Dr. Lalita BhattacharjeeTraining on Comparative Review of the Nutrition Situation

and Policies in Selected Countries and with particular reference to Bangladesh27 March to 6 April 2014

Introduction Nutrition issues and challenges Community based approaches and

strategies Conclusion

NutritionFood HealthAgriculture/Food supply/Service

PromotionProtectionTreatment

Nutrition is a link between food and health, Fulfillment of nutrient and non-nutrient

requirements from food in human life cycle.

Ultimate goals are food and nutrition security for all

Individual/Family&

Community as Core

Consumption

Consumer protection

Food processingFood production

Utilization

Nutrition labelling

Food-based dietary guidelines

Food combinationsFortification

Rice/cereals LegumesFish ChickenEggs VegetablesFruits Dairy

Monitoring and Surveillance

Health service &Caring practicesFood & Nutrition Programmes•Prevent & control malnutrition•School meals, etc.

Supplementation with micronutrients/food (food to food enrichment)

Food fortification Food regulation and legislation Nutrition education/communication (BCC) Food based approach: ensuring food

security/consumption of safe and nutritious food

Public health measures: basic services, immunization, sanitation, deworming …

Community based (integrated) approaches

6

Service driven programmes Service driven programmes

IndividualIndividualHouseholdHouseholdCommunityCommunity

- - Vertical, many become welfare oriented Vertical, many become welfare oriented- Little intra/inter- Little intra/inter sectoral coordination sectoral coordination- Little people /community participation- Little people /community participation- Dependency creation- Dependency creation- Not sustainable- Not sustainable- Inadequate coverage- Inadequate coverage

Community ownershipAdequate population coverageTargetingCentral/local support e.g. training, supplies, information

*Source: Mason, J, Tontisirin K (2000)

Ante-natal care Women’s health and nutrition Breastfeeding Complementary feeding Growth monitoring (and promotion) Micronutrient fortification Supplementary feeding-external supplies/local

supplies Oral rehydration therapy (ORT) Immunization deworming*Mason, J, Tontisirin K (2000)

1. Fortification2. Infant formula code3. National information, education, and

communication e.g. FBDGs, food labelling4. National (FS&N) information systems

Main requirements/features for some components in localprogrammes.

ComponentSuitability of:

Community-based Service delivery,facility based

Local organization (e.g. VNWs) Antenatal care Infant feeding Growth monitoring Micronutrient supplementation Supplementary feeding Immunization, ORT Deworming Health referral NA

Day care —

Water/sanitation Microcredit —

Forging the link between government and community

Are service providers (government, NGOs) in health, agriculture, education, rural development and so forth at village, sub district and district level providing training, information, supervision, and support community based programs

Could be village/community volunteers or block representatives or any support groups

Ideally, selection should be based on sociogram (1 per 10-20 HH), followed by training and supervision and support

Act as “change agents” linking service providers/facilitators and people, and also act as “communicators”

Help to reach the unreachable and increased coverage e.g. ANC, GMP, and immunization

A set of goals which could be used as indicators for individuals and community

Maybe also called essential minimum needs (EMN)

MDGs goals, targets and indicators could be adapted to be used as BMN

Once BMNs have been achieved, other indicators could be emerged e.g. prevalence of overweight and obesity, D.M

Some examples of BMNs: -ANC and safe delivery services coverage -prevalence of LBW -prevalence of under wt. and stunting of under 5 -IDD goiter rate or urinary iodine -Immunization coverage -HH with hygienic latrine -Adequate clean drinking water -Literacy rate in adults -primary and secondary education rate -Etc…

Kraisid Tontisirin 2007, Mahidol University

Thailand’s Nutrition Security Compact

Eliminate severe, moderate and mild protein-energy malnutrition (PEM).

Monitor growth among all pre-school children and provide food supplements where needed

Mainstream nutrition in health, education and agricultural policies

Encourage breast feeding and organise school lunch programmes

Promote home gardening, consumption of fruits and vegetables, aquaculture and food safety standards

Introduce an integrated food safety net with emphasis on household food and nutrition security.

Retrain and retool existing staff and mobilise community volunteers. Choose one community volunteer for every 10 -15 households and build their capacity.

Under the umbrella of the Poverty Alleviation Plan (PAP) targeting to the poor areas to achieving BMN

Primary Health Care (PHC) and Food and Nutrition Plan (FNP) have been incorporated in the PAP

Nutrition has been used as a goal and indicator

Kraisid Tontisirin 2007, Mahidol University

4 ANC for all pregnant mothers Nutrition and health education Food supplementation if needed MTV, iron and folate supplementation Two tetanus toxoids High risk identification and treatment Referral system and safe delivery service Etc..

Kraisid Tontisirin 2007, Mahidol University

Promotion, support and protection of BF Adequate and appropriate CF, food prepared at

HH, community, and also at commercial level Growth monitoring and promotion (GMP) -monitor wt and ht gains -follow up actions based on nutritional status

Kraisid Tontisirin 2007, Mahidol University

Home and school gardens growing vegetables, fruits, fish and chicken for learning, consumption and income

food preservation and processing Proper marketing for surplus products Cooperatives and micro credit

Counseling on nutrition and health e.g. food for pregnant and lactating mothers,

BF/CF, child growth and development Resource allocation in home and outside Promote FBDGs Access to health services

Nutritional assessment/surveillance Food services--school lunch/meals Basic food, personal and environmental

hygiene School gardens Nutrition education Promotion of physical activity and exercise Positive school environment for healthy diets

Kraisid Tontisirin 2007, Mahidol University

Minimum Basic Services(Health, Education, Agr. Extension)

Minimum Basic Services(Health, Education, Agr. Extension)

Supportive System•Training•Funding

•Problem Solving•Supervision

Interface(service providers and

community leaders)•Plan/goals

•Implementation•Monitoring/evaluation

Community LeadersFamily

Individual

Basic Minimum Needs Goals/IndicatorsBasic Minimum Needs Goals/Indicators

Menus (Menus (ActivitiesActivities))•Food productionFood production•Nutrition educationNutrition education•Food sanitation & safetyFood sanitation & safety•ANCANC•GMPGMP•BF/CFBF/CF•Other activitiesOther activities

Mobilizers(1:10 households)

Facilitators

Components of a successful community based program Components of a successful community based program

Kraisid Tontisirin 2007, Mahidol University

Top down policy supportStrengthening district and village level leadership

Training of critical mass of community collaborators

Expanding network of community collaborators

Community based approach to prevent and control malnutrition is an integrated program implemented at local level, below district level

National and local leadership and commitment to nutrition improvement, policies and goals, must be combined with basic services, mass mobilization to reach the unreachable, people empowerment and actions at community level

Successful experience of community based approached should be adapted/revitalized in prevention and control of double burden of malnutrition (DBM) and NCDs