national nutrition programjdflkdsjflkekfnjkjd,.pptx

notes

1. National Nutrition program

2. Background Nutrition section under Family Welfare Division is responsible for national nutrition program for improving the nutritional status of children, pregnant women and adolescents Its goal is to achieve nutritional well-being of all people to maintain a healthy life to contribute in the socio-economic development of the country, through improved nutrition program implementation in collaboration with relevant sectors. 2 3/6/2025

3. Nutrition interventions are cost effective investments for attaining many of the Sustainable Development Goals Government of Nepal is committed to ensuring that its citizens have adequate food, health and nutrition The Constitution (2015) ensures the right to food, health and nutrition to all citizens 3 Background…. 3/6/2025

4. Malnutrition in children and women is a major public health problem in most of the developing countries and Protein Energy Malnutrition (PEM) is more common among under five year children. Nutrition is a globally recognized development agenda. Since the year 2000, several global movements have advocated nutrition for development 4 Background…. 3/6/2025

5. The Scaling-Up-Nutrition (SUN) initiative calls for multi- sectoral action for improved nutrition during the first 1,000 days of life. The Government of Nepal as an early member of SUN adopted the Multi-sector Nutrition Plan (MSNP) in 2012 to reduce chronic nutrition. Recently, the UN General Assembly declared the 2016–2025 period as the Decade of Action on Nutrition. 5 Background…. 3/6/2025

6. The National Health Policy, 2071 highlights improved nutrition via the use and promotion of quality and nutritious foods generated locally to fight malnutrition. The Nutrition Technical Committee was established in CHD in 2011 to support multi- sectoral coordination for developing nutrition programmes . 6 Background…. 3/6/2025

7. According to new global estimates by UNICEF, WHO, and The World Bank, 156 million children under five were stunted in 2015 In world, the prevalence of malnutrition in term of underweight, stunting and wasting are 27%, 31% and 10% respectively. ( UNICEF, 2004) At present, 36% of the children are stunted and 10% are wasted,( NDHS 2016) 7 Background…. 3/6/2025

8. Historical Development Year Activity 1977 National nutrition coordination committee was formed under Nationa l planning commission(NPC) 1978 National nutrition strategies was formed and nutrition section was established(Pokhara declaration 1997 Comprehensive nutrition program was introduced 1989-1992 First multi sectoral nutrition program , the joint nutrition support program 1991 Nutrition section was put under child health division 8 3/6/2025

9. Historical Background… Year Activity 1992 Breast milk substitute act was approved 1993 Vitamin A program was initiated 1998 Nepal micronutrient status survey was done and national nutritional rehabilitation home was established MoHP has been providing iron foliate (IFA ) at “no cost” to pregnant women and breastfeeding mothers 9 3/6/2025

10. Historical Background… Year Activity 2003 Maternal and neonatal micronutrient program was initiated 2004 National nutritional policy and strategy was formulated ( MoHP ), (updated in 2008) 2006 National school health and nutrition strategy was formulated 2007 National plan of action on nutrition was formed by NPC 10 3/6/2025

11. Historical Background… Year Activity 2008 Community Based Management of Acute Malnutrition (CMAM) program has been implemented by MoHP with the help of UNICEF since 2008 in five districts like Achham , Bardiya , Jajarkot , Kanchanpur and Mugu . 2009 Multiple Micronutrient Powder (MMNP) Supplementations started and NAGA was done 2011 Nepal joined global SUN (Scaling Up Nutrition) movement on 5 May, 2011 and one of the most powerful examples of the SUN Movement in action can be found in the development of Nepal’s multi- sectoral nutrition plan (MSNP) 11 3/6/2025

12. Historical Background…. Year Activity 2012 Multi sectoral nutritional plan was formulated. The integrated approach (IMAM) was implemented in six additional districts ( Dhanusa , Jumla , Kapilvastu , Okhaldhunga , Saptari and Sarlahi ) 2011 Aug-2016 Aug Suaahara project was implemented in 20 district then expanded in 41 district 12 3/6/2025

13. Objectives of Nutrition Program General Objective: The overall objective of the national nutrition programme undertaken by nutrition section is to enhance nutritional well-being, reduce child and maternal mortality and contribute to equitable human development. 13 3/6/2025

14. Specific Objectives: To reduce protein-energy malnutrition in children under 5 years of age and women of reproductive age To improve maternal nutrition To reduce the prevalence of anemia among adolescent girls, women and children To eliminate iodine deficiency disorders and vitamin A deficiency and sustain elimination To reduce the infestation of intestinal worms among children and pregnant women 14 3/6/2025

15. Specific objective… To reduce the prevalence of low birth weight To improve household food security to ensure that all people can have adequate access, availability and use of food needed for a healthy life To promote the practice of good dietary habits to improve the nutritional status of all people To prevent and control infectious diseases to improve nutritional status and reduce child mortality 15 3/6/2025

16. National Plan, Policies and Strategy Anemia Control Plan, 2004 Multi- Sectoral Nutrition Plan (MSNP) 2013-2017, MSNP II(2018-2022) National Nutrition Policy and Strategy ( MoHP ), 2004 (updated in 2008) National School Health and Nutrition Strategy, 2006 National Plan for Action on Nutrition, 2007 National Emergency Nutrition Policy, 2008 Maternal, Newborn and Child Health Communication Strategy, 2011 16 3/6/2025

17. National Plan, Policies and Strategy… Five-Year Plan of Action for the Control of Anemia among Women and Children in Nepal, 2005 Nepal Agriculture and Food Security Country Investment Plan (CIP), 2010 2nd Plan of Action (2013‐2017) for Iodine Deficiency Disorders A national guideline to address MAM A food based dietary guidelines National nutrition survey guideline 17 3/6/2025

18. Nutrition Relevant legislation The Breast Milk Substitute Act and Regulation, 1991 -Provisions for the implementation of the International Code of Marketing of Breast Milk Substitutes fully endorsed by law. Maternity/Paternity Leave Regulation, 1991 -Maternity leave of 52 days (7.5 weeks) Salt Iodization Act, 1998 Mandatory Flour Fortification, 2011 18 3/6/2025

19. Nutrition programme implemented by FWD's Nutrition Section(1993-2016) National wide: Growth monitoring and counseling Prevention and control of iron deficiency anemia(IDA) Prevention, control and treatment of vitamin A deficiency(VAD) Prevention of iodine deficiency disorders(IDD) Control of parasitic infestation by deworming Mandatory flour fortification in large roller mills Infant and young child feeding(IYCF) 19 3/6/2025

20. Scaling-up programmme Maternal, Infant and Young Children Nutrition Programme (MIYCN) Integrated Management of Acute Malnutrition(IMAM) Micronutrient Powder(MNP) distribution linked Infant, young and child feedings(IYCF-MNP) School Health and Nutrition Programme (SHNP) Vitamin A supplementation to address the low coverage in 6-11 months olds Multi- Sectoral Nutrition Plan(MSNP) 20 3/6/2025

21. New Initiatives in Nutrition Program National Micronutrient Status Survey Implementation of MIYCN action plan Implementation of basic package of SHN as designed in new Joint Action Plan and updated guideline  Adolescent Iron and Folic Acid (IFA) supplementation Revision/Updating of National Nutrition Policy and Strategy in line with Health Policy 2071,NHSS and MSNP Establishment of National Nutrition Centre (NNC) 21 3/6/2025

22. Current Global Nutrition Targets Sustainable Development Goal Goal 2 — End hunger, achieve food security and improved nutrition and promote sustainable agriculture By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations including infants to safe nutritious and sufficient food all year round By 2030, end all forms of malnutrition, including achieving by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons 22 3/6/2025

23. Current Global Nutrition Targets.. By 2030, double the agricultural productivity and incomes of small-scale food producers, in particular women, indigenous peoples, family farmers, pastoralists and fishers, including through secure and equal access to land, other productive resources and inputs, knowledge, financial services, markets and opportunities for value addition and non-farm employment 23 3/6/2025

24. Current Global Nutrition Targets… b. Global Nutrition Target by 2025 (World Health Assembly [WHA]) Reduce the global number of children under five who are stunted by 40 percent Reduce an anemia in women of reproductive age by 50 percent Reduce low birth weight by 30 percent No increase in childhood overweight Increase the rate of exclusive breastfeeding in the first six months up to at least 50 percent Reduce and maintain childhood wasting to less than 5 percent 24 3/6/2025

25. Programme strategies The main overall strategies for improving nutrition are: the promotion of a food based-approach, food fortification, the supplementation of foods and the promotion of public health measures. 25 3/6/2025

26. Specific strategies: Control of PEM Household food security Improve dietary practices Control of iron deficiency anemia infectious disease control and prevention School health and nutrition programme Control of iodine deficiency disorders Integrated management of acute malnutrition 26 3/6/2025

27. Specific strategies…… Control of vitamin A deficiency Nutrition in emergencies Low birth weight Life style related disease 27 3/6/2025

28. Nutritional Status and Targets Indicators Status(%) Targets(%) NDHS 2001 NDHS 2006 NDHS 2011 NDHS 2016 MSNP 2022 WHA 2025 SDG 2030 Stunting among U5-children 57 49 41 36 28 24 15 Wasting among U5 children 11 13 11 10 7 <5 4 Underweight among U5 children 43 39 29 27 20 15 10 Percentage of LBW - 14 12 24 10 <1.4 <1.4 Exclusive breastfed - 53 70 66 80 85 90 Anaemia among U5 children - 48 46 53 28 20 <15 Anaemia among women (15- 49) - 36 35 41 24 20 <15 Source: DoHS , Annual Report 2073/74 (2016/2017) 28 3/6/2025

29. Major Achievements 29 3/6/2025

30. 30 Trend of under-nutrition in children Source: DoHS , Annual Report 2073/74 (2016/2017) 3/6/2025

31. Trend of malnutrition in women Source: DoHS , Annual Report 2073/74 (2016/2017) 31 3/6/2025

32. Growth monitoring 32

33. Exclusive breast feeding 33 3/6/2025

34. SAM and MAM Cases 3/6/2025 34

35. Iron and Folic Acid supplementation during pregnancy 35 3/6/2025

36. Integrated  Infant  and  Young  Child  Feeding and Micro-Nutrient  Powder (IYCF‐MNP) Community Promotion Program After  the  successful  completion of the pilot program, MoH implemented this program in  16 districts  of Nepal In FY 2079/80, national coverage of the MNP use of at least one cycle among 6-23 months’ children has increased from 29.6% in FY 2078/79 to 40.9% in FY 2079/80. The three cycle coverage has also increased from 2.8 in FY 2078/79 to 5.1 in FY 2079/80 . Data revealed that the returning back of users/ guardians to the facility for the second batch of MNP is very poor. Thus, demands assessment of the contextual factors to improve increased coverage and utilization. 36 3/6/2025

37. Prevention and control of iodine deficiency disorder Percentage of households using iodized salt 37 3/6/2025

38. School health and nutrition programme (SHNP) – a joint programme of MoHP & MoE Biannual School De-worming (75 districts) Health screening Weight-for-age Height-for-age Vision test IFA tablet distribution to Adolescents girls studying grade 6-10 First Aid service at schools also with provision of first aid kit box to schools School checklist Mobilizing child club Development of IEC materials School Action Plan Strengthening monitoring and supervision system Covered 75 districts till date with basic SHNP 38 3/6/2025

39. 3/6/2025 39

40. Major Nutrition Projects implementing in Nepal SUAAHARA II/USAID: 41 districts UNICEF/MSNP II(2018-2022) Sunaula Hajar Din: 15 districts (CDR, EDR) Agricultural and Food Security Project: 19 districts (Hill and Mountain districts of FWDR and MWDR)/FAO WFP/UN nutrition projects Sponsorship project/Save the children 40 3/6/2025

41. Planning Family Welfare Division are responsible to overall planning of nutrition program at central level Aligning with the MSNP and current global initiatives, FWD – nutrition section has developed strategies and plans for improving maternal infant and young child nutrition assisted by experts from the Nutrition Technical Committee. NPC led the plan with the involvement of key ministries: MOHP, MoFALD , MoE , Planning on nutrition from local, province and federal also 41 3/6/2025

42. Organizing FWD are majorly responsible to organize the Nutrition program from top to down approach, the focal person provide the technical support and assist in effective implementation to the district and periphery level program staffs. Help to enhance the technical capacity to deliver effective nutrition program in community by providing training to health workers. All the logistics and other management carried out by DoHS /FWD for nutrition program 42 3/6/2025

43. Staffing 43 MoHP DoHS Family Welfare Division Director-1(11th level) Nutrition Section Sr. Nutrition Officer-1(9/10th level)) Nutrition Officer-1(7/8th level) Nursing officer-1(7/8th level) At Central level 3/6/2025

44. Staffing…. H.A./Sr.AHW-1 AHW-1 ANM-1 FCHVS 44 At Periphery level D/PHO Sr. Public Health Administrator At District Level Health Assistant-1 Technical Section Diarhoea , Nutrition and ARI Section At Community level 3/6/2025

45. Coordination 45 3/6/2025 MoHP NPC MoFALD MOE MoWCSW DoHS Private sector Public Sector Bilateral/Multi-lateral agencies: unicef , USAID, UN/WFP, FAO I/NGOs: Save the children, Care Nepal, Plan International D/PHO PHCC/HP DCC Municipality CBOs Schools, Child Club Agriculture and livestock office FCHVs

46. Recording and reporting HMIS is one of the major source of information and recoding and reporting system in health Statistic officer and focal personnel responsible for timely recording and reporting using national system, now a day DHIS2 tool is using to reporting online directly 46 3/6/2025

47. Budgeting Top down budgeting from NPC- MoHP - DoHS -District-Peripheral level Urban municipality and rural municipal are responsible for annual planning and budgeting on health from unconditional budget and approval from Municipal assembly annually. 47 3/6/2025

48. Major challenge/problem in nutrition program in Nepal Slow scaling up of evidence based and cost effective interventions of IYCF, IMAM, MSNP, IYCF-MNP, SHNP due to resource gap Unclear and unstable organizational structure and position of nutrition focal officer in after federal government system in health Lack of proper guideline on nutrition and updated strategies, policy in federal system 48 3/6/2025

49. Recommendation to overcome Clear guideline and revised policy on nutrition Clear and stable organizational structure of health in federal context Clear position of nutrition officer and their role and responsibility in federal system Strengthening system for better health Quality improvement of nutrition program and service Regular supervision and monitoring of MSNP in collaboration with multi- secter . 49 3/6/2025

50. 50 3/6/2025