Sahel Micronutrient Initiative IIThe Sahel Micronutrient Initiative Phase II Strengthening vitamin A and iron programs in West Africa Center lile: 910313-00131210-181 Final Technical

The Sahel Micronutrient Initiative Phase II Strengthening vitamin A and iron programs in West Africa Center lile: 910313-00131210-181

Final Technical Report March 2001 — April 2003

I

pnur iicron ii Lri

(,r -

/ , ) - I -

Helen Kefler W 0 R L L' W U 1

Helen Keller International the international division of helen Keller Worldwide

Submitted to:

This t

Abidjan, July 4, 2003

RIMSD

Text Box

This report is presented as received by IDRC from project recipient(s). It has not been subjected to peer review or other review processes. This work is used with the permission of Helen Keller International. © 2003, Helen Keller International.

TABLE OF CONTENTS

Acronyms, Abbreviations, Special Term. 2

Background and Executive Summnaiy 3

Regional 5

Burkina Faso 14

Mali 21

Niger 25

Nigeria 29

Sahel Micronutrient Initiative II Strengthening vitamin A and iron programs in West Africa

Final Technical Report for Phase II Page 1 of 34 July 4,2003


Center File: Center file: 910313-00131210-181

Final Technical Report for Phase II March 2001 — April 2003

Acronyms, Abbreviations, Special Terms APOC African Program for Onchocerciasis Control BCI Behavioral Change Intervention CDD Community-directed distributor CDTI Community-directed treatment with ivermectin (for control of onchocerciasis) CNN - Centre National de Ia Nutrition —

CRAN Centre Regional de Reeherches en Alimentation et Nutrition CRS Catholic Relief Services ECOWAS Economic Community of West African States FAO Food and Agricultural Organization of the United Nations FOD Focus Group Discussion FRAT Fortification Rapid Assessment Tool GTZ Deutsche Gesellschaft für Technische Zusammenarbeit HKI Helen Keller International (the international division of Helcn Keller Worldwide) ICCIDD International Council for Control of Iodine Deficiency Disorder IDEA an anemia control project IEC Information, Education, Communication IMCI________ Integrated Management of Childhood Illnesses INACG International Nutritional Anemia Consultative Group IVACG International Vitamin A Consultative Group KAP Knowledge, Attitude and Practice LGAs Local Government Areas LOCT Local Onchocerciasis Control Team Mectizan® Iverinectin, drug used for onchocerciasis control, donated by Merck & Co. MIS Management Information System MOH Ministry of Health MPA Minimum Package of Activities NIDs

-

National Immunization Days NMDs National Mieronutrient Days NNA Nutrition News for Africa PHC Public Health Care PNAN Plan National d'Action pour Ia Nutrition PROFILES An evidence-based nutrition advocacy analysis RMDs Regional Micronutrient Days SASDE Stratégie d'Accélération dc Ia Survie et du du Jeune Enfant SOCT State Onchoeerciasis Control Team UNICEF United Nations Children's Fund URTL Union des Radiodiffusions et Télévisions Libres du Mali. USAID United States Agency for International Development VAD Vitamin A deficiency WAHO West African Health Organization WHO World Health Organization



Sahel Micronutrient Initiative II Strengthening v/tam in A and iron programs in West Africa CenterFSe Centerfile: 910313-00131210-i81

Technical Report for Phase II Narch 2002 — April 2003

l3ackground and

The Micronutrient Initiative Keller International (the international division of Helen Keller Worldwide) share a COflOfl goal of assisting countries in achieving the micronutrient objectives of the World SUmt for Children, with a particular focus on populations in greatest need. Discussions between Initiative and Helen Keller International on a Partnership in West Africa einforce rnicronutrient programs started in early 1997. Three target countries were selec' Burkina Faso, Mali and Niger. This choice was made based on the \'ery high levels of and Helen Keller International's history olpartnership in these three countries. They ha\ combi dpopulation of roughly 30 million people, of whom 3.9 tflillion are under five For the current phase of the project, we included a component in tW0 States in Nigeria, we work with partner organizations to implement community-

treatment (CDTI) for control of river blindness. Because of the focus on fortification, with its major food fortification potential, has started to play a

kirger role in the final technical report covers the period March 2002 to April 2003. FascS estimated that 59% of children under five are at risk of VAD, a total of chjjdjand that adequate vitamin A interventions could avert 20,500 child

deaths per year.

In Mali it is esiated that 79% of children under five are at risk of VAD, or 1,663,200 Children and adequately controlling vitamin A deficiency could avert the deaths of 27,900 childr( year.

In Niger it jqstimated that 55% of children under five are at risk of VAD, or 1,270,060

children controlling VAD could avert the deaths of over 27,500 children under

five per yeai

'a Nigeria .t is estimated that 35% of children under five are at risk of VAD, meaning

i,934,400 children. These analyses indicate that adequately controlling VAD in Nigeria

ould avert 102,000 child deaths per year. )verall directions of the second phase are:

VO, V. et al. Vitamin A Deficiency and Child Mortality in sub-Saharan Africa: A Reappraisal of Challenges

portunities. Helen Keller International — Africa Nutrition Working Papers. September 2002. Sahel Micronutrient Initiative II Strengthening vitamin A and iron programs in West Africa Final Technical Report for Phase H Page 3 of 34 July 4, 2003 /

• Accelerating large-scale fortification in West Africa and pilot-testing approaches for small- scale fortification.

• Maintaining high levels of coverage with vitamin A, focusing on strategies that will be able to replace NIDs as they are phased out.

• Scaling-up ironlfolate supplementation for pregnant women, with the option of modifying to replace ironlfolate with multi-micronutrient supplements as warranted (following outcomes of ongoing trials sponsored by UNICEF and other donors).

• Developing a core package of nutrition education that should take place in all health centers in each of the three initial countries, and provide health workers with materials and training in their use, based on results of regional nutrition IEC workshop.

• Institutionalizing micronutrient training into pre-service training, in Burkina Faso, Mali and Niger, and also at a regional level.

• Reinforcing partnerships with regional structures, particularly the West African Health Organization (WAHO) to promote fortification, institutionalize micronutrient training into pre-service training and provide 'as needed' technical assistance to partners in non-project countries.

The overall goal of this project is to support national governments and other partner organizations in sustainably reducing vitamin A and iron deficiencies thereby contributing to reduction of child and maternal deaths and improved health and well being. Country-specific objectives have been discussed in other reports.

Overall, the project has been implemented successfully. In Burkina Faso, Mali and Niger, over 75% of children 6-59 months have received vitamin A capsules twice per year during the first year of the project. In Nigeria, vitamin A coverage estimates in CDTI zones exceed those proposed. Côte d'Ivoire has been an active participant in the project since the start-up workshop. Regional efforts in networking, promotion of food fortification and information dissemination have been very successful. The major delay has been implementation of large-scale food fortification. While much progress was made in Fortification Rapid Assessment Tools (FRATs), industry assessments and a regional private sector-public sector dialogue, there has not yet been a new fortified food product put on the market directly because of the efforts of this project. This delay is mainly linked to international and regional instability. The events of September 11, 2001 delayed the sending of international consultants to undertake industry assessments, delaying the whole process. A last-minute decision by the UN system in July 2002 to postpone all travel into Côte d'Ivoire postponed the food fortification dialogue by three months. The attempted military coup on September 19, 2002 in Côte d'Ivoire and the subsequent civil war that is only now being resolved, greatly delayed food fortification efforts. However, there are two vitamin A-fortified cooking oils on the West Africa market, one in Côte d'Ivoire and one in Ghana, and the project's advocacy contributed to an environment favorable to this process. Furthermore, we have been



informed that the second largest cooking oil producer in Côte d'Ivoire plans on fortifying its oil by August 2003, and has already ordered the fortificant. This is more directly linked to the project's advocacy, as there have been a number of advocacy meetings with this company.

Regional

Achievements:

IVACG Hanoi

The 25th meeting of the Vitamin A Consultative Group (IIVACG) was held in Hanoi, February 5-8, 2001. Twenty-eight counterparts and HKI staff members from Africa attended, including from Burkina Faso, Cameroon, Guinea, Mali, Morocco, Mozambique, Niger, Nigeria, South Africa and Tanzania. Seven posters were presented based on the experiences of HKI and our partners: • Networking to Strengthen Vitamin A Programs in West Africa. • Beyond NIDs: Niger's experience in organizing National Micronutrient Days. • Identifying appropriate vitamin A-rich sweet potatoes for Niger. • Integrating vitamin A into National Immunization Days in Mozambique. • Change in key vitamin A indicators in a Child Survival program in Niger • Integrating Delivery of Micronutrient Services in Morocco. • Developing a Community Approach to Combat Micronutrient Deficiencies in Morocco.

Immediately following the IVACG meeting, the International Nutritional Anemia Consultative Group (INACG) meeting was held, and was attended by the same participants. Travel to both meetings for some West Africa participants was funded by the Micronutrient Initiative from Phase I monies, with prior approval.

Project Start-up Meeting

The Phase II project start-up workshop was held in Ouagadougou, April 25-27, 2001. Participants included nutrition and health education staff from Ministries of Health of Burkina Faso, Mali, Niger and Nigeria, the nutrition focal point from Côte d'Ivoire, representatives from UNICEF, Catholic Relief Services, Save the Children and Groupe Pivot Sante/Population, and Helen Keller International staff. The meeting was opened by the Secretary General of the Ministry of Health of Burkina Faso, the Director of the African Program for Onchocerciasis Control and HKI's Regional Director for Africa.

IDEA Conference

The Africa region was well represented at the IDEA Project workshop "Forging Effective Strategies for Combating Iron Deficiency", held in Atlanta, Georgia, May 6-9, 2001. Country



Representatives from Burkina Faso and Niger, the Director of Nutrition of the Ministry of Health of Côte d'Ivoire, the Provincial Coordinator from Mozambique, a representative from the Nutrition Division of the Ministry of Public Health of Mozambique, the Child Survival Project Coordinator from Niger, the Africa Regional Advisor for Nutrition and Child Survival and the Regional Director for Africa attended, as did the Deputy Director for Nutrition from headquarters and the Regional Director for Asia. Six posters were presented based on our partners' and our work in Africa: • Distributing iron through a campaign approach: The experience in Mali.

• Increasing demand for ironlfolate in pen-urban Mali. • Community-based distribution of ironlfolate in Niger. • Improving iron supplementation in a child survival program in Niger. • Iron Supplementation Programs Reaching Beyond Pregnant Women: How Feasible and

Costly is this for Africa? • The impact of weekly school-based iron supplementation on school children in Mali.

This was an important forum to disseminate lessons learned from MI-supported work in West Africa.

West Africa Food Fortification Meeting in Atlanta

Immediately following this workshop, on May 10, the Micronutrient Initiative and Helen Keller International co-hosted a half-day workshop on food fortification in West Africa. Presentations included a review of the findings of the FRAT studies (Fortification Rapid Assessment Tool) from Burkina Faso, Mali and Niger, a review of Côte d'Ivoire's experience and perspectives in fortification, a summary of different strategies for large-scale and small-scale fortification and their potential in the region, a review of the nutrition focal points network in West Africa and the West Africa health organization and future plans for fortification. A report of the workshop was prepared by the Micronutrient Initiative.

Sixth Annual ECO WAS Nutrition Focal Points Meeting

The sixth annual ECO WAS Nutrition Focal Points meeting was held in Accra, Ghana, in September 2001. 1-11(1 played a key role in the organization of the meeting. Over 100 people attended. Banjul, The Gambia was selected to host the meeting in 2002, Conakry, Guinea was selected for 2003 and Cap Verde was selected for 2004.

WHO-UNICEF-ilK! Micronutriellt Meeting for Francophone Africa

Helen Keller International took the lead in organizing the WHO inter-country workshop on micronutrients for Franchophone Africa, which was held in Niamey, March 26-29, 2002. Other agencies who participated included UNICEF, FAO, WAHO, ICCTDD and BASICS. Twenty- three countries were represented. Major themes discussed included vitamin A supplementation, particularly with the phasing out of NIDs, and food fortification. There was a side meeting of the Africa micronutrient Task Force. Recommendations involved strong support for food fortification and for post NIDs vitamin A supplementation.

Sahel Microitutrient Initiative II Strengthening vitamin A and iron programs in West Africa

Final Technical Report for Phase II Page 6 of 34 July 4, 2003

Coordination of Industry Assessments

The Micronutrient Initiative and Helen Keller International, in collaboration with local governments and industries, coordinated the visit of a number of food fortification consultants to

assess the feasibility of fortifying different food vehicles. The selected industries included sugar (Burkina Faso, Côte d'Ivoire, Mali); flour (Burkina Faso, Côte d'Ivoire, Mali, Niger); cooking oils (Burkina Faso, Côte d'Ivoire, Mali) and bouillon cubes (Burkina Faso, Côte d'Ivoire, Mali). In addition, as a follow-up to a FRAT carried out in Guinea with funding from the World Health Organization (WHO) and the United States Agency for International Development (USAID), the two agencies jointly organized an assessment of the wheat flour mill in Conakry. Potential for small-scale fortification was also assessed: shea nut butter in Burkina Faso, complementary foods in Mali and millet flour in Niger. In preparation of the regional food fortification dialogue, the Micronutrient Initiative prepared a summary of the assessments

Private Sector-Public Sector Dialogue on Food Fortification in West Africa.

The Micronutrient Initiative, WAHO, HKI, the National Nutrition Program of Côte d'lvoire and UNICEF started organizing the Private Sector-Public Sector Dialogue on Food Fortification in

West Africa. The dates were set as July 9-11, 2002 in Abidjan. Unfortunately, on July 4, the United Nations System in Côte d'Ivoire decided to cancel all travel into Côte d'Ivoire because of legislative elections. As UNICEF is one of the co-organizers, this made it impossible to hold the dialogue. The HKI regional office took the lead in informing partners and making arrangements. The new dates were set for October 15-17, 2002. The attempted military coup in Câte d'Ivoire on September 19, 2002 and the subsequent civil war made organizing the workshop impossible in Abidjan. HKI took the lead in moving the workshop to Accra, Ghana, and the dialogue was successfully held with over 100 participants. A full report has been prepared in English and in

French and will be published on the WAHO nutrition web site (by HKI) and on CD-ROM (by MI).

Specific follow-up steps have been identified to ensure that specific foods will be fortified in the next year, focusing on Burkina Faso, Guinea, Mali and Niger (cooking oil in Burkina Faso, Mali and Niger and wheat flour in Guinea). This proposal has been submitted to the Micronutrient Initiative.

Seventh Annual ECO WAS Nutrition Forum

The seventh annual ECOWAS Nutrition Forum (formally called the ECO WAS Nutrition Focal Points meeting) was held in Banjul, The Gambia, September 2-6, 2002. HKI provided support to the planning and organization of the meeting with support from the Micronutrient Initiative. The technical theme this year was "Nutrition: Key to Sustainable Development". HKI was requested by the organizers to take the lead in organizing the technical update and received additional funding from the World Bank to do so.



In order to make the WAHO nutrition web site more easily identifiable, it has been renamed www.nutritionecowas.org (it can still be accessed through www.pfnutrition.org or

www .nutritionwaho org).

Eight Annual ECOWAS Nutrition Forum

The eighth annual ECO WAS Nutrition Forum will be held in Conakry, Guinea, September 15-

19, 2003. The technical theme this year will be "Micronutrient Malnutrition the way forward".

HKI has facilitated contacts between WAHO and the Micronutrient Initiative, and MI will

coordinate the technical update. HKI continues to provide support to the planning process both at

the regional level, and in Guinea.

Nutrition Focal Points Network of Central Africa and Madagascar The ECO WAS experience has inspired the countries of Central Africa and Madagascar to set up

their own nutrition focal point network. The inaugural meeting was held in Kinshasa,

Democratic Republic of the Congo, October 7-11, 2002. HKI was requested to take the lead on

organizing the technical sessions, and provided support through the Micronutrient Initiative

project.

Support to WAHO

We continue to reinforce our relationship with the WAHO. In addition to the joint activities described above, we were invited to the Committee of Health Experts and the Assembly of Health Ministers meetings in Dakar, Senegal, July 22-23, 2002. HKI made a presentation entitled

"Vitamin A deficiency and child mortality in West Africa: A reappraisal of challenges and

opportunities". This was a critical opportunity to influence policy across all 15 ECO WAS

countries to improve support for vitamin A programming.

UNICEF Vitamin A Strategic Plan

The regional director for Africa was requested by UNICEF to draft a vitamin A strategic plan for

UNICEF. (UNICEF provided payment of salary during for this effort.) This has been an

excellent opportunity to inform international policy based on lessons learned from this project, and other Micronutrient Initiative-supported activities in Africa. A first draft was submitted to

UNICEF at the end of April 2002 and a second draft with revisions was submitted at the end of May 2002. The regional director has continued to provide input to the finalization of the plan and

the latest version was issued in April 2003. This version, while still officially a draft for comments, is being used by UNICEF country offices and partners in West Africa. A copy is

attached in Appendix 1.

Re-assessment of Levels of Vitamin A Deficiency in sub-Saharan Africa

Based on national-level prevalence surveys of vitamin A deficiency (VAD) that have taken place

since 1995 in a number of countries in sub-Saharan Africa, we have been undertaking analyses to

re-assess the magnitude of the problem in the region. Analyses would indicate that adequate vitamin A programming could avert 228,000 child deaths in ECO WAS and over 640,000 child



deaths in all of sub-Saharan Africa. An article on VAD in ECO WAS, jointly written with the

Director General of WAHO, has been submitted to the Bulletin of the World Health Organization; reviewers' comments have been received and responded to. An article on VAD in

all of sub-Saharan Africa has been submitted to an international peer-reviewed journal. This

analysis has been critical in mobilizing increased support for vitamin A programs in sub-Saharan

Africa. Results of the analysis have been presented at the Assembly of Health Ministers of the

West African Health Organization, at IVACG, at the Seventh Annual ECO WAS Nutrition Forum and at the technical meeting for preparation of the health component of the New

Partnership for African Development (NEPAD).

Information Dissemination

A. International Vitamin A Consultative Group (IVACG) and International Nutritional Anemia Consultative Group (INACG):

The International Vitamin A Consultative Group (IIVACG) and the International Nutritional Anemia

Consultative Group (INACG) meetings were held in Marrakech, Morocco, February 3-6, 2003. The

HKI Morocco office was a member of the local organizing committee and both meetings were an

excellent opportunity to showcase the achievements of the Africa programs in controlling vitamin A

deficiency and anemia. A total of 2 1 presentations were made by HKI staff and partners based on

our work in Africa, of which five were oral presentations:

• Ensuring vitamin A supplementation through routine health sevices in Mozambique. c Ismael, S Khan, V Van Steirtighem, and S Meershoek. Ministry of Health (CI, SK), UNICEF (VVS),

and Helen Keller International (SM), Maputo, Mozambique. (oral presentation)

• Using community-directed treatment with ivermectin (CDTI) as a vehicle for for vitamin A

supplementation in Nigeria. MA Obadiah, SK Baker, VM Aguayo, S Ogiri, A Nyam, and D

Almustafa, and B Oguntona. Helen Keller International-Nigeria (MAO, OS AN), Helen Keller International-Africa Region (SKB, VMA), and IJNICEF-Bauchi (DA), and University of Agriculture/Abeokuta (OB). (oral presentation)

• Maintaining high vitamin A supplementation coverage in a resource-poor environment: lessons from Niger H Hamani, X Crespin, A Mamadoultaibou, MB Tidjani, SK Baker, and YM Aguayo. Helen Keller International-Niger (HH, XC, AM), Ministry of Health (MBT), and Helen

Keller International-Africa Region (SKB, VMA). (oral presentation)

• Regional micronutrient days in Mali. A Cissé, D Koné, M Bore, K N'Diaye, SI Bamba, KZ

Waltensperger, and VM Aguayo. Helen Keller International-Mali (AC, DK, KZW); Ministry of Health and Social Affairs (MB, KIN, SIB); Helen Keller International-Africa Region (VMA).

Implementation of vitamin A supplementation in South Africa. ME de Hoop, A N

Mazibuko, J Matji, SK Baker, C MacArthur, Z Sifri. National Department of Health (MEH, AG,

NM); UNICEF (JM); Helen Keller International (SKB, CM, ZS).

• The potential contribution of vitamin A deficiency control to child survival in sub-Saharan Africa. VM Aguayo and SK Baker. Helen Keller International-Africa Region.



• Vitamin A deficiency and anemia in children and women: findings from a national-level survey in Mozambique. R Thompson, S Khan, C Ismael, V Van Steirtighem, A Assante, SJ

Meershoek. Ministry of Health (RT, SK, CI), UNICEF (VVS), WHO (AA), and Helen Keller

Intemational (SJM).

• Bleached red palm oil and vitamin A status of Cameroonian children. D Sibetcheu, M

Nankap, IN Tata, AA Ntonga, B Kollo, MM Gimou, and NJ Haselow. Ministry of Public

HealthlCameroon, Centre Pasteur!Cameroon, and Helen Keller International/Carneroon.

• Addressing vitamin A deficiency through diet diversification, a first inMpumalanga Province, South Africa. L Viljoen, C MacArthur, Z Sifri. Department of Health-Mpumalanga, South Africa; Helen Keller Intemational.

• Food fortification vehicles for the control of vitamin A deficiency in West African women and children: findings from a multi-country study in Burkina Faso, Guinea, Mali and Niger. VM AguayQ, NM Zagre, M Ag Bendech, A Nanema, A Ouedraogo, SK Baker. Helen Keller International-Africa Region (VMA, NZ, MAB, SKB); WHO-AFRO (AN, AO).

• Micronutrient health in Mali: pre-service training and health worker practice. A Cisse, A

Coulibaly, F Ouattara, A Telly, KZ Waltensperger, VM Aguayo. Helen Keller International (HKI)-

Mali (AC, AC, FO, AT, KZW); HKI-Africa Region (VMA).

Developing a community-based approach to gardening in Burkina Faso: the role of female village social workers. 0 Vebamba, F Guidetti, Z Sifri, Bendech. Helen Keller International- Burkina Faso (OV, ZS, MB) and UNICEF-Burkina Faso (FG).

• Integrated community development to control vitamin A deficiency. Dr. FZ Akalay, Pr. D.

Bensaid, Helen Keller International-Morocco.

• Improving the vitamin A status of populations: a Non-Governmental Organization perspective on present and future challenges in Africa. SK Baker, HKI-Africa Region. (oral

presentation)

• Traditional birth attendants can successfully ensure community-based supplementation of pregnant women with iron/folate. H Hamani, X Crespin, A Mamadoultaibou, MB Tidjani, SK

Baker, and VM Aguayo. Helen Keller International-Niger (HH, XC, AM), Ministry of Public Health (MBT), and Helen Keller International-Africa Region (SKB, VMA).

• Using data to advocate for anemia control in Cameroon. D Sibetcheu, M Nankap, AA Ntonga, B Kollo, A Toko, F Nissack, NJ Haselow, and VM Aguayo. Ministry of Health/Cameroon, UNICEF/Cameroon, WHO/Cameroon, Helen Keller International/Cameroon and Regional Office.

• Impact of an integrated school health program on the prevalence of anemia among school children in rural Burkina Faso. M Saka-Kaboré, A Tarini, Z Sifri, M Ag Bendech, EM Ilboudo and

SK Baker. Catholic Relief Services (MSK); Helen Keller International-Burkina Paso (AT, ZS, MB); Centre national pour la nutrition, Burkina Faso (EMI); Helen Keller International-Africa Region (S KB).

• Acceptability of daily iron/folate versus multiple micronutrient supplements by Malian pregnant women. VM Aguayo, D Kone, B Diallo, D Traore, P Signe, D Kagnassy, and SK Baker.



Helen Keller International-Africa Region (VMA, SKB), Helen Keller International-Mali (DK),

Ministry of Health-Mali (BD, DT, DK), and UNICEF-Mali (PS).

Anemia in Guinea: a severe public health and social development problem. Can it be

controlled through a programmatic focus on adolescent girls? M Donzo, A Camara, A

Toure, AB Bah, A Barry, MC Messier. National Institute for Nutrition and Child HealthlINSE (MD,

AC, AT); National Service for School and University Health (ABB); Stat-View Association (AB);

Helen Keller International-Guinea (LM, MCM).

Anemia in adolescent schoolgirls in rural Mozambique: a cross-sectional survey. S

E Wetzler, J Roley and C MacArthur. Helen Keller International-Mozambique.

• Panel discussion on iron/folate supplementation of pregnant women in Mali. Amenatou

Cisse, Helen Keller International-Mali (AC). (oral)

Thirteen of the presentations are based on work supported by the Micronutrient Initiative.

B. Nutrition News for Africa

Nutrition News for Africa (NNA) has become a major vehicle for disseminating relevant

nutrition information to key program managers throughout Africa in French and English. The

concept used in the first phase was a liaison bulletin. This has evolved into the current electronic

format. Every two weeks, a recent article concerning nutrition is identified and a summary is

prepared in French and English, highlighting the major points relevant to nutrition programs in

Africa. Since January 2003, a Portuguese version has been added. The summary and the attached

article are disseminated via e-mail. Subscription is active, in that persons request to be added to

the distribution list. As of April 2003, over 1,000 people have subscribed to the service.

C. African Journal of Food, Nutrition, Agriculture and Development (AJFNAD)

The AJFNAD is a new, peer-reviewed journal focusing on food and nutrition issues in Africa.

An article on PROFILES analysis in Côte d'Ivoire was published, and we have provided

assistance to the journal including translations of summaries into French, identification of

reviewers for articles written in French and encouraging submission of articles from

Francophone contributors.

D. APOC and OCP Donors Conference

We have been invited to make a presentation on integration of vitamin A into Community-

Directed Treatment with Ivermectin (CDTI) at the donors conference for the Onchocerciasis

Control Program (OCP) and the African Program for Onchocerciasis Control (APOC), in

October 2002.

Technical Assistance

In addition to the activities listed above, we were able to respond to two other specific technical

assistance requests. In Côte d'Ivoire we provided technical and financial assistance to organize a



) )

workshop to develop a proposal for submission to the Global Alliance for Improved Nutrition (GAIN) for food fortification. The draft proposal will be revised when the final GAIN Request for Proposals is posted.

The nutrition focal point of Sierra Leone requested assistance to undertake a PROFILES analysis. The two-week workshop was organized April 15-26 and attended by 15 senior policy advisors from 10 ministries.

Under separate funding from USAID and WHO, we lead a FRAT study in Guinea. Following this, MI and HKI collaborated to have industry assessments undertaken.

Opportunities and Constraints:

The major opportunities that have been seized are: the increasingly strong collaboration with WAHO, the formation of the Nutrition Focal Points Network for Central Africa and Madagascar, the potential for food fortification in Côte d'Ivoire, the request of Sierra Leone to undertake a

PROFILES analysis and UNICEF's undertaking the development of a global strategic plan for

vitamin A, focusing on vitamin A supplementation. Each of these has been discussed above. In

addition, lessons learned from both the first and current phase of the project in vitamin A

supplementation are being applied to five more countries (Cameroon, Côte d'Ivoire, Guinea, Sierra Leone and Togo) through leveraging of funding from the Canadian International Development Agency (CIDA), through UNICEF.

Through the period of this project, there have been a number of constraints, however, in general, they have been successfully managed.

The UNICEF Regional Nutrition Advisor has taken another position with UNICEF, and the new

advisor has not yet been named, leaving the post vacant for over a year. Given the strategic importance of the relationship with UNICEF in the region, this transition has slowed down some joint activities. HKJ was obliged to take a far greater leadership role in organization of the

regional food fortification dialogue than was originally planned. We maintain close contact with the Regional Health Advisor, who is following the nutrition portfolio until the new Regional Nutrition Advisor is appointed. However, the move of the UNICEF regional office to Dakar, Senegal, due to instability in Côte d'Ivoire (see below) has made contact more difficult. We maintain close contact with the UNICEF nutrition section in New York.

International and regional instability have had an impact on slowing down implementation of some activities, particularly large-scale food fortification. Helen Keller Worldwide headquarters were destroyed during the events of September 11, 2002 in New York City. During the same week, there was major inter-communal violence resulting in over 500 deaths in los, Nigeria, where our country office is located. These events resulted in certain delays in program implementation. There was a moratorium on international travel in the wake of September 11

(the Micronutrient Initiative also suspended travel). The industry assessments had to be delayed, leading to delay of the entire planning process for the food fortification dialogue.


Final Technical Report for Phase 11

Page 12 of 34 July 4, 2003

) )

Just prior to the events of September 11, the regional office for Africa was relocated from

Niamey, Niger to Abidjan, Côte d'Ivoire. Office set-up, establishment of communications and

staff recruitment required considerable effort at a time when the agency was in a very strained

situation.

The United Nations System in Côte d'Ivoire suspended all travel immediately prior to the

planned dates of the West African Food Fortification Dialogue. Since UNICEF is a co-organizer

of the meeting, and the participation of other UN agencies was anticipated, we were obliged to

re-schedule the meeting to October 2002. This again delayed overall implementation of food

fortification in the region.

On September 19, 2002 there was an attempted military coup in Côte d'Ivoire and a civil war

ensued. This made organizing the workshop impossible in Abidjan. HKI took the lead in moving

the workshop to Accra, Ghana. This required mobilization of far more HKI human resources

than originally planned. The security situation in Côte d'Ivoire has remained precarious since the

September 19 events, reducing the amount of travel possible and slowing down food fortification

efforts in Côte d'Ivoire.

Unrelated to September 11, air transportation in the region became increasingly difficult, with

the bankruptcy of the major regional carrier, Air Afrique. This, combined with the bankruptcy of

Swiss Air and Sabena increased the difficulties of traveling within the region. This was

particularly a factor in moving the regional food fortification dialogue from Abidjan to Accra.

The situation has improved with the emergence of new national companies.

Future Plans

Overall the partnership between the Micronutrient Initiative and Helen Keller International in

this project has been very successful. Several joint activities are planned or already started as a

direct result of this project, and several more are anticipated:

• Support to vitamin A supplementation outside of National Immunization Days (NIDs) in

Burkina Faso, Mali and Niger. This 18-month project has been approved by the

Micronutrient Initiative and implementation has started.

Accelerating large-scale food fortification in West Africa. This joint one-year work plan and

budget have been submitted to the Micronutrient Initiative and implementation is planned to

start within one month. The effort will target fortifying cooking oil with vitamin A in

Burkina Faso, Mali and Niger and fortifying wheat flour with iron in Guinea.

• Expansion of integration of vitamin A supplementation into CDTI in Nigeria. HKJ has

worked with CDTI partners, UNICEF, the Federal Ministry of Health Nutrition Division and

the National Primary Health Care Development Agency (NPHCDA) to develop a joint

proposal for vitamin A supplementation outside of NIDs in Nigeria. Under HKI's leadership,

the experience of integrating vitamin A supplementation into CDTI will be expanded to

cover six states. This proposal has been submitted, and implementation is anticipated to start

by the end of May.

Sahel Micronutrient Initiative H Strengthening vitamin A and iron programs in West Africa

Final Technical Report for Phase II Page 13 of 34 July4, 2003

Eighth Annual ECO WAS Nutrition Forum and second food fortification dialogue. The

Micronutrient Initiative will be the lead organizer of the technical update session for the

Forum "Micronutrient Malnutrition: the way forward". The two agencies will collaborate on

organizing a one-day session on food fortification for countries that did not participate in the

dialogue in Accra. This is planned for September 2003.

Under this project and the Micronutrient Initiative project in Mozambique, there has been

innovative work carried out in assessing the quality of nutrition services delivered through

the health system in Burkina Faso, Mali, Mozambique and Niger. In order to capitalize on

this work, we have identified an intern from a school of public health who will be working

over the summer to carry out detailed analyses of all of these surveys, resulting in an article

for submission to a peer-reviewed journal, a prototype protocol for dissemination and a case

study document. This is underway.

Expansion of support to vitamin A supplementation to the Democratic Republic of Congo

(DRC). HKI has been requested by a number of stakeholders in DR Congo to open up a

country office and to initially focus on supporting vitamin A supplementation. DR Congo has

an estimated under-five mortality rate of 207 child deaths per 1,000 live births and a VAD

prevalence in children 0-35 months old of 61%, one of the highest observed in sub-Saharan

Africa. In the DRC, an estimated 31% of deaths of children 6-59 months are attributable to

VAD; this means, that effective VAD control can save an estimated 92,200 child lives

annually. A draft proposal for DR Congo has been submitted to the Micronutrient Initiative

and a final proposal will be submitted in June 2003. It is hoped that funding can be secured

by the end of the year with implementation to start in early 2004.

• We are in the initial planning process of a phase III proj ect with the Micronutrient Initiative

in West Africa, to build on and consolidate the successes of the first two phases and other

activities that are in process. Initial thinking about the phase Ill project is that it would focus

on (1) broadened support to large-scale food fortification; (2) integrated anemia control for

women and children; (3) integrated school nutrition. There is also great interest in expanding

the small-scale fortification experience, but decisions on the future of this will depend on the

current assessment that is being undertaken on small-scale fortification supported by the

Micronutrient Initiative. We anticipate drafting a concept paper by September 2003, for

further discussion with the Micronutrient Initiative.

Burkina Faso

Achievements:

The National start-up workshop of Phase II of the project, organized by HKI and the National

Nutrition Center (CNN), was held on July 17, 2001. This workshop registered the participation

of many of the main actors in the field of nutrition in Burkina Faso. The aim was to make the


Final Technical Report for Phase II Page 14 of 34 Ju1y74, 2003

Project known to the main actors and to solicit their in the elaboration and the

implementation of a plan of action.

Supplementation

We carried out extensive advocacy with the Ministry of Health and other partners for the

organization of National Micronutrient Days.

Results for vitamin A supplementation for children 6-59 months through NIDs in December

2001 and 2002 are available and coverage is at approximately lOO%, or approximately

2.16 million children for both years. National Micronutrient Days were organized in May 2001

and June 2002, including children 6-59 months, and post-partum women. Figures 1 and 2 below

highlight the coverage rates for these two target groups respectively.


Final Technical Report for Phase II Page 15 of 34 2003

Figure 1: VAC coverage of children 6-59 months in

2001 and 2002 for the two regions covered by HKIIMI

during NMDs

DFada region

Dedougou region

2001 2002

Ironlfolate for pregnant women was also distributed in the two HKJIMI regions only 2001 (see Figure 3).

Supplementation for vitamin A and ironlfolate in routine services is being strengthened through in-service training (see below). Fada N'Gourma health district is receiving particular attention for post-partum supplementation, and all the maternity wards in the district are implementing post-partum supplementation. Coverage figures for routine services are not yet available because the activities started in December 2002 and vitamin A supplementation was not systematically reported by health workers the first months. Overall, the objective of supplementing at least 8O% of children 6-59 months through NIDs and in the regions covered by HKJIMI during NMDs was met.

Revising the National Plan of Action for Nutrition

During the project launching workshop the participants felt it was necessary to add to the existing objectives, one of revising the National Plan of Action for Nutrition. The National Plan of Action for Nutrition (NPAN) was a 10-year plan which was elaborated in 1994 and adopted in 2000. It presented an imbalance between the food components and the nutrition/health components. Micronutrient deficiency control, mass mobilization and food fortification were omitted from the Plan. This was also the case with the training and research aspects, the reinforcement of the Minimum Package of Activities, feeding in health services, and sectoral coordination. The Ministry of Health decided to revise the Plan at mid-term. The objectives were to cover the missing aspects, to adapt the plan to the changes in policies and programs, and to align it to the new national strategy of poverty eradication.

An NPAN review workshop was organized by the MOH. Members of the review commission were drawn from diverse sectors — health, agriculture, animal husbandry, finance, nutrition research, the Consumer Association, commerce, and industry. International partners included WHO, FAQ, and HKL The review made it possible to take into consideration new priorities in the national strategy for poverty eradication, food fortification, and quality control. HKI, after



Figure 3: Iron/folate coverage of pregnant women for the two regions covered by HKIIMI during NMDs

60% ——_________ 15115

50%

40%

30% OFada region

Dedougou region 20%

10%

0%

2002

having advocated for the concretization of this activity, gave financial support. Several documents were prepared by the commission among which were:

• the revised National Plan of Action for Nutrition, (which has been validated and is

currently being adopted), • the workshop findings and results, which may serve as a guide to other countries

going through similar processes, (Appendix 2)

• the triennial Nutrition /Health Project plan (2001 —2003), and

• a list containing seven urgent actions suggested to the MOH by the workshop.

The NPAN has been validated by the MOH and has been reproduced in 100 copies to be made

available at the National level.

Quality of Nutrition Services in Health Centers

In September 2001, a study was carried out to assess the quality of nutrition services provided in

health centers across Burkina Faso. The results of this survey were used for the evaluation of the

real training needs of community and health agents and for the revision of the Information, Education and Communication (lEG) Minimum Package. In addition to evaluating the quality of care, the study also explored the implementation of nutritional follow-up for children under the

age of five and the views that are held by health personnel on nutrition problems, and those of the women receiving the health services. (Study attached in Appendix 3).

Reinforcement of pre-service and training in nutrition and micronutrient deficiency control

A survey was conducted on the actual state and the perspectives of pre-service teachings on

micronutrient deficiencies and nutrition in the University, the School of Health, the School of Agronomy, and primary schools. A results dissemination workshop was carried out to sensitize

key actors on the issue and define next steps. A committee composed of the National Nutrition

Center, the Directorate for Literacy and Basic Education, and the National School of Public Health was set up. This committee, under the auspices of HKI, will be responsible to follow-up on the implementation of the workshop recommendations.

One of these recommendations was to conduct a training for persons in charge of nutrition training in pre-service institutions. This training was carried out in January 2003. Seventeen technical persons from the School of Health, the School of agronomy, the School of social services, and the School for the teachers of primary school attended the five-day training. A nutrition training guide was produced in draft form and distributed to all participants (Appendix 4). At the university level, this objective is not progressing as hoped due to the diversity of actors and the reluctance to change the existing curricula.

A micronutrient training of trainers module (Appendix 5) was developed and trainers were trained in all 53 health districts of the country. District-level trainings started in September and


Final Technical Report for Phase II Page 17 of 34 July 4,

ended in January, for all regions except one (Gaoua) covering a total of about 1,000 health

workers.

Micronutrient supply system

A study was made of the micronutrient supply system in order to complete information of the

study on the "Quality of Nutrition Services in Health Centers". The study revealed that outgoing

sales of iron represented 65% of the available supply for the whole of year 2000. However, the

iron supply barely covered 32%of the needs of pregnant women who where coming for health

services. This points to a possible underutilization of the iron supplement supply available, by

the technical services.

On the whole, the availability of iron and vitamin A supplements at the national level is not a

problem. But the use of this supply in health centers still remains weak outside mass distribution

days. If nutritional care in health structures were to become more active, the system would be

able to satisfy the needs for iron, though not necessarily those of vitamin A. A special bulletin

was prepared on these findings for wide dissemination.

Nutrition Information, Education and Communication (IEC) Materials

A nutrition flip chart was developed for use by health workers in counseling sessions. It was

printed in 900 copies that are being distributed to all health centers in the country. There are

currently more than 1000 health centers so discussions are being held to find solutions to provide

all health centers with the flip chart.

Food Fortification

In April 2002, the Ministries of Health, Agriculture, Industrial Development, and Finance signed

a joint Ministerial decree for the creation and attribution of a committee that will oversee food

fortification. The committee is made up of representatives of the 10 main ministries dealing with

nutrition, 10 development partners, of which HKI is one, and representatives of civil society.

Initially, this activity focused on salt iodization only and was later expanded to food fortification

in general, following major advocacy efforts of HKI.

A delegation of 8 persons attended the workshop "Private Sector-Public Sector Dialogue on

Food Fortification in West Africa" in Accra. A national workshop followed in December 2002. The goal of this workshop was to share with all actors the progress report of the food

fortification process and elaborate an action plan for the next steps. Participants included representatives of the private sector and public sector, and consumer associations. A workshop

report has been produced by the National Center for nutrition with assistance from HKI.

Following the workshop, the oil producer JOSSIRA Industry, officially requested the support of

the Ministry of health to enrich its oil with vitamin A.



Although the expected objective of the project to have one food fortified was not met, there is now a favorable environment that makes us think that this will be possible in the near future.

For small-scale fortification, the focus was on shea nut butter, and a technical feasibility study was carried out. Two prototypes for mixers were developed and placed in two different regions with the fortification of shea butter starting in December 2002. Two women's associations in two different towns were trained to take over the fortification activity. All women producers of shea butter can come to the association to fortify their production for 25 CfaF. This activity enabled us to reach 10 villages and 2 towns of about 35 500 inhabitants (Dedougou) and 22 500 inhabitants (Réo). Fat consumption is estimated at approximately 1 ig / person / day. To cover 50% of the vitamin A requirements for children the fortification level used is 2000 ERI100g.. The fortified butter is well accepted because there is no change in flavor, texture or color. The fortified butter is even sought by the populations who wonder how to differentiate fortified butter from non-fortified butter.

School Nutrition HKI has worked since 1999 with Catholic Relief Services (CRS) to implement a pilot school- based nutrition project. The evaluation of the implementation process has allowed the emergence of some recommendations for the extension phase (Appendix 6). The evaluation of Phase I has shown that having touched 9,725 school children, this program did meet its objectives, especially by reducing the rate of anemia by more than 50%. Sensitization campaigns were carried out including individual competitions and competitions among schools and campaigns for parents. Lesson plans for health and nutrition were edited for use in CP-CE and CM level grades. Over the 200 1/2002 school year, 86.4% of pupils in the schools received one vitamin A capsule (200,000 IU), at least 15 doses of iron (one tablet per week during at least 15 weeks without interruption) and one dose of albendazole. In the school year 2002-2003 the health and nutrition project was extended to a second region and is now covering 84 schools in the Kourweogo province and 102 schools in the Gnagna province for a total about 20 000 schoolchildren, thus allowing us to exceed the objective of reaching 70 additional schools.


A monthly bulletin covering HKI's activities in Burkina Faso was started in February 2002 and offers an excellent means to disseminate lessons learned from the project. Half of the bulletins produced to date report results of the project. The bulletin generated requests for technical assistance on behalf of several of our partners. Some partners and other HKI offices have initiated a bulletin (HKI Mali, HKI Côte d'Ivoire) or want to do so (Africare).

Opportunities and Constraints

One of the major opportunities has been the commitment of the government to the organization of NMDs. This has also been met with support from other partners. The information bulletin has generated far more interest than initially thought and is getting an increasingly wider distribution.


Final Technical Report for Phase II Page 19 of 34 July 4, 2.003

Constraints have included the delay in the regional food fortification dialogue, shortfalls in ironlfolate supplies to meet the demand for NMDs and the resistance to modification of pre- service curriculum at the university. On the other hand, within the framework of the fight against poverty, ironlfolate tablets became available again to meet the national needs for the next NMDs planned for June 2003.

Lessons learned

Supplementation (routine and mass campaign) - Working with decentralized structures allows a better motivation and better results as

shown by the success of the NMDs.

- It is necessary to produce clear guidelines for the NMDs and to disseminate them as early as possible to decentralized structures for a better planning.

- We feel that if we intensified JEC campaigns before and during NMDs this would facilitate the work of volunteers.

- The IEC material development process helped health workers find the role they can play in the elaboration and implementation of IEC/Nutrition activities and material.

Nutrition policies - Revising the National Plan of Action for Nutrition allowed a better definition of missions

and responsibilities of the Nutrition Directorate (support to decentralized structures, coordination of nutrition activities and projects).

Food fortification - The fact that fortification activities are conducted simultaneously at the national and

regional level permitted a fast involvement of industries (JOSSIRA case)

- Fortification of shea butter at community level is possible but further research is needed to decide if the women's associations can also take over the responsibility of producing the pre-mix.

School Health and Nutrition - Teachers can easily undertake the supplementation of schoolchildren. This activity can be

done by the education structures if this is planned and supervised in collaboration with the health structures.

- For all activities, JEC campaigns are a good way to reinforce feelings of commitment to projects. Intensive campaigns on a short period seem to have a better impact on the motivation of populations than continuous activities.

- There is a need to quantify the impact of IEC campaigns on knowledge, attitudes and practices of schoolchildren, teachers and the community.



Training - Pre-service training in nutrition is not sufficient to allow a real improvement of practices in

health services. It has to be complemented by practical internships and in-service training.

Mali

Achievements:

Supplementation

Vitamin A supplementation coverage through NIDs in both 2001 and 2002 exceeded 98%, or

approximately 2.22 million children. In 2001, Regional Micronutrient Days were canied out in

four regions (Koulikoro, Mopti, Gao, and Kayes). For vitamin A supplementation of children 6-

59 months, coverage exceeded 99% in Koulikoro and Gao. In Mopti, it was 100% for children 6-

11 months, and 78% for children 12-59 months. The Kayes coverage data for 2002 is apparently

of poor quality and unfortunately will need to be recalculated at the Regional level before it can

be used, if at all. In 2002, the Ministry of Health began promoting vitamin A supplementation

through routine services, and instructed all Regions to begin the transition to Universal Vitamin

A Supplementation through routine services, with mass distribution as necessary. This change in

strategy is based on discussions with UNICEF and its SASDE program. This shift in strategy led

to a shift in donor funds available for Regional Micronutrient Days. As a result, only one Region

(Gao) held RMDs in 2002. Coverage achieved was 98.5% for children 6-1 1 months, and 99.4%

for children 12-59 months.

For calendar year 2003, HKJ has joined with the Ministry of Health, UNICEF, USAID and other

partners to ensure that at least 80% of Malian children 6-59 months receive two doses of vitamin

A. The second dose will be delivered during the NIDs scheduled for November 2003. The first

dose for the calendar year will be distributed at the regional level during semaines

d'intensi:fications des activités de la nutrition (SIAN) scheduled for early June 2003. Vitamin A

will be distributed through routine services, expanded outreach, and mass campaigns, as

appropriate, to children 6-59 months and mothers within six weeks post-partum, per national

protocols. UNICEF is supporting the distribution in the regions of Koulikoro, Mopti, Segou, and

Kayes with funds and technical assistance. USAID is supporting the distribution in the regions of

Tombouctou, Kidal, Gao, Sikasso, and Bamako. HKI will provide technical assistance to the four

regions and Bamako and contribute to the costs of publicity at the national level. HKI will also

serve as fiduciary for USAID funds to the regions.

Routine use of vitamin A and iron/folate

In 2002, HKI conducted a study of vitamin A and ironlfolate supplements availability and

prescribing practices of community health center clinical staff. The aim was to identify areas of

weakness in compliance with national protocols for the curative and preventive supplementation

of children 6-59 months and pregnant and postpartum women at the health center level. The



study team surveyed and observed pharmacy agents and prescribing agents in health centers randomly selected from 4 of Mali's 8 regions. In-depth interviews were conducted with targeted agents; patients were intercepted following consultations; and medical records were examined retrospectively. This study of prescribing practices was facilities-based, not population-based. It was meant to assess health worker practices and availability of stock and was not intended to

confirm projected coverage. Results of this study have shown that thanks to the integration of micronutrient supplementation with national and regional immunization days in Mali, 70% of postpartum women and 58% of children 6-59 months surveyed had received preventive vitamin A supplementation. However, only 7% of sick children were prescribed vitamin A by health

agents, even though national policy calls for use of high-dose vitamin A supplementation in

children with measles, clinical signs of vitamin A deficiency, chronic diarrhea, severe malnutrition, and respiratory infections. Half of the health center pharmacies visited were found

to have stock outs (lasting 20-3 65 days) for vitamin A and ironlfolate supplements, despite these micronutrients being listed as essential medicines. Ironlfolate was prescribed to 93.7% of pregnant women coming for pre-natal consultations. Reasons cited for non-compliance with national protocols included lack of training, shortage of personnel, and competing activities. The

study concluded that health agents would benefit from additional training and improved supervision to enhance compliance; and that the supply system needs to be examined to identify

and correct the causes of stock outs.

Following the study, HKI collaborated with the MOH/Nutrition Division and health directorates of four regions to organize refresher trainings for physicians, midwives, and pharmacy agents. A

total of 69 health workers were trained.

Community-based Distribution of Iron/Folate

HKI had planned to work in collaboration with a national NGO to introduce an integrated package for anemia control in the two health districts of Fana and Bla. All stakeholders had been involved in the planning phase. A baseline survey was conducted, and data analyzed. However,

it emerged emerged that UNICEF and the Ministry of Health had selected the same health

districts for intensive community activities related to its Stratégie d 'Accélération de la Survie et

du Développement du Jeune Enfant (SASDE). SASDE is using community agents to promote the

use of EPI+ (e.g., consumption of iodized salt at the household level, antenatal iron+folic acid supplementation for pregnant women with IPT for malarial infection sulfadoxine pyrimethamine, post-partum vitamin A supplementation for new mothers within first 40 days after delivery, vitamin A supplementation of children 6-59 months, and distribution of impregnated bednets). The SASDE strategy is to use community promoters to encourage use of fixed health facilities, and will not provide community-based services.

In further discussions with stakeholders, it was decided that it would be best not to try to

implement the two strategies in the same districts. Given the time it takes to identify new sites,

undertake a new baseline survey and provide training, it has been decided to defer this objective to a new phase of funding.

Nutrition Information, Education and Communication



With the Ministry of Health and public and private partners, HKI has focused on building the

capacity of rural radio journalists and broadcasters throughout the country. Although no study was conducted on the impact of this activity on KAP, it has succeeded in:

• Holding a national workshop on elaboration of guidelines on radio messages dealing with nutrition in which forty participants from the health and social development sectors and 15 regional radio journalists participated;

• Training of managers and presenters of 110 of the 144 radio stations currently operating in Mali;

• Elaborating messages on vitamin A deficiency, anemia, and iodine deficiency; • Developing, recording messages, and delivering audio-tapes in French and four local

languages to radio stations throughout the country

A working group of partners in nutrition defined a minimum package of essential nutrition activities (e.g., key services and household practices) and developed supportive IEC materials to

be delivered to all community health centers. Four hundred flip charts and 2000 booklets were produced for distribution to facilities on themes related to maternal nutrition and infant and

young child feeding. A training of trainers was carried out on the use of materials to prepare for

the implementation at the service delivery level.

Pre-service Training

In 2001, HKI-Mali carried out a baseline assessment in 13 health care training institutions where nutrition is taught. The aim was to assess the status of pre-service training in micronutrient health and nutrition for health care personnel of various disciplines (e.g., medicine, nursing, technicians, etc.). Study methods were to: a) assess existing training curricula; b) perform structured interviews with key informants (e.g., headmasters, lecturers in nutrition, students); c)

administer a quantitative survey to national officials, administrators, faculty, and students. In all

13 schools, it was found that nutrition training emphasized scientific theory over practical considerations and that micronutrient content was weak, including vitamin A and ironlfolate protocols. In most institutions, nutrition is taught by non-specialists, who themselves might benefit from more in-depth training in nutrition and micronutrients.

Results of this study were presented at the IVACG Meeting in Marrakech in February 2002 and allowed the MOH/CPS/DSSAN to organize a reflection forum on the introduction of nutrition in the curricula of training schools and universities, followed by a second workshop to identify the three levels of nutrition instruction required for the various schools, in order to adapt training to

each level. Working groups were then constituted for each level to prepare the topics and contents relating to the curricula. Next steps include: (i) finalizing the curricula; (ii) organizing a

workshop to approve the various curricula; and, (iii) organizing training courses for the nutrition instructors by level. Training modules (Appendix 7) still need to be finalized and validated before they can be used in the schools as part of the official curriculum. Once they are available (July 2003) they will be distributed.

Food Fortification



During 2002, HKI facilitated a series of expert consultations on large- and small-scale

fortification of mass consumer products including sugar, flour, oil and bouillon cubes. Following

the Accra Public-Private Dialogue, a National Task Force for Food Fortification with

Micronutrients was established with technical assistance from HKI. This task force is now in the

final stages of achieving legal recognition, under the auspices of the Ministry of Trade and

Industries. It is composed of 30 key individuals in industry, health, consumer protection, and

public health nutrition. On small-scale fortification, consultations were carried out with Misola,

UCODAL and GAM to assess the possibility of fortifying flour used in complementary foods for

children. The results of the consultation are available in the MI consultant reports. MISOLA and

UCODAL are ready to begin fortification activities once the fortificant becomes available. Other

small-scale fortification (e.g., multifunctional platforms) are also ready and awaiting the

availability of fortificant and technical assistance.

School Health and Nutrition

HKI continues to play an active role in the national School Health Committee and continues to

pursue strategic partnerships with other organizations involved in integrated school health and

nutrition.

Information Dissemination and Technical Assistance

HKI is an active member of a number of important national committees including:

• National Immunization Days organizational committee

• PRODESS Nutrition Committee (National Health Program),

• Nutrition Partners' Committee, • School Health Committee • Reflection Group on Nutrition JEC

• National Food Fortification Committee

HKI was the only NGO invited by UNICEF to participate in the development of the training

module for SASDE community agents in June 2002.


Several opportunities need to be leveraged. The food fortification partners are very enthusiastic,

both for large-scale and small-scale fortification.

UNICEF has sought out our collaboration with SASDE. There is a growing interest on the part

of other partners to support nutrition IEC.

Constraints have included the delay in the regional food fortification dialogue, and the need to

defer implementation of community-based ironlfolate supplementation due to overlap with

SASDE as discussed above. In addition, community radios stations, which have sustainability



issues of their own, are increasingly asking for contract payments for the diffusion of fEC messages. This is a request accepted by other international and national donors, and will need to be taken into account in budgeting for a next phase of the project.

Niger

Achievements:

Supplementation

The biggest success FIKI has been 'saving' National Micronutrient Days. For several years NIDs have been held every six months in Niger, and NIDs were coupled with NMDs, reducing the costs of NMDs. Six weeks before the organization of the June round of NIDs, based on epidemiological information, it was decided to limit polio vaccination to 17 health districts (out of 42). The Deputy Secretary General of the Ministry of Health, president of the NMDs organizing committee and HKI led efforts to rapidly mobilize additional resources in order to cover the additional costs of organizing NMDs nationwide. Coverage for NMDs coupled with complete NIDs have been close to 100% for children 6-59 months (approximately 2.08 million children). For the June NMDs, which did not benefit from the logistical support of NIDs except in 17 health districts, coverage for children 6-59 months is estimated at 76.6%; 56.0% for women in post-partum and 43.3% for pregnant women for ironlfolate. This incident demonstrates both the government's and partners' commitment to maintaining high vitamin A coverage and the need to continue to mobilize resources in order to maintain this coverage in such a resource-poor country. The table below highlights the vitamin A and iron supplementation efforts and achievements for 2001 and 2002, by target group, during NIDs and NMDs. The Ministry of Public Health includes women post-parturn in the target group for NIDs, in addition to NMDs as it presents the advantage of maintaining the same target groups for both NIDs and NMDs, and it presents the added benefit of increasing coverage of women post-partum with vitamin A.

Vitamin A and iron coverage data

VITAMIN A IRON / FOLATE MONTHS

I POST-PARTUM WOMEN PREGNANT WOMEN Reached % Reached %

2747500 88.6 159 265 82586 51.9 410 725 243 639 59,3 2716497 88.6 81283 51.4 414181 238091 57,4

2295258 76.6 127973 56M 455233 196978 43,3 2611 213 79.7 - 88 115 52.3 215 735

Supplementation for vitamin A and ironlfolate in routine services is being strengthened through in-service training. There remain many challenges to ensure an adequate supply of vitamin A and ironlfolate in routine health services. We have focused efforts on the health district of Ouallam in collaboration with the GTZ project, Alafia, to strengthen vitamin A supplementation through

Sahel Micronutrjent Initiative II Strengthening vitamin A and iron programs in West Africa


3 100 894

3 101 576

2 994 848

routine services. This project integrates the distribution into routine services, thereby using the cost-recovery system at the District health centers. HKI assists GTZ in implementing this project through its technical support and through providing vitamin A capsules. In addition to the vitamin A capsules, 'vitamin A cards' were supplied to record supplements for all children 6-59 months and post-partum women. It is hoped that lessons learned from this district can be applied to others. Coverage figures for routine services are not yet available, but estimates show that coverage is around 30%, slightly below the health services coverage.

Community-based Distribution of Iron/Folate

CBD of ironlfolate for pregnant women is taking place in 9 health districts. Three hundred ten community health agents (traditional birth attendants and male community health workers) were trained in nutrition, particularly iron and iron deficiency, use of data collection tools and carrying out group discussions and inter-personal communication. The health districts are supplied every three months with ironlfolate tablets, and they then supply the communities. Communities are supervised every month by personnel from the closest health center, the district level undertakes supervisions every three months and the national level supervises every four months. The total yearly target population in the 310 target villages is 19,750 pregnant women. The data available from Diffa reveals that the average number of tablets effectively consumed went from 75% to 84% between the baseline study and the evaluation that took place approximately 6 months following the start of the distribution. Overall, the CBD allowed to cover an important number of women at the village level. Lessons learned include:

- Supplementation can be well conducted at the community level by midwives; - This strategy is an essential complement to other supplementation strategies such as

NMDs and NIDs; - Reliable data can be collected by midwives using simple monitoring tools; - Supervision of the midwives is essential to the success of the program

The program was expanded geographically from 2 districts (Tera and Tahoua) to 7 districts (Tera, Tahoua, Tanout, Doutchi and the 3 districts of Diffa). This can be done successfully, as long as the monitoring system is reinforced at every level of the health system and with adequate training/recycling the health agents and midwives.

The following graph summarizes the available data on iron distribution in the districts, during the 2 phases.

Sahel Micronutrient Initiative H Strengthening vitamin A and iron programs in West Africa


Distribution started in April 2002 (Tera), May 2002 (Tahoua) and in June 2002 (Diffa, Tanout and Doutchi). The level of performance is low because the length of the supplementation period is only 6 months, while the target was estimated to be a one year period. On average, each woman having benefited from distribution has received 45 ironlfolate tablets. The quantity of tablets distributed would be higher if we included distributions made during the National Immunization Days and Micronutrient Days (vitamin A and ironlfolate) of June and November 2002.

Nutrition Information, Education and Communication Materials

Following the identification of the minimum package of nutrition IEC, the existing IEC flip charts were revised and 260 series of counseling cards (26 cards per series) were printed covering: micronutrient-rich foods, iodizes salt, breastfeeding and diarrhea. One thousand posters on food groups and 1,000 posters on malnutrition were printed (Appendix 8).

IEC Minimum Package of Activities Workshop:

A workshop was held in Niamey in December 2002, and brought together 70 participants representing health districts and the central level to finalize the JEC minimum package of activities in order to be integrated to the district routine activities.



0 Grosses attendues lePhase le Phase DGrosses attendues 2e Phase D8eneficiaires 2e

Pre-service Training

Based on the results of the working groups to develop nutrition curriculum for the different pre- service institutions, a total of 800 modules were produced (Appendix 9): 100 for the National Institute for Youth and Sport; 100 for the Pedagogical Institute for Rural Development; 160 for the National Public Health Institute and 320 for the two National Public Health Schools. The remaining modules have been distributed to other partners, to other HKJ offices in Africa and during the last IVACG meeting.

Following duplication of the modules, the nutrition trainers in each of the institutes were identified and 20 teachers participated in a five-day workshop on use of the modules.

Food Fortification

This was delayed because of the delay in the regional food fortification dialogue discussed above. However, we continue to maintain contact with the principal partners and have developed a work plan to accelerate fortification. There was great enthusiasm generated by the regional dialogue, and the Niger delegation is very engaged. The food industry landscape in Niger continues to evolve with the oil factory in Maradi having started business again under the name 'Olga Oil'. The director general is committed to fortifying its oil, and an advocacy visit was made to the factory in Maradi. A National Food Fortification Committee was officially set-up in January 2003 by a decree from the Minister of Public Health. The Committee actually was already holding meetings since 2001 to engage discussions on food fortification for Niger. As for the small-scale food fortification, initial contacts were established by the MI fortification consultant. There has been no specific progress on that matter since.

Nutritional Surveillance

The third round of data collection took place in July 2002. In preparation, 64 data collectors, 33 nurses and 11 heads of epidemiological surveillance were trained.


In addition to a number of dissemination activities discussed above, HKJ is a member of a number of national committees.


One of the major opportunities has been the commitment of the government to the organization of NMDs as demonstrated by the ability to 'save' NMDs in a very short time frame. The partnership with GTZ will provide better documentation of how best to integrate vitamin A into routine services. There is a new opportunity for large-scale food fortification with the re-opening of Olga Oil in Maradi. The integration of nutrition into pre-service training has advanced more quickly than anticipated.

Sahel Micronutrjent Initiative II Strengthening vitamin A and iron programs in West Africa


There remain a number of constraints. While the 'saving' of NMDs in July is a success story, it

also demonstrates the fragility of the high levels of coverage that have been maintained in Niger of the last three years. In such a resource-poor country, it is necessary to have long-term commitment from partners. Providing adequate micronutrient supplements (vitamin A and iron) to health services has been problematic, and needs to be addressed in the next phase of the project. As DBC for ironlfolate has expanded there is a need to strengthen the management capacity of health districts. The nutritional surveillance activity is still encountering problems with under-performance of the epidemiological surveillance units in the districts and the national health information system. This renders the processing of data difficult. Finally, the objective concerning pilot-testing of iron supplementation of young children has not been able to be carried out due to two constraints. The first is the high cost of the supplement used for young children, and the other is that the specialists (pediatricians) have not been able to reach a

consensus on the action to be taken.

Nigeria

Achievements:

We hired a nutrition officer based at the HKI country office in Jos to coordinate the project activities. An orientation was given to 2 State Ministry of health officials on vitamin A deficiency and the integration of vitamin A supplementation along with the existing CDTI structure. This was followed by a restructuring of the State and 12 Local Government Food and Nutrition Committees to include the Onchocerciasis Taskforce Members in Borno State. Adamawa is yet to do the same due to government bureaucracy.

Advocacy visits were made to the State and Local Government Area (LGA) Officials to solicit political support and commitments to the program

Training and technical assistance

The Nutrition Officer hired to co-ordinate the program in addition provides both technical and managerial assistance to the project areas. All the Community-Directed Treatment with Ivermectin (CDTI) personnel as well as the nutrition staff involved in the program implementation have been trained and or re-trained under the supervision of the I-IKI Nutrition Officer. Relevant stakeholders in the 2 project States (Adamawa and Borno) have equally received adequate re-orientation on vitamin A and distribution of supplements along with existing CDTI structure. In Adamawa state further re-orientation on iron/folate supplementations have been provided to the program implementers and health officials at the State and local government area (LGA) levels.

Like in Borno State, a Food and Nutrition Committee has been established at the state level in Adamawa in anticipation that it will be extended to the LGAs pretty soon. Advocacy visits to States and LGAs precede program implementation activities and the teams usually comprise States and LGAs health workers, CDTI personnel, nutrition and HKI staff.

Sahel Initiative II Strengthening vitamin A and iron pro grams in West Africa


Integration of Vitamin A and Iron/Folate Supplementation into CDTI

The integration of VA in the existing CDTI structure has been well established in the project areas of Adamawa and Borno States. This approach has reached almost 100% geographic coverage and over 90% therapeutic coverage (terms used by CDTI). Therapeutic coverage is

hereby defined as the total number of actual populations supplemented with vitamin A over the total target populations (children 6 — 59 months and post partum mothers); and geographic coverage is defined as the percentage of total number of target communities reached with the vitamin A supplementation program.

Within the period under review a total of 3,527 communities in 29 LGAs have been mobilized and reached with vitamin A supplements in both Adamawa and Borno States.

In addition to the already developed protocol for the integration of vitamin A capsules along with Mectizan® tablets, another protocol has been prepared for the integration of ironlfolate along the

same structure. Information brochures on vitamin A and ironlfolate have also been developed to

enhance public awareness on the effects of vitamin A and iron deficiencies and the benefits of supplementation.

The program has also developed posters; a total of 4000 posters have been distributed to the target communities within the period. Three different types of posters are in use; two forms of posters highlight the various sources of vitamin A rich foods and the third type is on vitamin A

supplementation. They are being used for awareness campaigns at all the levels of program implementation.

The frontier of partnership for program implementation has been increased to include UNICEF, which facilitates the supply of supplements (vitamin A and ironlfolate) to the program in addition to the quantity being received from HKI. The program success can be ascribed partly to

the availability and utilization of vitamin A supplements, donor support, and technical assistance from HKI, dedication of field staff and supervision protocol. This is in addition to the training/re- training of relevant program personnel.

Ensuring Coverage of all Target Groups in Villages under CDTI

To ensure satisfactory vitamin A supplementation coverage of the target populations in the CDII areas, the following activities were undertaken:

• Verification of community census registers to cross validate the target populations desiring supplementation with vitamin A and iron/folate. This activity covered the two project states.

• Having a pool of trainers at the local level for program sustainability, training/re-training continued within the period under review and benefited all the CDTI personnel in Adamawa and Borno States. In addition some nutrition staff in both States were trained and re-trained to give back-up support to the CDTI personnel. The States and LGAs CDTI personnel were trained and re-trained to serve as resource persons for the training of Community Directed Distributors (CDDs). All the training sessions at the States and LGAs levels were done under



the supervision of HKI staff. HKI has developed a training manual/protocol for the

training/re-training of various cadres of CDTI personnel in the project areas.

• The modified Management Information Systems (MIS) developed by HKI have been put to

use at all the program levels to generate reliable data. These include modified Community Registers, Treatment Summary Forms, and Treatment Tally Sheets for the low literate CDDs, Supervisory Checklist, and Vitamin A and Iron/Folate Supply Inventory Forms. They have

undergone revision to be more user—friendly especially for the low literate CDDs.

• Community Education Campaigns were undertaken by the CDDs with support from the

States and LGAs staff prior to community registration update. The update provided the

denominators for calculating both therapeutic and geographic coverage of the program

Coverage Estimates

For the first round of VA supplementation, he available records for Adarnawa show that out of the targeted 202,23lchildren and 47,370 post-partum mothers, the program succeeded in the

supplementation of 189,410 children and 38,890 post partum mothers, giving a supplementation coverage of 93.7% for children and 82.1% for post partum mothers. The available records show

that for the state of Borno, 149,063 VA capsules were used to supplement 116,131 children 6-59

months and 32,933 mothers post-partum (out of the targeted 121,789 and 33,484 respectively). These results indicate that therapeutic coverage is 95.4% and 98.4% for children and mothers

respectively. Please refer to the table below for vitamin A supplementation data coverage for the

2 rounds and 2 States.

For the second round of VA supplementation a total of 601,500 VA capsules were delivered to

the CDTI areas of Adamawa and Bomo States for supplementation of targeted 505,852 children (Adamawa, 382,314 and Bomo, 123,538) and 84,572 post-partum mothers (Adamawa, 45,065 and Borno,39,507). For Adamawa State the records show that 316,526 children (82.8% coverage) and 39,866 post-partum mothers (88.5%) were supplemented with vitamin A. The

achievement records for Borno State show that a total of 103,371 children (83.7%) and 32,306

post-partum mothers (8 1.8%) were supplemented. Please refer to the table below for vitamin A

supplementation data coverage for the 2 rounds and 2 States.

Vitamin A Supplementation Coverage Data for Adamawa and Borno States, 2 rounds

Coverage percentages presented in parentheses

__________________________________

Adamawa Borno Round 1 Round 2 Round I Round 2

Children 6-59 months 189,410 (93.7)

316,526 (82.8)

116,131 (95.4)

103,371 (83.7)

Mothers post-partum 38,890 (82.1)

39,866 (88.5)

32,933 (98.4)

32,306 (81.8)



For the second round of supplementation is Adamawa State, in addition to VA supplementation, ironlfolate supplementation of pregnant women was introduced. A total of 1,231,296 ironlfolate

tablets were delivered to 10 LGAs of Adamawa State, utilizing CDTI structure as a vehicle for

the delivery. Unfortunately, because the tablets (from UNICEF-Lagos store) had a very short

shelf-life of less than 4 months, which is considered unsuitable for pre-distribution preparations, a limited number of tablets was distributed. In total, 22,392 pregnant mothers, from the targeted

figure of 26,003 in Adamawa State received a one-month supply of ironlfolate tablets (not the

recommended 3 months supply, because of the reasons explained above). This coverage of approximately 86% should be interpreted cautiously because of the one-month only supply

delivered to the pregnant mothers. Also, this coverage data does not take into consideration

adherence, so actual consumption of the tablets.

Like in the previous deliveries, and using the existing inventory systems, the supplements were

delivered to the States by HKI and the States in turn delivered to the target LGAs and to the

communities through health facilities nearest to them, which serve as collection centers. CDDs

under the support of their community members or organizations pick up their required supplements from the collection centers and distribute the supplements, at the household to the

eligible individuals. Therefore, the delivery of the supplements from the states down to the health

facility level is through the existing health systems, while community structure takes over from

the health facility level to the eligible recipients of the supplements. The community structure is

also being supervised by health workers who belong to the health systems and treatment results

are collected in the reverse order through the same structure.

Each household has a treatment card in which records of supplementation are entered and later

transferred to community registers. Records on the registers are collapsed and summarized on the

community tally sheets; and treatment results collected from various community tally sheets are

sent to the LGAs for further collectionlcollation to arrive at the final figures for any given

LGA. The LGAs send their results to the States for final collation and analysis, which is being

facilitated by HKI. The entire process of results collection, collationlanalysis involve the existing

health systems for capacity enhancement, program sustainability and cost efficiency.

Training/re-training have been on course and in Borno 9 State Onchocerciasis Control Team

(SOCT) staff, 48 Local Onchocerciasis Control Team (LOCT) staff, 14 nutrition staff, 127 health

workers and 1,507 CDDs received either training or re-training within the period under review. The training in Borno is yet to include ironlfolate supplementation. In Adarnawa a total of 1,592

CDTI personnel and nutrition staff received training and update training on vitamin A and ironlfolate supplementation.

Other Activities

Two surveys have been conducted in the project State of Adamawa with the following objectives: to determine the Knowledge, Attitude, Perception and Practice (KAPP) of the communities in relation to ironlfolate and vitamin A supplements being integrated into the CDTI

structure along with vitamin A supplements; baseline survey to determine the hemoglobin status

of the target populations before supplementation. The available survey results showed that the haemoglobin (Hb) level ranged from 50-105 gm/Liter, with population mean of 76gnillitre. In

Sahel Micronutrient Initiative II Strengthening vitamin A and iron pro grams in West Africa


the same vein the packed cell volume (PCV) or haematocrit values were generally low with a survey population mean of 35% (normal range is 36-41%). The survey was carried out with the Phase II MI funds. The KAPP data for vitamin A have been analyzed which formed the basis for the development of the current JEC materials in use. Results of the KAPP survey revealed that only 20% of the respondents were aware of the role of VA in the prevention of blindness and 14% said foods of animal origin contained more vitamin A than foods of plants origin} The data for ironlfolate have been collated and analyzed and will be used for developing ironlfolate IEC materials.

The followings are the conclusions from the ironlfolate survey results: 1. Protein-Energy Malnutrition (PEM) Z scores for the under-five children in the survey

area indicate a high prevalence of malnutrition. Overall more than 55 % of the children were stunted, 31% were under weight and almost 17% suffer from wasting.

2. Iron/Jblate Supplement coverage: Awareness of ironlfolate supplement was high (76%) among respondents and high proportion (64%) had ironlfolate supplement prescribed during previous pregnancy.

3. Adherence: Over 80% claimed to have completed their iron supplementation prescription. Most subjects that did not complete their prescriptions attributed this to non-availability of the supplements.

4. Daily Food Intake: Cereal based foods constituted between 65-70% of the total weight of food eaten daily, while vegetables contributed approximately 20%.

Information Sharing

The program has been able to share its experiences in three local and three international scientific meetings. The first meeting was with the Implementing Partners of USAID in Nigeria, and then the Annual Delegates Conference of Public Health Physicians of Nigeria, and the NGDOs Coalition in Nigeria. The two international fora are the National Onchocerciasis Taskforce Representatives and NGDO, Chairpersons from the 19 APOC countries in Africa and the OCP and APOC donors' conference that was held in Luxemburg in October 2002 and the IVACG meeting in Morocco from 3-5 February 2003.


1-IKI has started playing an increasingly important role nationally in nutrition in Nigeria, starting with the support to PROFILES analysis reported last period. In general, in due in large part to the PROFILES analysis, there is a growing interest in investing in nutrition in Nigeria. Partners in nutrition (principally UNICEF, USAID, IITA and BASICS II) have started to meet regularly to better coordinate nutrition actions, and 1-IKI is part of this group. There has been growing interest in Nigeria and internationally in the integration of vitamin A into CDTI. A proposal is being developed for extending the experience to all CDTI program areas. The results of this work are being widely disseminated. We are working more closely with UNICEF and this has resolved constraints tied to availability of vitamin A and ironlfolate supplements. With Nigeria's participation in the regional food fortification dialogue, we have been increasingly involved in the food fortification initiative in Nigeria.


Final Technical Report for Phase II Page 33 of 34 July 4, 2Q03

Constraints include frequent industrial actions by public health workers in Borno State that is affecting program implementation. Though it is more feasible to deliver one dose of VA supplements as Mectizan® delivery through CDTI is done once a year, however, as demonstrated in Adamawa second round supplementation of VA with ironlfolate tablets, two rounds of VA supplementations can be achieved through CDTI in a year. This becomes more possible as the project matures over time and if all necessary materials including VA supplements and funds are made available on time). This is sequel to irregular payment of salaries to public workers by the various levels of Governments. This has resulted to two rounds of Vitamin A Supplementation in Borno State instead of three because of frequent strike actions by health workers. As discussed during the last report, there are increasing demands from CDDs for some sort of remuneration. This is not specific to HKI program areas but affects the whole CDTI program. The project areas are vast and roads are often impassible affecting the degree of supervision and information dissemination. Nigeria has yet to have a national-level distribution of vitamin A outside of NIDs. Given the size and complexity of the country, it is unlikely that there can be any one strategy to cover the whole country. At this writing, it appears that the NIDs of 2002 will be the last for 'two rounds' in a year as only one round of NIDs will be carried out nationally per year up to 2005; but that state-level immunization days will continue in some states, particularly (about 12 states) in the North. Therefore the vitamin A supplementation situation becomes very complex: some states being covered with NIDs plus vitamin A; some states (or some LGAs in some states) potentially being covered with CDII plus vitamin A; some LGAs in some states benefiting from support from BASICS 11 to intensify coverage by routine health services including vitamin A and some states currently having no non-NIDs vitamin A strategies. The challenge is to map out the various opportunities and constraints state-by-state (and possibly LGA-by-LGA) and assist those areas not covered with the development of vitamin A supplementation strategies.



Liriks: Webmasters:

xe.com Universal Currency Converter® Results http://www.xe.com/ucc/ The Worlds Favorite Currency Tool XE.com Home Currency Services Site Map

I Help/FAQ

I Tell a Friend

How to Link I

Free Tools for Your Site More Resources...

Live mid-market rates as of 2003.07.04 18:51 :48 GMT.

160.00 AED United Arab Emirates Dirhams

1 AED = 0.272250 USD

— 43.5599 USD — United States Dollars

I USD=3.67310AED

TOP

I

Webmasters! XE.com has currencyjooLs for your site! I

Put This on You r for Free! Currency "XE, "XE. CCM, und upnnXg currency oqo of XL Crepuruhon

Copyright © 2003 Terms of

http ://www.xe.comlucc/convert.cgi 7/4/2003

For information on advertising on this page, c!ick,

xe.com Universal Currency Converter® Results

RE

GIO

NA

L

Obj

ectiv

e 1.

Doc

umen

t an

d di

ssem

inat

e le

sson

s le

arne

d fr

om

the

Mic

ronu

trie

nt I

nitia

tive/

Hel

en

Kel

ler

Inte

rnat

iona

l pro

ject

and

ot

her

mic

ronu

trie

nt p

rogr

ams

thro

ugho

ut t

he E

CO

WA

S r

egio

n.

Out

com

e: i

mpr

oved

In

dica

tors

: N

umbe

r of

ex

perie

nces

doc

umen

ted

and

diss

emin

ated

. N

umbe

r of

expe

rienc

es

repl

icat

ed.

Ass

umpt

ions

/Ris

k In

dica

tors

: E

ngag

emen

t by

part

ners

(lo

w r

isk)

Can

t be

tran

slat

ed d

irect

ly i

nto

ultim

ate

bene

ficia

ries

at th

is

stag

e. E

stim

ated

to

reac

h ov

er

150

key

nutr

ition

act

ors

Hel

en K

elle

r In

tern

atio

nal

Pag

e 1

of 9

Lo

g F

ram

e an

d R

esul

ts A

chie

ved

Sum

mar

y Lo

gica

l F

ram

ewor

k A

naly

sis

and

Est

imat

ed B

enef

icia

ries

Proj

ect

Nam

e: S

ahe/

Mic

ronu

trie

nt I

nitia

tive

Stm

igth

enin

g vi

tam

in/i

and

iron

.

in W

est A

fric

a (B

urki

na F

aso,

Ma/

i, N

iger

ia)

Dur

atio

n: 2

yea

rs (

Mar

ch 1

, 20

01 -

Feb

ruar

y 28

, 20

03

Bud

get:

C$

3,40

2687

req

uest

ed f

rom

Ml

(US

$ 2,

284,

210)

. C

$ 1,

525,

798

in m

atch

from

HK

I (U

S

$1,0

24,2

68)

Nar

rativ

e E

xpec

ted

Res

ults

P

erfo

rman

ce

Mea

surm

ents

A

ssum

ptio

ns/R

isk

Indi

cato

rs (

fact

ors)

B

enef

icia

ries/

Rea

ch

Res

ults

Ach

ieve

d

Goa

l: Su

ppor

t na

tiona

l go

vern

men

ts a

nd o

ther

par

tner

.

orga

niza

ttons

in

sust

aina

bly

.

redu

cing

A

and

de

ficie

ncie

s th

ereb

y co

ntrib

utin

g to

red

uctio

n of

child

and

mat

erna

l dea

ths

and

impr

oved

.

heal

th a

nd w

ell

bein

g.

Impa

ct:

Red

uced

chi

ld a

nd

mat

erna

l m

orta

lity

and

impr

oved

hea

lth a

nd w

ell

.

bein

g

Indi

cato

rs:

Chi

ld m

orta

lity,

m

ater

nal

mor

talit

y A

ssum

ptio

ns:

Rea

sona

ble

polit

ical

sta

brtit

y (lo

w r

isk)

, A

bilit

y of

cou

ntrie

s to

-

prog

ress

ivel

y as

sum

e

recu

rren

t co

sts

(meA

um

risk)

. P

oliti

cal c

omm

itmen

t, (m

ediu

m r

isk)

The

re is

som

e ov

erla

p in

the

po

tent

ial

bene

ficia

ry

popu

latio

ns,

ie

thos

e be

nefit

ing

.

from

for

tific

atio

n m

ay a

lso

bene

fit f

rom

sup

plem

enta

tion

and

nutr

ition

edu

catio

n.T

he

estim

ates

pre

sent

ed h

ere

are

for

thos

e re

acts

ed

by th

e m

ost

far-

re

achi

ng i

nter

vent

ion

for

each

.

grou

p. D

etaa

ts a

re p

rese

nted

for

ea

ch o

bjec

tive.

Chi

ldre

n 0-

59 m

onth

s:

1,93

9,00

0, o

f who

m 8

0% a

t ris

k

Chi

ldre

n 6-

59 m

onth

s: 5

.68

mill

ion,

of',

vhom

80°/

o at

ris

k

Pos

t pa

rtum

wom

en:

709,

000,

al

l of

who

m a

t ris

k

Pre

gnan

t w

omen

: 72

1,00

0, a

llot

svho

rn a

re at

ris

k

Wom

en o

f chi

ld b

m.r

ing

age:

3,24

3,00

0, o

f who

m 8

0% a

t ris

k

-

-

nutr

ition

pro

gram

s th

roug

hout

the

reg

ion

Obj

ectiv

e ac

hiev

ed (

or s

urpa

ssed

) th

roug

h pr

esen

tatio

ns a

t IV

AC

G/IN

AC

G a

nd o

ther

m

eetin

gs,

publ

icat

ions

in

peer

-rev

iew

ed jo

urna

ls,

'Nut

ritio

n N

ews

for

Afr

ica"

bul

letin

, etc

.

Obj

ectiv

e 2.

Rei

nfor

ce c

apac

ity o

f re

gion

al in

stitu

tions

, na

mel

y th

e C

RA

N a

nd t

he W

AH

O t

o ad

voca

te

for,

pr

omot

e, d

evel

op a

nd m

onito

r m

icro

nutr

ient

pr

ogra

ms,

inc

ludi

ng

prov

idin

g ad

hoc

tec

hnic

al

assi

stan

ce t

o m

embe

r co

untr

ies.

Out

com

e: i

mpr

oved

ca

paci

ty o

f re

gion

al

inst

itutio

ns t

o su

ppor

t nu

triti

on p

rogr

ams

Ass

umpt

ions

/Ris

k In

dica

tors

: po

litic

al

com

mitm

ent

by E

CO

WA

S

(low

ris

k, a

s in

dica

ted

by

rece

nt E

CO

WA

S h

ealth

fa

ir).

Obj

ectiv

e ac

hiev

ed s

urpa

ssed

with

sup

port

to

regi

onal

inst

itutio

ns o

n m

icro

nutr

ierit

pro

gram

s,

supp

ort

to i

naug

ural

mee

ting

of n

utrit

ion

foca

l po

ints

net

wor

k of

Cen

tral

Afr

ica

and

Mad

agas

car

and

tech

nica

l as

sist

ance

pro

vide

d to

Sie

rra

Leon

e, C

ôte

d'lv

oire

. U

nder

sep

arat

e fu

ndin

g,

unde

rtoo

k F

RA

T a

nd i

ndus

try

asse

ssm

ents

in

Gui

nea.

Obj

ectiv

e pa

rtia

lly a

chie

ved

with

foo

d fo

rtifi

catio

n di

alog

ue o

rgan

ized

and

adv

ocac

y un

dert

aken

T

he m

ajor

coo

king

oil

bran

d in

CO

te d

'lvoi

re a

nd

one

in G

hana

are

now

fort

ified

with

vita

min

A.

Thi

s is

not

dire

ctly

res

ulte

d to

thi

s pr

ojec

t bu

t lin

ked

to t

he a

dvoc

acy

wor

k w

e ha

ve c

arrie

d ou

t in

the

reg

ion.

The

sec

ond

larg

est c

ooki

ng o

il br

and

in C

Ote

d'lv

oire

will

be

fort

ified

in

Aug

ust

(equ

ipm

ent

and

supp

lies

have

bee

n O

rder

ed)

whi

ch i

s di

rect

ly li

nked

to

our

advo

cacy

wor

k.

Rea

sons

for

del

ay a

re d

iscu

ssed

in

text

.

Obj

ectiv

e ac

hiev

ed i

n B

urki

na F

aso,

Mal

i and

N

iger

. U

nder

sep

arat

e fu

ndin

g, p

rom

oted

sim

ilar

activ

ity in

Mad

agas

car.

Obj

ectiv

e pa

rtia

lly a

chie

ved

with

dra

ft re

com

men

datio

ns f

rom

Nia

mey

wor

ksho

p.

Hel

en K

elle

r In

tern

atio

nal

Pag

e 2

of9

Log

Fra

me

and

Res

ults

Ach

ieve

d

Proj

ect N

ame:

Sah

elM

icro

nutr

ient

Ini

tiativ

e St

reui

gthe

ning

vita

min

A a

nd ir

on

.

in W

estA

frzc

a (B

urki

na F

aso,

Mal

i, N

iger

, N

iger

ia)

Dur

atio

n: 2

yea

rs (

Mar

ch 1

, 20

01 -

Feb

ruar

y 28

, 20

03

Bud

get:

C$

3,40

2,66

7 re

ques

ted

from

Ml

(US

$ 2,

284,

210)

. C

$ 1,

525,

798

in m

atch

fro

m H

KI

(US

$1

,024

,268

) N

arra

tive

Exp

ecte

d R

esul

ts

Per

form

ance

M

easu

rmen

ts

Ass

umpt

ions

/Ris

k In

dica

tors

(fa

ctor

s)

Ben

efic

iarie

s/R

each

R

esul

ts A

chie

ved

Indi

cato

rs:

Res

ourc

es

(hum

an a

nd fi

nanc

ial)

allo

cate

d to

nut

ritio

n,

Can

't be

tra

nsla

ted

dire

ctly

int

o ul

timat

e be

nefic

iarie

s at

this

st

age.

Est

imat

ed to

rea

ch o

ver

150

key

nutr

ition

act

ors

z C 0 z C 0

Obj

ectiv

e 3.

P

rom

ote

fort

ifica

tion

of fo

od i

tem

s in

the

EC

OW

AS

re

gion

, re

sulti

ng i

n at

leas

t tw

o co

untr

ies

in t

he r

egio

n ha

ving

an

addi

tiona

l m

icro

nutr

ient

-for

tifie

d pr

oduc

t av

aila

ble

to c

onsu

mer

s by

th

e en

d of

pha

se I

I.

Out

com

e: i

ncre

ased

co

nsum

ptio

n of

vita

min

A

fort

ified

foo

ds

Indi

cato

rs:

Pro

port

ion

of

peop

le i

n 2

coun

trie

s co

nsum

ing

vita

min

A-

fort

ified

foo

ds

Ass

umpt

ions

/Ris

k In

dica

tors

: po

litic

al

com

mitm

ent

by E

CO

WA

S,

mem

ber

stat

es a

nd f

ood

indu

strie

s (m

ediu

m t

o hi

gh

risk)

. T

his

may

req

uire

a

long

er ti

me

fram

e to

ac

hiev

e, h

owev

er t

here

has

been

str

ong

dem

onst

ratio

n of

com

mitm

ent.

Pla

nned

to

reac

h ap

prox

imat

ely

50%

of

the

popu

latio

n of

2 c

ount

ries

- or

5

mill

ion

per

coun

try.

Pot

entia

lly

muc

h la

rger

pop

ulat

ion

can

be

reac

hed.

Obj

ectiv

e 4.

Pro

mot

e in

tegr

atio

n of

m

icro

nutr

ient

tra

inin

g in

to p

re-

serv

ice

trai

ning

of

heal

th c

are

prof

essi

onal

s.

Out

com

e: i

mpr

oved

m

icro

nutr

ient

pra

ctic

e by

he

alth

car

e w

orke

rs

Indi

cato

rs:

Pro

port

ion

of

pre-

serv

ice

inst

itutio

ns

deliv

erin

g st

ate

of t

he a

rt

mic

ronu

trie

nt t

rain

ing,

Ass

umpt

ions

/Ris

k In

dica

tors

: com

mitm

ent

of

pre-

serv

ice

inst

itutio

ns t

o m

odify

cur

ricul

um (

varie

s fr

om l

ow t

o m

ediu

m b

y in

stitu

tion)

.

Can

't be

tra

nsla

ted

dire

ctly

int

o ul

timat

e be

nefic

iarie

s at

thi

s st

age.

Pla

nned

to

reac

h at

le

ast

7,50

0 st

uden

ts p

er y

ear.

Obj

ectiv

e 5.

D

evel

op r

egio

nal

dire

ctiv

es o

n a

core

pac

kage

of

nutr

ition

edu

catio

n m

ater

ials

and

tr

aini

ng t

hat

shou

ld b

e an

int

egra

l pa

rt o

f al

l he

alth

fac

ilitie

s se

rvic

es

Out

com

e: i

mpr

oved

m

icro

nutr

ient

pra

ctic

es b

y be

nefic

iary

pop

ulat

ions

Indi

cato

rs:

Pro

port

ion

of

heal

th c

are

wor

kers

de

liver

ing

qual

ity n

utrit

ion

lEO

.

Ass

umpt

ions

/Ris

k In

dica

tors

: abi

lity

of

coun

trie

s to

rep

licat

e ex

perie

nces

of B

urki

na,

Mal

i an

d N

iger

(m

ediu

m

risk)

,

Can

't be

tra

nsla

ted

dire

ctly

into

ul

timat

e be

nefic

iarie

s at

thi

s st

age.

Ben

efic

iarie

s w

ill b

e th

ose

atte

ndin

g he

alth

clin

icsl

. A

ssum

ed t

hat

ther

e is

appr

oxim

atel

y 40

% c

over

age

of h

ealth

fac

ilitie

s in

EC

OW

AS

re

gion

.

Proj

ect N

ame:

Sah

e/M

icro

nutr

ient

Irn

tiativ

e St

rnz,

gthe

nin,

g vi

tam

in A

and

iron

to

-ogr

ams

in I

Ves

t Afn

ca (

Bur

/oin

a Fa

so, M

a/i,

Ni,g

eria

)

Nar

rativ

e E

xpec

ted

Res

ults

P

erfo

rman

ce

____

____

_

Mea

surm

ents

O

bjec

tive

6. A

sses

s im

pact

of

part

ners

hip

with

EC

OW

AS

st

ruct

ures

on

impr

ovin

g nu

triti

on

prog

ram

s in

the

reg

ion.

Out

com

e: i

mpr

oved

pa

rtne

rshi

p w

ith

EC

OW

AS

reg

iona

l st

ruct

ures

Indi

cato

rs: A

dopt

ion

and

appl

icat

ion

of

reco

mm

enda

tions

Dur

atio

n: 2

yea

rs (

Mar

ch 1

, 20

01

- F

ebru

ary

28,

2003

Bud

get:

C$

3,40

2,66

7 re

ques

ted

from

Ml

(US

$ 2,

284,

210)

. 0$

1,5

25,7

98 i

n m

atch

fro

m H

KI

(US

$1

,024

,268

)

Ass

umpt

ions

/Ris

k B

enef

icia

ries/

Rea

ch

Res

ults

Ach

ieve

d In

dica

tors

(fa

ctor

s)

Ass

umpt

ions

/Ris

k In

dica

tors

: C

omm

itmen

t of

E

CO

WA

S a

nd i

ts

stru

ctur

es (

low

ris

k)

Not

app

licab

le

Obj

ectiv

e 1.

M

aint

ain

vita

min

A

caps

ute

cove

rage

at

or a

bove

80%

fo

r ch

ildre

n 6-

59 m

onth

s th

roug

h a

com

bine

d st

rate

gy o

f N

ID5

and

NM

Ds.

Out

com

e: m

aint

aine

d hi

gh c

over

age

of c

hild

ren

6-59

mon

ths

with

vita

min

A

Indi

cato

rs: v

itam

in A

ca

psul

e co

vera

ge o

f ch

ildre

n 6-

59 m

onth

s

Ass

umpt

ions

/Rjs

k In

dica

tors

: Nig

er c

an

cont

inue

to m

obili

ze

adeq

uate

qu

antit

ies

of

caps

ules

(lo

w r

isk)

,

At

leas

t 1.

64 m

illio

n ch

ildre

n 6-

59

mon

ths

twic

e pe

r ye

ar,

of

who

m 8

0% a

re a

t ris

k

Z

—

Z

Z

Obj

ectiv

e 2.

Mai

ntai

n ro

utin

e us

e O

utco

me:

mai

ntai

ned

of v

itam

in A

in

heal

th c

ente

rs f

or

high

cov

erag

e of

chi

ldre

n cu

rativ

e do

sing

and

use

of

6-59

mon

ths

with

vita

min

iro

n/fo

late

for

pre

gnan

t wom

en in

A

for

cur

ativ

e do

sing

, he

alth

fac

ilitie

s.

post

-par

tum

wom

en w

ith

vita

min

A a

nd

preg

nant

llact

atin

g w

omen

with

iro

n/fo

late

,

Obj

ectiv

e 3.

D

evel

op a

co

re

Out

com

e: I

mpr

oved

nu

triti

on e

duca

tion

pack

age

base

d m

icro

nutr

ient

pra

ctic

e by

on

les

sons

lear

ned

from

nut

ritio

n be

nefic

iary

pop

ulat

ions

IE

C,

that

will

be

adm

inis

tere

d in

all

heal

th f

acili

ties,

Obj

ectiv

e 4.

Fac

ilita

te e

xpan

sion

of

Out

com

e: 8

0% o

f co

mm

unity

-bas

ed d

istr

ibut

ion

of

preg

nant

wom

en in

ta

rget

ro

n/fo

late

to

preg

nant

wom

en t

o vi

llage

s w

ill r

ecei

ve

cove

r an

ad

ditio

nal

160

villa

ges,

iro

n/fo

late

en

surin

g co

vera

ge o

f at

I

targ

et v

illag

es,

east

80%

com

mitm

ent o

f M

inis

try

of

Hea

8h(lo

wris

k)

Indi

cato

rs: v

itam

in A

A

ssum

ptio

ns/R

isk

caps

ule

cove

rage

of

Indi

cato

rs:

Nig

er c

an

child

ren

6-59

mon

ths,

pos

t co

ntin

ue t

o m

obili

ze

part

um w

omen

and

ad

equa

te q

uant

ities

of

iron/

fola

te c

over

age

for

caps

ules

(lo

w r

isk)

, ca

n pr

egna

nt w

omen

, m

obili

zed

adeq

uate

iro

n/fo

late

tab

lets

(m

ediu

m

risk)

, com

mitm

ent

of

Min

istr

y of

Hea

lth (

low

ris

k)

Indi

cato

rs:

heal

th w

orke

rs

Indi

cato

rs: A

dequ

ate

time

impl

emen

ting

nutr

ition

lE

G

of h

ealth

wor

kers

to

deliv

er

acco

rdin

g to

nat

iona

l lE

G (

med

ium

ris

k),

com

mitm

ent

of M

inis

try

of

guid

elin

es

Hea

lth (

low

ris

k)

Indi

cato

rs' p

ropo

rtio

n of

A

ssum

ptio

ns/R

isk

preg

nant

wom

en i

n ta

rget

In

dica

tors

: M

inis

try

of

villa

ges

rece

ivin

g an

d H

ealth

, co

mm

uniti

es a

nd

cons

umin

ot

her

part

ners

int

eres

ted

in

repl

icat

ing

expe

rie

tabl

ets

iron/

fola

te

nce

(low

At l

east

65,

600

child

ren

6-59

m

onth

s re

ceiv

e at

le

ast

one

cura

tive

dose

ann

ually

, al

l at

ris

k.

181,

000

wom

en r

ecei

ve

post

par

tum

VA

C (

all a

t ris

k).

181,

000

preg

nant

wom

en

rece

ive

iron/

fola

to l

atI

at r

isk)

. (A

ssum

es 4

0% h

ealth

co

vera

ge.)

890,

000

child

ren

0-5

year

s,

951,

000

wom

en o

f chi

ld

bear

ing

age

will

hav

e ac

cess

to

nutr

ition

lE

O t

hrou

gh h

ealth

fa

cilit

ies

(Ass

umes

40%

hea

lth

cove

rage

)

5,30

0 pr

egna

nt w

omen

per

ye

ar w

ilt r

ecei

ve i

ron/

tola

te

Ass

umes

ave

rage

vill

age

size

of

800

.

Obj

ectiv

e pa

rtia

lly a

chie

ved

and

unde

rway

. N

utrit

ion

adop

ted

as o

ne o

f eig

ht p

rogr

am

prio

ritie

s of

WA

HO

W

AH

O jo

intly

org

aniz

ed fo

od

fort

ifica

tion

dial

ogue

. H

KI

is c

olla

bora

ting

with

B

AS

ICS

and

oth

er W

AH

O p

artn

ers

to a

sses

s im

pact

of n

utrit

ion

foca

l poi

nts

(met

hodo

logy

co

mpl

eted

, w

ork

unde

rway

, to

be

pres

ente

d in

S

epte

mbe

r 03)

.

On

aver

age

over

the

tw

o ye

ars

of th

e pr

ojec

t, 80

% t

arge

t was

rea

ched

.

Rou

tine

serv

ices

mai

ntai

ned

in pa

rtne

rshi

p w

ith

GT

Z.

Cov

erag

e es

timat

es t

hrou

gh r

outin

e ar

e 30

%.

Cor

e nu

triti

on e

duca

tion

pack

age

deve

lope

d,

alon

g w

ith a

ccom

pany

ing

lEO

mat

eria

ls

CB

D o

f iro

n/fo

late

was

suc

cess

fully

exp

ande

d fr

om 2

to

7 D

istr

icts

Hel

en K

elle

r te

tern

atio

tiat

Page

3 of

9

Log

Fra

me

and

Res

ults

Ach

ieve

d

BU

RK

INA

FA

SO

:

Fle

len

Kel

ler

Inte

rnat

iona

l Pa

ge 4

of

9

Log

Fra

me

and

Res

ults

Ach

ieve

d

z c:t z z 0: z 0: z 0: z 0: z

Proj

ect N

ame:

Sah

elM

icro

nutr

ient

Ini

tiativ

e St

rnzg

then

ing

vita

min

A a

nd ir

on

in W

est A

fric

a (B

urin

ina

Faso

, M

ali,

1'\T

zger

,

Dur

atio

n: 2

yea

rs (

Mar

ch 1

20

01 -

Feb

ruar

y 28

,

2003

B

udge

t: 0$

3,4

02,6

67 r

eque

sted

from

MI

(US

$ 2,

284,

210)

. C

S 1

,525

,798

in

mat

ch f

rom

HK

I (U

S

$1,0

24,2

68)

Nar

rativ

e E

xpec

ted

Res

ults

P

erfo

rman

ce

Mea

surm

ents

A

ssum

ptio

ns/R

isk

Indi

cato

rs (

fact

ors)

B

enef

icia

ries/

Rea

ch

Res

ults

Ach

ieve

d

Obj

ectiv

e 5.

Tes

t fea

sibi

lity

of

expa

ndin

g iro

n/fo

late

dis

trib

utio

n to

in

clud

e ch

ildre

n 6-

59 m

onth

s in

tw

o he

alth

dis

tric

ts (

Tan

out

and

Dog

on

Dou

tchi

)

Out

com

e: 8

0% o

f

child

ren

6-59

mon

ths

atte

ndin

g he

alth

clin

ics

will

rec

eive

iro

n/fo

late

Indi

cato

rs:

prop

ortio

n of

ch

ildre

n 6-

59 m

onth

s at

tend

ing

heal

th c

linic

s re

ceiv

ing

iron/

fola

te

Ass

umpt

ions

/Ris

k In

dica

tors

: Will

ingn

ess

of

Min

istr

y of

Hea

lth t

o ex

pand

pol

icy

(low

), a

bilit

y to

ens

ure

adeq

uate

iro

n/fo

late

(m

ediu

m),

w

illin

gnes

s 0/

heal

th c

are

wor

kers

to a

pply

new

pr

otoc

ol (

low

).

3300

0 ch

ildre

n 6-

59 m

onth

s w

ill re

ceiv

e iro

rt/fo

late

su

pple

men

ts (

Ass

umes

40%

ha

ve a

cces

s to

hea

lth f

acili

ties

and

tota

l po

pula

tion

of 2

tar

get

dist

ricts

of

570,

000.

)

Thi

s ob

ject

ive

was

not

rea

ched

bea

use

of t

he

pric

e of

the

supp

lem

ent a

nd b

ecau

se a

conc

ensu

s co

uld

not

be r

each

ed a

mon

g pe

diat

ricia

ns o

n th

is a

ppro

ach

Obj

ectiv

e 6.

D

evel

op a

pi

lot

prog

ram

of

smal

l-sca

le fo

od

fort

ifica

tion

in a

t le

ast

25 v

illag

es,

Out

com

e: 7

0% o

f

child

ren

0-5

year

s an

d w

omen

0/c

hild

bea

ring

age

will

con

sum

e lo

cally

m

icro

nutr

ient

for

tifie

d pr

oduc

t in

tar

get

villa

ges,

prop

ortio

n of

ch

ildre

n 0-

5 ye

ars

and

wom

en o

f chi

ld b

earin

g ag

e co

nsum

ing

loca

lly

mic

ronu

trie

nt f

ortif

ied

prod

uct

in t

arge

t vi

llage

s.

Ass

umpt

ions

/Ris

k In

dica

tors

: W

illin

gnes

s of

vi

llage

lead

ers

and

mill

owne

rs t

o im

plem

ent

proj

ect (

low

); w

illin

gnes

s of

co

nsum

ers

to c

onsu

me

prod

uct

(med

ium

).

2,80

0 ch

ildre

n 6-

59 m

onth

s ye

ars

and

3,00

0 w

omen

of

child

bea

ring

age.

(A

ssum

es

aver

age

villa

ge s

ize

0/80

0 pe

rson

s.)

Initi

al c

onta

cts

set-

up b

y M

l fo

rtifi

catio

n co

nsul

tant

. N

atio

nal F

ood

For

tific

atio

n C

omm

ittee

es

tabl

ishe

d. N

o sp

ecifi

c sm

all-s

cale

fort

ifica

tion

yet.

Obj

ectiv

e 7.

In

stitu

tiona

lize

mic

ronu

trie

nt t

rain

ing

in p

re-s

ervi

ce

trai

ning

ins

titut

ions

for

hea

lth

wor

kers

in

Nig

er.

Out

com

e: I

mpr

oved

m

icro

nutr

ient

pra

ctic

e by

ne

w h

ealth

car

e w

orke

rs

Indi

cato

rs:

prop

ortio

n of

st

uden

ts in

pre

-ser

vice

tr

aini

ng re

ceiv

ing

mic

ronu

trie

nt t

rain

ing

acco

rdin

g to

gui

delin

es

Ass

umpt

ions

/Ris

k In

dica

tors

: Will

ingn

ess

of

pre-

serv

ice

inst

itutio

ns to

m

odify

cur

ricul

um (

low

),

Can

't be

tra

nsla

ted

dire

ctly

into

ul

timat

e be

nefic

iarie

s at

this

st

age.

Ass

ume

that

500

st

uden

ts w

ill b

e tr

aine

d pe

r ye

ar.

The

wor

king

gro

ups

deve

lope

d nu

triti

on c

urric

ula

for

the

diffe

rent

pre

-ser

vice

inst

itutio

ns. A

tot

al o

f 80

0 m

odul

es w

ere

prod

uced

, T

rain

ing

of tr

aine

rs

was

org

aniz

ed o

ver

a 5-

day

perio

d

Obj

ectiv

e 8.

C

ontin

ue s

uppo

rt to

the

nutr

ition

sur

veill

ance

sys

tem

to

prov

ide

ongo

ing

data

on

key

mic

ronu

trie

nt i

ndic

ator

s.

Out

com

e: I

mpr

oved

dat

a on

m

icro

nutr

ient

s In

dica

tors

: pr

opor

tion

of

stud

ents

in p

re-s

ervi

ce

trai

ning

rece

ivin

g m

icro

nutr

ient

tra

inin

g ac

cord

ing

to g

uide

lines

Ass

umpt

ions

/Ris

k In

dica

tors

: Will

ingn

ess

of

pre-

serv

ice

inst

itutio

ns t

o

mod

ify c

urric

ulum

(lo

w),

Can

't be

tra

nsla

ted

dire

ctly

into

ultim

ate

bene

ficia

ries

at t

his

stag

e. A

ssum

e th

at 5

00

stud

ents

will

be

trai

ned

per

year

.

The

sur

veill

ance

sys

tem

was

sup

port

ed w

ith a

trai

ning

of 6

4 da

ta c

olle

ctor

s,

33 n

urse

s an

d 11

head

s of

epi

dem

iolo

gica

l su

rvei

llanc

e, w

hich

en

abel

ed a

thi

rd r

ound

of

data

col

lect

ion

taki

ng

plac

e in

Jul

y 20

02.

Obj

ectiv

e 9.

P

rovi

de s

tate

0/th

e O

utco

me:

Im

prov

ed

Indi

cato

rs:

num

ber

of

Ass

umpt

ions

/Ris

k D

ata

are

repr

esen

tativ

e of

H

KI

regu

larly

pro

vide

s al

l its

par

tner

s w

ith c

opie

s

art

upda

tes

on m

icro

nutr

ient

s an

d te

chni

cal

assi

stan

ce t

o pa

rtne

rs

wor

king

in

mic

ronu

trie

nts

in N

iger

.

mic

ronu

trie

nt p

rogr

ams

by p

artn

ers

in N

iger

da

ta c

olle

ctio

n ro

unds

ca

rrie

d ou

t, an

alyz

ed a

nd

diss

emin

ated

,

Indi

cato

rs

Min

istr

y of

H

ealth

's a

bilit

y to

Con

tinue

sy

stem

(lo

w r

isk)

, co

mm

itmen

t of

loc

al d

ata

colle

ctor

s (lo

w r

isk)

.

appr

oxim

atel

y 40

/ of

the

popu

latio

n of

Nig

er.

of r

epor

ts i

t pr

oduc

es o

n its

act

ivie

s an

d sh

ares

w

ith t

hem

res

each

fin

ding

s

C z C

1D z C z C

ci:

Hel

en K

elle

r In

tern

atio

nal

Page

5 of

9

Log

Fra

me

and

Res

ults

Ach

ieve

d

Nar

rativ

e E

xpec

ted

Res

ults

Proj

ect

Nam

e:

Initi

ativ

e vi

tam

in A

and

iron

brog

ram

s in

Wes

t Fa

so,

Mal

i,

Dur

atio

n.

year

s (M

arch

20

03

Bud

get:

CS

3,4

0266

7 re

ques

ted

from

(U

S$

2,28

4,21

0).

C$

1525

,798

in m

atch

fro

m H

KI

(US

$1,0

24,2

68)

Obj

ectiv

e 1.

M

aint

ain

vita

min

A

caps

ule

cove

rage

at

or a

bove

80%

for

child

ren

6-59

mon

ths

thro

ugh

a

com

bine

d st

rate

gy o

f N

lDs

and

othe

r ca

mpa

igns

.

Per

form

ance

M

easu

rmen

ts

Out

com

e: m

aint

aine

d hi

gh c

over

age

of c

hild

ren

6-59

mon

ths

with

vita

min

A

Indi

cato

rs:

vita

min

A

caps

ule

cove

rage

of

child

ren

6-59

mon

ths

Ass

umpt

ions

/Ris

k IB

enef

icrs

/Rea

th

Indi

cato

rs (

fact

ors)

A

ssum

ptio

ns/R

isk

Indi

cato

rs:

Bur

kiria

can

cont

inue

to

mob

ilize

ad

equa

te q

uant

ities

of

caps

ules

(lo

w r

isk)

, co

mm

itmen

t of

Min

istr

y of

H

ealth

(lo

w r

isk)

At

leas

t 1.

86 m

illio

n ch

ildre

n 6-

59 m

onth

s at

lea

st o

nce

per

year

: m

ay r

each

tw

ice

per

year

,

who

m 8

0% a

re a

t ris

k.

Res

ults

Ach

ieve

d

- V

itam

in A

cap

sule

co

vera

ge m

aint

aine

d at

ove

r 80

%:

natio

nwid

e th

roug

h N

ID5,

and

in

Ded

ougo

u

and

Fad

s th

roug

h N

MD

5.

Obj

ectiv

e 2

Mai

ntai

n ro

utin

e us

e

of v

itam

in A

in

heal

th c

ente

rs f

or

cura

tive

dosi

ng a

nd u

se o

f iro

n/fo

late

for

preg

nant

wom

en in

heal

th f

acili

ties.

Out

com

e: m

aint

aine

d hi

gh c

over

age

of c

hild

ren

6-59

mon

ths

with

vita

min

A

for

cur

ativ

e do

sing

, po

st-p

artu

m w

omen

with

vita

min

A a

nd

preg

nant

/lact

atin

g w

omen

with

iror

i/fol

ate.

Indi

cato

rs:

vita

min

A

caps

ule

cove

rage

of

child

ren

6-59

mon

ths,

pos

t pa

rtum

wom

en a

nd

iron/

fola

te c

over

age

for

preg

nant

wom

en.

Indi

cato

rs:

Bur

kina

can

co

ntin

ue t

o m

obili

ze

adeq

uate

qua

ntiti

es o

f ca

psul

es (

low

ris

k),

can

mob

ilize

d ad

equa

te

iron/

fola

te t

able

ts (

med

ium

ris

k),

com

mitm

ent

of

Min

istr

y of

Hea

lth )

low

ris

k)

mon

ths

rece

ive

at l

east

one

cu

rativ

e do

se a

nnua

lly,

all

at

risk.

21

4,00

0 w

omen

rec

eive

po

st p

artu

m V

AC

)al

l at

ris

k).

214,

000

preg

nant

wom

en

rece

ive

iron/

fola

te (

all

at r

isk)

.

(Ass

umes

45%

hea

lth

cove

rage

.)

1,04

9,00

0 ch

ildre

n 0-

5 ye

ars,

trai

ning

und

erta

ken.

Due

to

late

im

plem

enta

tion

of

activ

ities

, no

re

sult

are

curr

ently

ava

ilabl

e ye

t.

Sur

vey

of th

e qu

ality

of

nutr

ition

ser

vice

s in

hea

lth

Obj

ectiv

e 3.

D

evel

op a

cor

e nu

triti

on e

duca

tion

pack

age

base

d

on le

sson

s le

arne

d fr

om n

utrit

ion

lEO

, th

at w

ill b

e ad

min

iste

red

in a

ll

heal

th f

acili

ties,

Out

com

e: I

mpr

oved

m

icro

nutr

ient

pra

ctic

e by

bene

ficia

ry p

opul

atio

ns

Indi

cato

rs:

prop

ortio

n of

he

alth

wor

kers

im

plem

entin

g nu

triti

on lE

G

acco

rdin

g to

nat

iona

l gu

idel

ines

Ass

umpt

ions

/Ris

k In

dica

tors

: A

dequ

ate

time

of h

ealth

wor

kers

to d

eliv

er

lEO

(m

ediu

m r

isk)

, co

mm

itmen

t of

Min

istr

y of

Hea

lth (

low

ris

k)

1,23

3,00

0 w

omen

of

child

bear

ing

age

will

hav

e ac

cess

to

nutr

ition

lEO

thr

ough

hea

lth

faci

litie

s (A

ssum

es 4

5% h

ealth

co

vera

ge.)

cent

ers

cond

ucte

d. L

ead

to t

he r

evis

ion

of th

e lE

G

min

imum

pac

kage

redu

ctio

n, t

his

obje

ctiv

e w

as

Obj

ectiv

e 4.

Est

ablis

h co

mm

unity

- ba

sed

dist

ribut

ion

of ir

on/fo

late

to

preg

nant

wom

en t

o co

ver

an

addi

tiona

l 10

0 vi

llage

s, e

nsur

ing

cove

rage

of a

t le

ast

80%

in

targ

et

villa

ges.

Out

com

e: 8

0% o

f pr

egna

nt w

omen

in

targ

et

villa

ges

will

rec

eive

iro

n/fo

late

Indi

cato

rs:

prop

ortio

n of

pr

egna

nt w

omen

in

targ

et

villa

ges

rece

ivin

g an

d co

nsum

ing

iron/

fola

te

tabl

ets

Ass

umpt

ions

/Ris

k In

dica

tors

: M

inis

try

of

Hea

lth,

com

mun

ities

and

othe

r pa

dner

s in

tere

sted

in

repl

icat

ing

expe

rienc

e (lo

w

risk)

3,05

0 pr

egna

nt w

omen

per

year

will

rec

eive

iro

n/fo

late

. A

ssum

es a

vera

ge v

illag

e si

ze

of 8

00.

scho

ol c

hild

ren

will

budg

et

rem

oved

(se

e B

aker

/Beg

in l

ette

r of

Jan

uary

25,

2001

)

Pro

gram

exp

ande

d to

ove

r 70

ne

w s

choo

ls t

hus

Obj

ectiv

e 5

Exp

and

nutr

ition

ed

ucat

ion

and

supp

lem

enta

tion

prog

ram

to

an a

dditi

onal

70

scho

ols

thro

ugh

part

ners

hip

with

CR

S a

nd o

ther

NG

O5

if ap

plic

able

,

Out

com

e: 9

0% o

f ch

ildre

n in

tar

get s

choo

ls

will

rec

eive

iron

/fola

te

supp

lem

enta

tion,

de-

w

orm

ing

and

nutr

ition

ed

ucat

ion.

Indi

cato

rs:

prop

ortio

n of

A

ssum

ptio

ns/R

isk

child

ren

in t

arge

t sc

hool

s In

dica

tors

: A

bilit

y of

CR

S

rece

ivin

g in

terv

entio

n to

rep

licat

e in

terv

entio

n

pack

age.

(lo

w),

com

itmen

t of

Min

istr

y of

Edu

catio

n (m

ediu

m)

rece

ive

nutr

ition

inte

rven

tion,

(Ass

umes

ave

rage

of

220

child

ren

per

scho

ol.)

reac

hing

a t

otal

of

186

scho

ols

in

2 P

rovi

nces

C

0)

C

(1) z

Obj

ectiv

e 10

. (A

dded

by

part

ners

du

ring

star

t-up

wor

ksho

p).

Rev

ise

the

Nat

iona

l P

lan

of A

ctio

n fo

r N

utrit

ion

MA

LI:

Out

com

e: I

mpr

oved

N

PA

N f

or B

urki

na F

aso

Indi

rect

ly a

ffect

s th

e w

hole

po

pula

tion

NP

AN

rev

ised

, fin

aliz

ed a

nd v

alid

ated

. N

utrit

ion

elev

ated

to

a D

irect

orat

e w

ithin

Min

istr

y of

Hea

lth.

Hel

en K

elle

r In

tern

atio

nal

Pag

e 6

of 9

Lo

g F

ram

e an

d R

esul

ts A

chie

ved

Proj

ect N

ame:

Sah

elM

uron

utri

ent

Initi

ativ

e St

rasg

then

ing

vita

min

A a

nd i

ron

.

5rog

ram

s in

Wes

t Afr

ica

(Bur

kina

Fas

o, M

ali,

Nig

er,

Nig

eria

)

Dur

atio

n: 2

yea

rs (

Mar

ch 1

, 20

01 -

F

ebru

ary

28,

2003

Bud

get:

0$ 3

,402

,667

req

uest

ed f

rom

Ml

(US

$ 2,

284,

210)

. 0$

1,5

25,7

98 i

n m

atch

fro

m H

KI

(US

$1

,024

,268

) N

arra

tive

Exp

ecte

d R

esul

ts

Per

form

ance

M

easu

rmen

ts

Ass

umpt

ions

/Ris

k In

dica

tors

(fa

ctor

s)

Ben

efic

iarie

s/R

each

R

esul

ts A

chie

ved

Obj

ectiv

e 6.

E

nsur

e at

lea

st o

ne

vita

min

A-f

ortif

ied

prod

uct

is

on t

he

mar

ket

and

prom

oted

to

cons

umer

s by

the

end

of

phas

e II

Out

com

e: 4

0% o

f ch

ildre

n an

d w

omen

will

ha

ve a

cces

s an

d co

nsum

e vi

tam

in A

fo

rtifi

ed fo

od

Indi

cato

rs: p

ropo

rtio

n of

ch

ildre

n an

d w

omen

co

nsum

ing

vita

min

A-

fort

ified

food

Ass

umpt

ions

/Ris

k In

dica

tors

: C

omm

itmen

t an

d ab

ility

of p

artn

ers

(Gov

ernm

ent

food

in

dust

ry)

to i

mpl

emen

t fo

rtifi

catio

n (m

ediu

m t

o hi

gh).

Thi

s m

ay r

equi

re a

long

er t

ime

fram

e to

achi

eve.

840,

000

child

ren

6-59

mon

ths,

of

who

m 8

0% a

t ris

k,

1,09

6,00

0 w

omen

of c

hild

be

arin

g ag

e of

who

m 8

0/ a

t ris

k.

Ena

blin

g en

viro

nmen

t fo

r for

tific

atio

n cr

eate

d fo

llow

ing

exte

nsiv

e lo

bbyi

ng f

or M

inis

teria

l or

der

and

advo

cacy

effo

rts.

No

fort

ifica

tion

yet.

Obj

ectiv

e 7.

D

evel

op a

pilo

t pr

ogra

m o

f sm

all-s

cale

foo

d fo

rtifi

catio

n in

at

leas

t 25

vill

ages

,

Out

com

e: 7

0% o

f

child

ren

0-5

year

s an

d w

omen

of c

hild

bea

ring

age

will

con

sum

e lo

cally

m

icro

nutr

ient

for

tifie

d .

prod

uct

in ta

rget

vill

ages

,

Indi

cato

rs:

prop

ortio

n of

ch

ildre

n 0-

5 ye

ars

and

wom

en

of c

hild

bea

ring

age

cons

umin

g lo

cally

m

icro

nutr

ient

fort

ified

'

.

prod

uct

in t

arge

t vi

llage

s.

Ass

umpt

ions

/Ris

k In

dica

tors

: W

illin

gnes

s of

vi

llage

lead

ers

and

mill

ow

ners

to

impl

emen

t pr

otec

t (lo

w);

will

ingn

ess

of

cons

umer

s to

con

sum

e .

prod

uct

(med

ium

).

2,80

0 ch

ildre

n 0-

5 ye

ars

and

3,00

0 w

omen

of

child

bea

ring

age.

(A

ssum

es a

vera

ge v

illag

e si

ze o

f 80

0 pe

rson

s.)

Pilo

t pr

ogra

m s

et-u

p fo

r sh

ea b

utte

r for

tific

atio

n at

th

e vi

llage

lev

el

Obj

ectiv

e 8.

In

stitu

tiona

lize

mic

ronu

trie

nt t

rain

ing

in p

rese

rvic

e tr

aini

ng i

nstit

utio

ns f

or h

ealth

w

orke

rs i

n B

urki

na F

aso

Out

com

e: I

mpr

oved

m

icro

nutr

ient

pra

ctic

e by

ne

w h

ealth

car

e w

orke

rs

Indi

cato

rs:

prop

ortio

n of

st

uden

ts i

n pr

e-se

rvic

e tr

aini

ng r

ecei

ving

m

icro

nutr

ient

tra

inin

g ac

cord

ing

to g

uide

lines

Ass

umpt

ions

/Ris

k In

dica

tors

: Will

ingn

ess

of

pre

serv

ice

inst

itutio

ns to

m

odify

cur

ricul

um (

low

)

Can

't be

tra

nsla

ted

dire

ctly

into

ul

timat

e be

nefic

iarie

s at

this

st

age

Ass

ume

that

650

st

uden

ts w

ill b

e tr

aine

d pe

r ye

ar.

Sur

vey

cond

ucte

d,

com

mitt

ee s

et-u

p, c

reat

ion

of

trai

ning

gui

de, t

rain

ing

of 1

7 st

aff,

pre-

serv

ice

trai

ning

at

Uni

vers

ity l

evel

stil

l di

scus

sed

Obj

ectiv

e 9.

P

rovi

de s

tate

of t

he

Out

com

e: I

mpr

oved

In

dica

tors

: nu

mbe

r of

A

ssum

ptio

ns/R

isk

Can

't be

tra

nsla

ted

dire

ctly

into

C

reat

ion

of a

m

onth

ly B

ulle

tin h

ighl

ight

ing

HK

I-

art

upda

tes

on m

icro

nutr

ient

s an

d m

icro

nutr

ient

pro

gram

s up

date

s an

d te

chni

cal

Indi

cato

rs:

Par

tner

s ab

ility

ul

timat

e be

nefic

iarie

s at

thi

s B

urki

na F

aso

activ

ities

with

les

sons

lear

ned.

te

chni

cal

assi

stan

ce t

o pa

rtne

rs

wor

king

in

mic

ronu

trie

nts

in B

urki

na

Fas

o.

by p

artn

ers

in B

urki

na

Fas

o as

sist

ance

req

uest

s.

to i

nteg

rate

upd

ates

into

pr

ogra

mm

ing

(med

ium

),

stag

e. A

ssum

e th

at a

t le

ast

50

key

nutr

ition

act

ors

will

be

affe

cted

.

Hig

h ci

rcul

atio

n.

Indi

cato

rs:

pres

ence

of

revi

sed

NP

AN

A

ssum

ptio

ns/R

isk

Indi

cato

rs: B

urki

na F

aso

will

ado

pt r

evis

ed N

PA

N

Nar

rativ

e

Obj

ectiv

e 1.

M

aint

ain

vita

min

A

caps

ule

cove

rage

at

or a

bove

80%

fo

r ch

ildre

n 6-

59 m

onth

s th

roug

h a

com

bine

d st

rate

gy o

f NlD

s an

d ot

her

cam

paig

ns.

Ass

umpt

ions

/Ris

k In

dica

tors

(fa

ctor

s)

Indi

cato

rs:

Mal

i ca

n

cont

inue

to

mob

ilize

ad

equa

te q

uant

ities

of

vita

min

A (

caps

ules

and

/or

disp

enso

rs)

(low

ris

k),

com

mitm

ent

of M

inis

try

of

Hea

lth (

low

ris

k)

Ben

efic

iarie

s/R

each

R

esul

ts A

chie

ved

At

leas

t 1.

70 m

illio

n ch

ildre

n 6-

59 m

onth

s at

lea

st o

nce

per

year

; m

ay r

each

tw

ice

per

year

,

of w

hom

80%

are

at r

isk.

Hel

en K

elle

r tn

tern

atio

nal

Pag

e 7

of 9

Log

Fra

me

and

Res

ults

Ach

ieve

d

Proj

ect N

ttme:

Sah

e/M

icro

nutr

ient

Initi

ativ

e vi

tam

in A

and

zro

n

in

Faso

, M

a/i,

Dur

atio

n: 2

yea

rs (

Mar

ch 1

, 20

01 -

F

ebru

ary

28,

2003

Bud

get:

CS

3,4

02,6

67 r

eque

sted

fro

m M

l (U

S$

2,28

4,21

0).

CS

1,5

25,7

98 i

n m

atch

fro

m H

KI

(US

$1

,024

,268

) E

xpec

ted

Res

ults

P

erfo

rman

ce

Mea

surm

ents

Out

com

e: m

aint

aine

d hi

gh c

over

age

of c

hild

ren

6-59

mon

ths

with

vita

min

A

Indi

cato

rs:

vita

min

A

caps

ule

cove

rage

of

child

ren

6-59

mon

ths

Tar

get

cove

rage

ach

ieve

d th

roug

h N

lDs

and

in

regi

ons

whe

re R

MD

s w

ere

held

Obj

ectiv

e 2.

Mai

ntai

n ro

utin

e us

e

of v

itam

in A

in

heal

th c

ente

rs f

or

cura

tive

dosi

ng a

nd u

se o

f iro

n/fo

late

for

pre

gnan

t w

omen

in

heal

th f

acili

ties.

Out

com

e: m

aint

aine

d hi

gh c

over

age

of c

hild

ren

6-59

mon

ths

with

vita

min

A

for

cura

tive

dosi

ng,

post

-par

tum

wom

en w

ith

vita

min

A a

nd

preg

nant

/lact

atin

g w

omen

with

iro

nlfo

late

.

Indi

cato

rs:

vita

min

A

caps

ule

cove

rage

of

child

ren

6-59

mon

ths,

pos

t pa

rtum

wom

en a

nd

ironl

fola

te c

over

age

for

preg

nant

wom

en.

Ass

umpt

ions

/Ris

k In

dica

tors

: Mal

i ca

n co

ntin

ue t

o m

obili

ze

adeq

uate

qua

ntiti

es o

f ca

psul

es (

low

ris

k),

can

mob

ilize

d ad

equa

te

iron/

fola

te t

able

ts (

med

ium

ris

k),

com

mitm

ent

of

Min

istr

y of

Hea

lth (

low

ris

k)

At

leas

t 68

,000

chi

ldre

n 6-

59

mon

ths

rece

ive

at l

east

one

cu

rativ

e do

se a

nnua

lly,

all

at

risk.

19

0,00

0 w

omen

re

ceiv

e po

st p

artu

m V

AC

(al

l at

ris

k).

190,

000

preg

nant

wom

en

rece

ive

iron/

fola

te (

all

at r

isk)

.

(Ass

umes

40%

hea

lth

cove

rage

.)

Vita

min

A a

s w

ell a

s iro

n/fo

late

is n

ow p

rom

oted

th

roug

hout

Mal

i bec

ause

of a

shi

ft in

str

ateg

y. H

KI

cond

ucte

d st

udy

whi

ch i

dent

ified

tra

inin

g ne

eds,

am

ong

othe

rs

Obj

ectiv

e 3.

Dev

elop

a c

ore

nutr

ition

edu

catio

n pa

ckag

e ba

sed

on le

sson

s le

arne

d fr

om n

utrit

ion

IEC

, th

at w

ill b

e ad

min

iste

red

in a

ll he

alth

fac

ilitie

s,

Out

com

e: I

mpr

oved

m

icro

nutr

ient

pra

ctic

e by

be

nefic

iary

pop

ulat

ions

Indi

cato

rs:

prop

ortio

n of

he

alth

wor

kers

im

plem

entin

g nu

triti

on

EC

ac

cord

ing

to n

atio

nal

guid

elin

es

Ass

umpt

ions

/Ris

k In

dica

tors

: A

dequ

ate

time

of h

ealth

wor

kers

to d

eliv

er

IEC

(m

ediu

m r

isk)

, co

mm

itmen

t of

Min

istr

y of

H

ealth

(lo

w r

isk)

944,

000

child

ren

0-5

year

s,

1,05

6,00

0 w

omen

of c

hild

be

arin

g ag

e w

ill h

ave

acce

ss t

o nu

triti

on l

EO

thr

ough

hea

lth

faci

litie

s (A

ssum

es 4

0% h

ealth

co

vera

ge.)

The

min

imum

pac

ked

has

been

dev

elop

ed a

nd

IEC

mat

eria

ls a

re b

eing

mul

tiplie

d an

d di

strib

uted

al

ong

with

a t

rain

ing

of tr

aine

rs o

n th

eir

use

Obj

ectiv

e 4.

Dev

elop

mic

ronu

trie

nt

info

rmat

ion

prog

ram

min

g ca

paci

ty

of th

e 14

7 pr

ivat

e co

mm

unity

ra

dios

and

tel

evis

ion

stat

ions

th

roug

h pa

rtne

rshi

p w

ith t

he U

nion

des

Rad

oidi

ffusi

ons

et T

é/O

vis

ion

Libr

es d

u M

a/i.

Out

com

e: I

ncre

ased

co

vera

ge o

f m

icro

nutr

ient

su

bjec

ts t

hrou

gh m

ass

med

ia,

Indi

cato

rs:

prop

ortio

n of

co

mm

unity

rad

ios

and

priv

ate

tele

visi

on s

tatio

ns

incl

udin

g m

icro

nutr

ient

in

form

atio

n in

the

ir pr

ogra

mm

ing.

Ass

umpt

ions

/Ris

k In

dica

tors

: C

omm

itmen

t of

priv

ate

stat

ions

to

inte

grat

e nu

triti

on p

rogr

amm

ing

(low

to

med

ium

ris

k, v

aryi

ng b

y st

atio

n).

1,05

6,00

0 w

omen

of

child

be

arin

g ag

e. A

sim

ilar

num

ber

of a

dult

men

. A

ssum

es t

hat

40%

of p

opul

atio

n w

ill l

iste

n to

co

mm

unity

rad

ios

broa

dcas

ting

mic

ronu

trie

nt

info

rmat

ion.

A w

orks

hop

on e

labo

ratin

g m

essa

ges

deal

ing

with

nu

triti

on w

as h

eld.

A t

otal

of

110

radi

o st

atio

n m

anag

ers

and

pres

ente

rs h

ave

been

tra

ined

Obj

ectiv

e 5.

E

xpan

d co

mm

unity

- ba

sed

dist

ribut

ion

of i

ron/

fola

te t

o pr

egna

nt w

omen

to c

over

an

addi

tiona

l 10

0 vi

llage

s, e

nsur

ing

cove

rage

of

at le

ast

80%

in

targ

et

villa

ges,

Out

com

e: 8

0% o

f pr

egna

nt w

omen

in ta

rget

vi

llage

s w

ill r

ecei

ve

iron/

fola

te

Indi

cato

rs

prop

ortio

n of

pr

egna

nt w

omen

in t

arge

t vi

llage

s re

ceiv

ing

and

cons

umin

g iro

n/fo

late

ta

blet

s

Ass

umpt

ions

/Ris

k In

dica

tors

: M

inis

try

of

Hea

lth,

com

mun

ities

an

d

othe

r pa

rtne

rs i

nter

este

d in

repl

icat

ing

expe

rienc

e (lo

w

risk)

3,20

0 pr

egna

nt w

omen

per

ye

ar w

ill r

ecei

ve i

ron/

fola

te.

Ass

umes

ave

rage

vill

age

size

of

800

.

Con

side

ring

the

late

dis

cove

ry th

at th

e se

lect

ed

area

s ar

e al

read

y co

vere

d by

UN

ICE

F it

was

de

cide

d to

def

er t

his

activ

ity

Obj

ectiv

e 9.

Pro

vide

sta

te o

f th

e

art

upda

tes

on m

icro

nutr

ient

s an

d

tech

nica

l as

sist

ance

to

part

ners

w

orki

ng i

n m

icro

nutr

ient

s in

Mal

i.

Indi

cato

rs:

num

ber

of

upda

tes

and

tech

nica

l as

sist

ance

req

uest

s.

Ass

umpt

ions

/Ris

k In

dica

tors

: P

artn

ers

abili

ty

to i

nteg

rate

upd

ates

int

o pr

ogra

mm

ing

(med

ium

).

Can

t be

tra

nsla

ted

dire

ctly

into

ultim

ate

bene

ficia

ries

at t

his

stag

e. A

ssum

e th

at a

t le

ast

50

key

nutr

ition

act

ors

will

be

affe

cted

.

Thr

ough

its

mem

bers

hip

in a

nu

mbe

r of

nat

iona

l

com

mitt

ees

HK

I pr

ovid

es t

echn

ical

ass

itanc

e to

its p

artn

ers

NIG

ER

IA:

Obj

ectiv

e 1.

Dev

elop

, te

st a

nd

diss

emin

ate

mod

els

of in

tegr

atin

g

vita

min

A a

nd i

ron/

fola

te

supp

lem

enta

tion

into

CD

TI

prog

ram

s in

Ada

maw

a an

d B

orno

Sta

tes.

Out

com

e: I

ncre

ased

co

vera

ge w

ith v

itam

in A

and

iron/

fola

te i

n C

DT

I pr

ogra

ms

whi

ch a

dopt

th

e m

odel

tha

t is

deve

lope

d.

Ass

umpt

ions

/Ris

k In

dica

tors

: P

artn

ers

abili

ty

and

com

mitm

ent

to

adop

ting

mod

elt

of

inte

grat

ion

of

mic

ronu

trie

nts

into

CD

T1

(var

iabl

e, l

ow t

o m

ediu

m).

Pot

entia

lly t

his

coul

d be

repl

icat

ed i

n 20

oth

er S

tate

s in

Nig

eria

, an

d in

18

oth

er

coun

trie

s in

Afr

ica,

whe

re C

DT

is im

plem

ente

d.

Exp

erie

nce

shar

ed in

3 lo

cal a

nd 3

int

erna

tiona

l m

eetin

gs.

A p

ropo

sal

was

dev

elop

ed t

o ex

pand

this

exp

erie

nce

to a

ll C

DT

I pr

ogra

m a

reas

. U

nder

new

fun

ding

from

Ml

for

post

-NID

5 V

A

supp

lem

enta

tion,

is

bei

ng e

xpan

ded

to 5

addi

tiona

l st

ates

. R

eplic

atio

n in

Cam

eroo

n un

derw

ay u

nder

sepa

rate

fun

ding

.

Hel

en K

elle

r In

tern

atio

nal

Pag

e 8

of 9

Lo

g F

ram

e an

d R

esul

ts A

chie

ved

Proj

ect N

ame:

In

itiat

ive

vita

min

A a

nd ir

on

.

in W

est A

fnca

Fa

so,

Mal

i,

year

s 20

03

Bud

get:

CS

3,4

02,6

67 r

eque

sted

fro

m M

I (U

S$

2,28

4,21

0).

C$

1,52

5,79

8 in

mat

ch f

rom

HK

I (U

S

$1,0

24,2

68)

Ben

efic

iarie

s/R

each

R

esul

ts A

chie

ved

Nar

rativ

e E

xpec

ted

Res

ults

P

erfo

rman

ce

Mea

surm

ents

In

dica

tors

(fa

ctor

s)

of

Ass

umpt

ions

/Ris

k 84

9,00

0 ch

ildre

n 6-

59 m

onth

s,

Nat

iona

l Tas

k F

orce

for

Foo

d F

ortif

icat

ion

set

up.

Obj

ectiv

e 6

Ens

ure

at le

ast

one

Out

com

e: 4

0% o

f In

dica

tors

: pr

opor

tion

and

Indi

cato

rs:

Com

mitm

ent

0/w

hom

80%

at

risk.

It

is a

wai

ting

its l

egal

rec

ogni

tion.

F

ortif

icat

ion

has

larg

e-sc

ale

vita

min

A-f

ortif

ied

prod

uct

is o

n th

e m

arke

t an

d

prom

oted

to c

onsu

mer

s by

the

end

of p

hase

II.

child

ren

and

wom

en w

ill

have

acc

ess

and

cons

ume

vita

min

A-

fort

ified

foo

d

child

ren

wom

en

cons

umin

g vi

tam

in A

- fo

rtifi

ed f

ood.

and

abili

ty o

f pa

rtne

rs

(Gov

ernm

ent.

food

to

im

plem

ent

fort

ifica

tion

(med

ium

to

high

). T

his

may

req

uire

a

1,05

6,00

0 w

omen

of

child

bear

ing

age,

of w

hom

80%

at

risk.

not

star

ted

yet

long

er t

ime

fram

e to

of

Ass

umpt

ions

/Ris

k 4,

770

child

ren

6-24

mon

ths

in

Tw

o po

ssib

le in

tere

sted

par

ties

are

read

y to

beg

in

Obj

ectiv

e 7

Pro

mot

e sm

all-s

cale

O

utco

me:

50%

of

Indi

cato

rs:

prop

ortio

n 6-

24 m

onth

s In

dica

tors

: pr

oduc

ers

to

targ

et v

illag

es.

(Ass

umes

fo

rtifi

catio

n on

ce t

he f

ortif

ican

t an

d te

chni

cal

fort

ifica

tion

by a

t le

ast

20 p

rodu

cers

of

at

leas

t on

e lo

cally

mad

e co

mpl

emen

tary

foo

d fo

r ch

ildre

n th

at i

s al

read

y on

the

mar

ket,

child

ren

6-24

mon

ths

will

cons

ume

loca

lly

mic

ronu

trie

nt f

ortif

ied

com

plem

enta

ry f

ood

prod

uct

in t

arge

t vill

ages

,

child

ren

cons

umin

g lo

cally

m

icro

nutr

ient

for

tifie

d co

mpl

emen

tary

foo

d pr

oduc

t in

tar

get v

illag

es,

of

impl

emen

t fo

rtifi

catio

n (lo

w)

will

ingn

ess

of

cons

umer

s to

co

nsum

e pr

oduc

t (m

ediu

m).

Ass

umpt

ions

/Ris

k

aver

age

villa

ge s

ize

of 8

00

pers

ons)

Can

't be

tra

nsla

ted

dire

ctly

int

o

assi

stan

ce b

ecom

e av

aila

ble

Ass

essm

ent

unde

rtak

en a

nd a

ctio

n pl

an f

inal

ized

. O

bjec

tive

B

Inst

itutio

naliz

e O

utco

me:

Im

prov

ed

Indi

cato

rs: p

ropo

rtio

n in

In

dica

tors

: W

illin

gnes

s of

ul

timat

e be

nefic

iarie

s at

thi

s C

urric

ula

will

be

final

ized

Jul

y 20

03 a

nd t

rain

ing

mic

ronu

trie

nt tr

aini

ng i

n pr

e-se

rvic

e tr

aini

ng i

nstit

utio

ns f

or h

ealth

w

orke

rs i

n M

ali

mic

ronu

trie

nt p

ract

ice

by

new

hea

lth c

are

wor

kers

st

uden

ts

trai

ning

rec

eivi

ng

mic

ronu

trie

nt t

rain

ing

acco

rdin

gto

guid

elin

es

pre

serv

ice

inst

itutio

ns t

o

mod

ify c

urric

ulum

(lo

w)

stag

e A

ssum

e th

at 4

50

stud

ents

will

be

trai

ned

per

will

fol

low

Out

com

e: I

mpr

oved

m

icro

nutr

ient

pro

gram

s

by p

artn

ers

in B

urki

na

Fas

o

Indi

cato

rs:

num

ber

of

CD

TI

prog

ram

s w

hich

ad

opt

mod

el th

at is

deve

lope

d.

z z I- z z z

Hel

en K

elle

r tn

tern

atio

nal

Pag

e 9

of 9

Lo

g F

ram

e an

d R

esul

ts A

chie

ved

Proj

ect

Nam

e: S

alie

/Mzc

ronu

trze

nt I

nitia

tive

vita

min

A a

nd ir

on

.

zn W

est A

fric

a (B

iir!e

zna

Faso

, M

ali,

Ni,g

er,

Dur

atio

n: 2

yea

rs (

Mar

ch 1

20

01

- F

ebru

ary

28,

2003

Bud

get:

C$

3,40

2,66

7 re

ques

ted

from

MI

(US

$ 2,

284,

210)

. C

$ 1,

525,

798

in m

atch

fro

m H

KI

(US

$1

,024

,268

) N

arra

tive

Exp

ecte

d R

esul

ts

Per

form

ance

M

easu

rmen

ts

Ass

umpt

ions

/Ris

k In

dica

tors

(fa

ctor

s)

Ben

efic

iarie

s/R

each

R

esul

ts A

chie

ved

Obj

ectiv

e 2.

E

nsur

e co

vera

ge o

f 70

% o

f ch

ildre

n 6-

59 m

onth

s an

d 70

% o

f wom

en i

n po

st p

artu

m w

ith

vita

min

A c

apsu

les

in v

illag

es

unde

r C

DII

in t

he t

wo

targ

et

Sta

tes

.

Out

com

e: C

over

age

of

child

ren

6-59

mon

ths

and

post

par

tum

wom

en w

ith

vita

mn

A

Indi

cato

rs:

prop

ortio

n of

ch

ildre

n 6-

59 m

onth

s an

d w

omen

in

post

par

tum

re

ceiv

ing

itam

in A

.

Ass

umpt

ions

/Ris

k In

dica

tors

: A

bilit

y of

C

omm

unity

Dis

trib

utor

s to

assu

me

new

tas

ks

(var

iabl

e lo

w to

med

ium

ris

k);

com

mitm

ent o

f pa

rtne

rs; a

bilit

y of

Nig

eria

to

mob

ilize

nec

essa

ry

vita

min

A (

med

ium

).

483,

200

child

ren

6-59

mon

ths,

tw

ice

per

year

, of

who

m 8

0% a

t ris

k. 1

24,1

00 p

ost

part

um

wom

en,

all

at r

isk.

Ass

umes

th

at 7

0% o

f vi

llage

s in

2 S

tate

s ar

e un

der

CD

II.

Cov

erag

e of

chi

ldre

n an

d m

othe

rs p

ost-

part

um

with

vita

min

A t

hrou

gh C

DT

I re

ache

d ov

er 7

0%

Obj

ectiv

e 3.

E

nsur

e co

vera

ge o

f 70

% o

f pr

egna

nt w

omen

with

iro

n/fo

late

tab

lets

in

villa

ges

unde

r C

DT

I in

the

tw

o ta

rget

Sta

tes,

Out

com

e: C

over

age

of

preg

nant

wom

en w

ith

iron/

fola

te t

able

ts

Indi

cato

rs:

prop

ortio

n of

pr

egna

nt w

omen

rec

eivi

ng

and

usin

g iro

n/fo

late

ta

blet

s,

Ass

umpt

ions

/Ris

k In

dica

tors

: A

bilit

y of

C

omm

unity

Dis

trib

utor

s to

assu

me

new

tas

ks

(var

iabl

e lo

w t

o m

ediu

m

risk)

; co

mm

itmen

t of

part

ners

; abi

lity

of N

iger

ia

to m

obili

ze n

eces

sary

ro

n/fo

late

(m

ediu

m).

124,

100

preg

nant

wom

en,

all

at r

isk,

sta

rtin

g ye

ar 2

.

Ass

umes

tha

t 70

% o

f vill

ages

in

2 S

tate

s ar

e un

der

CD

TI.

Cov

erag

e ov

er 7

0% o

f pr

egna

nt w

omen

in

one

stat

e, b

ut w

ith o

nly

a on

e-m

onth

sup

ply

of

iron/

fola

te d

ue t

o lo

gist

ical

prob

lem

s

Obj

ectiv

e 4.

Ass

ess

feas

ibili

ty o

f O

utco

me:

Pol

icy

on

Indi

cato

rs:

Pol

icy

Ass

umpt

ions

/Ris

k W

ith c

hang

e in

pol

icy,

expa

ndin

g gr

oups

cov

ered

by

supp

lem

enta

tion

of

esta

blis

hed

Indi

cato

rs:

Abi

lity

of

pote

ntia

lly 4

83,2

00 c

hild

ren

6-

iron/

fola

te s

uppl

emen

tatio

n to

in

clud

e ch

ildre

n 6-

59 m

onth

s ch

ildre

n w

ith i

ron/

fola

te

thro

ugh

CD

II C

omm

unity

Dis

trib

utor

s to

as

sum

e ne

w t

asks

(v

aria

ble

low

to m

ediu

m

risk)

; co

mm

itmen

t of

part

ners

; abi

lity

of N

iger

ia

to m

obili

ze n

eces

sary

iro

n/fo

late

(m

ediu

m t

o

59 m

onth

s co

uld

bene

fit in

thes

e tw

o S

tate

s. E

xpan

sion

po

ssib

ilitie

s ar

e di

scus

sed

abov

e.

Due

to

logi

stic

al c

onst

rain

ts l

inke

d to

iro

n/fo

late

su

pple

men

t su

pply

, th

is a

ctiv

ity h

as b

een

defe

rred

.

Documents

Sahel Micronutrient Initiative IIThe Sahel Micronutrient Initiative Phase II Strengthening vitamin A and iron programs in West Africa Center lile: 910313-00131210-181 Final Technical