Nutrition of sick children five Promotion use of food based dietary guideline developing and implementing nutrition protocols for sick children e.g. low weight, preterm etc., Proportion of caregiver of sick infants aged 0-23 months who received IYCF counselling – feeding during illness from health workers Nutrition in the context of Emergency Nutrition cluster coordination Nutrition assessment during emergency Management of acute malnutrition during emergency Access to Micronutrients from fortified foods , supplements or micronutrient preparations Infant and young child feeding (e-IYCF) accessed by affected women and children during emergency Coordination with other active stakeholders in emergencies Conduct nutritional assessment in emergency affected areas Monitor food safety of nutrition commodities for use in emergencies Screening and referral for acute malnutrition during emergencies Children and women with acute malnutrition access appropriate management services Blanket, targeted food distribution & micronutrient supplementation, as appropriate in emergencies Provide vitamin A deworming to children under 5 in the emergency affected areas Provision of micronutrient powder for children under 5 in the emergency affected areas. Providing education and skilled counselling and support on infant and young child feeding at health facility level Support monitoring of national regulation of marketing of breast milk substitute Number of cluster coordination meeting at national Number of Provinces conducting regular cluster coordination meeting at provincial level Number of provinces with emergency response plan in Number of RNA conducted in emergency affected areas Number of children screened and referred for acute malnutrition during emergencies Proportion of children 0 -59 months with acute malnutrition who were admitted for treatment (IPD-SAM, OPD-SAM and OPD-MAM) during emergencies Proportion of children & with acute malnutrition who were admitted for treatment (OPD-MAM) during emergencies Number of beneficiaries received Blanket, targeted food distribution &
micronutrient supplementation, as appropriate in emergencies Number of 6-59 months received vitamin A and deworming in the emergency affected areas Number of children 6-59 months received micronutrient powder for children in the emergency affected Proportion of caregiver of infants aged 0-23 months who received IYCF counselling in the emergency affected Number of violation against National Regulation on Promotion and Support of child feeding with breast milk reported during emergencies 1.2 Improved availability of nutrition products Developing partnership Industrial food fortification Scale up fortification of staple food Fortification of Wheat Flour and edible oil with micronutrients Universal Salt Iodization Promotion of the use of fortified foods including iodized salt at household level Advocate and create public awareness on food fortification Monitor quality of fortified regularly at all level % of household using fortified wheat flour % of households using fortified edible oil % of household iodized salt > 15 ppm Number of advocacy meetings about food fortification Number of TV and radio spots produced and aired on promotion of fortified staple foods
Number of quality control monitoring visits conducted at production and market levels Home-based food fortification Home-made complementary Home fortification with multiple micronutrient Fortification of complementary foods with multi-micronutrient powders % of children 6 -23 months received 2 dose ( 120 sachet) of MNP in the last year Supply chain management for all nutrition products Provision of therapeutic food for treatment of acute malnutrition Support secure delivery chain of critical supplies Developing standard operation producers for supply chain management Procure and distribute essential nutritional commodities (micronutrient supplements, MNP for home fortification, therapeutic milks and foods) and equipment (anthropometric and others) as per the SOP Establishing systems to support the procurement, storing and delivery of critical supply such as therapeutic food etc % of health facilities with no stock-out of nutrition products for treatment of acute malnutrition among children under five Strengthened community based nutrition Community outreach for essential nutrition actions focussed on 1000 days window Community based Infant and Young Child Feeding and Caring Practices Community Growth monitoring and promotion Proportion of health post/CHW reporting having had no stock-outs of MUAC tapes Proportion of health post/CHW with adequate materials/job aids/counselling cards etc. to
Control and prevention of diarrhea and parasitic infections Providing community support on infant and child feeding through CHW, family action groups, shuras etc. Community mobilisation and awareness on national regulation on promotion and support of child feeding with breast milk Provide community support for appropriate complementary feeding through CHW, family action groups, shuras etc. Provision of IEC materials to the health post/ CHW) Promote proper hygiene practices, and timely seeking of health care. Provision of adequate amount of Zinc and ORS to all health post based on case load for management and control of diarrhoea in under 5 children promote optimal IYCF practices and handwashing with soap at community level Proportion of caregivers of children 6-11 months who can correctly state the five critical points for handwashing with soap (after defecation, before and after eating, before food preparation, before breastfeeding, after nappy change) Proportion of caregivers of children months with evidence of practicing handwashing with soap at the household (observe for presence of handwashing place, water and soap for practicing handwashing) % of health post with adequate amount of zinc and ORS supply during last 3 months ( based on case load) Management of acute malnutrition Community mobilization for integrated management of acute malnutrition Conduct active screening, referrals and follow up of malnourished children by CHW Recipes for locally available food for treatment of MAM and prevention of SAM Number of health providing management of acute malnutrition for children under five
Mobilize mass and community media to play leading advocacy and information dissemination role for nutrition and care during the first 1000 days of life, through mass communication and campaigns Awareness creation on maternal and nutrition through mass media using Develop and launch mass and campaigns on 1000 special days (TV spots, Radio spots, documentary, and billboards) including the unifying logo/branding for the campaign. Orient and train key media executives and the media producers Using media free times to promote nutrition messages Conduct mass campaigns both at National media and local stations (TV spots, Radio spots, documentary, billboards) on key themes of nutrition in the first 1000 days of life (Pregnant women, Lactating Mother, Children 0-6months, Children 6-23Monhts) Number of Mass media and below the line campaigns conducted on nutrition during first 1000 days Number of media executives and media producers oriented and trained on nutrition first 1000 special days campaign Number of TV spots, radio spots, documentary and billboards including unifying logo/branding for nutrition first 1000 special days campaigns disseminated and aired Social Marketing Advocate and create public awareness on food fortification, supplementation and dietary diversification. Develop and launch mass media and campaigns on flour fortification, supplementation and dietary diversity (TV spots, Radio spots, documentary, and billboards) including the unifying logos for the campaign web-based social media to promote nutrition messages Number of TV spots, radio spots, documentary and billboards including unifying logo/branding for food fortification, supplementation, use of micronutrient powder for home fortification, and dietary diversity developed and disseminated number of nutrition messages on posted on social media platforms 2.3 Increased knowledge and skills of front line workers in health, education, agriculture, rural development and other institutions to promote basic nutrition Increased linkages with health, education, agriculture, development, WASH, ECD and other institutions for resilience building at the community level Basic nutrition package for front line workers in health, education, agriculture, rural development and other institutions Inclusion of nutrition education in different social programs, such as literacy for life, Life skill education, cash transfer, community development, and other development activities Provide standard kit and orientation for frontline workers: Guideline and flip chart nutrition in the first 1000 days of life (nutrition of Pregnant women, Lactating Mother, Children 0-6months, Children 6-23Monhts) % of frontline workers by cadre and sector oriented and trained on basic nutrition
Intermediate Results 3: Improved quality of nutrition services and products Sub-Intermediate Results 3.1 Strengthened capacity of service providers and facilities to deliver nutrition interventions - Nutrition to be recognized as core competencies of health providers - Update nutrition knowledge and competencies of health care providers In-service training Pre-service nutrition education Accredited degree education in public nutrition Creating positions within the health system that require a nutrition certificate the capacity and role of PND within MoPH initial and refresher trainings BPHS/EPHS personnel a system of mandatory training on nutrition as a continues education program for health professionals Nutrition in Nursing, midwifery and physicians curricula number of nutrition officers in sub national/facility level training tracking database within PND to strengthen the role of PND within MoPH - Develop and update nutrition guidelines and SOPs # of health personnel received training # of public and private institutes/universities included nutrition curricula in their system # of staff obtained a post graduate diploma or degree on nutrition # of nutrition officers positions filled at the sub-national/ facility # of guidelines developed and updated 3.2 Improved performance monitoring of nutrition services Involvement of MoPH different departments Innovative approaches Strengthening M&E system Establishing service delivery of ENA quality standards Performance improvement system in MoPH Community involvement in monitoring especially in areas with insecurity Use of technology to monitor activities joint monitoring with M&E and GCMU in monitoring nutrition services update and apply monitoring checklists, reporting forms and feedback system communication/feedback mechanisms between facility and community-level through periodic meetings and supportive supervision - Include and update nutrition indicators in the national monitoring checklist and third party evaluations # of monitoring visits conducted % of improvement in performance based on monitoring follow up 3.3 Improved quality assurance system for nutrition products Focus on special foods with claims of additional nutrition value (fortified food, ready to use complementary food, therapeutic food) Developing Standards, regulations and quality assurance monitoring system Involving multi-sectoral stakeholders food fortification regulation guidelines on quality assurance of nutrition products fortified foods standards Monitor quality and safety of nutrition products (special foods i.e. fortified food, complementary food) FF regulation endorsed # of guidelines developed for quality assurance of nutrition products % of special food samples certified quality assurance standards 3.4 Strengthened nutritional status monitoring and surveillance system
PART III INVOLVEMENT OF OTHERS Partnerships within the MoPH The MoPH, as steward of the public health and nutrition sector, sets policies and standards, develops guidelines, and coordinates the actions of its various departments with those of its partner and donor agencies, and implementing NGOs. The PND is the main technical unit of the MoPH responsible for the implementation and oversight of this strategy. The Public Nutrition Strategy calls for the PND to closely coordinate its work with other relevant programs of MoPH, such as child and adolescent health, reproductive health, environmental health, health promotion, food and drug quality laboratory, immunization, and grants and contracts management. The nutrition related responsibilities of the relevant units of the MoPH and coordination of their roles vis-a-vis the PND are described as below: Table 7. Coordination with other departments of MOPH Departments of MoPH Nutrition Related Responsibilities Key Nutrition Related Roles Related Role of PND Coordination Mechanism Child and Adolescent Health (CAH) Integrated Management of Childhood Illness (IMCI) Overall leadership, guidelines development, and implementation monitoring Technical support, oversight and review of nutrition components of IMCI General Directorate (GD) of Preventive Medicine, Child Health Taskforce, and meetings Community-Based Health Care (CBHC) Nutrition services provided by Community Health Workers (CHWs) Overall leadership, guidelines development, and implementation monitoring Technical support, oversight and review of nutrition components of CBHC GD of Preventive Medicine, CBHC Taskforce Immunization High dose vitamin A supplementation and deworming Vitamin A supplementation and deworming during National Immunization Days (NID) Technical support and monitoring of intervention coverage GD of Preventive Medicine, EPI Taskforce Reproductive Health acid supplementation for pregnant and lactating women, and IYCF promotion Monitoring and capacity building Technical support, development of strategies guidelines, and IEC materials, and monitoring coverage of nutrition interventions RH Taskforce hoc
Health Promotion Behavior change communication (BCC) Developing BCC messages, fund raising for BCC, relationship with media and production companies, and monitoring delivery of BCC messages Technical support related to development of nutrition messages, and monitoring coverage of BCC efforts Health Promotion Taskforce Food and Drug Quality Control Laboratory Quality control of hygienic safety and micronutrient composition of foods (e.g. fortified foods, therapeutic foods, infant formulas) Laboratory-based Quality Control monitoring of food products Technical support, providing food samples for testing, interpreting results and coordination with fortified food production and importing firms Food Safety and Quality Working Group GCMU Coordination with BPHS implementing NGOs Managing contracts, monitoring and coordination Technical support to NGOs in implementation of nutrition components of BPHS and monitoring quality and coverage of nutrition services EPHS/BPHS coordination workshops and ad-hoc meetings Curative Medicine EPHS and in-patient treatment of implementation of Baby Friendly Hospital Initiative Overall leadership in hospital care services Technical support, ensure availability of therapeutic food and monitoring service delivery Ad-hoc meetings and workshops Policy and Planning Strategic planning, developing procedures and ToRs based on regulations Processing reports, follow up of MoPH plan, processing approval of procedures and ToRs based on national regulations Provide annual implementation plans, reports, draft procedures and ToRs related to nutrition Ad-hoc meetings and workshops Afghanistan National Public Health Institute (ANPHI) Nutrition surveillance, survey, and research Leading implementation of Disease Early Warning Surveillance(DEWS), and Institutional Review Board (IRB) Implementation and sharing findings of Nutrition Monitoring and Surveillance System, and seeking IRB approval for research/surveys and studies IRB Nutrition Surveillance Taskforce, ad-hoc meetings and workshops Environmental Health Food safety and quality Monitoring and inspection of markets for safety and quality of food (other than special foods) Monitoring and inspection of special foodsat the production and market level; Certification and authorization of use of fortification logo for special foods Food Safety and Quality Working Group
Health Law &Regulations Enforcement Dept. Enforcement of regulations (fortified food and code of BMS) Legal monitoring of private and public institutions and enforcement of relevant national laws and regulations Technical support, coordinating and providing evidence toward disciplinary measures Need based meetings Resource Employment services, and capacity building Employment and management of civil service employees, and regulating capacity building programs Developing ToRs for relevant PND positions, supporting HR management in recruitment process, and PND staff capacity building Capacity Building Committee and ad-hoc meetings and workshops Pharmacy Micronutrient supplements and therapeutic foods Developing national of licensed and essential nutrition products Technical support and development of pharmacy related guidelines for nutrition items National Food and Drug Board Other Ministries and Government Agencies Collaboration with a number of other ministries (as described in the table below) is necessary for effective implementation of the Public Nutrition Strategy: 8. Role of other government agencies in implementation of Nutrition Strategy Ministry/ Government Agency Nutrition Related Responsibilities Key Nutrition Related Roles Related Role of PND Recommendations MoF Taxation and customs control of imported foods budget allocation Represented on the National USI Board, and the National Committee on Code of BMS Engagement with Customs Department regarding enforcement of fortification laws to imported foods, and providing information on PND budgetary requirements Current level of coordination is not satisfactory and should be improved MoEc Strategic planning and advocacy for the role of nutrition in national economic development To be developed; could be engaged in NAF To be developed Need to clarify roles and responsibilities
MoE Incorporation of nutrition into curriculum; provision of nutritious through school meals NAF To be developed Implement NAF MAIL Food security and food safety (of unprocessed food) NAF and AFSANA Coordination and collaboration with strategies and activities of Home Economics Department Implement NAF and renew existing MoU on food safety MoCI Regulation and control of domestic and imported fortified and fortified food industry related materials and equipment NAF, National Board on Iodized Salt, National Committee on Code of BMS To be developed Implement NAF and specify roles and responsibilities MRRD sanitation and hygiene in rural communities NAF To be developed Implement NAF and specify roles and responsibilities MoRA Public awareness building through religious leaders and facilities National Committee on Code of BMS To be developed Strengthen the follow up of existing TOR MoWA Women’s empowerment and nutrition education To be developed To be developed Clarify responsibilities and need for technical support MoLSAMD Safety net and nutrition education through targeted programs; maternity protection To be developed; be involved in NAF To be developed Clarify responsibilities and need for technical support MoJ Developing national laws and regulations Based on need Provision of information as needed Strengthen coordination
MoI Enforcement of food laws and regulations National Board onIodized Salt; National Committee on Code of BMS Collaborate with Health Department of MoI Strengthen coordination andfollow up of existing TORs ANSA Development of fortified food standards National Board on Iodized Salt; National Committee on Code of BMS; Food and Drug Board Collaborate with Standards Development Department Strengthen coordination Municipalities Monitoring of national regulations (e.g. Code of Marketing of BMS, USI) at the market National Board on Iodized Salt; National Committee on Code of BMS Collaborate with Environmental Health Unit Strengthen coordination, especially at the provincial level
Non-Government Partners The PND has essential collaborative relationships with various entities outside of the government sector. Public nutrition programs and projects are supported financially and technically by several partners. They include UN agencies (UNICEF, WHO, WFP, FAO); bi-lateral and multi lateral donor agencies (World Bank, USAID, EU and DFATD); NGOs (Micronutrient Initiative, GAIN, BASICS, ACF, Save the Children, Oxfam, and BPHS implementers); and private sector (salt factories, flour millers and importers, vegetable oil/ghee producers and importers, micronutrient powder producers, media). Examples of collaborations between PND and some of its non-government partner agencies are as follow: Table 9. Role of non-government agencies in the implementation of nutrition strategy Stakeholders Organizations Key Nutrition Related Activities Coordination mechanisms Recommendations United Nation Organizations UNICEF IYCF, treatment of SAM, maternal and adolescent nutrition, Community based surveillance, technical support to PND Annual plan, nutrition cluster, several other mechanisms Involvement of PND as of nutrition cluster WHO Inpatient treatment of SAM, facility surveillance, food safety and quality, IYCF Annual plan, nutrition cluster, several mechanisms Involvement of PND in the health cluster coordinate the two mechanisms WFP Treatment of MAM, maternal nutrition, production and promotion of fortified food Annual plan, nutrition cluster, several other mechanisms Develop comprehensive annual plan FAO Food based dietary guideline, food diversification National committee on FBDG Develop comprehensive annual plan UNOCHA Supporting nutrition in emergency Nutrition Cluster Involvement of PND in the decision process Development Partners World Bank BPHS/EPHS, system strengthening, nutrition communication/ advocacy Nutrition Program Coordination Committee Appreciation of stewardship role of PND in the sector
USAID In-service training, multi-sectoral approach to improve nutrition, nutrition in emergency, Food fortification, strengthening nutrition in BPHS NPCC Involvement of PND in the management of projects European Union Pre-service training, strengthening nutrition in BPHS, community based nutrition NPCC Involvement of PND in the management of projects Canada – DFATD Nutrition surveillance, strengthening nutrition in BPHS through Save the Children and World Vision NPCC, Project Steering Committee meetings Appreciation of stewardship role of PND in the sector
DFID Nutrition in emergency, agriculture No mechanism Need to establish mechanism GAIN Supporting private sector in producing fortified food NPCC, annual plan, MOU Comprehensive annual plan and MoU International NGOs MI Provision of Vitamin A supplies, supporting food fortification, zinc supplementation and IYCN NPCC, MOU Comprehensive annual plan and MoU AKDN Multisectoral approach to nutrition, diploma course in nutrition Project Steering Committee, technical sub committee Comprehensive annual plan and MoU
NEI Production and promotion of Soy products Ad Comprehensive annual plan and MoU IBFAN Supporting IYCF Annual breastfeeding forum and IYCF advocacy, capacity building Comprehensive annual plan and MoU BPHS/EPHS implementers Public nutrition component of BPHS and EPHS, implementation of nutrition in emergency BPHS/EPHS coordination meeting, GCMU Strengthen through GCMU Food industry Iodized Salt Production companies Producing Iodized salt National Board on USI, quarterly meetings Strengthening it by more involvement of other sectors
Fortified producers/ importers Producing/ importing fortified flour Ad hoc Need to establish national board of food fortification Fortified Oil Producers/ importers Production/ importing fortified vegetable oil Ad hoc Need to establish national board of food fortification Special food producers/ importers Production of Micronutrients powder, LNS, fortified supplementary food Not clear Need to establish a working mechanism Others Academia Training, education and research Not established Need to establish a working mechanism
Table 10. Coordination mechanisms Coordination Mechanism Chaired by/ secretariat Key participants* Meeting Frequency Main of Work Recommendation High committee on nutrition 2nd Ministers of health, economy, agriculture, rehabilitation and development, education, commerce and industry Multi-sectoral NAF Support of the Minister of Public Health is need to help activate the NAF National Board on Universal Salt Iodization Minister or deputy minister of public health/PND Representatives of MoF, MoMP, ANSA, MoCI, MoI, MoICY, MAIL, technical agencies (UNICEF, GAIN, MI) and Afghanistan Iodized Salt Producers’ Association (AISPA) Mandatory salt iodization Already active, on national regulation on salt iodization To be changed to National Board on Food Fortification once the food fortification law is promulgated, and representatives of additional Food Fortification Alliance members can be added National Committee for Promotion and Protection of Nutrition With Breast milk Minister or deputy minister of public health/ PND MoCI, MoF, MoI, Municipality, MoWA, MoRA, MoICY, tehnical agencies (Unicef) Regulating the marketing of BMS Already active, on national regulation on promotion and protection of child nutrition with breast milk (Cod of Marketing of BMS) Nutrition Program Coordination Committee PND Director/PND Donor agencies, UN agencies, technical agencies (MI, GAIN) Monthly Strategic directions on nutrition programs To be appreciated and supported by the leadership of the MoPH
Nutrition Cluster UNICEF Bi-lateral donor agencies, UN agencies, NGOs, PND Monthly Nutrition in emergency PND to gradually take the lead NAF technical meetings PND Director/PND Technical representatives of ministries involved in NAF Quarterly Multi sectoral NAF Needs support from the highest levels of related Ministries Technical Working Groups PND Director/PND NGOs, UN agencies, private sector, donors, technical departments of MoPH Quarterly and as needed Separate groups for: IYCF, IMAM, Micronutrients, Assessment, Surveillance, Trainings Strengthening involvement of relevant partners *In addition to MoPH and PND.