2.00 Denise Costa Coitinho.ppt [Modo de Compatibilidade]189.28.128.100/nutricao/docs/evento/seminario_internacional/11_11... · compromisso para atuar em escala • Apoio a gestao

REACHREACHAn inter-agency renewed effort to end child hunger and undernutritiong y gWFP WHO UNICEF FAO

REACH : um modelo para fortalecer o l j t t i i l?planejamento nutricional?

Seminario Internacional sobre Nutricao na Atencao PrimariaPainel 4 Planejamento Monitoramento e A aliacaoPainel 4 – Planejamento, Monitoramento e Avaliacao

A Epidemiologia nutricional mostra umA Epidemiologia nutricional mostra ummundo em transição

1REACH Progress Report I_August 2008_v1.ppt

Carga de doenças segundo 10 principais causas (2000)Países em desenvolvimento renda abaixo da média

84564

124398

461833-Unsafe water

2-Unsafe sex

1-Underweight

30393

26781

46183

5-Zinc deficiency

4-Indoor smoke

3-Unsafe water

20627

25137

26170

8-Blood pressure

7- Vit A deficiency

6-Iron deficiency

16683

640817 Overweight

9-Tobacco


6408

0 20000 40000 60000 80000 100000 120000 140000

17-Overweight

Thousands of DALY'sSource: WHO 2002

Carga de doenças segundo 10 principais causas (2000)Países em desenvolvimento renda acima da média

16294

25520

20278

3-Tobacco

2- Blood pressure

1-Alcohol

12596

111155-Overweight

4-Underweight

7595

7869

8609

8 Indoor smoke

7-Low f&v

6-Cholesterol

7595

7292

715010-Unsafe water

9-Iron deficiency

8-Indoor smoke


0 5000 10000 15000 20000 25000 30000


Carga de doenças segundo 10 principais causas (2000)Países desenvolvidos

19638

26104

20278

3-Alcohol

2- Blood pressure

1-Tobacco

16227

158935-Overweight

4-Cholesterol

3872

6986

8324

8 Illicit drugs

7-Physical inactivity

6-Low f&v

1626

3872

715010-Iron deficiency

9-Unsafe sex

8-Illicit drugs


0 5000 10000 15000 20000 25000 30000


11 mihões de crianças morrem todos os anos antes dos 5 anos: 1 em cada 3 estava desnutrida.1 em cada 6 recém-nascidos nos países em desenvolvimento tem baixo peso ao nascer comprometendo sua saúde futura;peso ao nascer comprometendo sua saúde futura;1 em cada 4 pre-escolares tem baixo peso para a idade e um número ainda maior baixa estatura para a idade, com efeitos em seu desenvolvimento 1 em cada 3 pessoas no mundo tem alguma carência de micronutrienteAs 40 milhões de pessoas vivendo com HIV/AIDS estão expostas a um alto risco de desnutriçãorisco de desnutriçãoNos países que enfrentam situações de emergência, a desnutrição afeta quase 40 milhoões de pessoas e é uma das principais causas de morte e doençasdoenças.


Mas este é apenas um lado do problema…

DCnT são responsáveis por 60% das mortes globalmente e por quase 50% de toda a carga de doença. 66% destas mortes ocorrem em países desenvolvidos.em países desenvolvidos.A maior parte das DCnTs são associadas a dieta.Mais de um 1 bilhão e meio de adultos no mundo tem sobrepeso, destes, meio milhão são obesos.

A desnutrição e o sobrepeso e a obesidade já ocorrem nas mesmas comunidades, as vezes até nas mesmas famílias.


Um assunto chave: a hipótese de BarkerUm assunto chave: a hipótese de Barker

O retardo do crescimento fetal e durante a primeira infancia são relacionados com o estado de saúde na vida adulta. Pessoas previamente desnutridas tem maior risco dePessoas previamente desnutridas tem maior risco de desenvolverem doenças crônicas ´metabólicas quando expostas a dietas inadequadas. A eficiencia metabólica que foi útil nas condições de desnutrição (fetal ou na infancia) torna-se maladaptativa sob estas exposições, levando ao desenvolvimento de um perfil lipídico anormal, metabolismos de glicose e insulina alterados e obesidade. A nutrição no início da vida tem um impacto substancial ao longo do curso da vida principalmente quanto ao risco para DCnTsdo curso da vida, principalmente quanto ao risco para DCnTs.


Baixo peso ao nascer

Falta de aleitamento materno

Alimentação complementar inadequada

Baixa estatura para idade (stunting) Solucoes comuns e

Inatividade física

Baixo consumo de frutas e vegetais;

comuns e acoes

Alto consumo de sal;

Alto consumo de gorduras saturadas e trans;integradas

Hipertensão arterial;

Hipercolesterolemia;


Sobrepeso e obesidade.

S lh d dSe melhoras de renda ocorrerem (MDG 1) sem a redução da desnutrição e a melhora da

qualidade das dietas a saúde da população vai deteriorarqualidade das dietas, a saúde da população vai deteriorar ainda mais, com um custo elevado para todos os países.


Aprovada pelos E t d M bEstados Membros na

55th World Health Assembly 2002Assembly, 2002

(WHA55.)

10REACH Progress Report I_August 2008_v1.ppt10

Aprovada pelos Estados M b 57th W ldMembros na 57th World Health Assembly, 2004

(WHA57 17)(WHA57.17)


O DESAFIO : fazer as coisas certas e nao fazer as erradas

- renovar esforços conjuntos de forma coordenada e com- renovar esforços conjuntos de forma coordenada e com foco para o combate prioritario a desnutrição materna e infantil com abordagem do ciclo vital e da promocao da g palimentacao saudavel

- apoiar os paises para identificar e implementar solucoes efetivas respaldadas por politicas adequadas, dirigidas

t i i li t d i / d / id dao trinomio – alimentos saudaveis/saude/cuidados –

- implementar em larga escala


Alimentos : demanda e oferta igualmente críticas

• Uma questão de escolha individual?

• Urbanização e industrializacao• Novos padrões de emprego • Demanda por "conveniência" • Propaganda cria desejo por alimentos associados a um status

social mais alto

• Afeta disponibilidade, preços e estratégias de marketingg g• Define o ambiente no qual a demanda é estabelecida• A escolha saudável tem que ser a escolha disponível,

acessível e desejada.


As grande 5 areas de solucoes-chave que podem ser operacionalmente integradas e efetivasoperacionalmente integradas e efetivas ….

Seguranca alimentar do domicilio

Suplementacao com micronutrientes para maes e

Promocao do aleitamento materno e alimentacao micronutrientes para maes e

criancas <5 anos e fortificacao de alimentos

complementar

Tratamento da desnutricao severa

Promocao da higiene e controle de parasitas severa p


Promocao da alimentacao saudavel e fortelecimento da mulher

… quando respaldadas por politicas adequadas… quando respaldadas por politicas adequadas

Tecnologia• Mudanças tecnológicas na produção de alimentos, processamento e

distribuição reduzem custos

Globalização• Liberalização do setor financeiro facilita as mudanças na produção e

comercialização dos alimentos• Marketing promocional encoraja a convergência de culturas de

consumo• Aparato regulatório (qualidade sanitária e nutricional) encoraja a

ê i d d õ d id tid d lid d d li tconvergência de padrões de identidade e qualidade de alimentos

Políticas agrícolas• Políticas de comercialização (e.g. bolsas de commodities)• Políticas de suporte de preços (e.g.subsidios)• Políticas tarifárias (e.g. sobretaxas, incentivos para exportação)


( g )• Crédito diferenciado

Fortalecendo o planejamento em nutricao : REACHFortalecendo o planejamento em nutricao : REACH

Uma parceria em formacao entre WFP , UNICEF , WHO and FAO

Outras agencias UN - SCN, IFAD, UNVSociedade civil - SCF, WVI, Rotary International, GAIN, Helen Keller Intl, CRS, JAM, Africare, MSF, ACFAcademia: Tufts, George Washington Univ, outrasSetor privado : Boston Consulting Group, Governos (Mauritania, Laos, etc …& alguns doadores)

REACH tem sido procurada continuamente por novos potenciais parceiros

REACH e facilitada por uma pequena equipe inter agencial baseada no PMA em Roma paraREACH e facilitada por uma pequena equipe inter-agencial, baseada no PMA em Roma para promover o apoio coordenado :

- A processos nacionais de planejamento operacional de solucoes intergradas para p p j p g po combate a desnutricao e identificacao de brechas e oportunidades,

- A processos “supra-nacionais” identificados como necessarios pelos paises participantes (ex. Advocacia, networking, mobilizacao de recursos) Ao fortalecimento dos setores de nutricao das organizacoes parceiras


- Ao fortalecimento dos setores de nutricao das organizacoes parceiras

REACH Overview

Ending child hunger and undernutritionEnding child hunger and undernutrition By 2015: REACH MDG 1, Target 3 (half the proportion of underweight children under 5)

Beyond 2015: Achieve sustainable acceleration of the rate of reduction in child underweight

Vision &Goals

Country actionplanning and coordination

to support national capacity to scale up evidence-based solutions

Communications and advocacy

Financing and resource

evidence based solutions

Knowledge-sharing

Action areas

yresource mobilization

Outcomes Increased efficiency and accountability

Strengthened national policies and

programmes

Increased capacity at all levels for action

Increased awareness of the problem and of

potential solutions


REACH promove a acao coordenada de parceiros sob a lideranca dos governos nacionaislideranca dos governos nacionais

UN Agencies/IFIs Government(lead) Bilaterals

Reach MDG 1 and end maternal and child undernutritionReach MDG 1 and end maternal and child undernutritionThrough a coordinated, “solution focused” approach to

scale-up activities in nutrition in the life-cycle

Private Sector/ NGO A d iPrivate Sector/Corporations NGOs Academia


REACH oferece apoio aos paises em dois niveisREACH oferece apoio aos paises em dois niveis

T d iT d iTroca de informacoes e “networking” Todos os paisesTodos os paises

• Troca de know-how sobre como atuar em escala

1 1

escala • Networking• Compilacao e disseminacao de informacoes

sobre os progressos alcancados

Assess,mobilize,

set upworking

• Laos/Mauretania• WHO landscaping

countries1

structure

D t il d Pilots in:

Apoio ao planejamento

22 Paises prioritariosPaises prioritarios

• Analise de situacao, competencias e compromisso para atuar em escala

• Apoio a gestao estrategica e mapeamento de demandas e ofertas

Detailedaction

planning & coordination

Pilots in:• Lao PDR• Mauritania

operaconal e mobilizacao de recursos

demandas e ofertas• Identificacao de necessidades nao

preenchidas e mobilizacao de apoio e recursos locais e globais

• Apoio para o monitoramento dos processos e


Apoio para o monitoramento dos processos e avaliacao de impacto

1. Burkina Faso, Ghana, Guatemala, Madagascar, Peru, South Africa and Timor Leste

atividades sao mobilizadas em 4 areas fundamentais capacitando paises para implantacao de solucoes em escalacapacitando paises para implantacao de solucoes em escala

Gestao Troca de Advocacia e comunicacao

Mobilizacao de recursos

Gestao estrategica e coordenacao

Troca de informacoes e

networking

A li d Compilar e Monitorar fontes D l• Analise de situacao, competencias e compromisso

Compilar e disseminar informacaoes

P i

Monitorar fontes de recursos

Prover apoio

Desenvolver ferramentas e capacidades para advocacia co p o sso

• Priorizar acoes • Estimar custos• Mapear

demandas/oferta e

Prover servicos e ferramentas para networking

para desenvolvimento de propostas para mobilizacao

pvisando promover investimentos governamentaisdemandas/oferta e

necessidades• M&A

Lid t

Facilitar contatos entre ciencia e pratica

pde recursos

Mobilizar recursos globais

governamentais e de doadores em solucoes integradas efetivasLideranca e gestao

estrategicarecursos globais efetivas


Testes- piloto iniciados em Julho na Mauritania e no LaosProposed “typical” REACH country process:

Testes piloto iniciados em Julho na Mauritania e no Laos

Detailed action planningOngoing REACH

activitiesAssess, mobilize, set-up working

structurePrepare

1-3 months 3 months 9-12 months Ongoing

Detailed country analysis & action

planning

Resourceplanning

& matching

Implementation and

monitoring

Country preparati

on

Exploratory

interviews &

mobilization (country

First assessment

Set-up of working

Regional information/ mobilization

Country request for REACH support

gn (country phase)

working modusREACH support

Global REACH involve-ment:

Laos1 Mauritania

ment:Inform and sequence

Initiate an mobilizeProvide process

experience and know how

Provide best practices, coach country processRaise local needs to global partnership

Support "match making", monitor results


1. Laos process may or may not be completed in 1 year, based on need to perform mobilize phase activitiesSource: BCG, REACH analysis

Facilitators support national teams to do the following

Detailed action planningOngoing REACH

activitiesAssess, mobilize, set-up working

structurePrepare

Mobilize resources Plan delivery Q antif cost

Advocacy and funding

Set-up operational planDefine

Finalizestock-taking

Assess readiness, willingness and ability to act at scale

Identify locally required set of interventions

Define appropriate delivery

Estimate costs and resource gaps

Define advocacy and fundraising

Mobilize resources locally

& commitmenty

channels Quantify cost funding strategyinterventionsstock-taking

act at scale

Situational and current response analysis, identify intervention gaps

interventionsand targets

delivery channels and operational mechanism

gaps fundraising strategy

locally, regionally and globally

Metrics, and information system

Develop tracking system, including indicators, sources, and processes

Ongoing communication & advocacy

Develop communication processes and content


Progress in each area to be reported via key “sentinel” indicators complemented by a broader set of M&E indicators

Backup

complemented by a broader set of M&E indicators

Action areaAction area Sentinel indicatorSentinel indicator 19901990 20062006 20112011 20152015Action areaAction area

Improve breastfeeding and complementary feeding

Sentinel indicatorSentinel indicator

% of <6 month olds that are exclusively breastfed1

19901990

33

20062006

37

20112011

45

20152015

601

Increase micronutrientintake

% of 6 to 59 month olds fully covered with 2 doses of VAS in the last year2

16 72 80 802

Improve diarrhea andparasite control

% of preschool children at risk treated with deworming tablets in the last year3

TBD 21.3 50 753

Increase treatment of severe acute malnutrition

y

# of countries with severe wasting rates > 10%4

TBD 25 18 124

Improve household food security

Proportion of population below minimum level of dietary energy consumption5

20%(823M)

17%(820M)

15%(800M)

10%(582M)

5


y gy p

1. Data available from WHO Global Databank on Infant and Young Child Feeding. 2. Data available from WHO 3. Data available from WHO Partners for Parasite Control; reflects % of preschool children receiving preventive chemotherapy against soil-transmitted helminthiasis in a given year; note that provisional 2007 data reflects only 10.7%; Note that the global target established at the World Health Assembly 2001 is to achieve 75% coverage of school-aged children at risk of STH and/or SS by 2010. 4. Data available from WHO. 5. Official indicator of MDG1 target 1C

Building on existing processes in Laos Laos

20092008

11 109872 51 412 310 69 MilestonesM th 11 109872 51 412 310 69

Feedback on NPAN compiledfrom dissemination workshop

MilestonesNNS/NPAN WorkplanNNP dissemination workshops

Sector/agency consultations 1 Sector workplans complete

Month

Sector/agency consultations 1. Sector workplans complete2. Technical approval of workplans3. Sector workplans integrated into FY2010 budgets in each ministryTBD

E t bli h t t tProvincial/district consultations

W ki t t fi li d

Toda

Dissemination workshops completeDissemination of NNS/NPAN

NNS/NPAN documents finalizedFinalize strategy and plan of action

Establish management structureTBDEstablish nutrition surveillance system

Working structure finalized

ay

REACH workplan

RTM pre-session

High-level action plan completeHigh level action planning

Stock-taking analysis completeCurrent country situation stock-taking

Consultation conducted prior to RTM

Detailed action plan complete

Advocacy & funding strategy 1. Advocacy/funding strategy draft2. Detailed advocacy/funding strategy

Other key events

RTM pre session Consultation conducted prior to RTM

Detailed action planning


Other key eventsRound Table MeetingEC Food Security RFP

Mauritania is taking stock of "who does what …" Example UN agency activities

Preliminary

Example UN agency activities

InterventionsInterventions OMSOMSUNICEFUNICEF PAMPAMFAOFAO PASNPASN GouvernementGouvernement

Treat severeacute malnutrition Therapeutic feeding

Improve breastfeeding and

complementary

Exclusive breastfeeding

C l t

S l t f di

complementary feeding Complementary

feeding

Increase micronutrient

intakeMicronutrient suppl.

and fortificationOnly Vitamin A, and Iodized Salt

Improve household food

security1

Conditional cash transfers

Local homestead food production

Supplementary feeding

2

Covers Vitamin A, and Iron

Handwashing with soapImprove diarrhea

and parasite control

Household water treatment

HWT not covered by any

3

Bednets and IPTp

Deworming

control

Diet diversification

covered by any UN agency?


1. WFP also intervenes in Food Security throgh SAVS2. VCT – cooperation with NGOs;3. Small pilot for monitoring water quality;

Need to detail Government-direct and FAO interventions

...along with a picture of "where they do it"......along with a picture of where they do it ...

LegendLegend

OrganizationOrganization SymbolSymbol

UNICEF1

PAM

CRI/CPSSAPASN

PASN


1. Couverture sur la carte pour la Alim. Thérapeutique; pour AME etAlim Complémentaire et Vitamine A la couverture est Nationale; pour lesAliments enrichis mêmes 8 régions sauf Tagant

Tracking progress in Mauritania

Taux de Insécurité Alimentaire

Score de diversification alimentaireTaux de diversification agricole

% ménages producteurs agricoles

P té

% population consommant en dessous du minimum quotidienne % Allaitement immédiate

% Allaitement exclusif

27

27

Pauvreté

Préval. palu. chez Mères enceintes

Couverture Vitam. A Mères PPCouverture Fer Mères E&A% 6-24 mois encore mise au sein

% 6-24 mois reçoivent alim. compl.

% 6-24 mois reçoivent 2 repas/ j +

4 42

3

3

% Mères E qui utilisent MIIPrévalence anémie chez Mères E&A

Faible poids a naissance

Carence Iode <5 ans

Prévalence MAM chez Mères E&A

Couverture Zinc < 5 ans

% de Mères qui reçoit TPIç p j

Utilisation sel iodé

44

3

10

10

% ménages qui dispose de MII

P é l é i h l <5

Carence Vitamine A <5 ans

Carence Zinc < 5 ansCouverture Vitamine A <5 ans

Couverture Fer enfants < 5ans

Couverture déparasitage

4

11

4

10

Mortalité <5ans pour paludismePrévalence paludisme <5 ans

% enfants < 5ans utilisant MII

% popn. avec eau amélioré à boire

Prévalence anémie chez les <5 ansPrévalence parasites

8

10

% enfants MAM admis CRENAMs

Taux de guérison CRENAMs 5

Prévalence MAM < 5 ans

5

% ménages traitant d'eau

% population avec assainissement

% de mères lavent mains correct.

98

9 % enfants MAS admis CRENIs

Taux de guérison CRENAMs 5

Taux de guérison CRENIs 1

Prévalence MAS < 5 ans

1


Mortalité à cause de mal. diarr.

Prévalence mal. diarrhéiquesNon - existant

Existant

# = # interventionMortalité chez les enfants < 5ans

Mortalité pour MAS

Taux de guérison CRENIs 1

“Know-how” operacional tem sido sistematicamente compilado Serie “Atuando em Escala”Serie Atuando em Escala

Physical component

Public health

UN facilities

Mass campaign

InterventionIntervention

Delivery overview: Deworming

• Drugs against soil-transmitted helminthsDrugs against water-borne schistosomiasis

Deworming

NGOs, UNICEF

Ministry of H lth

NGOs, UNICEF,

WFP

Ministry of Health

NGOs, UNICEF,

WFP

Ministry of Health

NGOs, UNICEF,

Ministry of Health

Other1Government

Deliverable to mother/child

Deliverable to mother/child Key delivery channelsKey delivery channels Key/typical implementersKey/typical implementers

Education component

Beneficiaries:• Children 1 – 5 in high worm

burden areas• P&L women in high worm

Deworming

Community mobilization and participation creates awareness Examples from large-scale HWT programs

The "Blue Bus"The "Blue Bus" Water testing daysWater testing days Promotion at health-eventsPromotion at health-events

Nicaragua Indonesia Indonesia

Implement

Atuando em escala : i ti

Nam e O rg anization and title Area of expertise C ontact deta ils

Charles Adam s R otary Internationa l Im p lem ent charles@ taer ia.comAm paro A raujo PPPH W C olum bia Im p lem ent lavam araujo@ ho tm ail.comAngela A rm strong W orld Bank Im p lem ent aarm strong@ worldbank .o rgAbdul Badru W SP-T anzan ia Im p lem ent abad ru@ worldbank .orgNancy Bock Soap & D ete rgent Assoc iation Im p lem ent nbock@ sdahq .orgJohn Borrazzo U SAID Im p lem ent JBorrazzo@ usaid.govSandy C allier AED Im p lem ent scallier@ aed .orgJason C ardosi W SP-A frica Im p lem ent jcardosi@ worldbank .orgCar los Augusto C laux M ora PPPH W Peru Im p lem ent caclaux@ worldbank .orgVal Cu rtis LSH TM R esearch val.curtis@ lshtm .ac.ukSylvie D ebom y W orld Bank Im p lem ent sdebom y@ worldbank .o rgCha rles Adam s R otary Internationa l Im p lem ent charles@ taer ia.comAm paro A raujo PPPH W C olum bia Im p lem ent lavam araujo@ ho tm ail.comAngela A rm strong W orld Bank Im p lem ent aarm strong@ worldbank .o rgAbdul Badru W SP-T anzan ia Im p lem ent abad ru@ worldbank .orgNancy Bock Soap & D ete rgent Assoc iation Im p lem ent nbock@ sdahq .org

Biblioteca completa

• Normas tecnicas

REACHEnding Child Hunger and Undernutrition

Version 1

Acting at Scale: Intervention Guide

76REACH_SP_Summary_v1.ppt

Schools2 UNICEF, WFP

Health, Education

1. W HO responsible for normative guidance on deworming. 2. Most common channel, but typically focused on 5+ children. Potentially can be expanded to reach <5s and P&L women if used as a community center.Source: Expert interviews; literature review; REACH analysis

• Hygiene education to induce behavior change to avoid reinfection

P&L women in high worm burden areas

23REACH_SP_Handbook_HWT_v1.ppt

Source: "Understanding Behavior Change for Safe W ater: Lessons from the Field." W ater Network W orking Meeting at Johns Hopkins Bloomberg School of Public Health, 2007.

• An entertaining vehicle for mobilizing communities for healthy behavior

• Visited 120 communities in 12 months

• Children learnt about water cleanness through experiments

• Entertainment-education

• Demonstration of water cleaning technology and benefits during an immunization campaign

guias programaticos

Draft – Work in progress

Direct consumer activities and mass media advertisement comprise the bulk of the program costs

Case study: Ghana

Draft – Work in progress

Successful practice case study (I)

Case study: Ghana

y p g p @ q gJohn Borrazzo U SAID Im p lem ent JBorrazzo@ usaid.govSandy C allier AED Im p lem ent scallier@ aed .orgJason C ardosi W SP-A frica Im p lem ent jcardosi@ worldbank .orgCar los Augusto C laux M ora PPPH W Peru Im p lem ent caclaux@ worldbank .orgVal Cu rtis LSH TM R esearch val.curtis@ lshtm .ac.ukSylvie D ebom y W orld Bank Im p lem ent sdebom y@ worldbank .o rgKatri Kontio W SP Im p lem ent Kkontio@ worldbank .orgT im Long P roc ter & G am ble Im p lem ent long .tj@ pg.comJack M olyneaux W SP-H Q Im p lem ent jm o lyneaux@ worldbank .orgKaposo M wam buli W SP-T anzan ia Im p lem ent km wam buli@ w orldbank .orgHarriet N attab i W SP-U ganda Im p lem ent hnattabi@ w orldbank .orgNga Nguyen PPPH W V ietnam Im p lem ent N nguyen4@ w orldbank .orgChr is N subuga -M ugga PPHW U ganda Im p lem ent ch rism ugga@ yahoo .co .ukEduardo Perez W SP Im p lem ent eperez1 @ worldbank .o rgPatricia Poppe JHU C ente r for Com m . P rogram m s R esearch ppoppe@ huccp.orgIda R afiqah W SP-Indones i Im p lem ent iraf iqah@ worldbank .orgEshuchi R ufus W SP-Kenya Im p lem ent reshuchi@ w orldbank .orgBas il Safi JHU C C P C en ter fo r C om m . P rogram m s R esearch bsafi@ huccp.o rgOrissa Sam aroo W SP-H Q Im p lem ent osam aroo@ worldbank .orgM yriam S idibe U nilever Im p lem ent M yriam .S idibe @ U nileve r.comTim T obery P roc ter & G am ble Im p lem ent tobery.t@ pg.comKate Tu lenko W SP Im p lem ent k tulenko@ worldbank .orgM erri W einger U SAID Im p lem ent m weinger@ usaid .gov

O rg an iza tio n W eb lin k C ateg ory D escrip tio n K ey activ ititesW a ter and San itation P ro gra m

w w w.w sp .org M ultila tera l Intern ational p artn ers hip ho sted by th e W orld B ank to im prove w ate r su pply

C o -ad m in is ters and pro vid es te chnica l prog ram lea dershipA dm iniste rs g lo bal se cre tariat of P P P-H W

U N IC E F w w w.u nicef .org M ultila tera l U N N atio ns C hildrens' Fu nd Im p lem ents pro gra m sIm p lem ents supp ort

W o rld B an k w w w.w orldban k.o rg M ultila tera l Intern ational d evelopm e nt ba nk F inan ces p rog ram s- A ls o throug h loan sP rovid es m an age m e nt su pport to PP P -H W

B an k/N eth erlan ds W a ter P artnership

w w w-esd. wo rldba nk.org /bnw pp/ B ila teral E stab lish ed by gove rnm e nt of N eth erlan ds a nd W o rld B ank to im pro ve w ater sec urity by pro m o ting inno vative ap proa ches to In tegrated W ater R e sources M ana gem en t

P rovid es f inancia l a ssistan ce to progra m s

F inan ces g lo bal co ordin a-tion and kno wled ge s har in g of PP P -H W

U S A ID w w w.u said.g ov B ila teral U nited States develop m e nt a gency F inan ces p rog ram s in several cou ntrie sC o -funds PP P -H W se cre tariat

D A N ID A w w w.d anida -dcc d.dk B ila teral D en m a rk 's de velopm en t age ncy F inan ces p rog ram sE H P En vironm e ntal H ea lth P ro ject

w w w.e hproject .org B ila teral U S AID pro gra m P rovid es a ccess to a bro ad range of capa bilities for m issio ns an d bu rea us w ishing to includ e hea lth p reve ntive com p onen ts in p rog ram sR e searche s state-o f-th e-a rt p reve ntive co m p onen ts

H ygiene Im pro vem ent P ro ject

w w w.h ip .w atsan .net B ila teral U S AID pro gra m Im p lem ents hyg ie ne program s a t sca le

P rovid es p ublication s, too ls , project pre senta tions, W E LL w w w.lbo ro.ac.uk /orgs/w ell/inde x.

htmB ila teral R eso urc e cen tre fun ded b y th e U K

D ep artm e nt fo r In ternationa l D evelo pm ent (D FID ), p rom ot in g en vironm en tal hea lth in de veloping

C o ord in ates and provide s services for wa ter, s anitation and enviro nm ental health pro gra m s to D F ID an d oth er agen cies

O rgan iza tio n des cription

• Normas tecnicas, guias operacionais, treinamentos, artigos

• Organizacoes-chave

Acting at Scale: Intervention GuideSupplementary feeding

August 2008

FundingFunding ExpensesExpenses

1

1

24

Public sector/ CWSA

Industry External support

agencies

Total

50%73 %

25%

0.200.50

0.05

0.40

Develop-mentcosts

(agency)

0.10

PR

0.20

M&E

0.40

Mgmt. of DCC

program

0.30

Overall program mgmt.

4.00

Total

0.25

1.00

District activities

0.60

0.30

0.90

Mass media

0.60

Direct community contact

(DCC) program

TV

RadioDistrict

SchoolsHealth units

Soap

Expenses for 3-year program (US$M)Funding for 3-year program (US$M)27 %

Successful practice case study (I)

Ghana, whole country

September 2003

• 2.5 M women with children under five• 3.5 M children in primary schools and junior secondary schools• Target to reach 80% of the target group within 3 years through mass media and direct community contacts

X Yes No

$ 4 M over 3 years

• Percentage of mothers and care-givers of children under five years that wash their hands with soap, especially after cleaning up a child (16% in 2002) and after using a toilet (24% in 2002 and 89% in 2005), before and after eating and before feeding babies

• Percentage of school children aged 6-15 years who wash their hands with soap, especially after using the toilet and before eating

Ghana Public-Private Partnership for Handwashing Physical component; Education

Ongoing

N/A

• Lead implementer: Community Water and Sanitation Agency (CWSA) at the ministry of Works and Housing• Public implementing partners: MoH (provision of existing health staff), MoE (contribution to school program)• Implementation assistance: UNICEF (assistance for the school program), LSHTM (consumer and market studies)• External funding: World Bank, DFID, CIDA • Private sector: Unilever Ghana, PZ-Cussons (technical assistance for campaign design, testing and implementation)

Handwashing with soap

X xRural Urban

Program name:

Location:

Start year: Ongoing?

Target group:

Total costs:

Metrics:

Type:

Duration:

Other resources used:

Lead & partner organizations:

Intervention:

Setting:

Atuando em escala:Estudos de caso

en vironm en tal hea lth in de veloping an d transitiona l coun triesM a nage d by LS H T M an d IR C in W eb site is a focal po in t of inform ation abou t w ater

L ondo n S choo l of H ygiene a nd T ropical M edicine

w w w.ls htm .ac.uk A cad em ia Le ading rese arc h institute in hygiene re search

P rovid es to ols fo r c onsum e r resea rch

R e searche s eff icacy and effectiven ess o f H W p rog ram sR e searche s psycholog y of hygiene beha vio ur c hang eP rovid es te chnica l in put to produc tsA dvoc ates

A E D /H ygien e Im provem en t P ro ject

w w w.h ip .w atsan .net A cad em ia U S AID -fu nded pro gra m that wo rks at sca le to im prove a nd su stain h ygien e

P rovid es te chnica l assista nce

P rovid es te chnica l in puts to produ ctsA dvoc ates

C e nter for D isea se C on trol w w w.cdc.g ov A cad em ia U nited States public h ealth a genc y P rovid es te chnica l assista nce for M & E R e searche s effectiven ess o f H WP rovid es te chnica l in puts to produ ctsA dvoc ates

U n ive rsity of L eeds w w w.lee ds.a c.uk A cad em ia Le ading rese arc h institute in hygiene R e searche s and tra in s on health educ ationH e alth E duc ation D a taba se

U n ive rsity of S ou thham p ton w w w.e ng4d ev.soton.ac .uk /res earch.htm l

A cad em ia Le ading rese arc h institute in hygiene re search

R e searche s gen der is sues in the pro m otion o f h ygien e an d san itation a m ongst the u rba n po or

G lo bal P ublic-Pr iva te w w w.g lo balha ndw ashin g.org N G O G lob al initiative of pr iva te an d pub lic A dvoc acyG lobal M &ED e velopm en t of stand ard toolsK no wled ge ex chan geIm p lem enta tio n in s evera l coun tries

IR C Internation al W ate r a nd S an ita tion C en tre

w w w.irc.nl N G O Ind epen dent, non -profit o rga niza tion sup ported b y a nd linke d w ith the

F acilitate s the shar ing, p rom o tio n an d use of k now ledg e to bette r su pport be nef ic ia ries to obtain A dvoc ates chan ge an d aim s to im pro ve the inform a tion a nd k now ledge bas e of the s ector via its w eb site, d ocum e ntation , pub lica tions

In ternation al Sc ie ntific F orum of H om e H ygiene

w w w.ifh-ho m ehyg iene.o rg/2003 /2new slette r/lette r.h tm

N G O N G O com prising sc ie ntists and h ealth care p rofession als w ho p la y an active ro le in hygiene policy and s cientific re search

P ub lish es a new slette r (H om e H ygiene a nd H e alth N e ws ) on latest new s, rese arch , even ts an d libra ry u pdates in th e fie ld of h om e h ygiene

N E T W A S– Ne tw ork fo r W a ter and San itation

w w w.n etw as.o rg N G O A cap acity b uilding an d inform at io n ne two rk for A frica foc using on w ate r, san itation a nd h ygien e

P rovid es a tra in in g cou rse

• Lista de experts

38REACH_Success Practices_Handwashing_v9.ppt

Note: The data is from the Ghana handwashing business plan, not actual dataSource: "Ghana washes her hands: A public-private-partnership." CWSA, 2002.; "Your health in your hands. Ghana public-private partnership for handwashing.", CWSA presentation

1REACH_Success Practices_Handwashing_v9.ppt

• In 2002 9 M annual episodes of diarrhea and 15% of children had diarrhea in the past two weeks prior to survey• In Ghana an estimated 84 K children die each year from diarrheal diseases

– about 25% of deaths in children <5 are attribute to diarrhea

Description of specific country situation & social context:

Source: "Ghana washes her hands: A public-private-partnership." CWSA, 2002.; "Your health in your hands. Ghana public-private partnership for handwashing.", CWSA presentation

Draft – work in progress

Intervention description: deworming (II)

• Cambodia school deworming program (MoH)• Nepal school deworming program (WFP) and integration of

deworming in national Vitamin A supplementation (UNICEF)

Examples of successful implement-ations:

• Advocacy: Partners for Parasite Control (hosted at WHO)• Funding: Gates Foundation; Pan American Health and Education

Foundation, Japan, CIDA• Tablet donation / sales: MedPharm, Bayer, other pharmacos

• Ministry of Health, Education (if school program)• UN: UNICEF, WFP• NGOs Schistosomiasis Control Initiative (SCI); The

CORE Group; Project HOPE; International Save the Children Alliance; Save the Children; OXFAM; The Partnership for Child Development

• Need to select tablets based on local prevalence patterns, e.g. schistosomiasis primarily present in Sub-Saharan Africa; intestinal worms in sub-Saharan Africa, India, China and East Asia

Localization issues:

• National programs by PPC in Nepal, Guinea, Mexico, Egypt• Schistosomiasis Control Initiative (SCI): Burkina Faso, Mali, Niger,

Tanzania, Uganda, Zambia (at-scale)

Typical funding sources & advocates:

Coverage• # (or %) of children and P&L women

i i d i d (PPC d t b k

Outcome• Prevalence of STH/schistosomiasis

(PPC d t b k d di t )

Impact• DALYs/deaths associated with intestinal

t d i f ti / hi t i i

Metrics(italics=not

Typical implementers:

Draft – work in progress

Intervention description: deworming (I)

Intervention: Deworming

Children under 5; P&L women

Description of intervention (incl. goals & rationale/ potential impact):

~2 bn people (30% of world population) carry two varieties of helminths, or parasitic worms: soil-transmitted helminths (STH or intestinal worms such as hookworm, roundworm, and whipworm) and water-borne schistosomiasis. The intestinal obstruction deprives children of micronutrients, creating undernutrition, which leads to stunting, learning deficiencies and learning deficiencies. STH are mostly treated with either albendazole or mebendazole (alternatives: levamisole or pyrantel). Praziquantel is used for treatment against schistosomiasis(bilharzia). The treatment is safe (even when given to uninfected children) and helps to prevent undernutrition as it eliminates the parasites from the childrens' intestinal system. Albendazole treatment can be very cost effective with $2-9 per DALY averted (DCP 2).

Type: Physical component; education

• Deliver tablets to <5s via– Public health: health center, hospitals – UN facilities: distribute tablets at feeding centers

$ 0.05-1.00 per child per yearCosts perperson/hh:

REACH target group:Detail of delivery channels and

Atuando em escala :

4REACH_Successful practices_deworming_v11.ppt

1. PPC 2005 attendants with potentially practical implementation knowledge; Email addresses available in document 2. WHO Global burden of disease database

receiving deworming drugs (PPC databank depending on country)

• Quantity of drugs distributed (program data)

(PPC databank depending on country)• % of highly/moderately infected individuals

(PPC databank depending on country)

nematode infections/schistosomiasis(WHO2)

• % children<5/ P&L mothers with mild, mod-erate, severe anemia (MICS2)

• Dr Henrietta Allen, WHO, Partners for Parasite Control, [email protected]• Dr Antonio Montresor, WHO, Focal point for helminth control WPRO, [email protected]• Dr Donald Bundy, World Bank, Lead Specialist for School Health and Nutrition, [email protected]• Dr Andrew Hall, Centre for Public Health Nutrition, School of Integrated Health, University of Westminster, [email protected]• Ms Rita Bhatia, WFP, Public Health Nutrition, [email protected]

Key implementation experts:

available):

3REACH_Successful practices_deworming_v11.ppt

g– Mass campaign: National/regional (child) health days; national/regional micronutrient days

• Often delivered along with immunization, antenatal care, general health

Required materials:

• Tablets: – for intestinal worms: treatment 1-3 times per year (depending on the worm burden in the area) with one tablet of albendazole (400mg) or

mebendazole (500mg) per child/year (cost per tablet $0.02); dosage regardless of children's size or age– for schistosomiasis: single dose of Praziquantel (600mg) once a year ($0.08 per tablet; $0.20-0.30 per treatment); number of pills has to be

adjusted to the weight/size of the child for which a dose pole is usually used– heat-stable and require no cold chain; shelf life of up to 4 years

• Training materials for those delivering tablets (e.g. teachers, community workers, healthcare providers)• Educational materials to promote awareness and (if employed) hygiene behavior for mothers and children• Registration forms to track overall and individual multi-year coverage

• Deworming can potentially reduce anaemia by 5-10% in populations with high rates of intestinal helminthiasis4

• One dose of deworming tablets is associated with 0.24kg weight increase and 0.14cm in height (review of 25 studies of children aged 1-16)4

• Infant mortality for children of mothers who received 2 doses albendazole at 6 months fell by 41% in Nepal study5

• Deworming also increases micronutrient status for pregnant women: The mean decline in haemoglobin concentration between first and third trimester in women who received albendazole was 6·6 g/L less than in women who received placebo4

channels and methods:

1. WHO Factsheet Nr. 115. 2. "School Deworming." World Bank, 2003. 3. WHO. 4. "What works? Interventions for maternal and child undernutrition and survival." Bhutta et. al., 2008. 5. "Antenatal anthelmintic treatment, birthweight, and infant survival in rural Nepal." Christian et. al., 2004.

Scientific evidence of effectiveness & efficacy:

resumos


Abordagem do ciclo vital enfatizada

Ferramenta e modelo para calculo de custo foi desenvolvido

Cost per beneficiary (USD)

Cost per beneficiary (USD)

Reflecting direct costsReflecting

direct costs Allocation basisAllocation basisReflecting full program costsReflecting full program costs

Cost/child <5 (USD)

Increase micro-

nutrient intake

Micronutrient supp.

Micronutrient fort.

$9.26 per child <5

$0.36 per capita

9.26

0.36

• N/A

• Assumes 10% of population are children <5

9.26

3.55

Improve BF and CF BF / CF $2.50 per P&L woman 1.25 • N/A1.25

Improve diarrhea and

parasite

HH water treatment

Handwashing

Malaria: bednets

$4.00 per household

$1 per woman

$4.97 per child <5

0.80

0.50

4.97

• Assumes households include 5 ppl, including two <5s

• N/A

• N/A

2.00

0.50

4.97

Therapeutic feeding $283 per SAM child 9.91Increase

treatment of • N/A29.91

pcontrol

Malaria: IPT

Deworming

$1.36 per P&L woman

$0.38 per child <5

0.68

0.38

• N/A

• N/A

0.68

0.38

Therapeutic feeding $283 per SAM child 9.91SAM1

N/A9.91

Increase household

food security

Supp. feeding

Homestead food prod.

$50 per MAM3 child

$22 per household

3.25

4.40

• N/A

• Assumes households include 5 ppl, including two <5s

3.25

11.00

Total cost w/o CCT

Total cost including CCT

yCond. cash transfer (CCT)5

$56-339 per household 11 - 68

$36

$47 - 104

• Assumes households include 5 ppl, including two <5s28–170

$47

$75–217


1. SAM = severely acute malnourished. 2. No change, as <5s are the only beneficiaries. 3. MAM = moderately acute malnourished. 5. CCT costs are highly variable, based on local economic conditions, and often include conditions for behaviors beyond nutrition, e.g. education. Figures used include both administrative costs and the value of the transfer. Ranges include data on programs excluding relatively prosperous middle-income countries, e.g. Brazil and Mexico, which provide higher-value transfers. Costs do not include nutrition services deliveredNote: All cost / child <5 calculations assume 2 <5 children / household and per P&L woman. Average household size assumed to be 5, including 2 <5 children

Ferramenta pode ser utilizada para orcamentacaoFerramenta pode ser utilizada para orcamentacao

Select which interventions1 Review the initial estimates

5

Determine the number of

Select which interventions should be included in cost

calculation

2

of the demographic data and enter custom

estimates for your country, if available

Determine the number of beneficiaries in need for

each intervention (column Q): Who the beneficiaries are is shown in column O

to the left

Select the target coverage level in relation to the

3

level in relation to the number of beneficiaries in need for each intervention

(column S)

Select whether cost savings arising from

integrating interventions should be included in the

4


calculations

Algumas licoes aprendidas

1. As ferramentas de planejamento estrategico e1. As ferramentas de planejamento estrategico e “gestores/facilitadores” qualificados deve ser mais empregados no campo da nutricao

2. Uma abordagem abrangente requer foco e priorizacao

3. Profissionais nutricionistas devem assumir o papel central na facilitacao de processos de planejamento conjunto, resolucao de conflitos e promocao de mudancas gerenciais e operacionaisconflitos e promocao de mudancas gerenciais e operacionais, comunicacao e advocacia.

4. Os gestores em nutricao devem buscar uma maior interacao e “networking” para empoderamento individual e coletivo.


Algumas licoes aprendidas

5. A articulacao entre acoes de nutricao e de desenvolvimento agricola5. A articulacao entre acoes de nutricao e de desenvolvimento agricola deve ser buscada no livel local e operacional.

6. O uso da abordagem do ciclo vital e fundamental:

• E intuitiva e oferece uma boa estrutura analitica (situacional de• E intuitiva e oferece uma boa estrutura analitica (situacional, de capacidades e compromisso – ready, willing and able analysis)

• Facilita o processo de identificacao de solucoes-chave e o processo de definicao de prioridades

• Facilita a discussao sobre integracao operacional • Pode se traduzir em reducao de custos operacionais (a ser testado)• Pode se traduzir em reducao de custos operacionais (a ser testado)


…. To REACH those in need …. Juntem-se ao network…. To REACH those in need …. Juntem se ao network

www.reach-partnership.org

Obrigada


Documents

2.00 Denise Costa Coitinho.ppt [Modo de Compatibilidade]189.28.128.100/nutricao/docs/evento/seminario_internacional/11_11... · compromisso para atuar em escala • Apoio a gestao