How to translate the nutrition

momentum into countries?

Lessons Learned from previous

program on implementing the

ENA framework

Jennifer Nielsen HKIAgnes Guyon SPRING/JSI

Core Group – Fall meeting 2012

What is the difference between ENA and IYCF?

What is the difference between ENA and Lancet High Impact Nutrition

Interventions?

Control of Anemia

OptimalBreastfeeding

Control of Vitamin A deficiency Control of Iodine

Deficiency Disorders

Women’s NutritionComplementaryFeeding with BF

Nutritional Care of the sick &

Malnourished child

The Essential Nutrition Actions

4

nutrition of girls & women especially pregnant and

lactating

infant & young children, especially 0-24 months

Window of opportunity 1,000 days from conception to two years

What is the history of ENA?

History of ENA since its birth in 1997

Nutrition Minimum Package

(MINPAK)

1997

Nutrition Essentials

1999

History of ENA

Essential Nutrition Actions coined in the USAID

supported program in Madagascar

8

Today… consensus now exists on ‘what’ nutrition actions make a difference…

The Lancet Series on Maternal and Child

Undernutrition

2008

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Lancet ‘Scaling Up Nutrition Framework for Action’

10

Control of Anemia

OptimalBreastfeeding

Control of Vitamin A deficiency

Control of Iodine Deficiency Disorders

Women’s NutritionComplementaryFeeding with BF

Nutritional Care of the sick &

Malnourished child

Great similarity…Essential Nutrition Actions, The Lancet

and The SUN Framework for Action

11

Today…

Agreement on the ‘what’

Challenge is now the ‘how’:

operationalizing how to mainstream these 7 ENAs

‘at large scale’ to achieve a public health impact

“The ENA framework”

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Countries with ENA* …

IndonesiaIndia

CambodiaBangladesh

Nepal

* Various levels of engagement from ENA at community level only to ENA at national level.

What are the objectives of the ENA framework?

What is the framework?

Consider the huge number of missed opportunities

Source: World Bank, HNP

How do we reduce the ‘missed opportunities’ to support nutrition in existing programs?

How do we mainstream into existing programs both inside and outside the health sector?

And, how do we roll out the ENA framework to achieve large scale?

How do we reduce the ‘missed opportunities’ to support nutrition in existing programs?

How do we mainstream into existing programs both inside and outside the health sector?

And, how do we roll out the ENA framework to achieve large scale?

Operationalize nutrition support at large scale

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Child HealthNutrition programs

Newborn healthEPI

Community IMNCI/CCMHealth facilities IMNCI

CMAM

Reproductive HealthLactation Amenorrhea Method

with Family PlanningMaternal Health

Infectious DiseasesControl of Malaria

(Insecticide Treated Nets &

Treatment) Tuberculosis

HIV/AIDS (PMTCT)

ENA framework extends nutrition coverage within the health sector…

From

pol

icy

to d

eliv

ery

17

DELIVERY: Cord clamping, Initiation BF, vitamin A, iron/folic acid, diet

PREGNANCY: diet, iodized salt, iron/folic acid, de-worming, anti-malarial, prep to BF.

POSTNATAL AND FAMILY PLANNING: LAM & BF, diet, iron/folic acid, treat anemia

WELL CHILD & GMP monitor growth, assess and counsel on IYCF, iodized salt

SICK CHILD & SAM/MAM:, counsel on IYCF feeding, assess and treat for anemia, check and complete vitamin A, de-worming,

IMMUNIZATION: BF & CF, vitamin A, de-worming, assess and treat anemia

Critical health contacts for infant feeding, micronutrients & women’s nutrition

Food ProductionFood Production Food SecurityFood Security

Water and Water and SanitationSanitation

ENA framework extendsnutrition coverage outside the health sector…

Women in Women in DevelopmentDevelopment

Climate ChangeClimate Change

SchoolsSchools

Pre-Service Pre-Service EducationEducation

Mass MediaMass Media

From

pol

icy

to d

eliv

ery

Agriculture Education

Local Development & Planning

Savings groups

ENA framework create the buzzat community level…

Community Health Workers

BCC the backbone for the ENA frameworkPromote small do-able actions to demystify nutrition

Job aids Health booklet

Counseling cardsPoopy and radio/TV

Newsletters Posters

Harmonization through various tools

Formative Research to help over-come family and community obstacles

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BCC: build on partners what already exists

1. Inter-personal counselingHealth provider with motherCommunity worker with motherMother-to-mother Peer counseling

2. Group discussionsBreastfeeding support groupsSavings & credit groupsHomestead food production groupsListening clubs (cassettes and radio)

3. Informal settingsMarket daysFetching water or wood

4. Mass mediaRadioVillage theatre groups

Community volunteers supporting women at

chance encounters (market, fields,

collecting firewood)

Community health festivals

Community volunteer making

home visits

Community volunteers

assisting at health clinic

Ultimate goal: saturate the environment with nutrition practicesEnroll a large number of volunteers

across sectors

Agricultural extension workers supporting

mothers

Health workers

supporting

mothers

Small Group Work

Each group discuss a case study (20 minutes)

Report back (5 minutes)

Small Group Work

Each group discuss a case study (20 minutes)

Report back (5 minutes)

Question: If you were Country Director…