UN Inventory of Nutrition Actions

A summary of the findings – MYANMAR

Myanmar, 30 June 2015

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Potential actions

Consumption

• Improvement of local recipes

• Public guidance & consumer

awareness/protection

• Complementary feeding

Horticulture/Crops

• Diversification & locally adapted

varieties

• Biofortification

Livestock & Fisheries

• Animal husbandry, fisheries & insect

farming

• Animal services

Food Processing, Fortification &

Storage

• Food processing (excluding fortification)

• Fortification (including salt iodization &

complementary foods)

• Food storage

Food, agriculture & diets Health-based

Maternal, Neonatal & Child Health Care• Ante- & post-natal care

• Health professional-assisted delivery

• Basic paediatric health services

Micronutrient Supplementation• Iron & folic acid/Iron supplementation

• Vitamin A/D/zinc/Ca/iodine supplementation

• Multiple micronutrient supplementation

Management of Acute Malnutrition • Mgt of severe acute malnutrition (SAM)

• Mgt of moderate acute malnutrition (MAM)

• Food technology support for specialized

nutrition foods

Disease Prevention & Management• Anti-malaria

• Diarrhoea mgt. (e.g. ORT w/ zinc)

• Vaccinations (measles, polio, etc.)

• HIV mgt. & PMTCT

• Mgt. of tuberculosis

• Mgt. of respiratory infections

Water & Sanitation • Improvement of water supply/source quality

• Sanitation facilities management

Governance• Situation analysis, advocacy & communications

• Policy formulation/review & planning

• Human & institutional capacity development/training

• Effectiveness & accountability

• Food assistance for vulnerable population groups

• School-based social safety nets

• Assisted health services

• Poverty reduction &/or emergency risk mitigation

Market Regulation & Insurance

• Minimum maternity protection

• Insurance (health, unemployment, weather, etc.)

• Macroeconomic levers

Social Safety Nets

Social protection

Infant & Young Child Feeding

• Protection, promotion & support of

optimal breastfeeding

• Improvement of complementary feeding

Hygiene

• Hand-washing

• Household water treatment & storage

• Food hygiene

• Sanitation management

Care for Children/ P&L Women

• Care to pregnant/lactating women

• Childcare support/caregiver workload

Health Behaviours

• Health-seeking behaviour

• Insecticide-treated nets (anti-malaria)

• Family planning behaviour (incl. adolescent

girls)

Maternal & child care

UN Inventory - Nutrition Action Framework

Chin

SagaingKachin

Shan

(N)

MandalayShan (S)

Rakhine

Shan (E)

Kayah

Yangon

Bago

(W)Bago

(E)

Kayin

Tanintharyi

MonAyeyawady

UN support compared to stunting prevalence and number of stunted children

Source: UN Inventory exercise; MICS 2009 (UNICEF); The 2014 Myanmar Population and Housing Census (Department of Population, Ministry of Immigration and Population, The Republic of the Union of Myanmar, May 2015)

MICS 2009 Are UN efforts concentrated in the ‘right’ geographic areas?

Number of UN nutrition actions

by region

Chin

Sagaing

Kachin

Shan (N)

Mandalay

Shan (S)

RakhineMagway

Shan (E)

Kayah

Yangon

Bago (W)Bago (E)

Kayin

Tanintharyi

MonAyeyawady

Chin

Sagaing

Kachin

Shan (N)

Mandalay Shan

(S)

RakhineMagway

Shan (E)

Kayah

Yangon

Bago

(W)Bago

(E)

Kayin

Tanintharyi

Mon

Ayeyawady

> 40%

30-39.9%

20-29.9%

< 20%

125,705

184,025

212,429

155,116

118,758

Stunting prevalence among <5s

Nay Pyi Taw

Nay Pyi Taw Nay Pyi Taw

(84)

(20)

(56)

(22)

(13)

(20)

(53)

(91)

(13)

(13)

(0)

(25)

(47)

(125)

(18)

(15)

(0)

Magway

DRAFT

Absolute numbers of <5s with

stunting

Map of UN presence in state and regions of Myanmar for nutrition-related actions

Agencies intervening at national level:

• How complementary are the nutrition actions? Is there combined value added?

• Is there a critical nutrition action missing in each region/state, that the UN is well-placed to deliver?

• Are there opportunities for improved collaboration on joint planning (targeting & geographic focus), implementation, M&E?

• How can the use of delivery mechanisms (e.g. schools, community health volunteers, agricultural extension) be optimized?

• Alignment of advocacy, communications, other?

Key questions: When more than one agency present

Key questions: When more than one agency present

Chin

Sagaing

Kachin

Shan

(N)

Mandalay Shan

(S)

Rakhine

Magway

Shan

(E)

Kayah

Yangon

Bago

(W)Bago

(E)

Kayin

Tanintharyi

MonAyeyawady

> 40%

30-39.9%

20-29.9%

< 20%

Stunting prevalence

among <5s

Source: UN Inventory exercise; MICS 2009 (UNICEF); The 2014 Myanmar Population and Housing Census (Department of Population, Ministry of Immigration and Population, The Republic of the Union of Myanmar, May 2015)

DRAFT

Sectoral Nutrition Actions

Implementation Vs. Governance

Most of the nutrition actions for which UN agencies are providing support are aligned to the national nutrition plan

Source: UN Inventory exerciseNational Plan of Action for Food and Nutrition (NPAFN) 2011-2015, National Nutrition Center, Department of Health, Ministry of Health, June 2013

UN agency alignment to

the national nutrition plan

[VALUE] [VALUE]91%

100%

80%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

UNICEF WFP FAO WHO

% actions

UNFPA

Average

94%

DRAFT

Most investments in Food, Agriculture and/or Diet-related nutrition actionsare channelled to Horticulture/Crops and Food Processing, Fortification

& Storage, and tend to be small

Source: UN Inventory exercise

Sectoral Actions

Small Medium Large

FAO

FAO

FAO

FAO WFP

FAO

FAO

WHO, WFP, UNICEF

FAO

Improvement of

local recipes

Public guidance & consumer awareness/ protection

Complementary feeding

Co

ns

um

ptio

n

Animal husbandry, fisheries & insect farming

Animal services

Biofortification

Diversification & locally adapted varieties

Food processing (excl. fortification)

Fortification (incl. salt iodization)

Food Storage

Liv

es

toc

k

&

Fis

he

ries

Ho

rticu

lture

/ C

rop

s

Fo

od

Pro

ce

ss

ing

, F

ortific

atio

n &

S

tora

ge

Large investments were only reported for diversification & locally adapted varieties by WFP

Fo

od

, Ag

ricu

lture

an

d D

iet

DRAFT

Investments in Maternal & Child Care-related nutrition actions are made by four agencies, and vary in size

BF = breastfeedingPLW = pregnant and lactating womenSource: UN Inventory exercise

Sectoral Actions

Small Medium Large

WFP, WHO UNICEF

UNICEF, WHO

WFP

WHO UNICEF

UNICEF, WFP, WHO

WHO

WHO UNICEF

WHO

WHO

WHO UNICEF

WHO

WHO UNFPA

Promotion, protection & support

of optimal BF practices

Improvement of complementary feeding

Hand-washing

IYC

F

Household water treatment & storage

Food hygiene

Care to PLW

Sanitation management

Childcare support/ caregiver workload

Health-seeking behaviour

Insecticide-treated bednets (anti-malaria)

Hyg

ien

eC

are

for

Ch

ildre

n &

P

LW

He

alth

B

eh

avio

urs

Large investments were reported for 2 actions, by UNFPA and UNICEF

Family planning behaviour

Mate

rnal a

nd

Ch

ild C

are

DRAFT

The Strategic Objectives of the National Nutrition Plan most supported by the UN agencies are not necessarily backed by large investments

Source: UN Inventory exercise; National Plan of Action for Food and Nutrition (NPAFN) 2011-2015, National Nutrition Center, Department of Health, Ministry of Health, June 2013

2

2

4

5

76

41

4

77

69

SO 3.9 Improve quality & quantify ofinformation

SO 3.8 Improve human capacity

SO 3.7 Improve institutional capacity& coordination

SO 2.6 Improve environmental health& food safety

SO 2.5 Improve mother & child care

SO 2.4 Improve access to food

SO 2.3 Increase & diversify domensticfood production

SO 1.2 Prevent & reduce food, water,vector-borne infectious diseases

SO 1.1 Promote consumption ofhealthy foods & improve nutrient intake

Most UN nutrition actions support Strategic Objectives 1.1, 1.2 & 2.5 in the National Nutrition

Plan

Most UN nutrition actions support Strategic Objectives 1.1, 1.2 & 2.5 in the National Nutrition

Plan

Small Medium Large

Number of actions by magnitude of investment

34 25

53 10

04

16

45

0

0

2

2

5

2

0

0

0

0

10

14

0

20

29

5

4

0

0

# of actions

DRAFT

DRAFT

UN support on prevention & management of soil, waterborne & endemic diseases is mainly focused on governance actions as opposed to implementation actions

Key findings:

• No implementation actions are being supported in anti-malaria programmes/projects, nor the management of diarrhoea and respiratory infections

• Governance actions are virtually distributed equally among: (1) situation analysis, advocacy & communications; (2) policy and planning; (3) capacity development/training; and (4) effectiveness & accountability

• Whereas UNICEF and WFP were engaged in implementation actions, FAO, UNICEF, WFP, WHO, and UNFPA were all engaged in governance actions

# actions

0 01 1 1

0

56

8

15

9

5

0

2

4

6

8

10

12

14

16

18

Implementation Governance

Anti-

malaria

Vaccina-

tions

HIV mgt.

& PMTCT

5

Most of the actions undertaken by the UN are

related to HIV management and PMTCT

Most of the actions undertaken by the UN are

related to HIV management and PMTCT

16

6

PMTCT = prevention of mother to child transmission

TB = tuberculosis

Source: UN Inventory exercise

59

10

Diarrhoea

mgt.

TB

mgt.

Respiratory

infections

mgt.

DRAFT

Multi-sectoral Nutrition Actions

Governance

DRAFT

Most UN agencies carry out actions in nutrition governance, particularly sectoral actions

Sectoral actions in nutrition governance are clustered in the Sit. Analysis, Advocacy &

Communications; Policy/Planning/Programing;

and Capacity Development/Training domains…

Sectoral actions in nutrition governance are clustered in the Sit. Analysis, Advocacy &

Communications; Policy/Planning/Programing;

and Capacity Development/Training domains…

# governance actions

Source: UN Inventory exercise

20 22 21 23

13 11 12 11

2618

2817

10

9

9

3

1

4

4

2

0

10

20

30

40

50

60

70

80

Sit. Analysis,Advocacy &

Communications

PolicyFormulation/

Review &Planning

Human &Institutional

Capacity Dev./Training

Effectiveness &Accountability

UNICEF WFP WHO FAO UNFPA

56

7064 74

… while multi-sectoral facilitation for nutrition governance is most conducted in the Policy

Formulation/Review & Planning domain

… while multi-sectoral facilitation for nutrition governance is most conducted in the Policy

Formulation/Review & Planning domain

# governance actions

1 2 212 1

2

11

1

0

2

4

6

8

10

12

14

16

18

20

Sit. Analysis,Advocacy &

Communications

PolicyFormulation/

Review &Planning

Human &Institutional

Capacity Dev./Training

Effectiveness &Accountability

UNICEF WFP WHO FAO UNFPA

3

74

0

DRAFT

Note: These results capture information on nutrition-related governance actions only, recognizing that some agencies are involved in nutrition

to differing extents