"programme_id","programme_title","programme_language","programme_type","other_program","iso3code","country_name","program_location","area","status","start_date","end_date","brief_description","references","related_policy","new_policy","partner_gov","partner_government_details","partner_un","partner_un_details","partner_ngo","partner_ngo_details","partner_donors","partner_donors_details","partner_intergov","partner_intgov_details","partner_national_ngo","partner_nat_ngo_details","partner_research","partner_research_details","partner_private","partner_private_details","partner_other","partner_other_details","cost","fsector_0","fpartner_0","fdetails_0","fsector_1","fpartner_1","fdetails_1","fsector_2","fpartner_2","fdetails_2","fsector_3","fpartner_3","fdetails_3","fsector_4","fpartner_4","fdetails_4","fsector_5","fpartner_5","fdetails_5","fsector_6","fpartner_6","fdetails_6","fsector_7","fpartner_7","fdetails_7","fsector_8","fpartner_8","fdetails_8","fsector_9","fpartner_9","fdetails_9","fsector_10","fpartner_10","fdetails_10","fsector_11","fpartner_11","fdetails_11","fsector_12","fpartner_12","fdetails_12","fsector_13","fpartner_13","fdetails_13","fsector_14","fpartner_14","fdetails_14","fsector_15","fpartner_15","fdetails_15","fsector_16","fpartner_16","fdetails_16","fsector_17","fpartner_17","fdetails_17","fsector_18","fpartner_18","fdetails_18","fsector_19","fpartner_19","fdetails_19","fsector_20","fpartner_20","fdetails_20","fsector_21","fpartner_21","fdetails_21","fsector_22","fpartner_22","fdetails_22","fsector_23","fpartner_23","fdetails_23","fsector_24","fpartner_24","fdetails_24","fsector_25","fpartner_25","fdetails_25","fsector_26","fpartner_26","fdetails_26","fsector_27","fpartner_27","fdetails_27","fsector_28","fpartner_28","fdetails_28","fsector_29","fpartner_29","fdetails_29","fsector_30","fpartner_30","fdetails_30","fsector_31","fpartner_31","fdetails_31","fsector_32","fpartner_32","fdetails_32","fsector_33","fpartner_33","fdetails_33","fsector_34","fpartner_34","fdetails_34","fsector_35","fpartner_35","fdetails_35","fsector_36","fpartner_36","fdetails_36","fsector_37","fpartner_37","fdetails_37","fsector_38","fpartner_38","fdetails_38","fsector_39","fpartner_39","fdetails_39","fsector_40","fpartner_40","fdetails_40","fsector_41","fpartner_41","fdetails_41","fsector_42","fpartner_42","fdetails_42","fsector_43","fpartner_43","fdetails_43","fsector_44","fpartner_44","fdetails_44","fsector_45","fpartner_45","fdetails_45","fsector_46","fpartner_46","fdetails_46","fsector_47","fpartner_47","fdetails_47","fsector_48","fpartner_48","fdetails_48","fsector_49","fpartner_49","fdetails_49","action_id","theme","topic","new_topic","micronutrient","micronutrient_compound","target_group","age_group","place","delivery","other_delivery","dose_frequency","impact_indicators","me_system","target_pop","coverage_percent","coverage_type","baseline","post_intervention","social_det","social_other","elena_link","problem_0","solution_0","problem_1","solution_1","problem_2","solution_2","problem_3","solution_3","problem_4","solution_4","problem_5","solution_5","problem_6","solution_6","problem_7","solution_7","problem_8","solution_8","problem_9","solution_9","other_problems","other_lessons","personal_story","language" "11473","A2Z: The USAID Micronutrient and Child Blindness Project","English","Multi-national","","TZA","United Republic of Tanzania","Dar es Salaam, Tanzania","Urban|Rural|Peri-urban","completed","01-2006","01-2011","
A2Z: The USAID Micronutrient and Child Blindness Project consolidates, builds, and expands on USAID's long-term investment in micronutrients, child survival, and nutrition. A2Z takes proven interventions to scale, introduces innovation, expands services, and builds sustainable programs to increase the use of key micronutrient and blindness interventions to improve child and maternal health. With work in vitamin A supplementation of children, newborn vitamin A, food fortification, maternal and child anemia control, monitoring and evaluation, and health systems strengthening, A2Z's focus countries have included Bangladesh, Cambodia, the East, Central and Southern Africa region, India, Nepal, Philippines, Tanzania, Uganda and West Bank.
","While Tanzania has achieved high vitamin A supplementation coverage over the past few years, there is concern that this achievement is fragile because of decentralization. A2Z is supporting national, zonal, regional, and district health teams to institutionalize twice-yearly distributions through ongoing advocacy and routine planning and budgeting. This activity is conducted in collaboration with the National Program for Extension of Tools and Strategies, the Tanzania Essential Health Interventions Project, Ifakara Health Research and Development Centre, the Tanzania Food and Nutrition Center (TFNC), and UNICEF. To foster sustainable vitamin A supplementation, the A2Z project is supporting behavior change communication through community workers and a popular radio serial. Based on information gathered on sustainability indicators by TFNC with support of A2Z and HKI, those districts that have not yet integrated funding for vitamin A supplementation in their plans are receiving additional technical support. Several resources developed in Tanzania are available to ensure program sustainability.
","Given the twice-yearly nature of the VAS program as well as its historic evolution from immunization campaigns, it is easy for district staff to see the program as separate from their regular day-to-day work. Considering the program to be part of the routine work for the district is critical for sustainability, and is reflected in both attitudes and the support provided to the program. Ninety-one (76%) of the 119 districts regarded implementation of the twice-yearly VAS and deworming program to be a routine activity. About 84% considered VAS and deworming a very important service, and 99% thought the service should continue. Although the majority of the districts viewed VAS/deworming as a routine activity, more than half (55%) had not yet included VAS/deworming services in their routine supervision checklist. Moreover, payment of allowances to staff for VAS/deworming while at their normal duty stations implies that these services were viewed as special rather than routine. The allowance scheme in particular, with an excessive number of supervisors at some distribution sites and inadequate supervision at other sites, may increase a district’s vulnerability to a decline in coverage. Overall, 11 districts (9%) were judged vulnerable with low sustainability related to supervision and monitoring
","Those districts that have not yet integrated funding for vitamin A supplementation ","","","","","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","Others, please specify below","For an activity to be sustained, it must be considered part of the district’s regular activities, and thus must be included in the annual planning process.","Management","The VAS program requires clear management for effective and efficient implementation, and thoughtful management also reflects the value placed on the program. Poor management may make the program vulnerable, and less likely to be sustained in an effective fashion.","Supplies","The VAS program depends on effective logistics, and capsule and promotional materials must reach distribution sites on time and in adequate quantities for the program to be effective. Poor logistics supply management makes the program vulnerable. Adequate communication between programs and departments within district councils facilitated effective use of available resources in 117 (98%) of the districts assessed.","Financial resources","Ensuring adequate provision for the VAS/deworming program within the basket fund can improve the financial sustainability of the program.","Insufficient staff","Twice yearly VAS distribution involves extended outreach to communities, and thus requires significant mobilization of both health staff and community volunteers. Failure to plan for adequate human resources is likely to place districts at risk of not sustaining their coverage achievements.","","","","","","","","","","","","Planning
Districts should be encouraged to budget for the program in their own CCHP budget including the basket fund which is considered the most reliable source of funds. Once basket funds are planned, they cannot be reallocated
Advocacy and community ownership
The program is more likely to continue effectively if it is understood and valued by community members who are involved with planning and implementation.
Management and Leadership
Efforts should be made to protect the current best practices in management and leadership reported in most of the districts.
Logistics Supply
Key actors at the national level need to ensure timely procurement and delivery of supplies to the districts
Supervision and Monitoring
Districts should determine the appropriate number of site supervisors to contain costs and include VAS/deworming in the routine supervision checklist to ensure that children missed during the twice-yearly events are reached through “mop up” actions.
Advocasy and Community Ownership
The successful efforts to date should continue to build community ownership of the program through well-designed, regular sensitization meetings and advocacy to engage the community, mobilize participation, and raise the profile of VAS/deworming events.
Availability of Financial Resources
Ensuring adequate provision for the VAS/deworming program within the basket fund can improve the financial sustainability of the program.
Availability of Human Resources
Local councils and the central government need to fill staff positions and find secure mechanisms to ensure mobilization of adequate human resources to sustain service delivery.
Programme Effectiveness
Efforts should be made to maintain the high performance of the majority of districts and help the few low performing districts improve their coverage.
","","English" "11473","A2Z: The USAID Micronutrient and Child Blindness Project","English","Multi-national","","TZA","United Republic of Tanzania","Dar es Salaam, Tanzania","Urban|Rural|Peri-urban","completed","01-2006","01-2011","A2Z: The USAID Micronutrient and Child Blindness Project consolidates, builds, and expands on USAID's long-term investment in micronutrients, child survival, and nutrition. A2Z takes proven interventions to scale, introduces innovation, expands services, and builds sustainable programs to increase the use of key micronutrient and blindness interventions to improve child and maternal health. With work in vitamin A supplementation of children, newborn vitamin A, food fortification, maternal and child anemia control, monitoring and evaluation, and health systems strengthening, A2Z's focus countries have included Bangladesh, Cambodia, the East, Central and Southern Africa region, India, Nepal, Philippines, Tanzania, Uganda and West Bank.
","With advocacy from A2Z/HKI and other donors, the Government of Tanzania in December 2006 adopted a policy for the use of zinc for the treatment of diarrhea. A2Z/HKI provided technical support to the National IMCI coordinator to incorporate zinc therapy as part of diarrhea management and developed modified IMCI guidelines. Zinc treatment and low osmolarity solution oral rehydration salts (ORS) have been incorporated into the National Standard Therapeutic Guidelines. The project facilitated formative research to learn about the health-seeking practices of the community around diarrhea by Ifakara Health Research and Development Centre and Johns Hopkins University. The formative research also tested the acceptability of zinc treatment for diarrhea among mothers and caretakers. The findings of the study are expected to be used to assist in the development of health worker training modules and behavior change communication materials for use by the Ministry of Health and Social Welfare and the community.
","Under-five mortality rate
","","","","","","","Vulnerable groups","","Zinc supplementation in the management of diarrhoea>>>Zinc supplementation in the management of diarrhoea>>http://www.who.int/elena/titles/zinc_diarrhoea","","","","","","","","","","","","","","","","","","","","","","The project facilitated formative research to learn about the health-seeking practices of the community around diarrhea by Ifakara Health Research and Development Centre and Johns Hopkins University.
","","English" "11480","A2Z: The USAID Micronutrient and Child Blindness ","English","Multi-national","","UGA","Uganda","Kampala, Central Region, Uganda|Hoima, Western Region, Uganda|Bushenyi, Western Region, Uganda|Kitgum, Northern Region, Uganda|Lira, Northern Region, Uganda ","Urban|Rural|Peri-urban","completed","01-2005","01-2011","A2Z: The USAID Micronutrient and Child Blindness Project consolidates, builds, and expands on USAID's long-term investment in micronutrients, child survival, and nutrition. A2Z takes proven interventions to scale, introduces innovation, expands services, and builds sustainable programs to increase the use of key micronutrient and blindness interventions to improve child and maternal health. With work in vitamin A supplementation of children, newborn vitamin A, food fortification, maternal and child anemia control, monitoring and evaluation, and health systems strengthening, A2Z's focus countries have included Bangladesh, Cambodia, the East, Central and Southern Africa region, India, Nepal, Philippines, Tanzania, Uganda and West Bank.
The objectives of A2Z’s program in Uganda are to support increased vitamin A supplementation coverage in selected districts, expand coverage of fortified foods, improve coverage and adherence to anemia protocols for pregnant women, and support development of guidelines to include zinc in diarrhea case management for young children.
","A2Z supports Uganda’s national Child Days Plus (CDP) program for vitamin A and deworming each year at national and district levels. The project is collaborating with the Neglected Tropical Diseases program to train community medicine distributors to administer vitamin A supplements to children 6-59 months old, assist target districts in the development of guidelines, share best practices for planning of Child Days Plus, and conduct regional Child Days Plus feedback and planning meetings in collaboration with UNICEF. The project also supports data collection and supervision activities as part of the national health management information system.
",".
","","some districts","","","","","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","","","","","","","","","","","","","","","","","","","","","","","","English" "11480","A2Z: The USAID Micronutrient and Child Blindness ","English","Multi-national","","UGA","Uganda","Kampala, Central Region, Uganda|Hoima, Western Region, Uganda|Bushenyi, Western Region, Uganda|Kitgum, Northern Region, Uganda|Lira, Northern Region, Uganda ","Urban|Rural|Peri-urban","completed","01-2005","01-2011","A2Z: The USAID Micronutrient and Child Blindness Project consolidates, builds, and expands on USAID's long-term investment in micronutrients, child survival, and nutrition. A2Z takes proven interventions to scale, introduces innovation, expands services, and builds sustainable programs to increase the use of key micronutrient and blindness interventions to improve child and maternal health. With work in vitamin A supplementation of children, newborn vitamin A, food fortification, maternal and child anemia control, monitoring and evaluation, and health systems strengthening, A2Z's focus countries have included Bangladesh, Cambodia, the East, Central and Southern Africa region, India, Nepal, Philippines, Tanzania, Uganda and West Bank.
The objectives of A2Z’s program in Uganda are to support increased vitamin A supplementation coverage in selected districts, expand coverage of fortified foods, improve coverage and adherence to anemia protocols for pregnant women, and support development of guidelines to include zinc in diarrhea case management for young children.
","A2Z provides technical inputs to a wheat and maize flour fortification program supported by the Global Alliance for Improved Nutrition (GAIN). A2Z is also strengthening existing fortification programs in such as areas as inspection and monitoring of iodized salt and vitamin A fortified oil. The country routinely supervises factories, importation sites, and retail stores. Most of the salt in the country complies with iodization regulation, and more than 95 percent of the oil available at retail stores appears to be fortified with adequate vitamin A content. Wheat flour samples are also periodically analyzed for their iron content. A food and nutrition consumption survey is underway in collaboration with Makerere University, the National Working Group in Food Fortification, and GAIN to determine the suitability and potential benefit of the food fortification policies of the country. As part of advocacy and planning support, A2Z is assisting in cost studies of oil and sugar fortification.
","A2Z is also strengthening existing fortification programs in such as areas as inspection and monitoring of iodized salt and vitamin A fortified oil.
","more than 95 percent of the oil available at retail stores appears to be fortified ","","","","","Other","Universal salt iodization, vitamin A fortification of all oils","Iodization of salt>>>Iodization of salt>>http://www.who.int/elena/titles/salt_iodization","","","","","","","","","","","","","","","","","","","","","","","","English" "11480","A2Z: The USAID Micronutrient and Child Blindness ","English","Multi-national","","UGA","Uganda","Kampala, Central Region, Uganda|Hoima, Western Region, Uganda|Bushenyi, Western Region, Uganda|Kitgum, Northern Region, Uganda|Lira, Northern Region, Uganda ","Urban|Rural|Peri-urban","completed","01-2005","01-2011","A2Z: The USAID Micronutrient and Child Blindness Project consolidates, builds, and expands on USAID's long-term investment in micronutrients, child survival, and nutrition. A2Z takes proven interventions to scale, introduces innovation, expands services, and builds sustainable programs to increase the use of key micronutrient and blindness interventions to improve child and maternal health. With work in vitamin A supplementation of children, newborn vitamin A, food fortification, maternal and child anemia control, monitoring and evaluation, and health systems strengthening, A2Z's focus countries have included Bangladesh, Cambodia, the East, Central and Southern Africa region, India, Nepal, Philippines, Tanzania, Uganda and West Bank.
The objectives of A2Z’s program in Uganda are to support increased vitamin A supplementation coverage in selected districts, expand coverage of fortified foods, improve coverage and adherence to anemia protocols for pregnant women, and support development of guidelines to include zinc in diarrhea case management for young children.
","A2Z works at national and district levels to help implement national guidelines on the prevention and control of maternal anemia. The intervention package includes reduction of malaria, deworming, and improved iron intake. Efforts are underway to revitalize maternal anemia reduction activities by positioning it as a key maternal mortality reduction approach. The project is systematically addressing bottlenecks such as low health worker knowledge and motivation and generally low community awareness (especially among mothers) on the dangers of anemia. Another bottleneck—poor logistics management with frequent stock outs of iron—was examined as part of an assessment of the availability of micronutrient supplements and medicines for use in micronutrient programs. The assessment was conducted in Uganda by A2Z in collaboration with MSH/RPM+.
","maternal anaemia
maternal mortality
","","","","","","","Sex","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "11480","A2Z: The USAID Micronutrient and Child Blindness ","English","Multi-national","","UGA","Uganda","Kampala, Central Region, Uganda|Hoima, Western Region, Uganda|Bushenyi, Western Region, Uganda|Kitgum, Northern Region, Uganda|Lira, Northern Region, Uganda ","Urban|Rural|Peri-urban","completed","01-2005","01-2011","A2Z: The USAID Micronutrient and Child Blindness Project consolidates, builds, and expands on USAID's long-term investment in micronutrients, child survival, and nutrition. A2Z takes proven interventions to scale, introduces innovation, expands services, and builds sustainable programs to increase the use of key micronutrient and blindness interventions to improve child and maternal health. With work in vitamin A supplementation of children, newborn vitamin A, food fortification, maternal and child anemia control, monitoring and evaluation, and health systems strengthening, A2Z's focus countries have included Bangladesh, Cambodia, the East, Central and Southern Africa region, India, Nepal, Philippines, Tanzania, Uganda and West Bank.
The objectives of A2Z’s program in Uganda are to support increased vitamin A supplementation coverage in selected districts, expand coverage of fortified foods, improve coverage and adherence to anemia protocols for pregnant women, and support development of guidelines to include zinc in diarrhea case management for young children.
","A2Z provided assistance to the MOH in reviewing the plan for revitalization of oral rehydration therapy and advocated for the inclusion of zinc as an adjunct therapy for diarrhea treatment. Zinc therapy as part of diarrhea management was accepted as national treatment in December 2006.
","diarreal cases
","","","","","","","Vulnerable groups","","Zinc supplementation in the management of diarrhoea>>>Zinc supplementation in the management of diarrhoea>>http://www.who.int/elena/titles/zinc_diarrhoea","","","","","","","","","","","","","","","","","","","","","","","","English" "11483","The MOST Project","English","Multi-national","","ETH|GHA|ZAF|UGA|ZMB","Ethiopia|Ghana|South Africa|Uganda|Zambia","Ethiopia|Ghana|South Africa|Uganda|Zambia","Urban|Rural|Peri-urban","completed","01-1997","01-2001","Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Twice a year, at designated times, the three programs distribute capsules to children aged six months to five years. Each program follows a campaign model based upon intensified social mobilization and service delivery over two to seven days. The twice-yearly events have created a cadre of field-tested personnel in the three countries, who are skilled at working with the local communities and at promoting their support and active participation. All three programs have been associated with National Immunization Days (NIDs), a WHO global program to eradicate polio. Since NIDs were held annually, however, they provided an opportunity for only one dose of vitamin A each year. Because children with vitamin A deficiency should receive a supplement at least twice a year (every four to six months), another mechanism was needed for the second dose. Relying exclusively upon facility-based distribution to deliver the second dose was not a viable option for several reasons, but in particular because healthfacility attendance for older children was not high enough to ensure adequate coverage in the one-to-five-year age group.
In Zambia, the first non-NIDs vitamin A supplementation program was launched in August 1999, and later renamed Child Health Week (CHW) to make the focus on the child more explicit. It was also felt that, instead of limiting activities to a vertical vitamin A supplementation program, the opportunity should be seized to deliver an integrated service that included not only vitamin A capsules but also other health services such as de-worming, health education, immunization, family planning, prenatal care, and growth monitoring. Districts were encouraged to provide an integrated package of services commensurate with their local capacity and need — as long as vitamin A supplementation remained the core activity during that week. In Zambia, the first NIDs campaign took place in 1997, and was a nationwide undertaking. The program was scaled down to about half the districts in recent years. Since 1999, the focus has shifted to priority districts, where communities have been at a constant risk of cross-border polio infections due to civil-war-related migrations from neighboring countries. This narrower focus is referred to in Zambia as sub-NIDS.
The first round of vitamin A supplementation in Ghana was integrated into NIDs in 1996. By 1999, a detailed plan was developed to implement a nationwide stand-alone supplementation program for the second round. In 2000, the Ministry of Health (MOH) carried out the first vitamin A standalone capsule distribution in the country’s ten regions. Since that date, the program has become a two- to three-day stand-alone event used to deliver a second dose of vitamin A to all children 6 to 59 months of age. Volunteers from the Ghana Education Service, along with personnel from other decentralized departments, assist with the supervision and capsule-distribution effort. Community-based volunteers are in direct contact with caregivers and children and also work very closely with health workers, assemblymen, chiefs, opinion leaders, gong-gong beaters, and other community leaders to mobilize beneficiaries, administer vitamin A, and maintain distribution records.
In contrast to Zambia and Ghana, Nepal followed a phased approach to program implementation. Integration of vitamin A into NIDs in Nepal was initiated in 1997,
four years after a supplementation program was established in 8 of the country’s 75 districts. The second distribution campaign has since been phased in at a rate of eight to ten districts per year. By 2001, the program covered all but three politically unstable districts. Under the program, high-dose vitamin A capsules are distributed to all children aged 6 to 59 months during a twoday event.
","
Ghana
A monitoring team consisting of national, regional, and district supervisors carries out organized and random spot checks. Where necessary, vitamin A capsule administrators are assisted in performing their tasks. Capsule-distribution teams use all means of transportation available within the region and district, whether these be 4x4 vehicles, 2x4 pickups, motorcycles, or bicycles. MOH, district assemblies, decentralized departments, and local and international NGOs provide fuel and contribute to vehicle maintenance. At the end of each day, tally sheets are counted and summary sheets completed. Data are compiled by sub-district and district health management teams. After all figures are checked for accuracy, district coverage is calculated. District coverage data are sent to the regional nutrition officers and senior medical officers of public health, who compile regional coverage figures before sending them to the Nutrition Unit in Accra. Using regional figures, the Nutrition Unit estimates national coverage.
Zambia
Monitoring teams consisting of national, provincial, and district staff carry out systematic or random observations, depending on what they are monitoring. Where necessary, vitamin A capsule administrators are assisted in performing their tasks. At the end of each day, tally sheets are counted, summary sheets completed, and data compiled. District figures are then checked for accuracy, after which district coverage is calculated and the results forwarded to NFNC.
","Ghana: 3.5 million children ","Ghana: Exceeded target in May 2001; Zambia: 28 percent in 1999, 88 in Febraury 2002","","serum retinol levels of &lt;20 ug/dl,night-blindness prevalence,vitamin A supplementation coverage for children,subclinical vitamin A deficiency,","serum retinol levels of <20 ug/dl,night-blindness prevalence,vitamin A supplementation coverage for children,subclinical vitamin A deficiency,","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","Insufficient staff","In Zambia and Ghana, it has been somewhat more difficult to generate a consistent cadre of volunteers for the vitamin A distribution. In each country, districts mobilize health post and sub-health post staff, identify extended outreach sites (including clinics, schools, and community centers),and then recruit community members to assist them with their activities. In Ghana, this has been relatively successful since there have been adequate clinic staff and a manageable number of outreach sites. In spite of this, many districts have continued to do some house-to-house visits to ensure high coverage. In Zambia, it has been more difficult to recruit community volunteers, and the clinic staff have been stretched to cover outreach sites.","","","","","","","","","","","","","","","","","","","","","Robin Houston (2003). Why They Work: An analysis of three successful public health interventions - Vitamin A supplementation programs in Ghana, Nepal, and Zambia
Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Five data collection methods were used:
During the fieldwork, the enumerators worked in pairs. The enumerators were not allowed to use the instruments in the facilities where they worked. Each pair spent a full day at a health facility. Field supervisors supported the enumerators during the data collection and checked the questionnaires for consistency and completeness. This was to ensure that the data collected was accurate as possible.
","""""Many pregnant mothers do not come to ANC because they had several normal pregnancies and think all will continue to go on well always.”
- Health worker, Apac
“ The health worker at the health centre is very rude, she has no time for us; so we fear even asking questions or discussing any issue about our health. So I go all the way to Naguru health clinic and only here if I have no money for transport.”
- A pregnant woman, Kojja, Mukono
“ I think these tablets for blood should be given only to pregnant women who have no blood. It may cause a high blood level and lead to high blood pressure.”
- TBAs, Kyampisi
“ Women with increased blood should not take these tablets (iron and folic acids) because their heartbeats will increase and they will sweat very much.”
- TBAs, Seeta Nazigo
“ Some mothers say it smells and they throw away the tablets soon after the clinic.”
- Pregnant mothers, Kojja
“ Some mothers do not like taking tablets when they are pregnant.”
- Pregnant mothers, Seeta Nazigo
Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Ethiopia
MOST is providing technical and implementation support to the Ministry of Health in the development of a national micronutrient program. The program is a cooperative effort between the MOH, USAID/Ethiopia, MOST, and UNICEF. Program components include strengthening of the newly formed nutrition division at the MOH and the micronutrient committee; development of a locally designed vitamin A supplementation strategy and its pilot test; support for initial trials of vitamin A sugar fortification in one of the country's four sugar factories; and support for information, education, and communication activities.
South Africa
MOST is working with counterparts at the University of the Western Cape (UWC) to support and strengthen a new vitamin A supplementation program being started by the Department of Health in Eastern Cape province. MOST is also supporting a pilot initiative by UWC that aims to incorporate micronutrient interventions into the Eastern Cape Integrated Nutrition Program.
.
","","","","","","","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","","","","","","","","","","","","","","","","","","","","","","","","English" "11483","The MOST Project","English","Multi-national","","ETH|GHA|ZAF|UGA|ZMB","Ethiopia|Ghana|South Africa|Uganda|Zambia","Ethiopia|Ghana|South Africa|Uganda|Zambia","Urban|Rural|Peri-urban","completed","01-1997","01-2001","Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Government agencies encouraged the initial development of fortification: NFNC promoted initial research, sponsored meetings, and coordinated activities related to fortification; MOH researched the legal framework; the National Institute for Scientific and Industrial Research (NISIR) provided technical guidance; the Food and Drug Control Laboratory (FDCL) conducted monitoring and evaluation; and the Zambian Revenue Authority (ZRA) examined the tax structure. Industry acceptance allowed planning to begin, but donor support was critical to the development of the program: the U.S. Agency for International Development (USAID) was the lead financer of the project and provided technical assistance, UNICEF provided spare parts, and the Japanese International Cooperation Agency (JICA) provided spectrophotometers for Zambia Sugar and the FDCL.
While legislation was still being developed, Zambia Sugar went ahead with the launch of fortified Whitespoon Sugar on May 15, 1998. Zambia Sugar began its fortification program at 15 mg/kg, but cost considerations led the company to reduce the level to 10 mg/kg within three months. In May 1997, one year before fortification began, a consultant estimated the cost of fortifying 100,000 metric tons of sugar at 16 mg/kg to be around $1 million U.S., while fortifying at 20 mg/kg would cost almost $1.25 million.24 Reducing the level from 16 to 10 mg/kg could thus have reduced costs by approximately $375,000 a year.
","Modified Relative Dose Response Test (MRDR) in children
","The first outside tests of fortificant levels in sugar were controversial. Four months after the launch of fortified sugar, a team consisting of representatives from the MOH, the NFNC, and NISIR visited the Zambia Sugar mill. The team tested samples from the mill at the FDCL; these tests showed far lower levels of vitamin A than those shown in tests by Zambia Sugar. The government’s tests indicated a range of 0–13.6 mg/kg, while Zambia Sugar’s tests indicated a range of 9–21 mg/kg for the same samples. Zambia Sugar believes that the samples suffered sedimentation in the transport to the government laboratory and that this explains the different results.
MOST, the USAID micronutrient program, sponsored the creation of training manuals for health inspectors and Food and Drug enforcement officers, as well as a national training workshop from September 24 to October 7, 2000. The workshop focused on inspection procedures and methods, provided laboratory training where appropriate, and included a trip to the Zambia Sugar plant. Since the implementation of that program, Zambia Sugar has expressed satisfaction with law enforcement efforts. UNICEF subsequently funded workshops at the district level, using reproductions of the training manuals that had been produced with MOST funding.
","nationwide","..","","","","Vulnerable groups","","","Financial resources","","Communication","","Financial resources","","Adherence","","","","","","","","","","","","","","","","","English" "11629","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","UGA","Uganda","Northern Uganda |central “Maize Belt|Southwest Uganda","Rural|Peri-urban","on-going","01-2011","12-2015","Feed the Future, the U.S. government’s global hunger and food security initiative, is a $3.5 billion commitment to support country-driven approaches to address the root causes of poverty, hunger and undernutrition. A whole-of-government initiative led by the United States Agency for International Development (USAID), Feed the Future leverages the strengths of multilateral institutions, civil society and the private sector. Globally we aim to assist 18 million vulnerable women, hildren, and family members – mostly smallholder farmers – escape hunger and poverty. Together, we will increase agricultural productivity, decrease poverty, drive economic growth, and reduce undernutrition to improve millions of lives.
Over the next five years in Uganda, Feed the Future aims to help an estimated 709,000 vulnerable Ugandan women, children and family members—mostly mallholder farmers—escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Uganda is making core investments in three key areas:
1. Nutrition
2. Agriculture. The maize, coffee and bean belt are in Southwest and Central Uganda. The choice to focus on these value chains represents considerations regarding Ugandan government priorities, division of donor labor, and the highest impact interventions for the expected scale of Feed the Future resources.
3. Connecting Nutrition to Agriculture
USAID will build on previous strategic investments in nutrition and take them to scale in the areas and populations of greatest need to support the GOU and private sector to reduce chronic undernutrition in the country with a primary focus on prevention. Through these interventions an estimated 709,000 vulnerable Ugandan women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. The core investments in nutrition will focus on community and facility based prevention and treatment, targeted nutrition service delivery, the enabling environment for nutrition and capacity building.
Community and Facility-Base Prevention and Treatment
By emphasizing prevention, FTF programs will help to reduce not only chronic undernutrition, but should also reduce the number of severely/acutely malnourished children as well, resulting in fewer children outside HIV and emergency situations needing treatment for severe acute malnutrition. For the treatment of acute malnutrition, Uganda has adopted a national protocol for the Integrated Management of Acute Malnutrition (IMAM). Through a ommunity and facility based approach to treating under nutrition, therapeutic and/or supplementary food is provided to severe or moderately malnourished children, with medical support, nutrition education, and at-home follow up through community based volunteers. FTF and PEPFAR’s partnership on the production, distribution, and management of RUTF support the larger national IMAM protocols.
Capacity Building
Capacity building at the national and district level is critical. Nutrition has only recently become a priority in the health sector, and without strong nutrition champions and policies centrally, nutrition priorities will not be realized. USAID will continue to train health workers in new IMAM guidelines for use in health facilities and will expand technical assistance and capacity building at the national level beyond the health sector to include Agriculture and other ministries who can contribute to a national action plan on nutrition.
","Some key outputs of nutrition activities are: nutrition officers placed in a majority of districts; active Food and Nutrition Councils organized in districts; mandatory fortification of major manufactured foods; therapeutic food reconstituted from locally available foods developed and distributed to district and regional hospitals; and community behavior changes to prevent undernutrition.
","PERFORMANCE MONITORING
Through an interactive approach across Mission teams and in collaboration with other donors and the GOU, the USG FTF effort will go beyond the status quo of performance monitoring. At the basic level, data will be collected by implementing partners and reported to USAID/Uganda through quarterly reports while quality will be assessed via Data Quality Assessment visits to the field.
IMPACT EVALUATION
To build an evidence base to adjust ongoing projects and inform future programs, we will design rigorous impact evaluations for select FTF programs. We have already identified such an opportunity with our Community Connector program, which fully integrates agriculture and nutrition activities at the household level. Discussions have been held with partners within the MIT Poverty Action Lab consortium on the use of Randomized Control Trial (RCT) experiments. We will use the results of these impact evaluations to test the hypotheses of our FTF strategy and make mid-stream adjustments to programs if necessary, or scale up programs that are working well. Using the earning component of FTF programs like Community Connector is in line with the Mission’s continuing CLA component. We will also partner with other donors to disseminate and promote lessons learned. USAID/Uganda, through unbiased and independent impact evaluations, will identify interventions that work; we will be an active contributor to the greater discourse in testable development hypotheses and our programs will benefit from our increased understanding
CAPACITY BUILDING/SUPPORT TO DATA COLLECTION
A key component of our Feed the Future program will be capacity building of the Government of Uganda in the collection, analysis, and use of agriculture and nutrition data for planning, monitoring, and evaluation. We will work with all relevant government agencies and ministries including the Uganda Bureau of Statistics, the Ministry of Agriculture, Animal Industry and Fisheries, and the Ministry of Health. We will work in partnership with the National Planning authority as they attempt to convene the multisectoral Food and Nutrition Council as a cohesive and functional unit. We will seek to build local academic institutions’ capacity in nutrition through improved pre-service and in-service training, and enhanced research capacity. In addition to training in data collection and assistance in improving data systems, we will build analytical capacity in the Ministry of Agriculture by establishing a Strategic Analysis and Knowledge Support System (SAKSS) node.
NUTRITION COLLABORATIVE RESEARCH AND SUPPORT PROGRAM (CRSP)
We will use the Nutrition CRSP to assist us with specific research questions that tell us about the impact of our nutrition-related FTF programs. We have already had preliminary discussions with a Nutrition CRSP team. The Nutrition CRSP is intended to investigate effective ways of translating research results into widespread development practice. The CRSP anticipates the development of a well-balanced research strategy that is both innovative and problem solving, responds to the food and nutrition scientific needs, and to the capacity development requirements of Uganda. USAID/Uganda, through the CRSP, will be better positioned to build more effective strategies and programs, while establishing a research capacity within the Mission and the country as a whole. As programs continue to be developed and procured in the coming months, the CRSP will assist in collecting the relevant local and international knowledge base needed to better implement, evaluate, and learn from our programs. Within individual programs, the CRSP will be an active participant in identifying and rigorously measure testable hypotheses related to food security.
","estimated 709,000 vulnerable Ugandan women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition","This component will reach children in 47 districts in the Southwest and North of Uganda","","","Prevalence of households with moderate or severe hunger;Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Number of health facilities with established capacity to manage acute under nutrition; Prevalence of anemia among children 6-59 months; Prevalence of Poverty: Percent of people living on less than $1.25/day; Expenditures of rural households;Prevalence of stunted children under five; Change in average score on Household Hunger index; Percent of children 6-23 months who received a Minimum Acceptable Diet.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11629","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","UGA","Uganda","Northern Uganda |central “Maize Belt|Southwest Uganda","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. government’s global hunger and food security initiative, is a $3.5 billion commitment to support country-driven approaches to address the root causes of poverty, hunger and undernutrition. A whole-of-government initiative led by the United States Agency for International Development (USAID), Feed the Future leverages the strengths of multilateral institutions, civil society and the private sector. Globally we aim to assist 18 million vulnerable women, hildren, and family members – mostly smallholder farmers – escape hunger and poverty. Together, we will increase agricultural productivity, decrease poverty, drive economic growth, and reduce undernutrition to improve millions of lives.
Over the next five years in Uganda, Feed the Future aims to help an estimated 709,000 vulnerable Ugandan women, children and family members—mostly mallholder farmers—escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Uganda is making core investments in three key areas:
1. Nutrition
2. Agriculture. The maize, coffee and bean belt are in Southwest and Central Uganda. The choice to focus on these value chains represents considerations regarding Ugandan government priorities, division of donor labor, and the highest impact interventions for the expected scale of Feed the Future resources.
3. Connecting Nutrition to Agriculture
USAID will build on previous strategic investments in nutrition and take them to scale in the areas and populations of greatest need to support the GOU and private sector to reduce chronic undernutrition in the country with a primary focus on prevention. Through these interventions an estimated 709,000 vulnerable Ugandan women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. The core investments in nutrition will focus on community and facility based prevention and treatment, targeted nutrition service delivery, the enabling environment for nutrition and capacity building.
Targeted Nutrition Service Delivery – Fortification and Supplementation
Targeted nutrition service delivery is focused primarily on approaches to reduce specific micronutrient
deficiencies in Uganda. FTF will continue to support vitamin A supplementation and de-worming for
children and iron folic acid supplementation and de-worming for pregnant women at the facility level,
through district-level health programs in target geographical areas. In addition, food fortification
activities will be supported to improve the necessary vitamin and mineral content of staple foods that
will reach a larger target audience, primarily in urban and peri-urban areas where fortified foods are
more accessible. This will build on previous work supported by the USG that has resulted in cooking
oil fortification with vitamin A that now covers more than 85 percent of the country’s market and the
fortification of maize and wheat flour with vitamin A, iron, zinc, folic acid and vitamin B12 and. New food fortification vehicles will be added that include sugar fortification with vitamin A.
The agriculture team is also looking at improved seed varieties to increase micronutrient content such as the orange-fleshed sweet potato, which has increased levels of beta-carotene (Vitamin A). The introduction of fortification of foods will be combined with educational activities that promote dietary diversity through the community and facility based programs.
As previously mentioned, a key component to treatment of undernutrition in Uganda is the production of therapeutic and complementary foods. USG’s Feed the Future will expand on previous investments in local ready-to-use therapeutic food production to increase availability and distribution in health facilities across the country to treat acute undernutrition.
Enabling Environment
Our program will work to leverage other sectors (e.g., agriculture, water, public/private, etc) to create demand for fortified foods, adopt good nutrition behaviors, and activities like exclusive breastfeeding and integrated nutrition/WASH/food hygiene. Advocacy efforts will continue to emphasize the importance of nutrition among key stakeholders. Uganda is one of the countries that is taking on the Scaling Up Nutrition (SUN) initiative spear headed globally by the Irish Government, U.S. Government and the UN. SUN focuses on integration of relevant sectors with a view to addressing the window of opportunity within the 1,000 days (from minus 9 months to 24 months). We will work to harmonize FTF and SUN activities to maximize efficiency and national coverage in close consultation with MOH, MAAIF and other stakeholders. Through the existing micronutrient fortification program that has successfully enriched common staples such as oil and flour, FTF will continue to advocate for mandatory fortification of manufactured foods.
","Some key outputs of nutrition activities are: nutrition officers placed in a majority of districts; active Food and Nutrition Councils organized in districts; mandatory fortification of major manufactured foods; therapeutic food reconstituted from locally available foods developed and distributed to district and regional hospitals; and community behavior changes to prevent undernutrition.
","PERFORMANCE MONITORING
Through an interactive approach across Mission teams and in collaboration with other donors and the GOU, the USG FTF effort will go beyond the status quo of performance monitoring. At the basic level, data will be collected by implementing partners and reported to USAID/Uganda through quarterly reports while quality will be assessed via Data Quality Assessment visits to the field.
IMPACT EVALUATION
To build an evidence base to adjust ongoing projects and inform future programs, we will design rigorous impact evaluations for select FTF programs. We have already identified such an opportunity with our Community Connector program, which fully integrates agriculture and nutrition activities at the household level. Discussions have been held with partners within the MIT Poverty Action Lab consortium on the use of Randomized Control Trial (RCT) experiments. We will use the results of these impact evaluations to test the hypotheses of our FTF strategy and make mid-stream adjustments to programs if necessary, or scale up programs that are working well. Using the earning component of FTF programs like Community Connector is in line with the Mission’s continuing CLA component. We will also partner with other donors to disseminate and promote lessons learned. USAID/Uganda, through unbiased and independent impact evaluations, will identify interventions that work; we will be an active contributor to the greater discourse in testable development hypotheses and our programs will benefit from our increased understanding
CAPACITY BUILDING/SUPPORT TO DATA COLLECTION
A key component of our Feed the Future program will be capacity building of the Government of Uganda in the collection, analysis, and use of agriculture and nutrition data for planning, monitoring, and evaluation. We will work with all relevant government agencies and ministries including the Uganda Bureau of Statistics, the Ministry of Agriculture, Animal Industry and Fisheries, and the Ministry of Health. We will work in partnership with the National Planning authority as they attempt to convene the multisectoral Food and Nutrition Council as a cohesive and functional unit. We will seek to build local academic institutions’ capacity in nutrition through improved pre-service and in-service training, and enhanced research capacity. In addition to training in data collection and assistance in improving data systems, we will build analytical capacity in the Ministry of Agriculture by establishing a Strategic Analysis and Knowledge Support System (SAKSS) node.
NUTRITION COLLABORATIVE RESEARCH AND SUPPORT PROGRAM (CRSP)
We will use the Nutrition CRSP to assist us with specific research questions that tell us about the impact of our nutrition-related FTF programs. We have already had preliminary discussions with a Nutrition CRSP team. The Nutrition CRSP is intended to investigate effective ways of translating research results into widespread development practice. The CRSP anticipates the development of a well-balanced research strategy that is both innovative and problem solving, responds to the food and nutrition scientific needs, and to the capacity development requirements of Uganda. USAID/Uganda, through the CRSP, will be better positioned to build more effective strategies and programs, while establishing a research capacity within the Mission and the country as a whole. As programs continue to be developed and procured in the coming months, the CRSP will assist in collecting the relevant local and international knowledge base needed to better implement, evaluate, and learn from our programs. Within individual programs, the CRSP will be an active participant in identifying and rigorously measure testable hypotheses related to food security.
","estimated 709,000 vulnerable Ugandan women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition","This component will reach children in 47 districts in the Southwest and North of Uganda.","","","Prevalence of households with moderate or severe hunger;Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Number of health facilities with established capacity to manage acute under nutrition; Prevalence of anemia among children 6-59 months; Prevalence of Poverty: Percent of people living on less than $1.25/day; Expenditures of rural households;Prevalence of stunted children under five; Change in average score on Household Hunger index; Percent of children 6-23 months who received a Minimum Acceptable Diet.","Vulnerable groups","","Multiple micronutrient powders for home fortification of foods consumed by pregnant women>>>Multiple micronutrient powders for home fortification of foods consumed by pregnant women>>http://www.who.int/elena/titles/micronutrients_pregnancy","","","","","","","","","","","","","","","","","","","","","","","","English" "11629","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","UGA","Uganda","Northern Uganda |central “Maize Belt|Southwest Uganda","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. government’s global hunger and food security initiative, is a $3.5 billion commitment to support country-driven approaches to address the root causes of poverty, hunger and undernutrition. A whole-of-government initiative led by the United States Agency for International Development (USAID), Feed the Future leverages the strengths of multilateral institutions, civil society and the private sector. Globally we aim to assist 18 million vulnerable women, hildren, and family members – mostly smallholder farmers – escape hunger and poverty. Together, we will increase agricultural productivity, decrease poverty, drive economic growth, and reduce undernutrition to improve millions of lives.
Over the next five years in Uganda, Feed the Future aims to help an estimated 709,000 vulnerable Ugandan women, children and family members—mostly mallholder farmers—escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Uganda is making core investments in three key areas:
1. Nutrition
2. Agriculture. The maize, coffee and bean belt are in Southwest and Central Uganda. The choice to focus on these value chains represents considerations regarding Ugandan government priorities, division of donor labor, and the highest impact interventions for the expected scale of Feed the Future resources.
3. Connecting Nutrition to Agriculture
Priority Value Chains
Our investments will focus on value chains with the greatest market potential, the highest number of farmers, and the greatest income potential for farmers. Impact on nutrition and role of gender were also critical considerations in our value chain focus, as was the potential for sector-wide impact and maximum return on investment. Many of the value chain components have integrated nutrition and agriculture dimensions. The starting point for this strategy is the Government of Uganda’s Agriculture Sector Development Strategy and Investment Plan (DSIP) where ten priority value chains were selected. In looking at each commodity, maize and coffee stood out as key drivers for conomic growth in terms of number of farmers, market demand, and income potential. Most of the Ugandan staple diet is built around other staples like beans, cassava, and banana – leaving maize to function more as a cash crop that responds to regional food security and trade demands, rather than as a household staple. Fish, dairy and livestock were also considered. However all three present a number of challenges that would require substantially higher levels of investment to address and would deliver a much lower rate of return for dollar invested.
Value-chain Investments
Policy - The USG FTF strategy will support a five-year policy reform initiative in agriculture, trade, health and gender equity. Some examples of policy priorities include the passage of Uganda’s Biotechnology and Bio-safely bill, effective implementation of the Agricultural Chemicals Control Act (1989, amended in 2006) which establishes a licensing regime for insecticides, herbicides, fungicides and fertilizers, and controls and regulates the manufacture, storage, distribution, trade, import, and export of agricultural chemicals, effective implementation of the Agriculture Seeds and Plant Act (1994) which regulates seed companies operating or importing plant material into Uganda, and passage of the Food and Nutrition Bill and related Health, Nutrition and Sanitation policies for a proposed National Food and Drug Authority. Review of Uganda’s marriage and family act lays out the ownership and control of assets for women. It is critical to address key gender components of legislation.
Capacity Building - Support to strengthen key public and private sector institutions at the national and district levels is essential to the overall success of our Feed the Future activities. This five-year set of activities will focus on building capacity within the Uganda Bureau of Statistics, and Ministries of Health and Agriculture to collect and analyze data, and to monitor and evaluate the effectiveness of their programs. There will also be a short, medium, and long-term training and education component to develop the next generation of Uganda decision makers.
Agriculture Research – Feed the Future will support continued research in three areas:Biotechnology to protect food security crops from serious disease threat – specifically cassava (Cassava MOSAIC) and banana (Banana Wilt (BXW) and Black Sigatoka Disease); breeding to increase stress tolerance and disease resistance for Feed the Future focus crops (maize, coffee and beans); and partnership with Harvest Plus to scale-up the production and mainstream marketing of bio-fortified/nutritionally enhanced crop varieties - specifically Orange-fleshed Sweet Potato and high zinc/iron beans.
Increased Quality and Production – USG will contribute to a $50 million partnership with DANIDA, the EU, Belgium, and Sweden to address farm-level constraints to quality and production in maize, beans and coffee. The program will also focus on increasing farmer access to financial services and supporting trade-related sanitary and phytosanitary standards and quality management systems. Agro-Input Supply - A five-year program to increase the quality, availability, and use of inputs. This program will build the capacity of the Uganda National Agriculture Input Dealers Association (UNADA) and private sector retailers.
Farm-level Aggregation and Market Linkages - This program will work to build the capacity of farmer organizations to enter into agreements with major buyers, access finance, purchase inputs, bulk, clean, and process their commodities. The program will work in conjunction with the Abi-Trust Partnership (DANIDA) and emphasize linkages to the WFP's Purchase for Progress efforts and the Uganda Commodity Exchange.
Market-Information System - This program will work with local partners to utilize the latest in information and communications technology to address market information gaps for smallholder farmers.
","Some key outputs include:
PERFORMANCE MONITORING
Through an interactive approach across Mission teams and in collaboration with other donors and the GOU, the USG FTF effort will go beyond the status quo of performance monitoring. At the basic level, data will be collected by implementing partners and reported to USAID/Uganda through quarterly reports while quality will be assessed via Data Quality Assessment visits to the field.
IMPACT EVALUATION
To build an evidence base to adjust ongoing projects and inform future programs, we will design rigorous impact evaluations for select FTF programs. We have already identified such an opportunity with our Community Connector program, which fully integrates agriculture and nutrition activities at the household level. Discussions have been held with partners within the MIT Poverty Action Lab consortium on the use of Randomized Control Trial (RCT) experiments. We will use the results of these impact evaluations to test the hypotheses of our FTF strategy and make mid-stream adjustments to programs if necessary, or scale up programs that are working well. Using the earning component of FTF programs like Community Connector is in line with the Mission’s continuing CLA component. We will also partner with other donors to disseminate and promote lessons learned. USAID/Uganda, through unbiased and independent impact evaluations, will identify interventions that work; we will be an active contributor to the greater discourse in testable development hypotheses and our programs will benefit from our increased understanding
CAPACITY BUILDING/SUPPORT TO DATA COLLECTION
A key component of our Feed the Future program will be capacity building of the Government of Uganda in the collection, analysis, and use of agriculture and nutrition data for planning, monitoring, and evaluation. We will work with all relevant government agencies and ministries including the Uganda Bureau of Statistics, the Ministry of Agriculture, Animal Industry and Fisheries, and the Ministry of Health. We will work in partnership with the National Planning authority as they attempt to convene the multisectoral Food and Nutrition Council as a cohesive and functional unit. We will seek to build local academic institutions’ capacity in nutrition through improved pre-service and in-service training, and enhanced research capacity. In addition to training in data collection and assistance in improving data systems, we will build analytical capacity in the Ministry of Agriculture by establishing a Strategic Analysis and Knowledge Support System (SAKSS) node.
NUTRITION COLLABORATIVE RESEARCH AND SUPPORT PROGRAM (CRSP)
We will use the Nutrition CRSP to assist us with specific research questions that tell us about the impact of our nutrition-related FTF programs. We have already had preliminary discussions with a Nutrition CRSP team. The Nutrition CRSP is intended to investigate effective ways of translating research results into widespread development practice. The CRSP anticipates the development of a well-balanced research strategy that is both innovative and problem solving, responds to the food and nutrition scientific needs, and to the capacity development requirements of Uganda. USAID/Uganda, through the CRSP, will be better positioned to build more effective strategies and programs, while establishing a research capacity within the Mission and the country as a whole. As programs continue to be developed and procured in the coming months, the CRSP will assist in collecting the relevant local and international knowledge base needed to better implement, evaluate, and learn from our programs. Within individual programs, the CRSP will be an active participant in identifying and rigorously measure testable hypotheses related to food security.
","estimated 709,000 vulnerable Ugandan women, children and family members—mostly smallholder farmers—escape hunger and poverty. ","This component will reach farmers in 62 districts in the maize, coffee, and beans belt in Southwest and Central Uganda.","","Uganda National Household Survey, 2009/2010; Demographic Health Survey, 2006; The 2008 Uganda Food Consumption Survey; 2007 Uganda Service Provision Survey; The Uganda National Household Survey 2008/2009","Percent growth in agricultural GDP of maize and coffee; Percent change in value of intra-regional exports of targeted agricultural commodities as a result of USG assistance; Post-harvest losses as a percentage of overall harvest, for selected commodities; Value of new private sector investment in the agriculture sector or food chain leveraged by FTF.implementationCapacity of relevant national statistical office to collect high-quality agricultural data","Socio-economic status","","Biofortification of staple crops>>>Biofortification of staple crops>>http://www.who.int/elena/titles/biofortification","","","","","","","","","","","","","","","","","","","","","","","","English" "23344","Tamil Nadu Integrated Nutrition Project I (TINP I)","English","Large scale programmes","","IND","India","Tamil Nadu","Rural","completed","","01-1970","The Tamil Nadu Integrated Nutrition Project I (TINP I) ran from 1980 to 1989.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of TINP Iis retrieved from the ENA Part II where TINP I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Community health workers (CHWs) for TINP I was reported as 1:150 households, or 40;1000 households. Resource intensity was previously estimated as US$ 9,50/household per year. ","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23343","","Growth monitoring and promotion","","","","Infants and young children|Preschool-age children (Pre-SAC)|School age children (SAC)","","","Community-based","","","Underweight
","Among TINP participants, there was an approximate 1.25 to 2.40 ppt/ year decline in underweight prevalence. In TINP areas, there was an approximate 0.83 to 1.12 ppt/year decline in underweight prevalence as compared with non-TINP areas where an approximate 0.26 to 1.12 ppt/year decrease in underweight prevalence was observed. The estimated underlying trend for the whole of India during this time was a 0.7 ppt/year decrease in underweight prevalence. Thus an estimated one quarter to one half of the decrease in underweight prevalence is attributable to the project.
","","Approximately 46 % coverage by ares (173/373 rural blocks in 11 districts). ","","","","","","","","","","","","","","","","","","","","","","","","","","","","
The Tamil Nadu Integrated Nutrition Project I (TINP I) ran from 1980 to 1989.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of TINP Iis retrieved from the ENA Part II where TINP I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Community health workers (CHWs) for TINP I was reported as 1:150 households, or 40;1000 households. Resource intensity was previously estimated as US$ 9,50/household per year. ","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23345","","Food distribution/supplementation for prevention of acute malnutrition","","","","Infants and young children|Preschool-age children (Pre-SAC)|School age children (SAC)","","","Community-based","","Internal provision supplementary feeding
","Underweight
","Among TINP participants, there was an approximate 1.25 to 2.40 ppt/ year decline in underweight prevalence. In TINP areas, there was an approximate 0.83 to 1.12 ppt/year decline in underweight prevalence as compared with non-TINP areas where an approximate 0.26 to 1.12 ppt/year decrease in underweight prevalence was observed. The estimated underlying trend for the whole of India during this time was a 0.7 ppt/year decrease in underweight prevalence. Thus an estimated one quarter to one half of the decrease in underweight prevalence is attributable to the project.
","","approximately 46 % coverage by areas (173/373 rural blocks in 11 districts)","","","","","","","","","","","","","","","","","","","","","","","","","","","","There are important issues related to data sources. Data on residents in TINP and non- TINP areas (rather than on TINP participants) come from the National Nutrition Monitoring Bureau (NNMB) while data on TINP participants comes from programme monitoring records. NNMB estimates are from an 11-year period (1979–1990) while TINP estimates are from an 8-year period (1982–1990). Furthermore, NNMB surveys consistently produce higher estimated underweight prevalence than TINP surveys because NNMB surveys cover entire areas rather than only programme participants. This may reveal differences between participants and non-participants.
","","English" "23344","Tamil Nadu Integrated Nutrition Project I (TINP I)","English","Large scale programmes","","IND","India","Tamil Nadu","Rural","completed","","01-1970","The Tamil Nadu Integrated Nutrition Project I (TINP I) ran from 1980 to 1989.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of TINP Iis retrieved from the ENA Part II where TINP I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Community health workers (CHWs) for TINP I was reported as 1:150 households, or 40;1000 households. Resource intensity was previously estimated as US$ 9,50/household per year. ","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23346","","Nutrition education and counselling","","","","","","","Community-based","","","Underweight
","Among TINP participants, there was an approximate 1.25 to 2.40 ppt/ year decline in underweight prevalence. In TINP areas, there was an approximate 0.83 to 1.12 ppt/year decline in underweight prevalence as compared with non-TINP areas where an approximate 0.26 to 1.12 ppt/year decrease in underweight prevalence was observed. The estimated underlying trend for the whole of India during this time was a 0.7 ppt/year decrease in underweight prevalence. Thus an estimated one quarter to one half of the decrease in underweight prevalence is attributable to the project.
","","approximately 46 % coverage by areas (173/373 rural blocks in 11 districts)","","","","","","","","","","","","","","","","","","","","","","","","","","","","There are important issues related to data sources. Data on residents in TINP and non- TINP areas (rather than on TINP participants) come from the National Nutrition Monitoring Bureau (NNMB) while data on TINP participants comes from programme monitoring records. NNMB estimates are from an 11-year period (1979–1990) while TINP estimates are from an 8-year period (1982–1990). Furthermore, NNMB surveys consistently produce higher estimated underweight prevalence than TINP surveys because NNMB surveys cover entire areas rather than only programme participants. This may reveal differences between participants and non-participants.
","","English" "23344","Tamil Nadu Integrated Nutrition Project I (TINP I)","English","Large scale programmes","","IND","India","Tamil Nadu","Rural","completed","","01-1970","The Tamil Nadu Integrated Nutrition Project I (TINP I) ran from 1980 to 1989.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of TINP Iis retrieved from the ENA Part II where TINP I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Community health workers (CHWs) for TINP I was reported as 1:150 households, or 40;1000 households. Resource intensity was previously estimated as US$ 9,50/household per year. ","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23347","","Vitamin A supplementation","","Vitamin A","","Infants and young children|Preschool-age children (Pre-SAC)|School age children (SAC)","","","Community-based","","","Underweight
","Among TINP participants, there was an approximate 1.25 to 2.40 ppt/ year decline in underweight prevalence. In TINP areas, there was an approximate 0.83 to 1.12 ppt/year decline in underweight prevalence as compared with non-TINP areas where an approximate 0.26 to 1.12 ppt/year decrease in underweight prevalence was observed. The estimated underlying trend for the whole of India during this time was a 0.7 ppt/year decrease in underweight prevalence. Thus an estimated one quarter to one half of the decrease in underweight prevalence is attributable to the project.
","","approximately 46 % coverage by areas (173/373 rural blocks in 11 districts)","","","","","","","","","","","","","","","","","","","","","","","","","","","","There are important issues related to data sources. Data on residents in TINP and non- TINP areas (rather than on TINP participants) come from the National Nutrition Monitoring Bureau (NNMB) while data on TINP participants comes from programme monitoring records. NNMB estimates are from an 11-year period (1979–1990) while TINP estimates are from an 8-year period (1982–1990). Furthermore, NNMB surveys consistently produce higher estimated underweight prevalence than TINP surveys because NNMB surveys cover entire areas rather than only programme participants. This may reveal differences between participants and non-participants.
","","English" "23382","Oportunidades","English","Large scale programmes","","MEX","Mexico","","Urban|Rural","on-going","","","Oportunidades (known as Progresa from 1997–2002) is a conditional cash transfer (CCT) programme in operation at the time of writing. It was initiated in rural areas and expanded to include urban areas beginning in 2002, although approximately 70% of programme participants reside in rural areas. Targeting for Oportunidades is based on both geography, through identification of localities with high marginality indices, and socioeconomic status, through proxy means testing. Approximately 60 % of households in the bottom decile of per capita expenditures are participants, suggesting effective targeting of the poorest.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Oportunidades is retrieved from the ENA Part II where Oportunidades is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
The health and nutrition transfer component of Oportunidades is US$ 15/household per month, about 20% of average monthly household expenditures. Receipt of transfer is conditional upon regular health visits for all children in which growth monitoring is included, pre- and postnatal care for women, and adult (greater than 15 years of age) participation in health and nutrition education sessions.
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Multiple evaluations of Oportunidades have been conducted with data demonstrating significant improvements in nutritional outcomes.
","","5 million families, approximately 20 % of the population","","","Increase in height in children 0–6 months of 1.1 cm (26.4 cm versus 25.3 cm) in programme beneficiaries compared to a control group. In rural children ages 12–24 months, a significant increase in mean hemoglobin of 0.37 g/dl was found after 12 months in the programme; 11.12 g/dl in the treatment group compared to 10.75 g/dl in the controls. Corresponding anaemia prevalence among beneficiary children was 44.3% compared to 54.9% among control children, a significant 10.6 ppt decrease. Even with improvement, nearly half of beneficiary children were still anaemic.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23382","Oportunidades","English","Large scale programmes","","MEX","Mexico","","Urban|Rural","on-going","","","Oportunidades (known as Progresa from 1997–2002) is a conditional cash transfer (CCT) programme in operation at the time of writing. It was initiated in rural areas and expanded to include urban areas beginning in 2002, although approximately 70% of programme participants reside in rural areas. Targeting for Oportunidades is based on both geography, through identification of localities with high marginality indices, and socioeconomic status, through proxy means testing. Approximately 60 % of households in the bottom decile of per capita expenditures are participants, suggesting effective targeting of the poorest.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Oportunidades is retrieved from the ENA Part II where Oportunidades is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
Regular health visits for all children in which growth monitoring is included
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Multiple evaluations of Oportunidades have been conducted with data demonstrating significant improvements in nutritional outcomes.
","","5 million families, approximately 20 % of the population","","","Increase in height in children 0–6 months of 1.1 cm (26.4 cm versus 25.3 cm) in programme beneficiaries compared to a control group","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23382","Oportunidades","English","Large scale programmes","","MEX","Mexico","","Urban|Rural","on-going","","","Oportunidades (known as Progresa from 1997–2002) is a conditional cash transfer (CCT) programme in operation at the time of writing. It was initiated in rural areas and expanded to include urban areas beginning in 2002, although approximately 70% of programme participants reside in rural areas. Targeting for Oportunidades is based on both geography, through identification of localities with high marginality indices, and socioeconomic status, through proxy means testing. Approximately 60 % of households in the bottom decile of per capita expenditures are participants, suggesting effective targeting of the poorest.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Oportunidades is retrieved from the ENA Part II where Oportunidades is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
Adult (greater than 15 years of age) participation in health and nutrition education sessions
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Multiple evaluations of Oportunidades have been conducted with data demonstrating significant improvements in nutritional outcomes.
","","5 million families, approximately 20 % of the population","","","Increase in height in children 0–6 months of 1.1 cm (26.4 cm versus 25.3 cm) in programme beneficiaries compared to a control group (35). In rural children ages 12–24 months, a significant increase in mean hemoglobin of 0.37 g/dl was found after 12 months in the programme; 11.12 g/dl in the treatment group compared to 10.75 g/dl in the controls. Corresponding anaemia prevalence among beneficiary children was 44.3% compared to 54.9% among control children, a significant 10.6 ppt decrease. Even with improvement, nearly half of beneficiary children were still anaemic","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23382","Oportunidades","English","Large scale programmes","","MEX","Mexico","","Urban|Rural","on-going","","","Oportunidades (known as Progresa from 1997–2002) is a conditional cash transfer (CCT) programme in operation at the time of writing. It was initiated in rural areas and expanded to include urban areas beginning in 2002, although approximately 70% of programme participants reside in rural areas. Targeting for Oportunidades is based on both geography, through identification of localities with high marginality indices, and socioeconomic status, through proxy means testing. Approximately 60 % of households in the bottom decile of per capita expenditures are participants, suggesting effective targeting of the poorest.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Oportunidades is retrieved from the ENA Part II where Oportunidades is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
The nutrition supplement is intended to provide 20% of daily caloric and 100% of daily micronutrient requirements.
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Multiple evaluations of Oportunidades have been conducted with data demonstrating significant improvements in nutritional outcomes.
","","5 million families, approximately 20 % of the population","","","An increase in height in children 0–6 months of 1.1 cm (26.4 cm versus 25.3 cm) in programme beneficiaries compared to a control group. In rural children ages 12–24 months, a significant increase in mean hemoglobin of 0.37 g/dl was found after 12 months in the programme; 11.12 g/dl in the treatment group compared to 10.75 g/dl in the controls. Corresponding anaemia prevalence among beneficiary children was 44.3% compared to 54.9% among control children, a significant 10.6 ppt decrease. Even with improvement, nearly half of beneficiary children were still anaemic.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23382","Oportunidades","English","Large scale programmes","","MEX","Mexico","","Urban|Rural","on-going","","","Oportunidades (known as Progresa from 1997–2002) is a conditional cash transfer (CCT) programme in operation at the time of writing. It was initiated in rural areas and expanded to include urban areas beginning in 2002, although approximately 70% of programme participants reside in rural areas. Targeting for Oportunidades is based on both geography, through identification of localities with high marginality indices, and socioeconomic status, through proxy means testing. Approximately 60 % of households in the bottom decile of per capita expenditures are participants, suggesting effective targeting of the poorest.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Oportunidades is retrieved from the ENA Part II where Oportunidades is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
Mean haemoglobin
Anemia prevalence
","Multiple evaluations of Oportunidades have been conducted with data demonstrating significant improvements in nutritional outcomes.
","","5 million families, approximately 20 % of the population","","","In rural children ages 12–24 months, a significant increase in mean hemoglobin of 0.37 g/dl was found after 12 months in the programme; 11.12 g/dl in the treatment group compared to 10.75 g/dl in the controls. Corresponding anaemia prevalence among beneficiary children was 44.3% compared to 54.9% among control children, a significant 10.6 ppt decrease. Even with improvement, nearly half of beneficiary children were still anaemic","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23388","","Conditional cash transfer","","","","Infants and young children|Preschool-age children (Pre-SAC)","Children below 5 years","","Community-based","","RPS participants received a nutrition/food security transfer equivalent to US$ 18/month upon confirmation that conditions were met. The transfer was equivalent to approximately 18% average monthly household expenditure. Conditions for receipt of the transfer included: monthly growth monitoring for children less than 24 months (every other month for children ages 2–5 years), participation in nutrition and health education sessions on topics such as breastfeeding, hygiene and feeding practices, regular vaccinations for children, and routine care for pregnant women. Antiparasitic medications and iron supplements were also provided.
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","","","165 000 persons (approximately 3 % of the population)","","","An increase in HAZ of 0.17 was reported for beneficiary children and stunting decreased in RPS versus control groups by 5.5 ppt. A significant change in underweight was also reported; it decreased in RPS areas (13.7% to 9.8%) while it increased in control areas (14.3% to 16.6%). ","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23390","","Growth monitoring and promotion","","","","Infants and young children|Preschool-age children (Pre-SAC)","Children below 5 years","","Community-based","","Monthly growth monitoring for children less than 24 months (every other month for children ages 2–5 years)
","","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","","165 000 persons (approximately 3 % of the population)","","","An increase in HAZ of 0.17 was reported for beneficiary children and stunting decreased in RPS versus control groups by 5.5 ppt. A significant change in underweight was also reported; it decreased in RPS areas (13.7% to 9.8%) while it increased in control areas (14.3% to 16.6%).","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23391","","Breastfeeding promotion and/or counselling","","","","Lactating women (LW)|Pregnant women (PW)","Mothers of children under two","","Community-based","","Participation in nutrition and health education on breastfeeding in order to receive ransfer
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","","","165 000 persons (approximately 3 % of the population)","","","An increase in HAZ of 0.17 was reported for beneficiary children and stunting decreased in RPS versus control groups by 5.5 ppt. A significant change in underweight was also reported; it decreased in RPS areas (13.7% to 9.8%) while it increased in control areas (14.3% to 16.6%).","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23392","","Complementary feeding promotion and/or counselling","","","","Infants and young children","Mothers of children under two years of age","","Community-based","","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","","","165 000 persons (approximately 3 % of the population)","","","An increase in HAZ of 0.17 was reported for beneficiary children and stunting decreased in RPS versus control groups by 5.5 ppt. A significant change in underweight was also reported; it decreased in RPS areas (13.7% to 9.8%) while it increased in control areas (14.3% to 16.6%). ","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23393","","Promotion of improved hygiene practices including handwashing","","","","Women of reproductive age (WRA)","","","Community-based","","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23394","","Iron supplementation","","Iron","","Infants and young children|Preschool-age children (Pre-SAC)","Children below 5 years","","Community-based","","","","","","165 000 persons (approximately 3 % of the population)","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23395","","Nutrition education and counselling","","","","Women of reproductive age (WRA)","Mothers of children under five years of age","","Community-based","","Participation in nutrition and health education sessions in order to receive conditional cash transfer
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","","","165 000 persons (approximately 3 % of the population)","","","An increase in HAZ of 0.17 was reported for beneficiary children and stunting decreased in RPS versus control groups by 5.5 ppt. A significant change in underweight was also reported; it decreased in RPS areas (13.7% to 9.8%) while it increased in control areas (14.3% to 16.6%). ","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23315","Enhanced Outreach Strategy/Extended Enhanced Outreach Strategy (EOS/EEOS)","English","Large scale programmes","","ETH","Ethiopia","","","on-going","","","The EOS/Targeted Supplementary Feeding (TSF) programme began in 2004 as a pilot, and quickly scaled up to cover 6.8 million children in 365 drought-prone woredas. In 2005/6, the programme was expanded through the EEOS, which covers additional woredas with a reduced package of only vitamin A supplementation and deworming. National coverage by EOS and EEOS has expanded to reach around 95% of children under 5. In 2008, the programme covered 163 food-insecure woredas.
Under the Health Extention Programme (HEP) the EOS programme is currently phasing out and being replaced by Community Health Days. These events will offer the same inputs as EOS but will move away from the regionally-supported biannual mobilizations and instead be carried out quarterly, supported by the district health structures and Health Extention Workers (HEWs)
Children 6-59 months of age were screened using mid-upper arm circumference (MUAC) cutoff 12.0 cm.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of EOS/EEOS is retrieved from the ENA Part II where EOS/EEOS is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 43 million.Estimated cost of US$ 1.14 per child (with measles vaccination, US$ 0,57 without).","UN","United Nations Children's Fund (UNICEF)","The EOS/Targeted Supplementary Feeding (TSF) programme began in 2004 as a pilot, and quickly scaled up to cover 6.8 million children in 365 drought-prone woredas. In 2005/6, the programme was expanded through the EEOS, which covers additional woredas with a reduced package of only vitamin A supplementation and deworming. National coverage by EOS and EEOS has expanded to reach around 95% of children under 5. In 2008, the programme covered 163 food-insecure woredas.
Under the Health Extention Programme (HEP) the EOS programme is currently phasing out and being replaced by Community Health Days. These events will offer the same inputs as EOS but will move away from the regionally-supported biannual mobilizations and instead be carried out quarterly, supported by the district health structures and Health Extention Workers (HEWs)
Children 6-59 months of age were screened using mid-upper arm circumference (MUAC) cutoff 12.0 cm.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of EOS/EEOS is retrieved from the ENA Part II where EOS/EEOS is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 43 million.Estimated cost of US$ 1.14 per child (with measles vaccination, US$ 0,57 without).","UN","United Nations Children's Fund (UNICEF)","Measles vaccination
","","","","2.9 million children 6–59 months in 163 food insecure Woredas","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23315","Enhanced Outreach Strategy/Extended Enhanced Outreach Strategy (EOS/EEOS)","English","Large scale programmes","","ETH","Ethiopia","","","on-going","","","The EOS/Targeted Supplementary Feeding (TSF) programme began in 2004 as a pilot, and quickly scaled up to cover 6.8 million children in 365 drought-prone woredas. In 2005/6, the programme was expanded through the EEOS, which covers additional woredas with a reduced package of only vitamin A supplementation and deworming. National coverage by EOS and EEOS has expanded to reach around 95% of children under 5. In 2008, the programme covered 163 food-insecure woredas.
Under the Health Extention Programme (HEP) the EOS programme is currently phasing out and being replaced by Community Health Days. These events will offer the same inputs as EOS but will move away from the regionally-supported biannual mobilizations and instead be carried out quarterly, supported by the district health structures and Health Extention Workers (HEWs)
Children 6-59 months of age were screened using mid-upper arm circumference (MUAC) cutoff 12.0 cm.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of EOS/EEOS is retrieved from the ENA Part II where EOS/EEOS is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 43 million.Estimated cost of US$ 1.14 per child (with measles vaccination, US$ 0,57 without).","UN","United Nations Children's Fund (UNICEF)","Insecticide-treated bednets in malarial areas
","","","","2.9 million children 6–59 months in 163 food insecure Woredas","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23315","Enhanced Outreach Strategy/Extended Enhanced Outreach Strategy (EOS/EEOS)","English","Large scale programmes","","ETH","Ethiopia","","","on-going","","","The EOS/Targeted Supplementary Feeding (TSF) programme began in 2004 as a pilot, and quickly scaled up to cover 6.8 million children in 365 drought-prone woredas. In 2005/6, the programme was expanded through the EEOS, which covers additional woredas with a reduced package of only vitamin A supplementation and deworming. National coverage by EOS and EEOS has expanded to reach around 95% of children under 5. In 2008, the programme covered 163 food-insecure woredas.
Under the Health Extention Programme (HEP) the EOS programme is currently phasing out and being replaced by Community Health Days. These events will offer the same inputs as EOS but will move away from the regionally-supported biannual mobilizations and instead be carried out quarterly, supported by the district health structures and Health Extention Workers (HEWs)
Children 6-59 months of age were screened using mid-upper arm circumference (MUAC) cutoff 12.0 cm.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of EOS/EEOS is retrieved from the ENA Part II where EOS/EEOS is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 43 million.Estimated cost of US$ 1.14 per child (with measles vaccination, US$ 0,57 without).","UN","United Nations Children's Fund (UNICEF)","The EOS/Targeted Supplementary Feeding (TSF) programme began in 2004 as a pilot, and quickly scaled up to cover 6.8 million children in 365 drought-prone woredas. In 2005/6, the programme was expanded through the EEOS, which covers additional woredas with a reduced package of only vitamin A supplementation and deworming. National coverage by EOS and EEOS has expanded to reach around 95% of children under 5. In 2008, the programme covered 163 food-insecure woredas.
Under the Health Extention Programme (HEP) the EOS programme is currently phasing out and being replaced by Community Health Days. These events will offer the same inputs as EOS but will move away from the regionally-supported biannual mobilizations and instead be carried out quarterly, supported by the district health structures and Health Extention Workers (HEWs)
Children 6-59 months of age were screened using mid-upper arm circumference (MUAC) cutoff 12.0 cm.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of EOS/EEOS is retrieved from the ENA Part II where EOS/EEOS is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 43 million.Estimated cost of US$ 1.14 per child (with measles vaccination, US$ 0,57 without).","UN","United Nations Children's Fund (UNICEF)","Moderately malnourished children 6 - 59 months, and moderately malnoursihed pregnant or lactating women, are referred to Targeted Supplementary Feeding (TSF) for 3-month supplementary food rations
","","","","720 000 children 6-59 months and 420 000 pregnant or lactating women ","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23322","National Nutrition Programme/Community-based Nutrition (NNP/CBN)","English","Large scale programmes","","ETH","Ethiopia","","","on-going","","","The Government of Ethiopia launched the National Nutrition Programme (NNP) in 2008. NNP has many relevant components to reduce the magnitude of malnutrition in Ethiopia by reorienting the focus away from emergency and food security interventions and mainstreaming nutrition into community-based health and development programmes. Key nutrition activities of the NNP include:
1. Health Extension Programme (HEP): The core strategy for universal primary health service coverage. It aims to improve family health status through disease prevention and control at the community level
2. Promotion of Essential Nutrition Actions
3. Therapeutic Feeding Programme (TFP): Children with complicated SAM receive care through therapeutic feeding units, and children with uncomplicated SAM are managed in the community through Outpatient Therapeutic Programmes (OTP) at decentralized sites. There are more than 5000 OTP sites across 200 woredas.
4. Enhanced Outreach Strategy (EOS)/ Extended Enhanced Outreach Strategy (EEOS) and Targeted Supplementary Feeding (TSF).
5. Community-based Nutrition (CBN). The CBN was launched in 2008 and will expand to cover 35% of Ethiopia’s total population (228 woredas). CBN is focused on children under two and uses monthly growth monitoring and promotion to involve families and community members in assessing health and nutrition-related problems, analysing causes of these problems, taking action and monitoring progress.
Quarterly screening for acute malnutrition through Community Health Days
Referral of severely underweight children to Therapeutic Feeding Programme (TFPs) and/or Targeted Supplementary Feeding (TSFs) as required;
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of NNP/CBN is retrieved from the ENA Part II where NNP/CBN is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","CBN: Intensity of Community health workers (CHWs) is about 1:23 children, estimated as 0,2 Full-time equivalents (FTE), i.e. 86:1000 households. Per capita costs are not available.HEP: Government of Ethiopia aimed for a ratio of 1 health extension worker (HEW):2500 persons, and 1 health post:5000 persons. Government of Ethiopia spending on health is only 7.5% of the total government budget,and total per capita public health expenditure was US$ 3.00 in 2008, below the target expenditure of US$ 4.80 per capita estimated for full implementation of the HEP.","UN","Other","Multi-donor support","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23321","","Growth monitoring and promotion","","","","Adolescents|Infants and young children|Lactating women (LW)|Pregnant women (PW)|Preschool-age children (Pre-SAC)","","","Community-based","","Monthly growth monitoring and promotion to involve families and community members in assessing health and nutrition-related problems,
","Underweight
","Initial analysis of routine programme data from 1.5 million under-2 children weighed in 4 regions showed a decline in underweight from 30% in January 2009 to 20% in March 2010
","86 % of woredas","Population coverage in target areas (now approximately 250/640 woredas (districts)) is approximately 40%","","","Participants' initial rate of underweight reduction: 8.0 ppt/year. Participants’ sustained rate of underweight reduction: 5.0 ppt/year, with estimated 40% coverage this gives a sustained population rate of 2.0 ppt/year.
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23322","National Nutrition Programme/Community-based Nutrition (NNP/CBN)","English","Large scale programmes","","ETH","Ethiopia","","","on-going","","","The Government of Ethiopia launched the National Nutrition Programme (NNP) in 2008. NNP has many relevant components to reduce the magnitude of malnutrition in Ethiopia by reorienting the focus away from emergency and food security interventions and mainstreaming nutrition into community-based health and development programmes. Key nutrition activities of the NNP include:
1. Health Extension Programme (HEP): The core strategy for universal primary health service coverage. It aims to improve family health status through disease prevention and control at the community level
2. Promotion of Essential Nutrition Actions
3. Therapeutic Feeding Programme (TFP): Children with complicated SAM receive care through therapeutic feeding units, and children with uncomplicated SAM are managed in the community through Outpatient Therapeutic Programmes (OTP) at decentralized sites. There are more than 5000 OTP sites across 200 woredas.
4. Enhanced Outreach Strategy (EOS)/ Extended Enhanced Outreach Strategy (EEOS) and Targeted Supplementary Feeding (TSF).
5. Community-based Nutrition (CBN). The CBN was launched in 2008 and will expand to cover 35% of Ethiopia’s total population (228 woredas). CBN is focused on children under two and uses monthly growth monitoring and promotion to involve families and community members in assessing health and nutrition-related problems, analysing causes of these problems, taking action and monitoring progress.
Quarterly screening for acute malnutrition through Community Health Days
Referral of severely underweight children to Therapeutic Feeding Programme (TFPs) and/or Targeted Supplementary Feeding (TSFs) as required;
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of NNP/CBN is retrieved from the ENA Part II where NNP/CBN is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","CBN: Intensity of Community health workers (CHWs) is about 1:23 children, estimated as 0,2 Full-time equivalents (FTE), i.e. 86:1000 households. Per capita costs are not available.HEP: Government of Ethiopia aimed for a ratio of 1 health extension worker (HEW):2500 persons, and 1 health post:5000 persons. Government of Ethiopia spending on health is only 7.5% of the total government budget,and total per capita public health expenditure was US$ 3.00 in 2008, below the target expenditure of US$ 4.80 per capita estimated for full implementation of the HEP.","UN","Other","Multi-donor support","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23324","","Vitamin A supplementation","","Vitamin A","","Adolescents|Infants and young children|Lactating women (LW)|Pregnant women (PW)|Preschool-age children (Pre-SAC)","","","Community-based","","Biannual vitamin A supplementation
","Underweight
","Initial analysis of routine programme data from 1.5 million under-2 children weighed in 4 regions showed a decline in underweight from 30% in January 2009 to 20% in March 2010
","86 % of wordeas","Population coverage in target areas (now approximately 250/640 woredas (districts)) is approximately 40%","","","Participants' initial rate of underweight reduction: 8.0 ppt/year. Participants’ sustained rate of underweight reduction: 5.0 ppt/year, with estimated 40% coverage this gives a sustained population rate of 2.0 ppt/year.
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23322","National Nutrition Programme/Community-based Nutrition (NNP/CBN)","English","Large scale programmes","","ETH","Ethiopia","","","on-going","","","The Government of Ethiopia launched the National Nutrition Programme (NNP) in 2008. NNP has many relevant components to reduce the magnitude of malnutrition in Ethiopia by reorienting the focus away from emergency and food security interventions and mainstreaming nutrition into community-based health and development programmes. Key nutrition activities of the NNP include:
1. Health Extension Programme (HEP): The core strategy for universal primary health service coverage. It aims to improve family health status through disease prevention and control at the community level
2. Promotion of Essential Nutrition Actions
3. Therapeutic Feeding Programme (TFP): Children with complicated SAM receive care through therapeutic feeding units, and children with uncomplicated SAM are managed in the community through Outpatient Therapeutic Programmes (OTP) at decentralized sites. There are more than 5000 OTP sites across 200 woredas.
4. Enhanced Outreach Strategy (EOS)/ Extended Enhanced Outreach Strategy (EEOS) and Targeted Supplementary Feeding (TSF).
5. Community-based Nutrition (CBN). The CBN was launched in 2008 and will expand to cover 35% of Ethiopia’s total population (228 woredas). CBN is focused on children under two and uses monthly growth monitoring and promotion to involve families and community members in assessing health and nutrition-related problems, analysing causes of these problems, taking action and monitoring progress.
Quarterly screening for acute malnutrition through Community Health Days
Referral of severely underweight children to Therapeutic Feeding Programme (TFPs) and/or Targeted Supplementary Feeding (TSFs) as required;
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of NNP/CBN is retrieved from the ENA Part II where NNP/CBN is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","CBN: Intensity of Community health workers (CHWs) is about 1:23 children, estimated as 0,2 Full-time equivalents (FTE), i.e. 86:1000 households. Per capita costs are not available.HEP: Government of Ethiopia aimed for a ratio of 1 health extension worker (HEW):2500 persons, and 1 health post:5000 persons. Government of Ethiopia spending on health is only 7.5% of the total government budget,and total per capita public health expenditure was US$ 3.00 in 2008, below the target expenditure of US$ 4.80 per capita estimated for full implementation of the HEP.","UN","Other","Multi-donor support","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23325","","Deworming","","","","Infants and young children|Preschool-age children (Pre-SAC)","","","Community-based","","","Underweight
","Initial analysis of routine programme data from 1.5 million under-2 children weighed in 4 regions showed a decline in underweight from 30% in January 2009 to 20% in March 2010
","86 % of wordeas","Population coverage in target areas (now approximately 250/640 woredas (districts)) is approximately 40%","","","Participants' initial rate of underweight reduction: 8.0 ppt/year. Participants’ sustained rate of underweight reduction: 5.0 ppt/year, with estimated 40% coverage this gives a sustained population rate of 2.0 ppt/year.
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23322","National Nutrition Programme/Community-based Nutrition (NNP/CBN)","English","Large scale programmes","","ETH","Ethiopia","","","on-going","","","The Government of Ethiopia launched the National Nutrition Programme (NNP) in 2008. NNP has many relevant components to reduce the magnitude of malnutrition in Ethiopia by reorienting the focus away from emergency and food security interventions and mainstreaming nutrition into community-based health and development programmes. Key nutrition activities of the NNP include:
1. Health Extension Programme (HEP): The core strategy for universal primary health service coverage. It aims to improve family health status through disease prevention and control at the community level
2. Promotion of Essential Nutrition Actions
3. Therapeutic Feeding Programme (TFP): Children with complicated SAM receive care through therapeutic feeding units, and children with uncomplicated SAM are managed in the community through Outpatient Therapeutic Programmes (OTP) at decentralized sites. There are more than 5000 OTP sites across 200 woredas.
4. Enhanced Outreach Strategy (EOS)/ Extended Enhanced Outreach Strategy (EEOS) and Targeted Supplementary Feeding (TSF).
5. Community-based Nutrition (CBN). The CBN was launched in 2008 and will expand to cover 35% of Ethiopia’s total population (228 woredas). CBN is focused on children under two and uses monthly growth monitoring and promotion to involve families and community members in assessing health and nutrition-related problems, analysing causes of these problems, taking action and monitoring progress.
Quarterly screening for acute malnutrition through Community Health Days
Referral of severely underweight children to Therapeutic Feeding Programme (TFPs) and/or Targeted Supplementary Feeding (TSFs) as required;
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of NNP/CBN is retrieved from the ENA Part II where NNP/CBN is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","CBN: Intensity of Community health workers (CHWs) is about 1:23 children, estimated as 0,2 Full-time equivalents (FTE), i.e. 86:1000 households. Per capita costs are not available.HEP: Government of Ethiopia aimed for a ratio of 1 health extension worker (HEW):2500 persons, and 1 health post:5000 persons. Government of Ethiopia spending on health is only 7.5% of the total government budget,and total per capita public health expenditure was US$ 3.00 in 2008, below the target expenditure of US$ 4.80 per capita estimated for full implementation of the HEP.","UN","Other","Multi-donor support","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23326","","Breastfeeding promotion and/or counselling","","","","Lactating women (LW)|Pregnant women (PW)","Mothers of children under two","","Community-based","","","Underweight
","Initial analysis of routine programme data from 1.5 million under-2 children weighed in 4 regions showed a decline in underweight from 30% in January 2009 to 20% in March 2010
","86 % of wordeas","Population coverage in target areas (now approximately 250/640 woredas (districts)) is approximately 40%","","","Participants' initial rate of underweight reduction: 8.0 ppt/year. Participants’ sustained rate of underweight reduction: 5.0 ppt/year, with estimated 40% coverage this gives a sustained population rate of 2.0 ppt/year
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23322","National Nutrition Programme/Community-based Nutrition (NNP/CBN)","English","Large scale programmes","","ETH","Ethiopia","","","on-going","","","The Government of Ethiopia launched the National Nutrition Programme (NNP) in 2008. NNP has many relevant components to reduce the magnitude of malnutrition in Ethiopia by reorienting the focus away from emergency and food security interventions and mainstreaming nutrition into community-based health and development programmes. Key nutrition activities of the NNP include:
1. Health Extension Programme (HEP): The core strategy for universal primary health service coverage. It aims to improve family health status through disease prevention and control at the community level
2. Promotion of Essential Nutrition Actions
3. Therapeutic Feeding Programme (TFP): Children with complicated SAM receive care through therapeutic feeding units, and children with uncomplicated SAM are managed in the community through Outpatient Therapeutic Programmes (OTP) at decentralized sites. There are more than 5000 OTP sites across 200 woredas.
4. Enhanced Outreach Strategy (EOS)/ Extended Enhanced Outreach Strategy (EEOS) and Targeted Supplementary Feeding (TSF).
5. Community-based Nutrition (CBN). The CBN was launched in 2008 and will expand to cover 35% of Ethiopia’s total population (228 woredas). CBN is focused on children under two and uses monthly growth monitoring and promotion to involve families and community members in assessing health and nutrition-related problems, analysing causes of these problems, taking action and monitoring progress.
Quarterly screening for acute malnutrition through Community Health Days
Referral of severely underweight children to Therapeutic Feeding Programme (TFPs) and/or Targeted Supplementary Feeding (TSFs) as required;
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of NNP/CBN is retrieved from the ENA Part II where NNP/CBN is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","CBN: Intensity of Community health workers (CHWs) is about 1:23 children, estimated as 0,2 Full-time equivalents (FTE), i.e. 86:1000 households. Per capita costs are not available.HEP: Government of Ethiopia aimed for a ratio of 1 health extension worker (HEW):2500 persons, and 1 health post:5000 persons. Government of Ethiopia spending on health is only 7.5% of the total government budget,and total per capita public health expenditure was US$ 3.00 in 2008, below the target expenditure of US$ 4.80 per capita estimated for full implementation of the HEP.","UN","Other","Multi-donor support","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23327","","Food distribution/supplementation for prevention of acute malnutrition","","","","Infants and young children|Preschool-age children (Pre-SAC)","","","Community-based","","Internal provision supplementary feeding for severely underweight children.
","Underweight
","Initial analysis of routine programme data from 1.5 million under-2 children weighed in 4 regions showed a decline in underweight from 30% in January 2009 to 20% in March 2010
","86 % of wordeas","Population coverage in target areas (now approximately 250/640 woredas (districts)) is approximately 40%","","","Participants' initial rate of underweight reduction: 8.0 ppt/year. Participants’ sustained rate of underweight reduction: 5.0 ppt/year, with estimated 40% coverage this gives a sustained population rate of 2.0 ppt/year.
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23338","Atención Integral a la Niñez en la Comunidad (AIN-C)","English","Large scale programmes","","HND","Honduras","","","on-going","","","The national Atención Integral a la Niñez en la Comunidad (AIN-C) began in the mid- 1990s and remains in operation at the time of writing as a community-based expansion from the original AIN programme.
Referral to the health facility as needed
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of AIN-C is retrieved from the ENA Part II where AIN-C is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Intensity as measured by Community Health and Nutrition Workers (CHNWs):children is 3:25, where CHNWs work part-time for 3.5 hours weekly. Financial resource intensity is US$ 6.43/child per year","Government","Health","Ministry of Health","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","Monthly growth monitoring of children less than 24 months of age and sick children 24–60 months of age at the community centre, although home visits are provided for children who do not attend.
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Evaluation of the AIN-C was planned as a pre- and post-intervention, project and control comparison study, but the design was altered due to extensive contamination of control communities, non-equivalent groups, and reduced intensity of programme implementation due to changes in funding. A cross-sectional study using baseline data compared AIN-C. participants to non-participants.
Mean height-for-age was lower in the AIN-C group as compared to non-participants at less than six months of age. At 6–11 months and 12–23 months of age, there was no difference between AIN-C children and nonparticipants, suggesting a protective effect of AIN-C against growth faltering. Since a pre-/post- comparison was not possible, this conclusion cannot be certain. Intensity of participation in the programme was based on percentage of possible weighings attended by the child; after controlling for household assets and age of child, for every 1% increase in participation intensity, weight-for-age increased 0.005 z-score.
","","Coverage of the programme by area was 24 of 42 health areas (>50%) in 2006 and by population was 90% of children less than 24 months of age.","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23338","Atención Integral a la Niñez en la Comunidad (AIN-C)","English","Large scale programmes","","HND","Honduras","","","on-going","","","The national Atención Integral a la Niñez en la Comunidad (AIN-C) began in the mid- 1990s and remains in operation at the time of writing as a community-based expansion from the original AIN programme.
Referral to the health facility as needed
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of AIN-C is retrieved from the ENA Part II where AIN-C is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Intensity as measured by Community Health and Nutrition Workers (CHNWs):children is 3:25, where CHNWs work part-time for 3.5 hours weekly. Financial resource intensity is US$ 6.43/child per year","Government","Health","Ministry of Health","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","Nutrition counselling for EBF less than 6 months of age
","Exclusive breastfeeding (EBF) rates
","Evaluation of the AIN-C was planned as a pre- and post-intervention, project and control comparison study, but the design was altered due to extensive contamination of control communities, non-equivalent groups, and reduced intensity of programme implementation due to changes in funding. A cross-sectional study using baseline data compared AIN-C participants to non-participants. Improved caring practices were reported among AIN-C mothers. A 15.8 ppt difference in EBF at 6 months was found (55.8% AIN-C, 40% non- AIN-C).
","","24 of 42 health areas (>50%) in 2006 (18), and by population was 90% of children less than 24 months of age.","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23338","Atención Integral a la Niñez en la Comunidad (AIN-C)","English","Large scale programmes","","HND","Honduras","","","on-going","","","The national Atención Integral a la Niñez en la Comunidad (AIN-C) began in the mid- 1990s and remains in operation at the time of writing as a community-based expansion from the original AIN programme.
Referral to the health facility as needed
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of AIN-C is retrieved from the ENA Part II where AIN-C is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Intensity as measured by Community Health and Nutrition Workers (CHNWs):children is 3:25, where CHNWs work part-time for 3.5 hours weekly. Financial resource intensity is US$ 6.43/child per year","Government","Health","Ministry of Health","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","Micronutrient distribution for children (iron and vitamin A)
","","Evaluation of the AIN-C was planned as a pre- and post-intervention, project and control comparison study, but the design was altered due to extensive contamination of control communities, non-equivalent groups, and reduced intensity of programme implementation due to changes in funding. A cross-sectional study using baseline data compared AIN-C participants to non-participants. With regard to receiving iron and vitamin A supplementation, differences of 36.1 ppt (65.6% AIN-C, 29.5% non-AIN-C) and 6.8 ppt (94.3% AIN-C, 87.5% non-AIN-C) respectively, were reported for children.
","","Coverage of the programme by area was 24 of 42 health areas (>50%) in 2006 and by population was 90% of children less than 24 months of age.","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23338","Atención Integral a la Niñez en la Comunidad (AIN-C)","English","Large scale programmes","","HND","Honduras","","","on-going","","","The national Atención Integral a la Niñez en la Comunidad (AIN-C) began in the mid- 1990s and remains in operation at the time of writing as a community-based expansion from the original AIN programme.
Referral to the health facility as needed
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of AIN-C is retrieved from the ENA Part II where AIN-C is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Intensity as measured by Community Health and Nutrition Workers (CHNWs):children is 3:25, where CHNWs work part-time for 3.5 hours weekly. Financial resource intensity is US$ 6.43/child per year","Government","Health","Ministry of Health","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","Nutrition counselling for complementary feeding less than 24 months of age
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Evaluation of the AIN-C was planned as a pre- and post-intervention, project and control comparison study, but the design was altered due to extensive contamination of control communities, non-equivalent groups, and reduced intensity of programme implementation due to changes in funding. A cross-sectional study using baseline data compared AIN-C. participants to non-participants. Mean height-for-age was lower in the AIN-C group as compared to non-participants at less than six months of age. At 6–11 months and 12–23 months of age, there was no difference between AIN-C children and nonparticipants, suggesting a protective effect of AIN-C against growth faltering. Since a pre-/ post- comparison was not possible, this conclusion cannot be certain. Intensity of participation in the programme was based on percentage of possible weighings attended by the child; after controlling for household assets and age of child, for every 1% increase in participation intensity, weight-for-age increased 0.005 z-score
","","Coverage of the programme by area was 24 of 42 health areas (>50%) in 2006 and by population was 90% of children less than 24 months of age.","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English"