AIMING FOR PROGRAM EXCELLENCE - PowerPoint Presentation

Slide1

AIMING FOR PROGRAM EXCELLENCE — HOME FORTIFICATION WEBINAR SERIES

Moderated by Jonathan Siekmann, PhD

Technical Advisor, GAIN

Secretariat, Home Fortification Technical Advisory Group (HF-TAG)Slide2

Home Fortification Webinar Series

What:

A series webinars organized by UNICEF, CDC, and HF-TAG to address the increasing demand

for technical support and to continuously address knowledge capacity

gaps in

home

fortification

Objectives:

Increase

knowledge and capacity to design and implement effective home fortification programs.

Share

country

experiences and lessons learned with developing, implementing, and scaling up home fortification

programs

Target audience:

The main audience for the webinars will be program implementers who are either planning or implementing home fortification programs.

Where:

The

HF-TAG site

http://www.hftag.org/webinars

/

Frequency:

Bi-monthly Slide3

Today’s webinarGlobal evidence and policies for home fortificationWHO guideline and HF-TAG complement each other in support to countries

Monitoring to improve program effectiveness

Speakers

Dr. Werner

Schultink

(

UNICEF) 10 min

Dr. Martin

Bloem

(WFP) 10 min

Dr. Juan Pablo Peña-Rosas (WHO) 10 min

Dr. Laurence

Grummer

-Strawn (CDC) 10 minSlide4

Home Fortification Webinar Series Launch

Werner

Schultink,

Chief

, Nutrition Section,

UNICEF

Headquarters, New YorkSlide5

Session Outline

Overview of global nutrition situation

UNICEF’s

work

Home fortification technical resources to address increasing

demandSlide6

6

The

global

picture: stunting prevalence

UNICEF Improving Child Nutrition Report 2013Slide7

The global picture: severe acute malnutrition

UNICEF Improving Child Nutrition Report 2013Slide8

Vitamin and mineral deficiencies account for over 50 million disability-adjusted life years (DALYs) lost globally (Murray et al, 2013)

Global estimates of anemia prevalence are 42% in pregnant women and 47% pre-school age children. (WHO, 2009)

Severe anemia kills more than 50,000 women a year during childbirth. (Micronutrient Initiative, 2014)

18 million babies are born mentally impaired due to iodine deficiency each year. (Micronutrient Initiative, 2014)

Deficiencies of vitamin A and zinc account for nearly 300,000 child deaths annually (Black et al., 2013)

8

The global picture:

“Hidden Hunger” Slide9

Growing momentum to scale up nutrition

Scaling Up Nutrition (SUN) movement

Interest in nutrition increased dramatically

Investing in nutrition key development priority

Partnerships are more operational, enhanced complementarity

54 countries have committed to SUN Slide10

Markedly improve nutrition for all children and women by creating an enabling environment that results in evidence-based, sustainable, multisectoral nutrition actions delivered at scale

Adolescent girls

Women of RA

Pregnant & lactating women

Maternal nutrition (prevention of low birth weight)

Infant

& young child feeding

Prevention and treatment of severe acute malnutrition

Micronutrient fortification and supplementation

Nutrition support for those with infectious diseases

Health, WASH, early childhood development, social protection, education, agriculture, poverty reduction

Target

populations

(focusing on the

most disadvantaged)

Nutrition-specific interventions

Nutrition-sensitive approaches

Children under 2 years

Children aged 2−5 years

UNICEF

programme

actions

Reduce micronutrient deficiencies

Prevent and treat SAM

Improve nutritional care for those with infectious

disease

Protect, promote and support appropriate feeding & adequate food

Increase synergies with health, WASH, ECD and social protection

Promote strengthened linkages with agriculture

Promote linkages with health & education to prevent childhood obesity

UNICEF’s commitment to nutrition

UNICEF’s programmatic work in nutritionSlide11

Markedly improve nutrition for all children and women by creating an enabling environment that results in evidence-based, sustainable, multisectoral nutrition actions delivered at scale

Operational approach 6:

Strengthen systems to ensure effective monitoring, evaluation and knowledge management for policy and programming

for nutrition.

Operational approach 5:

Foster a community-centred approach that empowers communities with the knowledge and tools to address their own nutrition issues

.

Operational approach 4:

Develop human, institutional and organizational capacity to implement contextually relevant nutrition programmes.

Operational approach 3:

Support the scale-up of evidence-based, sustainable nutrition-specific interventions and nutrition-sensitive programming.

Operational approach 2:

Build commitment, strengthen leadership and strengthen governance for improved nutrition.

Operational approach 1:

Perform a rights-based, equity-focused situation analysis for nutrition and its determinants to inform policy development and programme design.

Reduce micronutrient deficiencies

Prevent and treat SAM

Protect, promote and support appropriate feeding & adequate food

Increase synergies with health, WASH, ECD and social protection

Promote strengthened linkages with agriculture

Promote linkages with health & education to prevent childhood obesity

Improve nutritional care for those with infectious disease

UNICEF’s commitment to nutrition

UNICEF

programme

actions

Notes: Green arrows illustrate that the operational approaches are interrelated.

UNICEF’s operational approaches to improving nutrition programming for mothers and children Slide12

PartnershipGlobal/national policies and guidelines

Capacity:

Workshops reaching 66 countries on design, implementation, scale up and monitoring of HF programs

Information:

2011

global assessment

of HF.

UNICEF to make it annual through

NutriDash

from 2013 Implementation of home fortification programs 12

Work in Home Fortification using MNPsSlide13

13

Impressive scale-up

2011*

36 MNP interventions implemented in 22 countries

Planned interventions in 20 countries

4 countries were implementing at national scale

2013**

62 MNP interventions implemented in 42 countries

MNP interventions are planned in 19 countries

13 countries implementing at national scale

**UNICEF

NutriDash

, 2014

*

Home Fortification Global Assessment 2011 Slide14

With rapid scale up

Increased technical needs

Variation in challenges depending on the level of implementation

G

reat opportunity for inter-country and inter-agency learning Slide15

Community of practice online opportunity for inter- country learning

http

://network.hftag.org/categories

MNP toolkit

( upcoming)

consolidation various tools, best practices and examples on implantation of home fortification

S

eries of Home Fortification Webinars

15Technical Resources to address the growing capacity needsAiming for Program Excellence Slide16

Home fortification webinars are great and timely opportunity to enhance capacity of program implementers for program improvement

Webinars

and resources are open to all program implementers

16

Timely opportunity to build capacity Slide17

HF-TAG Home Fortification Webinar:

Session One

Martin Bloem

Senior Nutrition Advisor, Nutrition Advisory Office

World Food ProgrammeSlide18

Key messages

Home fortification (HF) is a key and promising intervention to address micronutrient deficiencies and to improve quality of food for young children

Home fortification is a priority nutrition intervention for WFP

WFP is working with HF-TAG partners to enhance capacity and provide harmonized guidance on why and how to implement HF

Home fortification webinars

are an important opportunity

to enhance understanding and capacity of program implementers

for design and implementation of

infant and young child feeding (IYCF) programs that have an HF componentSlide19

Home fortification (HF) is a promising intervention

Rationale for home fortification

Young children require a large range of nutrients in order to grow, develop and remain healthy

Even when affordability and availability do not constrain food access, it is difficult to meet the recommended intakes of some nutrients,

– e.g. iron and

zinc, particularly for children 6-23

mo

Objectives of home fortification programs

Increase micronutrient (MN) intake and improve IYCF practices

Improve MN status

Improve child health, appetite and growth, and reduce morbidity and mortalitySlide20

WHO guideline based on review of studies that provided MNPStudies primarily focused on anemia and iron deficiency and used limited set of MN

Hence: WHO guideline: Minimum 3 micronutrients and at least 60 sachets/6 mo

Note that this is a guideline for decision making, not a fixed prescription

HF-TAG programmatic guidance brief further expands WHO guideline

I

mprove micronutrient intake in order to meet the recommended nutrient intake(FAO/WHO RNI) for more micronutrients, in addition to those relevant for anemia

Considering programming circumstances and experience

Integrate with wider infant and young child nutrition & ‘1000 days’ programming

HF-TAG

brief & WHO MNP

guidelineSlide21

HF is a priority intervention for WFP’s work

WFP is committed to preventing undernutrition and

meeting nutrient requirements

during the

critical first 1,000 days

MNPs play a critical role in combatting micronutrient deficiencies through

fortifying meals of vulnerable populations, in particular young children

WFP and UNICEF are the main procurers

of MNPs, and WFP is the only organization that utilizes MNPs in school feeding

WFP’s work in home fortification

WFP uses

MNPs in 19 countries in nutrition programming In 2013, WFP reached over a half a million beneficiaries under 5 in 7 countries

Through school feeding programmes, WFP reached almost 900 thousand school children aged 6-15 in 12 countries Slide22

WFP is working together with HF–TAG partners to enhance capacity for home fortification

WFP is a committed partner of

HF-TAG, with the aim of providing

harmonized

guidance

on why and how to implement

HF

HF-TAG

works closely with private sector

partners,

including

manufacturers of MNP

WFP also works with HFTAG

partners through the Scaling Up

Nutrition (SUN)

Movement and the SUN Business

Network

HF-TAG: Better results through partnershipSlide23

Webinars are a high potential opportunity to enhance capacity for program improvement

Webinars and resources are open to everyone, and particularly aimed at program implementers

Webinars will cover design and planning of home fortification programs, including:

For whom?

What formulation?

How much and for how long?

What frequency for distribution and use?

Cost?

How quickly can a program start?

What distribution channels to use?

What to monitor and evaluate? Slide24

Point-of-use fortification of foods with multiple micronutrient powders: WHO recommendations

Dr

Juan Pablo Peña-Rosas

Coordinator, Evidence and Programme Guidance

Department of Nutrition for Health and Development Slide25

WHO core functions

providing

leadership on matters critical to health and engaging in partnerships where joint action is needed

;

shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge

;

setting norms and standards and promoting and monitoring their implementation

;

articulating ethical and evidence-based policy options

;

providing technical support, catalysing change, and building sustainable institutional capacity;

and

monitoring the health situation and assessing health trends.

These

core functions are set out in the Twelfth General Programme of Work,

entitled

"Not merely the absence of disease", it covers the 6-year period from 2014 to 2019Slide26

Vitamin and mineral malnutrition

It is estimated that 42.6% of children 6-59 months of age are

anaemia

(2011), which represented 273.2 million children worldwide, with SEARO and WPRO having the absolute highest numbers of children affected.

Children's

haemoglobin

status might have deteriorated in

some southern countries in Africa.

It is estimated that about half of the

anaemia

is due to iron deficiency although the relative contribution varies.

Iron deficiency is thought to be the most common cause of

anaemia

globally, although other conditions, such as folate, vitamin B

12

and vitamin A deficiencies, chronic inflammation, parasitic infections, and inherited disorders can all cause

anaemia

.

Data on the prevalence of other vitamin and mineral deficiencies is scarce.Slide27

WHO evidence-informed guideline development process

New WHO guideline development process

2

nd

edition of WHO Handbook for guideline development released in

D

ecember 2014

Provides guidance on the development of documents or publications containing WHO recommendations

Sets out procedures to follow Slide28

WHO evidence-informed guideline development processSlide29

WHO.

Guideline: Use of multiple micronutrient powders for home fortification of foods consumed by infants and children 6–23 months of age.

Geneva, World Health Organization, 2011.

WHO

evidence-informed

guidelinesSlide30

De-Regil LM, Suchdev PS, Vist GE, Walleser S, Peña-Rosas JP. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD008959. DOI: 10.1002/14651858.CD008959.pub2.

The

evidenceSlide31

WHO recommendations

Home

fortification of foods with multiple micronutrient powders is recommended

to improve

iron status and reduce

anaemia

among infants and children 6–23 months

of age

(

strong recommendation

)Slide32

WHO recommendations

In malaria-endemic areas, the provision of iron should be implemented

in conjunction

with measures to prevent, diagnose and treat

malaria.

Programmes

should

be preceded by an evaluation of the

nutritional status

among children

and

existing measures to

control

anaemia

and vitamin A

deficiency

Behaviour

change

communication strategy

that promotes: awareness and correct use of the powders along

with information

on recommended breastfeeding practices; commencement

of complementary

foods at 6 months of age; preparation of

complementary foods

at age-appropriate frequency, amounts, consistency and

varietySlide33

WHO recommendations

Hand washing with soap and hygienic preparation of food; prompt attention to fever in malaria settings; and measures to manage

diarrhoea

.

The selection of the most appropriate delivery platform should be

context-specific, with

the aim of reaching the least

favoured

populations and

ensuring an

adequate and continued supply of the powders.Slide34

Adoption and adaptation

WHO offers several tools to help countries adopt and adapt the global guidelines into their national and subnational contexts.

To ensure that WHO global guidelines and other

evidence-informed recommendations

for micronutrient interventions are better implemented in

low and middle-income

countries, the Department of Nutrition for Health

and Development

works with the WHO Evidence-Informed Policy Network (EVIPNet

) programme

.

EVIPNet

promotes partnerships at country level between policy-makers

, researchers

, and civil society to facilitate policy development and

implementation through

use of the best available evidence.Slide35
Slide36

Home-Fortification Technical Advisory Group (HFTAG)

The Home Fortification Technical Advisory Group (HF-TAG) is a community of stakeholders involved in home fortification comprised of members from the public, private, academic and non-governmental organization sector.

Its

vision is a world without malnourished children.

WHO has observer status in this group.Slide37

HFTAG

resources for implementationSlide38

Updating WHO recommendations

To include recommendations to the preschool and school-age children informing by the growing body of evidence.

Confirm results from previous 2011 recommendations with updated evidence from Cochrane reviews.

Identify research gaps, particularly in the area of implementation research.

Highlight the need to address the social determinants of health in the implementation of these interventions.Slide39

Acknowledgements

The Evidence and Programme Guidance Unit receives financial resources from several external sources for biennium 2014-2015

Ongoing support – longer term agreements

Bill & Melinda Gates Foundation (2013-2016)

US Centers for Disease Control and Prevention (CDC) (2009-2014)

IMMPaCt Programme

National Center on Birth Defects and Developmental Disabilities

The Micronutrient Initiative (2014-2017)

Harvest Plus (2014)

Donors do not fund specific guidelines and do not participate in any decision related to the guideline development process including the composition of policy questions, membership of the guideline groups, the conduct and interpretation of systematic reviews, or the formulation of recommendations.Slide40

Monitoring Home Fortification Programs

Laurence Grummer-Strawn, PhD

Chief

, Nutrition

Branch

Division

of

Nutrition, Physical Activity,

and

ObesityU.S. Centers for Disease Control and PreventionSlide41

Principles of monitoring

Monitoring improves

program

effectiveness

H

elps achieve

good coverage and adherence to the

intervention

Programmes

must be well designed, implemented and monitored in order to achieve and sustain impactDifferent data collection systems needed for different purposesMonitoring changes and adapt over time

Capacity in country can impact the quality of monitoring systemsSlide42

Monitoring Manual

Multi agency and institutional involvement

Monitoring frameworks

Practical tools –such as worksheets

Case studiesSlide43
Slide44

Will

be available late

2014 at:

www.

hftag.org

HF-TAG MNP ToolkitSlide45

Webinar seriesFuture sessions will include monitoring topics

Potential topics might include:

L

og frames and logic models – how to develop these tools for your program

How to select monitoring indicators

Developing a monitoring protocol

Pros and cons of different approaches to monitoringSlide46

Thank you

Source – GAIN Global Alliance for Nutrition