SANCADI

Southern AfricanSouthern African

Nutrition Capacity Nutrition Capacity

Development Development InitiativeInitiative

David SandersDirector: School of Public HealthUniversity of the Western Cape

SANCADI Global initiative to develop human capacity in nutritionGlobal initiative to develop human capacity in nutrition

Spearheaded by UNU and IUNSSpearheaded by UNU and IUNSEstablished as the first of the African nutrition capacity Established as the first of the African nutrition capacity

development initiatives. development initiatives. Developed as a “learning co-operative”, comprised of Developed as a “learning co-operative”, comprised of

institutions in the region, which would provide a institutions in the region, which would provide a mechanism for mutual transfer of expertise and capacity.mechanism for mutual transfer of expertise and capacity.

From 2005 funded by USDA andFrom 2005 funded by USDA and facilitated through facilitated through University of the Western Cape (RSA)University of the Western Cape (RSA)

Focus: Focus: Botswana, Zambia, Mozambique, Malawi, South AfricaBotswana, Zambia, Mozambique, Malawi, South Africa

Inform: Inform: Namibia, SwazilandNamibia, Swaziland

Rates of childhood stunting

Sub-Saharan Africa

0

10

20

30

40

50

60

70

80

1985 1990 1995 2000 2005

Cl VAD

SCl VAD

Anem NP

Anem P

Anem kids

TGR

uwt

South Asia

0

10

20

30

40

50

60

70

1985 1990 1995 2000 2005

Cl VAD

SCl VAD

Anem NP

Anem P

Anem kids

TGR

uwt

S E Asia

0

10

20

30

40

50

60

70

1985 1990 1995 2000 2005

Sub-Saharan Africa

0

10

20

30

40

50

60

70

80

1985 1990 1995 2000 2005

Cl VAD

SCl VAD

Anem NP

Anem P

Anem kids

TGR

uwt

South America

0

10

20

30

40

50

60

1985 1990 1995 2000 2005

Cl VAD

SCl VAD

Anem NP

Anem P

Anem kids

TGR

uwt

National Trends in Underweight Prevalence

0

5

10

15

20

25

30

35

Sep-9

1

Aug-9

2

Jun-

93

May

-94

Apr-9

5

Mar

-96

Jan-

97

Dec-9

7

Nov-9

8

Sep-9

9

Aug-0

0

Jul-0

1

May

-02

Apr-0

3

Date

Prev (%)

Lesotho

Malawi

Mozambique (6Provinces)Zambia

Zambia (S.Prov.)Zimbabwe

Global HIV prevalence

40 million people around the 40 million people around the world live with HIV - more world live with HIV - more than the population of than the population of Poland. Poland.

Nearly two-thirds of them live in Nearly two-thirds of them live in Sub-Saharan Africa, where in Sub-Saharan Africa, where in the two hardest hit countries the two hardest hit countries HIV prevalence is almost HIV prevalence is almost 40%. 40%.

The global HIV/Aids epidemic The global HIV/Aids epidemic killed more than 3 million killed more than 3 million people in 2003 people in 2003

there are emerging and growing there are emerging and growing epidemics in China, epidemics in China, Indonesia, Papua New Indonesia, Papua New Guinea, Vietnam, several Guinea, Vietnam, several Central Asian Republics, the Central Asian Republics, the Baltic States, and North Baltic States, and North Africa. Africa.

The AIDS debate, BBC News

Progress in the area of Infant Feeding and HIV/AIDS

There has been growing recognition and understanding of the complex dilemma facing There has been growing recognition and understanding of the complex dilemma facing HIV+ mothers re: infant feeding.HIV+ mothers re: infant feeding.

In 1998, the perception in the HIV community was that formula milk should be provided In 1998, the perception in the HIV community was that formula milk should be provided to all HIV+ women to avoid infant transmission – it was a heated dialogue.to all HIV+ women to avoid infant transmission – it was a heated dialogue.

New evidence from programs and research have highlighted the risks (social, New evidence from programs and research have highlighted the risks (social, nutritional, health) with this intervention.nutritional, health) with this intervention.

In most countries (though not all), the focus has shifted toward promotion of HIV-free In most countries (though not all), the focus has shifted toward promotion of HIV-free survival & finding ways to make breastfeeding safer.survival & finding ways to make breastfeeding safer.

Numerous guidelines and tools have been developed (HIV & IF Framework for Action, Numerous guidelines and tools have been developed (HIV & IF Framework for Action, Global IYCF strategy, policy & program guidelines, counseling tools, reference Global IYCF strategy, policy & program guidelines, counseling tools, reference guide, training courses) to strengthen infant feeding counseling in PMTCT programguide, training courses) to strengthen infant feeding counseling in PMTCT program

But there is a But there is a LONGLONG way to go – a far more energetic effort and more resources are way to go – a far more energetic effort and more resources are needed to seriously make these tools and knowledge available on the ground to needed to seriously make these tools and knowledge available on the ground to reach affected communities & individuals.reach affected communities & individuals.

Progress in the area of Nutrition and HIV/AIDS

The role of nutrition in HIV/AIDS has long been recognized but action was limited. The role of nutrition in HIV/AIDS has long been recognized but action was limited.

In 1999, most focus was on AIDS-related wasting only. Now there is growing In 1999, most focus was on AIDS-related wasting only. Now there is growing understanding of that HIV affects nutrition early in the course of infection and that there understanding of that HIV affects nutrition early in the course of infection and that there are multiple entry points. are multiple entry points.

Likewise, the important associations between food & nutrition insecurity and HIV are better Likewise, the important associations between food & nutrition insecurity and HIV are better understood today. understood today.

A comprehensive review of the evidence on nutrition & HIV/AIDS was completed last year. A comprehensive review of the evidence on nutrition & HIV/AIDS was completed last year. Two consultations in Durban last year highlighted this issue and charted a “way Two consultations in Durban last year highlighted this issue and charted a “way forward”.forward”.

Many tools and materials for capacity development & implementation have been developed Many tools and materials for capacity development & implementation have been developed in Africa and shared between countries. in Africa and shared between countries.

WHO Executive Board and other resolutions have increased global commitment to WHO Executive Board and other resolutions have increased global commitment to addressing this issue. Several agencies have been actively involved. addressing this issue. Several agencies have been actively involved.

But, like with infant feeding, these tools and knowledge must be put into practice. But, like with infant feeding, these tools and knowledge must be put into practice. Implementation lags far behind. Human resources are a serious constraint.Implementation lags far behind. Human resources are a serious constraint.

The nutrition community has been slow to respond to this crisis.The nutrition community has been slow to respond to this crisis.

CFRs in hospitals: Implementing the WHO guidelines for severe malnutrition saves lives.

CountryCountry Case fatality (%)Case fatality (%)

BEFOREBEFORE

Case fatality (%)Case fatality (%)

AFTERAFTER

AFRICAAFRICA

MalawiMalawi 5555 1616

South AfricaSouth Africa 3030

3535

4646

2525

4545

66

2020

21 21

1818

88

GhanaGhana 2020 1818

Research, Education and Training Products.

SANCADI Objectives

- Nutrition and HIV/AIDSNutrition and HIV/AIDS- Management of severe malnutritionManagement of severe malnutrition- Nutrition programming and advocacyNutrition programming and advocacy- Nutrition and food securityNutrition and food security

SANCADI Objectives (1)

Nutrition and HIV/AIDSNutrition and HIV/AIDS- Disseminate learning moduleDisseminate learning module- Training of trainersTraining of trainers- Monitor and evaluate use of moduleMonitor and evaluate use of module- Support and mentoring of traineesSupport and mentoring of trainees

SANCADI Objectives (2)

Management of severe malnutritionManagement of severe malnutrition- Assessment of current practicesAssessment of current practices- Capacity development where requiredCapacity development where required

SANCADI Objectives (3)

Nutrition programming and advocacyNutrition programming and advocacy- AuditAudit- Identify institutions and organisations to Identify institutions and organisations to

facilitate support and mentoringfacilitate support and mentoring

SANCADI Objectives (4)

Nutrition and food securityNutrition and food security- Enhance visibility and sustainabilityEnhance visibility and sustainability- Strengthen government support throughStrengthen government support through• evaluating & spreading of WHO/FAO evaluating & spreading of WHO/FAO

training course training course • advocacy and marketing by SANCADIadvocacy and marketing by SANCADI

Regional capacity building training courses Regional capacity building training courses on on Intersectoral Food & Nutrition PoliciesIntersectoral Food & Nutrition PoliciesMain Aim: Providing support to countries in strengthening and implementing national intersectoral food and nutrition plans & policies to address emerging & re- emerging nutrition issues, i.e. the double burden of malnutrition, through:

► bringing together concerned sectors (health, agriculture, education, finance/planning)

► incorporating various on-going work and international commitments (MDGs, poverty eradication, child survival, FIVIMS, etc.)

AnglophoneNairobi, February 2002:

Eritrea, Ethiopia, Kenya, Liberia, Seychelles, Sierra Leone, Zimbabwe (7 countries)Cape Town, Feb 2003:

Lesotho, Malawi, South Africa, Tanzania, Uganda, Zambia, Zimbabwe (7 countries)Cape Town, Oct 2004:

South Africa, Botswana, Zimbabwe, Namibia, Nigeria, Ghana (6 countries)FrancophoneCotonou, May 2004:

Benin, Burkina Faso, Burundi, Cameroon, RDC, Guinée, Niger, Togo (8 countries)

Capacity building training courses onintersectoral food and nutrition plans and policies

Main outcomes of the review meeting

1. Training course to become a WHO/FAO/UNICEF training course through strengthening food access

concept & incorporating issues related to MDGs and child survival

2. Further strengthen the sections on advocacy and partnership (including civil society)

3. Encourage synergy with other existing training courses aiming to support action at different levels, (i.e. to design and implement specific programmes & projects at local & community levels)

Common actions recommended by all Regions

• strengthen the mechanisms for following up with the course participants & countries to review their implementation status after the training courses

• strengthen communications between regional institutions, networks and partners involved in food & nutrition issues

• develop a forum for discussion through internet to allow exchange of experiences, ask for information/questions on how to overcome any specific problems encountered, etc.

• ensure sustained funding for regional/country training workshops to provide continued support for countries in strengthening and implementing national food & nutrition

policies and strategies.

NEXT STEPS• Appoint coordinator Appoint coordinator

• Undertake rUndertake rapid audit of CD activities on apid audit of CD activities on nutrition programming nutrition programming and advocacyand advocacy

• Select institutions/ organisations to facilitate and support on-Select institutions/ organisations to facilitate and support on-going CD (eg using UWC manuals/modules, RCQHC Tanzania)going CD (eg using UWC manuals/modules, RCQHC Tanzania)

• Disseminate the learning module developed by RCQHC on Disseminate the learning module developed by RCQHC on Nutrition and HIV/AIDS Nutrition and HIV/AIDS

• Evaluate effectiveness of/disseminate current CD approaches to Evaluate effectiveness of/disseminate current CD approaches to Food Security challenges (eg WHO/FAO/UNICEF course )Food Security challenges (eg WHO/FAO/UNICEF course )

• Assess and improve current practice at 1st level (district) Assess and improve current practice at 1st level (district) hospitals on hospitals on Management of severe malnutrition Management of severe malnutrition in selected in selected countries (eg using WHO 10 steps plus RUTF)countries (eg using WHO 10 steps plus RUTF)

• Develop an advocacy and marketing strategy for SANCADIDevelop an advocacy and marketing strategy for SANCADI