By: Dila Ram Panthi Planning Officer, Health & Nutrition, NPC

Transcription

1 MULTI-SECTORAL NUTRITION PLAN A KEY TO PLANNING WITH OTHER SECTORS Experiences from Nepal By: Dila Ram Panthi Planning Officer, Health & Nutrition, NPC Prepared by: National Planning Commission (NPC), GoN, Involving 5 key sectors MoHP, MoAD, MoE, MoFALD, and MoUD Lead Technical Support: UNICEF in close collaboration with WB, HKI, WFP and Other DPs

2 Rationale: why? Improvement in nutritional status results to Better immunity, lowered death rates, decreased morbidity, protection from diseases in adult life Improved growth Improved cognitive development Increased productivity Increased GDP Achieving MDGs Stunting at the age of 2 is the indicator for human capital

3 LIFE COURSE CONSEQUENCES OF POOR MATERNAL AND CHILD UNDERNUTRITION (MCU) BETTER UNDERSTOOD BY GON Poor nutrition in uterus and early childhood (STUNTING) Short term Brain development Growth and muscle mass Body composition Long term Cognitive and educational performance Immunity Work Capacity Death Metabolic Syndrome: programming of metabolism of glucose, lipids, protein Hormone/receptor/gene Diabetes, Obesity Heart Disease High blood pressure Cancer, stroke, and ageing (James et al 2000) 3

4 Stunting is preventable and is no longer chronic: Need to act when the women are pregnant to before the child is 2 years The Critical Window of Opportunity : 1000 DAYS Pregnancy: 9*30= 270 days 2 years: 365*2=730 days

5 Strategic Shift Needed Priority focus on pregnancy to under 2 years: Spending vs. Brain Development Nutrition in National Budget Brain s development potential Spending on Health, Education and Welfare Total National Budget 000s: NRs in F/Y 2068/ /11) Health Budget: NRs (7.5% of Total National Budget) Nutrition Budget: NRs (1.77 % of Total Health Budget) (0.13% of Total National Budget) Age 70 about 1000 per capita.

6 Background to MSNP Ministry of Food and Agriculture +FAO plan 1970 NPC: Nutrition coordination committee 1977 leading to nutrition strategies 1978/86 Joint Nutrition Support Program National Plan of Action on Nutrition (NPAN) 1998 National Nutrition Policy and Strategies (MoHP) 2004 School Health and Nutrition Policy and Strategy, 2006 NPC Technical Working Group: NPAN 2007 draft Nutrition Assessment and Gap Analysis NAGA: 2009 Key Learning from past Experience: Thorough Consultation and Involvement, Ownership by each sectors and Including the plan in Sectoral Plans of the key Ministries

7 Nutrition Assessment and Gap Analysis ( ) Identified strengths, weaknesses, and gaps; Need for a national nutrition architecture; and A multi-sectoral approach through an agreed nutrition determinants model. Build the National Nutrition Architecture ( ): NPC led National Nutrition Steering Committee revitalized; High Level Nutrition and Food Security Steering Committee chaired by the Vice Chair of the NPC; and Technical working group to guide multi-sectoral nutrition review, planning, implementation and monitoring.

8 Nutrition Multi-Sectoral Reviews: A consultative Process (2011) Nutrition reviews by sector: Health; Agriculture, Education, Urban Development, and Local development Defined scope: Global and national evidences for what works : essential nutrition specific interventions through the Health sector & nutrition sensitive interventions through other sectors Systematic consultation: through Reference Group Meetings by sector at key stages and All Reference Group Meetings to identify the crosssectoral linkages Costed Multi-sectoral Nutrition Plan of Action (Ongoing) Clear leadership: the NPC and actively involving health & other sectors Focused: the first 1,000 days of life and stunting reduction Addressing the immediate, underlying and basic factors: women and children s access to health and nutrition; safe water & sanitation; and education and inequity. Emphasis on decentralized implementation: initially in selected districts ( ) Vision to gradually scale up: to all other districts by 2016 (A new approach: learning by doing)

9 Rationale: How? Nutrition specific interventions: feeding and care practices and protection from illnesses aimed at individuals, mainly through health sector Nutrition sensitive interventions: food availability, affordability and access, quality, utilization aimed at families and communities mainly through non-health sectors i.e. agriculture, education, local development, water supply and sanitation sectors

10 Multi-sectoral Nutrition Planning Framework Strategic Objective (SO) 1. National Planning Commission Result (R) 1.1. Multi-sectoral commitment and resources for nutrition are increased R 1.2. Nutritional information management and data analysis strengthened R 1.3 Nutrition capacity of implementing agencies is strengthened SO 4. Ministry of Education R 4.1 Adolescent girl s awareness and behaviours in relation to protecting foetal, infant and young child growth improved SO 2. Ministry of Health and Population R 2.1 Maternal Infant Young Child (MIYC) micronutrient status improved R 2.2 MIYC feeding improved R 2.3 IYC Malnutrition better managed R 2.4 Nutrition related policies, standards and acts updated SO 3. Ministry of Urban Development R3.1 All young mothers and adolescent girls use improved sanitation facilities R 3.2 All young mothers and adolescent girls use soap to wash hands R 3.3 All young mothers and adolescent girls as well as children under 2 use treated drinking water The intergenerational transmission of growth failure: When to intervene in the life cycle Low Birthweight baby Child growth failure/ death Early pregnancy Small adult woman SO 6. Ministry of Agriculture Development R6.1 Increased availability of animal foods at the household level Low weight & height in teenagers Small adult man R 6.2 Increased income amongst young mothers and adolescent girls from lowest wealth quintile R 6.3 Increased consumption of animal foods by adolescent girls, young mothers and young children R 6.4 Reduced workload of women and better home and work environment R 4.2 Parents better informed with regard to avoiding growth faltering R 4.3 Nutritional status of adolescent girls improved R 4.4 Primary and secondary school completion rates for girls increased SO 5. Ministry of Federal Affairs and Local Development/ Social Protection R 5.1 Nutritional content of local development plans better articulated R 5.2 Collaboration between local bodies health, agriculture, and education sector strengthened at DDC and VDC level R 5.3 Social transfer programmes corroborated for reducing chronic under nutrition R 5.4 Local resources increasingly mobilized to accelerate the reduction

11 Goal and Purpose of MSNP Goal To enhance human capital, especially among the poorer segments of the society Purpose to improve maternal and child nutrition by accelerating the reduction in maternal and child under nutrition through implementation of nutrition specific and nutrition sensitive interventions aimed at the window of opportunity of 1000 days from Pregnancy to 24 months

12 Major Outcomes and Outputs Outcome 1: Policies, plans and multi-sectoral coordination improved at national and local levels 1.1: Policies and plans updated/reviewed to incorporate nutrition specific indicators at national and local government levels 1.2: Multi-sectoral coordination mechanisms functional at national and local government levels Outcome 2: Practices that promote optimal nutrition behaviors improved 2.1: Maternal and child care service utilization pattern changed 2.2 : Adolescent girls education, life skills and nutritional status improved 2.3 : Reduced episodes of diarrheal diseases and ARI among mothers, adolescents and IYC 2.4 : Feeding behaviors improved with increased availability and access to appropriate food (in quality, quantity, frequency and safety) Outcome 3: Strengthened capacity of central and local governments on nutrition to provide basic services in an inclusive and equitable manner 3.1 : Capacity of national and local government enhanced to provide appropriate support to improve maternal and child nutrition 3.2 : Multi-sectoral nutrition information updated and linked both at national and local government level

13 Schedule for Roll-out and Scale-up Gradual and incremental Within 5 years, scale up to 75 districts: 6, 12, 16, 15 and 16 districts respectively Each starting districts to start work in 2 VDCs and expand gradually so that by the end of the year 50% of VDCs are covered Selection criteria: Based on 13 set of indicators (malnutrition, poverty, HDI, Water sanitation, ecology, region, delivery by SBAs, school enrollment, Girls/boys enrollment etc) Not all VDCs will be covered, cover at least 50%, those most disadvantaged! MSNP implementation period (First Phase):

14 MNSP Management Arrangements At National Level National Nutrition and Food Security Steering Committee chaired by the Honorable Vice-Chair of NPC (HLNFSC) National Nutrition and Food Security Coordination Committee (NNFSCC) formed under the chairmanship of honorable member (Health) of NPC. Technical Committee with key technical experts from government, DPs, the private sector, academia, and CSOs under NNFSCC. Nutrition Secretariat: Nutrition information management and M/E, Advocacy & coordination and capacity building to be established. At Local Level District Level Nutrition and Food Security Steering Committee chaired by DDC Chairperson Municipality Nutrition and Food Security Steering Coordination Committee chaired by Mayor VDC level Nutrition and Food Security Steering Coordination Committee chaired by VDC Chairperson

15 Authorization Implementation Modality Coordination and Facilitation NPC Implementing Agencies at Central Level MoHP MOE MoUD MoAD MoFALD District Level DDC Line Agencies Municipality VDC

16 SIX INITIAL DISTRICTS (Bajura, Achham, Jumla, Kapilvastu, Nawalparasi and Parsa) PROPOSED BASED ON ABOVE MENTIONED INDICATORS Far-Western Region DARCHULA HUMLA Mid-Western Region NEPAL Proposed Initial MSNP Roll-out Districts BAITADI BAJHANG BAJURA MUGU DADEL- DHURA KANCHAN- PUR DOTI KAILALI ACHHAM BARDIYA KALIKOT DAILEKH SURKHET BANKE JUMLA JAJARKOT SALYAN DANG RUKUM ROLPA Proposed Initial MSNP Roll-Out Districts PYUT- HAN DOLPA KAPIL- BASTU MYAGDI GULMI ARGHAK HACHI RUPAN- DEHI PARBAT SYANGJA PALPA MUSTANG KASKI NAWAL PARASI MANANG TANAHU LAMJUNG CHITWAN Western Region GORKHA DHADING MAKAWAN- PUR RASUWA NUWAKOT KATHM BHAK PARSA BARA RAUT- AHAT LALIT KAVRE Central Region SINDHU- PALCHOK SINDHULI DOLAKHA OKHAL- DHUNGA SARLAHI MAHO- TARI DHANUSA SIRAHA SULUK- HUMBU SAPTARI Eastern Region SANKHUWA- SABA KHOTANG TERHA- BHOJ- THUM PUR DHAN- KUTA UDAYAPUR SUNSARI MORANG TAPLEJUNG ILAM JHAPA

17 Summary of Ongoing Nutrition Actions in the Proposed MSNP Initial Roll-Out Districts Districts Development Region Nutrition Related Actions Bajura FW Hills CFLG, Suaahara, FtF, WB/NASP, HKI/Homestead food production, WFP Achhaam Jumla MFW Hills MW Mountains CFLG, UNICEF IYCF/MNPs, CMAM, FtF, WB NASP, WFP CFLG, UNICEF/ADB IYCF/CG, MI/UNICEF VAS, USAID FtF, WB NAFSP, SCF/UNICEF GM, WFP, WV Parsa Central Terrai CFLG, UNICEF IYCF/MNPs, ECD, Health Kapilvastu Nawalparasi Western- Terrai Western- Terrai CFLG, UNICEF IYCF/MNP, CMAM, WASH, ECD, Health CFLG, Suaahara, WASH, Health, ECD

18 Role of Sectoral Ministries Mainly responsible for mainstreaming nutrition in sectoral programs, mobilization of resources and implementation through their regional and district networks. providing technical backstopping carrying out monitoring and evaluation of the implementation process.

19 Role of EDPs and I/NGOs Support and Strengthen Government System Technical Support in rolling out MSNP, M/E, Capacity Building of sectors to implement it Joint Planning, Budgeting, Monitoring and Review Support on Basket Funding System Joint Financial Arrangement (JFA) and provide support to the government

20 Key Innovative Approaches Process Led by the highest Planning Body- National Planning Commission and their commitment Management Arrangements made at Central, District and Community Levels Reference Groups for each sectors: key experts for each sectors from Govt, NGOs and Pvt Sectors For Each Sectors: Strategic Objectives, Plans, Interventions were identified/selected by each sectors Thorough Discussions/Consultations within each sectors Joint Meetings of All Sectors for Linkages Linked to Annual Planning Processes Joint Initiative of Government and Development partners and joint ownership

21 Challenges to Overcome Major Challenges 1. Sensitizing of Each Sectors and ownership 2. Time Consuming 3. Coordination among many Key Government Sectors 4. Coordination among Development agencies 5. Budget Allocation by each sector ministry and Donors for MSNP: Sectoral Nutrition Interventions Responses to Overcome 1. Importance of Nutrition for each sector, their roles and linkages clearly explained, internalized 2. Needed for Consultations and Ownership 3. Sectoral reviewers well understand/coordinating sectors- Extra Support to NPC for Sectoral Coordination 4. Joint Funding for review, continues sharing of progress in National Nutrition Group and other coordination mechanisms 5. Still Challenging, NPC coordinating with Sectoral Ministries, but for Development partners- Strong Government stand/action necessary

22 Next Steps Cabinet Approval Launching Program Budgetary Resources and Commitment Phased Plan for Implementation with clear Implementation guideline (6 Districts for Year 1) More detailed strategies and plans on: Multi-sectoral Nutrition Advocacy & Communication, Nutrition Capacity Development, and Monitoring & Evaluation

23 THANK YOU ALL!!!