS) NI is supporting a pilot project in Swabi , KPK to transition from Iron and Folic Acid (IFA) to Multiple Micronutrient Supplementation (MMS) . The specific objective of the project is to: Introduce and authenticate MMS as a replacement for IFA supplementation. Expand fortification programs to reach over 150 million people annually with oil fortified with Vitamin A & D .

9. 2) Multiple Micronutrient Supplementation (MMS) ( Continued ) During the one-year implementation period, all newly enrolled women accessing public antenatal care services will receive MMS instead of IFA supplements.Technical support provided under this project includes : Training and supervision of healthcare providers. Behavior change intervention strategies and materials. Program monitoring and strengthening the supply chain system from district-level to facility-level and community service delivery platforms.

10. 3) Adolescent Health and Nutrition NI , in collaboration with national and provincial health departments, pioneered the Weekly Iron and Folic Acid Supplementation (WIFAS) program for in-school adolescent girls in Pakistan. Through this initiative, NI is supporting the government in identifying opportunities, challenges, and limitations of implementing adolescent nutrition programs in schools, particularly WIFAS and nutrition education. Project Achievements: Two to three-month rounds of WIFAS were successfully completed within one year. NI expanded the program to Balochistan , KPK, and Punjab . NI's Goals Through These Interventions: Advocate for the adoption of WIFAS as a national government-led program . Develop and expand an inclusive WIFAS program to support: Both in-school and out-of-school adolescent girls. Girls living in vulnerable circumstances . Provide gender-sensitive nutrition education to both girls and boys . Address nutritional needs of pregnant adolescent girls . Include water sanitation & hygiene and menstrual hygiene management in adolescent nutrition programs.

11. 4) Vitamin A Supplementation Aimed at improving the health and survival of children aged 6–59 months living in vulnerable situations. NI ensures continuous efforts so that children receive two doses of life-saving Vitamin A annually . Key Achievements: In 2022 , more than 35 million children in the country received two doses of Vitamin A. NI's Role in Supporting the Government of Pakistan: Improve and sustain Vitamin A supplementation coverage. Provide technical support , including: Monitoring and capacity building of district focal persons . Task force meetings to enhance coordination. Advocacy and awareness campaigns on Vitamin A’s importance through radio and TV commercials .

12. Universal Salt Iodization (USI) NI has been working with the Government of Pakistan, the salt industry, and other key partners since 2006 to support Universal Salt Iodization (USI) across the country. Objective: Reduce iodine deficiency disorders (IDDs) , which can lead to serious health issues. Current Progress: Almost 80% of all edible salt produced in the country is adequately iodized . Iodization coverage increased from 17% in 2001 to 80% in 2018 . Impact: Significant decrease in iodine deficiency disorders among mothers, school-aged children, and newborns . NI ensures an uninterrupted provision of potassium iodate, the fortificant used for salt iodization. Potassium iodate (KIO₃) is used to fortify salt due to its higher stability in the presence of salt impurities, humidity, and porous packaging. Every year, around 180 million people in the country are reached with iodized edible salt.

13. 06.Wheat Flour Fortification Mandatory fortification of wheat flour with iron, folic acid, zinc, and vitamin B12 is considered the most viable solution to eradicate micronutrient deficiency on a large scale.NI has provided capacity-building support to the wheat flour industry to implement fortification through the installation of 2333 micro feeders in 992 flour mills and trained government officials and wheat flour millers on fortification processes and Quality Assurance and Quality Control (QAQC).Sindh, KPK & Balochistan provinces enact the food fortification laws where NI provides support in drafting food fortification bills.

14. 07. Edible Oil Fortification NI implemented the edible oil fortification program in 2017. The program gradually expanded to 146 operational mills in Pakistan and reaches 140 million people annually, with the adequacy of fortification improving from 49% in 2017 to 90% in 2021 .

15. Ehsaas Nashonuma Program The Ehsaas Nashonuma Program is a health and nutrition initiative launched by the Government of Pakistan to combat stunting in children under 23 months of age. Recognizing the critical issue of child malnutrition, with national stunting rates at 40.2%, the program focuses on providing conditional cash transfers and nutritional support to pregnant and lactating women, as well as their young children . Key Features of the Ehsaas Nashonuma Program: Conditional Cash Transfers: Beneficiaries receive quarterly stipends—PKR 1,500 for boys and PKR 2,000 for girls—contingent upon: Regular consumption of specialized nutritious food. Completion of immunizations and health check-ups. Participation in health awareness sessions. Nutritional Support: Distribution of specialized nutritious food to address deficiencies among mothers and children. Health Services: Provision of prenatal and postnatal care, along with routine immunizations for children.

16. Implementation in Khyber Pakhtunkhwa (KP) and Former FATA Regions: he program commenced in August 2020, with the inaugural Ehsaas Nashonuma Center established in the Khyber Tribal District of KP. This center serves as a model for subsequent centers aimed at addressing malnutrition in the region. App.com.pk In its initial phase, the program has set up 33 centers across nine districts, including: Khyber District: 3 centers Upper Dir : 6 centers Kurram District Other Districts: Centers established in Bagh , Ghizer , Hunza , Kharmang , Kharan , Badin, and Rajanpur . These districts were selected based on high prevalence rates of stunting among children . Program Objectives: Reduce Stunting: Aim to decrease the national stunting rate by providing essential nutritional support and health services. Empower Women: Financially support pregnant and lactating women, enhancing their access to health services and nutritious food. Promote Health Education: Conduct sessions on breastfeeding practices, hygiene, and nutrition to improve overall community health awareness.

17. Community-Based Management of Acute Malnutrition (CMAM) In Pakistan, particularly in Khyber Pakhtunkhwa (KP) and the former Federally Administered Tribal Areas (FATA), two critical nutrition programs have been implemented to combat malnutrition: 1. Community-Based Management of Acute Malnutrition (CMAM): Initiated in 2008 by the Government of Pakistan and the Department of Health, the CMAM program addresses acute malnutrition through community engagement. The program expanded significantly following the 2010 floods, especially in KP. Key components include: Community Outreach: Active screening, referral, and follow-up of malnourished children. Outpatient Therapeutic Programs (OTPs): Home-based treatment for children with severe acute malnutrition (SAM) without complications, utilizing ready-to-use therapeutic food (RUTF). Inpatient Care: Stabilization centers for children with SAM and medical complications. Supplementary Feeding Programs (SFPs): Management of moderate acute malnutrition (MAM). An evaluation highlighted that, between December 2010 and November 2011, the CMAM program in KP achieved a 72% cure rate among enrolled children, with a defaulter rate of 10%. These outcomes underscore the program's effectiveness in treating uncomplicated severe wasting.

18. Infant and Young Child Feeding (IYCF): The IYCF initiative promotes optimal feeding practices to enhance child nutrition and development. In KP and former FATA regions, the program emphasizes: Breastfeeding Promotion: Encouraging exclusive breastfeeding for the first six months. Complementary Feeding: Introducing appropriate and nutritious foods at six months while continuing breastfeeding. Maternal Nutrition: Ensuring pregnant and lactating women receive adequate nutrition. Integration of IYCF counseling within CMAM services has been pivotal. Community health workers provide education on proper feeding practices, aiming to prevent malnutrition and support recovery in affected children. This combined approach has been instrumental in addressing both immediate and underlying causes of malnutrition in the region . These programs, supported by UNICEF and other partners, continue to play a vital role in improving child health and nutrition outcomes in KP and the former FATA areas.

19. Solutions Nutrition International has been working in Pakistan since 2001 to improve the health of people in need, especially women and children, through better nutrition. ▶ In partnership with national and provincial governments, we work to: Improve and sustain the coverage of vitamin A supplementation for children under five across Pakistan Increase the coverage and utilization of zinc supplements and oral rehydration salts to manage childhood diarrhoea

20. Conti… ▶ Ensure that young girls, pregnant women, mothers and children aged six to 24 months residing in remote rural areas of Pakistan receive improved nutrition and healthcare ▶ Improve effectiveness of the national and provincial universal salt iodization program ▶ Support the Scaling Up Nutrition (SUN) movement by hosting the SUN Civil Society Alliance and SUN Academia and Research Network ▶ Reach 50 million people with fortified wheat flour and 148 million people with fortified edible oil or ghee ▶ Improve the levels of iron, vitamin B12, and folic acid among children and women Edible Oil Fortification Institutionalize and sustain fortification programs for edible oil to combat Vitamin A and D deficiencies. Expand outreach to over 143 million people to reduce malnutrition-related health risks.