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UPDATES ON MSNP

Updates on MSNP, SUN/REACH , Initiatives and MYCNISA Saba Mebrahtu , PhD Nutrition Section Chief UNICEF Nepal Nutrition Central Level Advocacy Grand Hotel, Soalteemode , Kalimati Kathmandu, Nepal 15 July 2012. UPDATES ON MSNP.

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UPDATES ON MSNP

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  1. Updates on MSNP, SUN/REACH, Initiatives and MYCNISASaba Mebrahtu, PhDNutrition Section ChiefUNICEF NepalNutrition Central Level AdvocacyGrand Hotel, Soalteemode, KalimatiKathmandu, Nepal15 July 2012

  2. UPDATES ON MSNP

  3. NPC led High Level Nutrition and Food Security Steering Committee chaired by the Vice Chair of the NPC in place and National Nutrition and Food Security Coordination Committee; • Technical working group to guide multi-sectoral nutrition review, and planning; and • Nutrition and Food Secretariat being established at the NPC – with links to NNC of the MoHP and MoAD • Identified strengths, weaknesses, and gaps; • Need for a national nutrition architecture; and • A multi-sectoral approach through an agreed nutrition determinants model.

  4. Clear leadership: the NPC and actively involving health & other key sectors • Focused: the first 1,000 days of life and stunting reduction • Addressing the immediate, underlying and basic factors: • women and children’s access to health and nutrition; • safe water & sanitation; and • education and inequity. • Emphasis on decentralized implementation: initially in selected districts (2013-2014) • Vision to gradually scale up:to all other districts by 2017 (A new approach: learning by doing) • Nutrition reviews by sector: Health; Agriculture, Education, Physical Planning and Works, and Local development • Defined scope: Global and national evidences for ‘what works’: essential nutrition specific interventions through the Health sector & nutrition sensitive interventions through other sectors • Systematic consultation: through Reference Group Meetings by sector at key stages and All Reference Group Meetings to identify the cross-sectorallinkages

  5. Stunting is preventable : BUT Need to act before the child is 2 years Source: Victora et al 2010 The Critical “Window of Opportunity”: 1000 DAYS Pregnancy: 9*30= 270 days 2 years: 365*2=730 days

  6. Life course consequences of poor maternal and child undernutrition (MCU) Short term Long term Brain development Cognitive and educational performance Poor nutrition in uterus and early childhood (STUNTING) Growth and muscle mass Body composition Immunity Work Capacity Diabetes, Obesity Heart Disease High blood pressure Cancer, stroke, and ageing Metabolic Syndrome: programming of metabolism of glucose, lipids, protein Hormone/receptor/gene Death (James et al 2000)

  7. NEPAL IS ON TRACK TO REACH MDG4: REDUCING CHILD MORTALITY Mortality Trend and MDG Goal(Under 5, Infant and Neonatal) BUT, without Improvement in Stunting, further Child Mortality Reduction is very unlikely Improved Nutrition, especially micronutrients has contributed Deaths associated with under-nutrition At - min 35% Sources: EIP/WHO. Black et al, 2008. The Lancet Series on Maternal and Child Under-nutrition.

  8. Stunting Remains High and Wasting Stagnant • 18.2 per cent women are with a BMI <18.5 • 12.4 percent babies are LBW (<2500 grams) Source: NDHS 2011

  9. Stunting Remains High and Wasting Stagnant • 18.2 per cent women are with a BMI <18.5 • 12.4 percent babies are LBW (<2500 grams) Source: NDHS 2011

  10. Nepal Numbers of Children Affected by Chronic and Acute Under-nutrition • With a current under five population of 3.5 million, some 1.61 million children are suffering from stunting • The long-term consequences of stunting, include slower cognitive and mental development, educability and economic potential cannot be overestimated. • Similarly, some 585,000 children under five years of age are suffering from wasting • Consequences include heightened risk of morbidity and mortality

  11. Cognitive function is benefitted across the life course, and optimal birth weight is above the mean Cognitive Function score(relative to 3-3.5kg) Birth weight (kg) OPTIMAL WEIGHT Years of age Richards, M. Et al. 2001 Birth weight and cognitive function in the British 1946 birth cohort: longitudinal population based study. BMJ. 322:199-203

  12. Declining Prevalence of StuntingAsian Refugee Children in the U.S. Stunting = height-for-age < 5th percentile of Ref Yip & Mei, 1996

  13. Require MSN Approach To Tackle Stunting Sustainably CHILD STUNTING Inadequate Foetal Growth Inadequate IYC* Growth 50% 50% Poor maternal nutrient status Poor IYC nutrient status Nutrition Specific Poor maternal nutrient intake Maternal Infections Poor IYC nutrient intake IYC infections IMMEDIATE CAUSES Poor medical and environmental health services Poor maternal and child caring practices Inadequate Household Food Security UNDERLYING CAUSES Nutrition Sensitive BASIC CAUSES: Resources, Institutions, Education, Infrastructure, Cultural Practices * IYC = Infant and young child

  14. Multi-sectoral Operational Linkages & Accountabilities Strategic Objective (SO) 1. National Planning Commission Result (R) 1.1. Multi-sectoral commitment and resources for nutrition are increased R 1.2. Nutritional information management and data analysis strengthened R 1.3 Nutrition capacity of implementing agencies is strengthened SO 4. Ministry of Education • R 3.1 Adolescent girl’s awareness and behaviours in relation to protecting foetal, infant and young child growth improved • R 3.2 Parents better informed with regard to avoiding growth faltering • R 3.3 Nutritional status of adolescent girls improved • R 3.4 Primary and secondary school completion rates for girls increased SO 2. Ministry of Health and Population R 2.1 MIYC micronutrient status improved R 2.2 MIYC feeding improved R 2.3 SAM better managed R 2.4 Diarrhoea adequately treated SO 5. Ministry Local Development/ Social Protection R 4.1 Nutritional content of local development plans better articulated R 4.2 Collaboration between local bodies’ health, agriculture, and education sector strengthened at DDC and VDC level R 4.3 Social transfer programmes corroborated for reducing chronic under nutrition R 4.4 Local resources increasingly mobilized to accelerate the reduction of MCU SO 3. Ministry of Physical Planning and Works R3.1 All young mothers and adolescent girls use improved sanitation facilities R 3.2 All young mothers and adolescent girls use soap to wash hands R 3.3 All young mothers and adolescent girls as well as children under 2 use treated drinking water SO 6. Ministry of Agriculture and Cooperatives R4.1 Increased availability of animal foods at the household level R 4.2 Increased income amongst young mothers and adolescent girls from lowest wealth quintile R 4.3 Increased consumption of animal foods by adolescent girls, young mothers and young children R 4.4 Reduced workload of women and better home and work environment

  15. Ongoing Activities to Prepare the Grounds for MSNP district level implementation

  16. 1. MNIS review and a strategic plan to strengthen the existing system, ongoing 2012

  17. MoE EMIS NPC PMAS MoAC AIS CENTRAL MoPW NMIP MoHP HMIS MoLD • NeKSAP DSFN • (make IPC Class) DISTRICT • DEO • 100s Resource Centers • 1000s schools • DADO • 100s Service Centers DDC-DPMAS • DHO • 1000s facilities • DoWS • Village Wat/san committees 80 Impact indicators

  18. 2. Nutrition capacity assessment and a strategic plan, ongoing 2012

  19. Comprehensive mapping of community workers across the key sectors involved in the MSNP: • Health • Agriculture • Education • WASH • Local Development • Review of individual, organization and institutional capacities – and identify the gaps • Review of Job descriptions • Training curriculum • Supervision and mentoring mechanisms • Reporting mechanisms • Policy and legal systems

  20. 3. Operational Guidelines, Materials and Tools for Modelling of MSNP in Six Districts of Nepal, 2012-2014 REACH ENDING CHILD HUNGER AND UNDERNUTRITION NHSP II NEPAL FOOD SECURITY ENHANCEMENT PROJECT NEPAL WASH MASTER PLAN & MULTI-SECTORAL ECD PLAN

  21. HUMLA DARCHULA BAJHANG MUGU BAITADI BAJURA DADEL- JUMLA DOTI DHURA ACHHAM DOLPA KALIKOT MUSTANG KANCHAN- DAILEKH PUR JAJARKOT KAILALI RUKUM MANANG SURKHET MYAGDI BARDIYA KASKI SALYAN B GORKHA A ROLPA G L U LAMJUNG N G PARBAT RASUWA PYUT- BANKE GULMI HAN DANG SINDHU- ARGHAK TANAHU SYANGJA NUWAKOT DOLAKHA PALCHOK HACHI PALPA SULUK- KATHM DHADING KAPIL- P BHAK HUMBU SANKHUWA- RUPAN- NAWAL A BASTU H CHITWAN SABA H DEHI PARASI C LALIT TAPLEJUNG MAKAWAN- E KAVRE M A PUR R OKHAL- R DHUNGA A PARSA SINDHULI H KHOTANG TERHA- T E BARA BHOJ- H THUM C RAUT- SARLAHI A PUR P DHAN- AHAT MAHO- KUTA TARI ILAM UDAYAPUR DHANUSA SIRAHA SUNSARI SAPTARI JHAPA MORANG NEPAL Mid-Western Region Far-Western Region Western Region Central Region Eastern Region Initial MSNP Roll-Out Districts

  22. Summary of Ongoing Nutrition Actions in the Proposed MSNP Initial Districts

  23. Work Plan: Six Model Districts • Sensitization of key stakeholders at the regional, district and community levels on MSNP - ongoing • Baseline impact evaluation – prepwork ongoing • Detailed Operational Guideline – July 2012 • MSN Monitoring and reporting formats • MSN Supervisory mechanisms and checklists • Training materials and tools (REACH/WB) for community workers - August/September 2012 • District MSN profiles • VDC mapping of nutrition situation, activities & stakeholders (inventory) • Existing resources and gaps (mobilization to meet these) • MSN database management (DPMAS) • Verification survey guideline (every six months – as part of national MN) • MSNP adoption to the district context • MIYCN integrated package (nutrition sepecific interventions) • Package of nutrition sensitive interventions (Education, WASH, Agriculture, Local Development/Social Protection) • Process evaluation – August/September 2013 • Endline impact evaluation – 2014

  24. SUN/REACH INITIATIVES

  25. The Goal of SUN “To reduce hunger and under-nutrition and contribute to the realization of all the Millennium Development Goals, with particular emphasis on MDG 1 - halving poverty and hunger by the year 2015” .

  26. The SUN Framework calls for scaling up efforts against under-nutrition in a coordinated multi-stakeholder approach human rights focusas a basis for economic, social and human development, and on addressing food and nutrition security within that framework abundant evidenceon the impact of under-nutrition on infant and young child mortality and its largely irreversible long-term effects on intellectual, physical and social development as well as on health recognition of a series of well-tested and low-cost interventions can protect the nutrition of vulnerable individualsand communities and benefit millions of individuals if incorporated into agriculture, social protection, health and educational programmes ...basis for action 1 2 3 endorsedby 100+ organizations June 2010

  27. The SUN framework identifies two complementary ways of reducing under-nutrition: direct, nutrition-specific interventions:have nutritional improvement as the primary goal and should be accessible to all individuals and their households, especially in pregnancy, in the first two years of life and at times of illness or distress (b) a multisectoral approach aimed at promoting adequate nutrition as the goal of national development policies in agriculture, food supply, social protection, WASH, health and education programmes. The focus: • Increased resource mobilization through advocacy & innovative financing mechanisms • Better alignment of donors' investments with national priorities • Countries to identify their capacity development needs to extend nutrition interventions • Plans need to be costed, including financial resources for capacity development, strengthening the delivery of services • Expected benefits should be quantified

  28. The SUN Movement • SUN Countries: As of April 2012 the following countries have committed to Scaling up Nutrition: • 1. Bangladesh, • 2. Benin, • 3. Burkina Faso, • 4. Ethiopia, • 5. Gambia, • 6. Ghana, • 7. Guatemala, • 8. Indonesia, • 9. Kyrgyz Republic, • 10. Laos PDR, • 11. Madagascar, • 12. Malawi, • 13. Mali, • 14. Mauritania, • 15. Mozambique, • 16. Namibia, • 17. Nepal, • 18. Niger, • 19. Nigeria • 20. Peru • 21. Rwanda • 22. Senegal • 23. Sierra Leone • 24. Tanzania • 25. Uganda • 26. Zambia • 27. Zimbabwe • The Scale Up Nutrition Movement (SUN) was initiated in September 2010 – NY UN Assembly. • The SUN Movement focuses on the 1000 day window of opportunity between the start of pregnancy and the child’s second birthday. • Stakeholders in the Movement are increasing the resources made available to SUN countries and better aligning their financial and technical support to national nutrition priorities, momentum increased in the last months with 27 countries having made commitment to scale up nutrition. • The UN Secretary General appointed a high-level, multi-stakeholder Lead Group to provide overall strategic leadership of the SUN Movement. • A SUN Movement Secretariat, withbudget is estimated at around $3.5million/year • http://www.scalingupnutrition.org/key-documents/

  29. The SUN Movement Stewardship Arrangements [1]At 4 April 2012 [2]Effective 5 April 2012

  30. From Mobilization to Results: Priorities for the Movement and future areas of focus for the Lead Group • Focus on work to be undertaken before the next meeting of the Lead Group (in late September 2012). • Take part in the development of an updated Strategy (revised Road Map) for the SUN Movement. These will include ways to ensure that results are monitored and analyzed, that advocacy around the results is intensified, and that the Lead Group continues to facilitate the growth of the Movement driven by SUN countries. Lead Group Members were invited to form sub-groups to work on six key areas: • Best practices, and which interventions have greatest potential to leverage results; • Gathering evidence of the cost-effectiveness of scaling up nutrition; • Tracking financing and investments in nutrition to identify key resource gaps; • Building a robust results and accountability framework, based on clear indicators and targets (e.g. MDGs, post-2015 goals and the World Health Assembly); • Articulating the importance of empowering women to be at the centre of policies and actions to Scale Up Nutrition; • Improved advocacy and mobilization of national and international resources for nutrition (NEPAL).

  31. Nepal’s SUN Architecture • The Honorable Member of the NPC, (Social Sector)acts as the chair ofthe National Nutrition and Food Security Coordination Committee. This coordination committee will act as a country coordination mechanism for SUN Initiative under the NPC leadership.  • The SUN Country Focal Point is the Secretary, Ministry of Health (MOHP). MOHP will contribute towards the technical aspects. • NPC, MoHP, and MOFA took part in the UN SUN tele-conference on Thursday 14 June 2012 at 12:45 KTM time, on the thematic area: Improved advocacy and mobilization of national and international resources for nutrition. • Teleconference on 5 July at 14:15 KTM time involving MoHP and NPC: Country SUN progress report – prepared through consultative process and submitted on 15 July by the MoHP. • NPC, MOHP with multi-stakeholders consultations will identify personnel for The Selected Thematic Task Team, to contribute to the SUN Strategy development plus continued consultation to finalize SUN Country Progress Report required for September 2012 UN Meeting.

  32. From Mobilization to Results: Priorities for the Movement and future areas of focus for the Lead Group • Under the guidance of the SUN Movement Lead Group Chair, the Secretariat and its Networks will support Lead Group members as they establish the elements of a SUN Movement Strategy (revised Road Map). • The Strategy will be debated and finalized in the next Lead Group meeting in New York over a half-day in the week starting 24 September. • The meeting will focus on substantive issues, on action items and on measuring the impact of the Movement. • Coordinated advocacy to maintain the focus on scaling up nutrition remains a priority . • To help sustain this momentum, and to showcase the impact of the Movement, Canada has offered to co-host a SUN side event at the UN General Assembly in September 2012.

  33. REACH partnership aims to accelerate reduction in child undernutrition Initiating Partners Further Participating Partners • Other UN agencies: • IFAD, SCN, WB • Governments: • Mauritania, Lao PDR, Sierra Leone, Bangladesh, Nepal, Mozambique, Rwanda, Uganda, Mali, Ghana • NGOs & Civil society: • SC, WVI, Rotary, HKI, GAIN, MI, ACF, CRS • Academia: • Tufts, Wageningen, Cornell, Tulane, George Washington, John Hopkins University • Donors: • ECHO, DFID, Bill & Melinda Gates Foundation, USAID,++ • Private sector: • The Boston Consulting Group The team • REACH approach developed and facilitated globally by Inter-Agency team hosted by WFP in Rome • Global REACH coordinator by rotation from the four agencies

  34. REACH focuses on scaling-up nutrition (SUN) actions Ending child hunger and undernutrition By 2015: REACH MDG 1, Target 3 (half the proportion of underweight children under 5) Beyond 2015: Achieve sustainable acceleration of the rate of reduction in child underweight Vision & Goals Country action planning and coordination to support national capacity to scale up evidence-based solutions Action areas Knowledge-sharing Communications and advocacy Financing and resource mobilization 1. Increased awareness of the problem and of potential solutions 2. Strengthened national policies and programmes 3. Increased capacity at all levels for action 4. Increased efficiency and accountability Outcomes

  35. The REACH Facilitator(s): ‘Embodiment’ of REACH in-country • The REACH Facilitator serves as a catalyst for scaling up agreed essential nutrition actions with quality and capacity to sustain • REACH facilitator profile: • - Inclusive, Participatory development practitioner • - Change management skills • - Excellent communication skills • - Knowledge of good nutrition programming practices • Position of the REACH Facilitator(s) strategically within: • Government structures – e.g. at the NPC in Nepal • Partnerships (NGOs, Private sector, Donors, Academia) • The UN System Nepal Update: International facilitator expected in mid September and national facilitator in mid August – interim support between mid July to 10th August

  36. Proposed REACH Nepal Work Plan, 2012-2014

  37. MYCNSIA IN NEPAL

  38. Outline of MYCNSIA Contribution to Nutrition in Nepal: 2011- Q2 of 2012 • Pillar 1: • High level advocacy to at the PM level to raise nutrition in the national development agenda • Technical assistance to streamline nutrition governance under the lead of the NPC and involving all the key Ministries • Support development of evidence based MSNP + Operational guidelines, MNIS review and MSN capacity needs assessment • Support to NUTEC - development of national comprehensive IYCF strategy and costed plan, maternal nutrition strategy and costed plan – with an overarching strategy framework on MYCN integrated and harmonized package • Support NNC establishment • Partnership and coordination – NNG, FSWG, EDPs, SUN/REACH, Nutrition cluster, Nutrition and Food Security Steering and Coordination Committees, and Secretariat, Reference Groups. • Pillar 2: • Community training related to key interventions – IYCF/MNPs and CMAM/NiE • Plans to undertake nutrition capacity needs assessment - in collaboration with the Bank and the RO, and on this basis comprehensive CB with a focus on the community level • Pillar 3: • IYCF/MNPs internal process monitoring, external coverage surveys three and fifteen-month – final draft report • CMAM evaluation – phase one formative, and phase two – impact evaluation • Plans for implementing IYCF/MNPs baseline survey • Initiated MNIS Review – as the basis for developing a strategy and costed plan to strengthen the existing system with links to existing early warning systems – NeKSAP, IPC • Pillar 4: • IYCF/MNPs pilot in six districts completed, with MoHP policy decision to expand in additional nine • CMAM pilot in five districts completed, plans ongoing to expand in five districts • IYCF/CCG in five districts, with process monitoring and evaluation design • MSNP: Identification of initial 6 districts to model MSNP, with a plan to gradually scale-up (learning by doing) • IFA with de-worming to adolescent girls integrated with the school health and nutrition strategy / FHD

  39. INPUTSPROJECT COMPONENTS / ACTIVITIES (A-E) OUTPUTS (O)OUTCOMES (T) IMPACTS (I) Effective Project Management & Monitoring and Evaluation Impact on intake, status and function Policies, Production, Delivery, Quality & Behaviour Change Communication Access & Coverage / Knowledge & Appropriate Use • Guidelines developed for implementation of integrated MIYCN , including counselling as part of Cash grants and CMAM in target districts (O.1) • Costed plan for National MSNP endorsed (O.2) • Multi-sector nutrition profiles developed at district level (O.3) • Commitment at district level to support MSNP with resources allocated (O.4) • District-level MSNP plans in place (O.5) • MIYCN Services • Coverage of IYCF counselling increased among mothers and children (O.17) • MoH delivery system functions effectively and adequate supply (MNP/IFA/RUTF) is available where expected and needed (O.18) • MIYCN Focal points, providers & volunteers have knowledge to adequately distribute MNP, deliver MIYCN with mothers & caretakers (O.19) • Mothers & caretakers know, demand, accept, & have ability to appropriately use MIYCN services (O.20) • CMAM Services • Health workers know how to identify and treat children with SAM in target districts (O.21) • Qualified children enrolled and treated in CMAM program(O.22 ) • Complementary Services • Place for Hand washing (O.23) • Availability of soap (O.24) • Safe disposal of faeces (O.25) • Hand washing/ hygiene coverage, knowledge of caregivers of U2’s (O.26) • Qualified HHs enrolled in cash grant program (O.27) • Results Area 1: Upstream Policy • Comprehensive National MSNP Costed Plan of Action developed (A.1) • National coordinating mechanism established for multi-sector nutrition program -MSNP (A.2) • Commitment to allocate budget and ensure implementation of MSNP (A.3) • Protocol established for nutrition profiles (as basis for planning) at district level (A.4) • Comprehensive MIYCN strategy and costed plan developed (A.5) • IYCF (Breastfeeding) • Early Initiation of BF (T.1) • Exclusive breastfeeding under 6 months (T.2) • Continued breastfeeding to 1 year (T.3) • Continued breastfeeding to 2 years (T.4) A. POLICIES AND PLANS • IYCF • (Complementary feeding) • Introduction of solid, semi-solid and soft foods, 6-8 months (T.5) • Minimum dietary diversity, 6-23.9 months (T.6) • Minimum meal frequency 6-23.9 months (T.7) • Minimum acceptable diet, 6-23.9 months (T.8) • Consumption of iron-rich (or iron-fortified) foods, 6-23.9 months (T.9) • Training packages (Facility ANC Package) revised for MIYCN to guide training across sectors (B.1 ) • Procurement management system in place for MIYCN/CMAM products, e.g. MNP, IFA, RUTF (B.2) B. PRODUCTION & SUPPLY • Consolidated MIYCN training materials adapted and rolled-out (O.6) • Nutrition (ANC) integrated with Family Health Division (O.7) • Supply and recording systems for MIYCN/CMAM products (O.8) • Timely and adequate supply of MIYCN/CMAM products(O.9) • Reduction in Stunting in children 0-23.9 months (I.1) • Reduction in Anaemia in children 6-23.9 months (I.2) • Results Area 2: Capacity Building • Development of ToRs for nutrition focal points from all sectors at district level (C.1) • District-capacity enhanced to guide preparation of profiles, plans and implementation (C.2 ) • Key stakeholders and service providers sensitized and trained on MIYCN (C.3) • Provide IYCF counselling as part of CMAM program in ten districts (C.4 ) • Provide IYCF counselling as part of MNPs (C5) • Provide IYCF counselling as part of child cash grants in target districts (C.6 ) Management, staff, national micronutrient coalition, government & international financial resources, health facility & community volunteer infrastructure • Refresher training and supervision provided to all health workers (O.10) • Functional multi-sector coordination in place at District level (O.11 ) • Nutrition focal points from all sectors in place at district level and oriented in multi-sector approach (O.12 ) • Data available and used from surveys - baseline, endline, coverage surveys, etc. (O.13 ) C. SERVICE DELIVERY • Improved Iron/MN Intake/Deworming • Coverage of IFAs among adolescent girls, women (T.10) • Utilization of IFAs among adolescent girls/women (T.11) • MNP coverage of children 6-23.9 months (T.12) • MNP utilization of children 6-23.9 months (T.13) • VAS coverage of children (T.14) • Deworming coverage of different age groups (T.15) • Reduction in Anaemia in women and adolescent girls - select districts (I.3) • Results Area 3: Data and Knowledge Sharing • Refresher training and Supervision provided at all levels of MIYCN implementation (D.1) • Data available to monitor coverage of MIYCN interventions (D.2) • Data available to evaluate impact of MIYCN interventions (D.3) • Capacity enhanced for M&E (D.4) D. QUALITY • Planned advocacy events held (O.14) • Planned media implemented (O.15) • Targeted caregivers reached with mass messages on MIYCN/MNP, linked with hygiene, CMAM and cash grant interventions (O.16) • Advocacy events held at national and district level to maintain commitment for multi-sector program (E.1) • BCC Strategy and Plan of Action harmonized with community MIYCN (E.2) E. BCC Logic Model for Nepal

  40. Priority MYCNISIA Supported Interventions for 2012

  41. Scale-upCommunity IYCF Integrated with MNPs in Nine Districts

  42. Scale Up Community Management Of Acute Malnutrition (CMAM/IMAM) in Five Districts

  43. Pilot IYCF promotion linked with Child Grant (IYCF/CG) in Karnali

  44. MODEL MULTI-SECTORAL NUTRITION PLAN IN SIX DISTRICTS Under the lead of the National Planning Commission (NPC) and involving 5 key sectors – MoHP, MoAC, MoE, MoLD, and MPPW Lead Technical Support: UNICEF, funded by the EU in close collaboration with the World Bank, HKI, and WFP

  45. Thank You

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