Government of the Peoples Republic of Bangladesh

Operational Plan For NAT ONA! N"TR T ON #$R% &$#'

(ul) *+,,

- (une *+,.

Health, Population and Nutrition Sector Development Program (HPNSDP)

/ R$&TORAT$ G$N$RA! OF 0$A!T0 #$R% &$#

1inistr) of 0ealth and Famil) 2elfare

(ul) *+,,

Abbreviation: ABCN ADP AIDS ANC ARH ARI BBS BCC BDHS B HI BH" B$A B$I BNNC BS&I DAAR CB' CBN CC CC$) CHCP CHP CH& C$SD C$A$ CN* CS CSBA DD P D ID D) P D)HS DPs +B +C +CD +NC +PI +SD P "A ".P )$P )'B HA H+B H+P H "C HI HIS H/I HNPSP HPN

Area Based Community Nutrition Annual Development Program Acquired Immune Deficiency Syndrome Ante Natal Care Adolescent Reproductive Health Acute Respiratory Infection Bangladesh Bureau of Statistics Behavioral Change Communication Bangladesh Demography and Health Survey Ba!y riendly Hospital Initiative Bangladesh Health "or#force Bangladesh $edical Association Body $ass Inde% Bangladesh National Nutrition Council Bangladesh Standard and &esting Institution Dis!ursement of Accelerated Achievement of Results Community Based 'rgani(ation Community Based Nutrition Service Community Clinic Community Clinic $anagement )roup Community Health Care Provider Community Health Provider Chittagong Hill &racts Centre for $edical Store Depot Community !ased $anagement of Acute $alnutrition Child Nutrition *nit Civil Surgeon Community S#ill Birth Attendant Deputy Director of amily Planning Department for International Development Directorate )eneral of amily Planning Directorate )eneral of Health Services Development Partners +%clusive Breast eeding +%ecutive Committee +arly Childhood Development +ssential Ne,!orn Care +%panded Program on Immuni(ation +ssential Service Delivery amily Planning amily "elfare Assistant amily "elfare -isitor ive .ear Plan )ro,th $onitoring and Promotion )overnment of Bangladesh Health Assistant Health +ducation Bureau Health +ducation Programme Health and amily "elfare Centre Health Inspector Health Information System Helen /iller International Health 0 Nutrition and Population Sector Program Health Population Nutrition

HPNSDP HPSP HR HR$ HRD ICDDR0B IDA IDD I+C I$CI I$R IPH IPHN I.C 1C$S$S 1Ds $3+ $CH $D)s $IS $NCH $NH $NP $'I $'* $&R NCD N)' NID NNP NNS N* N-AC 'P 'PD PHC PIP PNC PPR 4A R " RPA SAC$' SA$ &A &'R &'& *HC *H "C *PHCP *SI "B "H'

Health0 Population and Nutrition Sector Development Program Health and Population Sector Program Human Resource Human Resources $anagement Human Resources Development International Centre for Diarrheal Diseases Research0 Bangladesh International Development Association Iodine Deficiency Disorder Information0 +ducation and Communication Integrated $anagement of Childhood Illness Infant $ortality Rate Institute of Pu!lic Health Institute of Pu!lic Health Nutrition Infant and .oung Child eeding 1iquid Chromatography 2 $ass Spectrometry 1ine Directors $onitoring and +valuation $aternal and Child Health $illennium Development )oals $anagement Information System $aternal0 Neonatal and Child Health $aternal and Neonatal Health $icro2Nutrient Po,der $inistry 'f Information $emorandum of *nderstanding $id &erm Revie, Non Communica!le Diseases Non )overnment 'rgani(ation National Immuni(ation Day National Nutrition Program National Nutrition Service Nutrition *nit National -itamin A Plus Campaign 'perational Plan 'ut2door Patient Department Primary Health Care Program Implementation Plan Post Natal Care Pu!lic Procurement Rules 4uality Assurance Results rame,or# Reim!ursa!le Pro5ect Aid Su! 2Assistant Community $edical 'fficer Severe Acute $alnutrition &echnical Assistance &erms of Reference &raining 'f &rainer *pa(ila Health Comple% *nion Health and amily "elfare Centre *r!an Primary Health Care Pro5ect *niversal Salt Iodi(ation "orld Ban# "orld Health 'rgani(ation

Sl. No.

Table of Content

Page No

1 2 3 % 5 6 ( , 0 1/ 11 12 13 1% 15 16 1( 1, 10 2/ 21 22 23 2% 25 26 2( 2, 20 3/ 31 32 33 3% 35 36 3( 3, 30 %/ %1 %2 %3 %% %5 %6 %( %, %0 5/ 51 52 53 5% 55 56 5( 5, 50 6/ 61 62 63 6% 65 66 6( 6, 60

Objectives of the OP Estimated Cost of OP (According to Financing Pattern) OP anagement !tr"ct"re and O#erationa$ P$an Com#onents ajor Com#onents of OP and their Programme anagers & 'P Pro#osed an#o)er in the 'eve$o#ment *"dget (as #er P+P) 'escri#tion agnit"de of the Prob$em of a$n"trition in *ang$adesh Po$ic- and Program .es#onse 1ationa$ 1"trition !ervices (11!)2 A ainstreamed and +ntegrated A##roach to Addressing a$n"trition oda$ities of +nstit"tiona$ Arrangements oda$ities of +m#$ementation Arrangements (1"trition !ervice 'e$iver-) 1"trition !ervice 'e$iver- at 3#a4i$a 5ea$th Com#$e6 7eve$ 1"trition !ervice 'e$iver- at 3nion Faci$it- 7eve$ 1"trition !ervice 'e$iver- at Comm"nit- C$inic 7eve$ 1"trition !ervice 'e$iver- at Comm"nit- 7eve$ .e$ated strategPriorit- +nterventions and Activities of the 1ationa$ 1"trition !ervices 8ro)th onitoring and Promotion (8 P) *ehavio"r Change Comm"nication to Promote 8ood 1"tritiona$ Practices icron"trient s"##$ementation 9itamin A s"##$ementation +ron fo$ate s"##$ementation +ron !"##$ementation and 'e)orming of Ado$escent 8ir$s :inc !"##$ementation d"ring treatment of diarrhea 9itamin '; Ca$ci"m s"##$ementation Contro$ of +odine 'eficienc- 'isorder (+'') and !a$t +odi4ation Program anagement of !evere Ac"te a$n"trition (!A ) and Comm"nit- anagement of !evere Ac"te a$n"trition (C A ) 1"trition d"ring Emergencies Comm"nit- based n"trition services 1"trition interventions in hard to reach areas; chars; hi$$<tract Ear$- Chi$dhood 'eve$o#ment (EC') Coordination )ith + C+ #rogram C$imate change 8eriatric n"trition 1on<Comm"nicab$e 'isease (1C') Other NNS Core Activities =raining&Ca#acit- *"i$ding 1"trition =raining P$an !choo$ n"trition ed"cation Program Coordination of 1"trition Activities across 'ifferent !ectors Proc"rement of e>"i#ments; micron"trients; and de)orming tab$ets onitoring; !"rvei$$ance; .esearch and Eva$"ation anagement +nformation !-stem ( +!) .eferra$ Food fortification ainstreaming 8ender into 1"trition Programming +nstit"tiona$ 'eve$o#ment Com#$ementar- feeding (P"shti Pac?et) to address A =ab$e s"mmari4ing ?e- 11! activities )ith res#onsibi$ities at different $eve$ of services in the hea$th sector #rogram Priorit- activities of the OP .e$evant .es"$ts Frame)or? +ndicators (.F@) and OP 7eve$ +ndicators .e$evant .F@&P+P +ndicators OP $eve$ indicators (O"t#"t&Process) !o"rce and methodo$og- of data co$$ection Estimated b"dget Com#onent and Aear )ise #h-sica$ and financia$ target of OPs *"dget (+n#"t )ise) Estimated 'etai$ed *"dget (+n#"t @ise) 7ocation<)ise brea?<"# of the com#onent (Attached Anne6"re) Organogram of 1ationa$ 1"trition !ervices (11!) 7og Frame Ann"a$ Proc"rement P$an for 8oods; @or?s; !ervices (!e#arate tab$e for aB 8oods; bB @or?s; cB !ervices) =raining P$an 7ist of E>"i#ments 7ist of F"rnit"re and Fi6t"res Action P$an for ainstreaming 1"trition services Com#onents and Estimated cost s"mmar+m#$ementation of !#ecific 1"trition +ntervention 7ist of Assets (11P)

5 6 6 ( , , , 1/ 11 11 12 12 13 13 1% 15 16 16 1( 1, 1, 1, 10 10 10 2/ 2/ 2/ 21 21 22 22 22 23 23 23 23 2% 25 25 26 26 2( 2( 2( 2, 2, 2, 20 31 31 31 33 33 3% 35<%2 %3<%% %0<5/ 51 53 5% 5, 51 62 63 66 6( 6, 65

Name of the Operational Plan (OP)2 National Nutrition Services (NNS)

5

1. Name of the Sector Programme: Health, Population and Nutrition Sector Development Pro ram (HPNSDP) 2B Sponsoring Ministry: inistr- of 5ea$th and Fami$- @e$fare 3B Implementing Agency: 'irectorate 8enera$ of 5ea$th !ervices . Implementation Perio!: a" Commencement : C"$- 2/11 b" Completion : C"ne 2/16

#. Ob$ectives of the OP:

General Objective:

!o reduce the prevalence o" malnutrition amon the people o" #an ladesh $ith special emphasis on the children, $omen, adolescents and underprivile ed section o" the societ%.

Specific Objectives:
!o implement a mainstreamed, comprehensive pac&a e o" nutrition services to reduce maternal and child malnutrition and ensure universal access !o develop and stren then coordination mechanisms $ith &e% relevant sectors (especiall% 'inistr% o" (ood and Disaster 'ana ement, 'inistr% o" ) riculture, 'inistr% o" *omen and +hildren )""airs, 'inistr% o" ,n"ormation, 'inistr% o" -ducation, 'inistr% o" .ivestoc& and (isheries, 'inistr% o" .ocal /overnment and 0ural Development and +ooperative, etc.) to ensure a multi1sectoral response to malnutrition !o stren then the human resource capacit% to mana e, supervise and deliver nutrition services at the di""erent levels o" the health 2"amil% plannin services. !o stren then nutrition mana ement in"ormation s%stems and operations research to ensure an evidence13ased response and esta3lish lin&a es to H,S.

%. &stimate! Cost: '.( PIP OP Cost (Ta)a in la)h" Approve! cost of the PIP (*evelopment +,!get"
A##roved cost of P+P ('eve$o#ment b"gged)

Total

-O+

PA (.PA"
135(316B/5 (,60(01B/3)

So,rce of PA
Poo$ F"nd; 'Ps D Co<financiers Poo$ F"nd; 31+CEF; 3!A+'; @5O; C+CA;C+'A; @FP; FAO; etcB

221(666B21

,6/35/B12

Estimated Cost of the OPB

1%0//0B3,

2,52,B// 3B31E

12/%,1B3, (,5/55B3,) ,B,,E

Cost of OP as E of P+P

6B(2E

'./ &stimate! Cost of OP (Accor!ing to 0inancing Pattern": (Ta)a in la)h"

So,rce 0inancing Pattern 8O* =AFA (Foreign E6change) C'<9A= Total -O+4 .PA (=hro"gh 8O*) PA 'PA Total PA4 -ran! Total /1((2(/ 5316B60 6/B// #3'%.%5 ,,0B51 3(6/B// % 5.#( (11/%./1 /1(/2(3 50(/B/3 6/B// %131.13 2,//3B/, (533B// 3##3%.16 (#%%.(( /1(32( 5(%1B%3 6/B// #61(. 3 2(365B6, 02%/B// 3%%1#.%6 / 1'.(( /1( 2(% 11100B,5 12/B// ((3(5.6# 2,(0(B11 1%,03B// 3%51.(( ##115.5% Total 2,22, 3//B// /6#/6.11 ,5/55B3, 35%26B// (/1 6(.36 ( 5115.36 Poo$ed f"nd inc$"ding C+CA So,rce of f,n!

8O*

6. OP Management Str,ct,re an! Operational Plan Components : (Attached anagement set "# at Anne6"re<+)

6.( 7ine *irector 2 'irector; +nstit"te of P"b$ic 5ea$th 1"trition

6./ Ma$or Components of OP an! their Programme Managers 8 *PM

Program Manager (PM" P <'85! (''<+P51) Ma$or Activity a) *ehavio"r Change Comm"nication (*CC) b) c) d) e) f) g) h) i) j) ?) Contro$ of 9itamin<A deficienc- disorder Contro$ D #revention of Anaemia Contro$ of +odine deficienc- 'isorder Other icron"trient #rob$ems of P"b$ic 5ea$th im#ortance ( 4inc; vitamin G';H ca$ci"m etcB) Comm"nit- D faci$it- based management of severe ac"te ma$n"trition(!A ) Protection; Promotion D !"##ort of *reastfeeding& +nfant and Ao"ng Chi$d Feeding (+ACF) inc$"ding *F5+ D * ! Code Food fortification (!a$t +odi4ation; fortification of oi$&other food )ith 9itamin GAH; iron etcB) !choo$ 1"tritiona$ ed"cation Program Food I"a$it- and Food !afetonitoring; Eva$"ation; O#erations .esearch; !"rve'P 2 *PM

'P 1

'P 3 'P 5

$) 1"trition !"rvei$$ance Program m) Estab$ishment of n"trition "nit (13) and strengthening of e6isting 13 n) Comm"nit- based 1"trition (C*1) in se$ected area o) 1"trition in emergenc- & 1C'

'P %

#) Estab$ishment of n"trition !ervice in CC D 8 P

P <'8FP (''<'8FP on de#"tation) *ehavio"r Change Comm"nication (*CC) Contro$ of 9itamin<A deficienc- disorder Contro$ D #revention of Anaemia Contro$ of +odine deficienc- 'isorder Other icron"trient #rob$ems of P"b$ic 5ea$th im#ortance ( 4inc; vitamin G';H ca$ci"m etcB) f) Comm"nit- D faci$it- based management of severe ac"te ma$n"trition (!A ) g) Protection; Promotion D !"##ort of *reastfeeding& +nfant and Ao"ng Chi$d Feeding (+ACF) inc$"ding *F5+ D * ! Code h) onitoring; Eva$"ation; O#erations .esearch; !"rvea)*ehavio"r Change Comm"nication (*CC) b)Contro$ of 9itamin<A deficienc- disorder c) Contro$ D #revention of Anaemia d)Contro$ of +odine deficienc- 'isorder e)Other icron"trient #rob$ems of P"b$ic 5ea$th im#ortance ( 4inc; vitamin G';H ca$ci"m etcB) f) Comm"nit- D faci$it- based management of severe ac"te ma$n"trition (!A ) g)Protection; Promotion D !"##ort of *reastfeeding& +nfant and Ao"ng Chi$d Feeding (+ACF) inc$"ding *F5+ D * ! Code h) onitoring; Eva$"ation; O#erations .esearch; !"rvea) b) c) d) e) 'P 1/ 'P 0 'P , 'P 0

'P , 'P 6

P < "$tisectora$

'P (

'P 6

!"! Propose! Manpo9er in the *evelopment +,!get (as per PIP"

( Pay in ta)a " Sl. No. 1 2 3 % 5 6 ( , 0 1/ 11 12 13 1% 15 Name of the Post Programming Officer Acco"nts Officer Persona$ Officer Programme Assistant A"ditor 'ata Entr- O#eratorJ 7ogistic Assistant .ece#tionist 'river 7!! Finance !#ecia$ist (98'<11P) .e#orter<c"m<Com#"ter O#erator (98'<11P) Acco"ntant (98'<11P) 'river (98'<11P) 7!! (98'<11P) Total 4 N,mber of post 1 1 2 , 1 2 2 1 0 15 1 1 1 1 1 ' Pay Scale 1,5// 11/// ,/// 6%// 6%// %(// 50// 50// %(// %1// 12/// ,/// 6%// %(// %1// -ra!e 6 0 1/ 11 11 16 12 12 16 2/ , 1/ 11 16 2/ Consoli!ate! Pay per Person8Month 203(5 1,2// 135// 11/0/ 11/0/ ,6/5 1/20/ 1/20/ ,6/5 ((5/ 103// 135// 11/0/ ,6/5 ((5/ Total Month 65 65 65 65 65 65 65 65 65 65 65 65 65 65 65 Total Pay 10/03(5B// 11,3///B// 1(55///B// 5(66,//B// (2/,5/B// 111,65/B// 133((//B// 66,,5/B// 5/33025B// (55625/B// 125%5//B// ,((5//B// (2/,5/B// 550325B// 5/3(5/B// 3(%3#('#.11 .emar)s Carried over Carried over Carried over Carried over Carried over Carried over Carried over Carried over O"t so"rcing O"t so"rcing Carried over Carried over Carried over O"t so"rcing O"t so"rcing

7 Note8 )ccordin to the (inance 'inistr%9-+N-+ decision under process 45 months is made 3% 4: months; salar% and added 5 months other allo$ances included "estival 3onus

#! Description
#! a!$! %agnitude of the Problem of %alnutrition in &angladesh Durin the past 2 decades, #an ladesh has made considera3le pro ress in development, sustainin hi h rates o" economic ro$th and reducin povert% rates 3% <= 3et$een 2::: and 2::5 ("rom 4<= to 4: =). !he countr% is also on trac& to meet some o" the 'illennium Development /oals ('D/s) related to human development such as child mortalit% and com3atin H,>9),DS, $here it has outper"ormed other countries in the re ion. Ho$ever, all these improvements have not translated into positive e""ects on maternal and child nutrition. !he prevalence o" malnutrition in #an ladesh is still one o" the hi hest amon the developin countries. )lthou h there has 3een a decline in rate o" under$ei ht children over the %ears, the rates o" under$ei ht, stuntin and $astin are still all a3ove the *H?;s thresholds "or ver% hi h levels, t%picall% "ound in emer enc% situations. )round 5.6 million children su""er "rom under nutrition, $hich contri3utes to at least one third o" child deaths@ Percenta e o" under$ei ht children (under$ei ht "or a e) declined to 41= in 2::4 "rom 46= in 2::3. !he percenta e <

o" $asted children (under$ei ht "or hei ht) "luctuates, $ith ver% hi h levels in the pre1 harvest season (15= in 2::5) and lo$er levels in other seasons. Percenta e o" stunted children (short "or a e) has not chan ed much over the %ears and $as estimated at 43= in 2::5 (#DHS). )ccordin to *H? health tar ets set in 1<<6, stuntin rate in children should 3e less than 2:= in all countries and in all speci"ic su31 roups $ithin the countries 3% the %ear 2:2:A. Stuntin is an indicator o" chronic malnutrition and unli&e stuntin , under$ei ht status is in"luenced 3% short term chan es in health or "ood securit% situation. ,t is also note$orth% that lar e disparities in nutritional status eBist across the socio1economic roups. Nearl% 51= o" under1"ives in the lo$est Cuintile are undernourished, compared to 24= in the hi hest Cuintile (#DHS 2::5). ). !he causes o" stuntin are multi"actorial and include amon other "actors, lac& o" eBclusive 3reast"eedin , inappropriate complementar% "eedin , recurrent in"ections, etc. De"iciencies in &e% micronutrients have 3een and still continue to 3e a pu3lic health challen e in #an ladesh. >itamin ) de"icienc% $as identi"ied as a pu3lic health pro3lem since the 1<4:;s and has 3een the sin le most important preventa3le cause o" ni ht 3lindness in children. 'ore importantl%, su3clinical vitamin ) de"icienc% amon pre1school a ed children $as classi"ied as a pu3lic health pro3lem in rural #an ladesh $here almost 55= had vitamin ) values 3elo$ the *H? cut1o"" o" D1.:5 Emol9 "or mild vitamin ) de"icienc%. 'ore than 2:= had serum retinol concentrations less than :.5: Emol9l, the 3enchmar& "or a pu3lic health pro3lem. Such hi h levels o" mild vitamin ) de"icienc% are associated $ith increased ris& o" mortalit% in children. Since the past 25 %ears, vitamin ) supplementation pro ram tar etin children < 1 5< months o" a e has 3een implemented 3% the ,PHN, health services and N/?s $ith covera e reachin over 6:=. !his has contri3uted to a reduction in ni ht 3lindness in children 1215< months o" a e livin in rural areas reduced "rom 3.5= (1<63) to :.42= (1<<6)4. !o sustaina3l% eliminate vitamin ) de"icienc% in the population, supplementation needs to 3e complemented $ith more e""ective and sustaina3le improvements in dietar% vitamin ). (orti"ication o" edi3le oil and other "oods is one o" the means o" achievin this. Ho$ever, the lon term solution throu h dietar% diversit% needs to 3e promoted "or sustaina3le reduction in >itamin ) and other micronutrient de"iciencies. )lthou h oiter is the most visi3le "orm o" iodine de"icienc%, insu""icient iodine at conception, durin pre nanc% and earl% childhood period causes var%in de rees o" irreversi3le 3rain dama e. !he median urinar% iodine levels in children, an indicator is cu31 clinical iodine de"icienc%, increased "rom 54 u 9. in 1<<3 to 143 u 9. in 2::495 1. (urthermore, the total oiter rate declined "rom 4<.<= to 4.2 = in school children and "rom 55.4= to 11.5= in $omen. #ased on the urinar% iodine rate in school children, the ,DD pro3lem in #an ladesh is classi"ied as mild. Ho$ever, despite these ains, the covera e o" adeCuatel% iodiFed salt remains lo$ and there are some areas $here pre nant $omen and su3seCuentl% their ne$3orn are not su""icientl% protected "rom var%in de rees o" 3rain dama e as a result o" iodine de"icienc%. !he 2::495 National ,DD and GS, Surve% "ound that onl% 51= o" household salt is adeCuatel% iodiFed (H15 ppm). !he same surve% sho$ed onl% 45= o" iodiFed "actor% salt samples contained H3: ppm o" iodine, and <= contained H1:: ppm. Gnli&e iodine and vitamin ) de"iciencies, over the %ears there has 3een ver% limited pro ress on anemia and in some cases an increase. )nemia is $idespread across the di""erent a e roups, $ith 44= o" pre nant $omen, 44= o" children a ed 4123 months, 42= o" children a ed 2415< months, 3:= o" adolescent irls and 33= o" non1pre nant $omen (##S9GN,+-(, 2::4). )ccordin to *H? criteria, the rates in children are considered a severe pu3lic health pro3lem (a3ove 4:=). !he pro3lem in pre nant $omen
6

1:

is considered moderate (prevalence 2:13<=). ,n the ur3an areas o" #an ladesh, the prevalence o" anaemia in preschool children is stron l% associated $ith the education level o" his9her mother, an indicator o" socio1economic status8 4<= o" children o" illiterate mothers are anaemic compared $ith onl% 35= o" children o" mothers $ho have a Secondar% School +erti"icate or hi her level o" education (##S9GN,+-(, 2::4). #!a!'! Polic( and Program )esponse !he /overnment o" #an ladesh has, "or man% %ears, emplo%ed man% di""erent strate ies and pro rams to com3at the pro3lem o" malnutrition in the countr%. ,n 1<54 the /overnment esta3lished the ,nstitute o" Pu3lic Health Nutrition (,PHN) to assist it on "ormulatin polic% and strate % "or nutrition related activities and pro rams and also to conduct research, trainin and surveillance. 'ore speci"icall%, some o" the salient terms o" re"erences o" ,PHN $ere to investi ate into the distri3ution, causes, nature and ma nitude o" the nutrition pro3lem and provide uidelines "or the development "or national nutrition pro ram, plans and proIects as part o" national development in order to propose e""ective treatment "or the nutritional diseases, to develop appropriate interventions "or the solution o" the nutrition pro3lems, to develop speci"ic approaches in "ood technolo %, education to the pu3lic and deliver% o" services, to test current technolo % in pilot areas and to evaluate nutritional impact o" di""erent interventions, to develop appropriate norms and uidelines "or all nutritional interventions, sa"et% o" "ood advertisement and trainin and education@ to promote colla3oration amon di""erent institutions $or&in in the "ield o" nutrition as to avoid unnecessar% duplications and to promote "ull utiliFation o" the human resources and to act as technical secretariat nutrition. ,n 1<55, the #an ladesh National Nutrition +ouncil (#NN+) $as esta3lished 3% order o" the President o" #an ladesh. Headed 3% the Prime 'inister, the +ouncil $as constituted 3% concerned ministers, secretaries, senior administrators, polic% ma&ers, nutrition eBperts, Iournalists, heads o" relevant or aniFations, and divisional $omen representatives. !he mana ement o" the council $as vested in an -Becutive +ommittee (-+), headed 3% the 'inister "or Health and (amil% *el"are. Secretaries o" di""erent ministries and heads o" di""erent a encies represent the other -+ mem3ers. !he #NN+ also has a Standin !echnical +ommittee consistin o" technical eBperts on nutrition. !he o3Iectives o" the #NN+ are the "ormulation and updatin o" the National (ood and Nutrition Polic%@ approval o" nutrition pro rams "or di""erent ministries and institutes@ and monitorin and evaluation o" nutrition research pro rams. ?ther "unctions include1 esta3lishment o" a nutrition in"ormation and documentation centre, preparation o" a national plan "or nutrition, or aniFin national and international con"erences and trainin courses@ pu3lishin and disseminatin technical and eneral in"ormation on nutrition@ and providin "inancial support "or nutrition related research proIects. )lthou h #NN+ has 3een tas&ed $ith important responsi3ilities "or nutrition in the countr%, it has un"ortunatel% not 3een e""ective durin the past decade. !he "irst maIor nutrition pro ram in the countr% $as the #an ladesh ,nte rated Nutrition Pro ram (#,NP), $hich $as implemented "rom 1<<4 to 2::2. !he core component o" #,NP $as the communit% 3ased nutrition activities implemented throu h N/?s. !he proIect covered 41 upaFilas and approBimatel% 14= o" the rural population. #,NP ended in 2::2 and the same activities $ere continued under the National Nutrition ProIect (NNP). !he NNP "ormulation $as 3ased on the success o" #,NP and $as desi ned to cover a3out one "ourth o" the population. !he proIect $as implemented in 11: upaFilas includin #,NP upaFilas. )ctual implementation $as dela%ed 3% t$o %ears and in 2::4 it $as inte rated into the Health, Nutrition and Population Sector Pro ram (HNPSP). 11

#!a!"! National Nutrition Services (NNS*: + %ainstreamed and ,ntegrated +pproach to +ddressing %alnutrition Gnder HNPSP, there $ere t$o ?Ps named National Nutrition Pro ramme (NNP) and 'icronutrient Supplementation ('NS). (acilit% 3ased limited services $ere provided throu h 'NS and communit% 3ased services $ere underta&en throu h NNP1?P. !here $as evidence o" lac& o" coordination and duplication activities amon these t$o ?Ps. 'oreover, the NNP interventions $ere contracted to several N/?s and had "ra ile or no lin&s $ith the mainstream health s%stem. 0e"erral and intensive mana ement "or children $ith severe acute malnutrition $as ver% inadeCuate. !here are also several other nutrition related proIects9 pro ramme run 3% the di""erent 'inistries9Divisions supported 3% DPs 3ut their activities $ere not $ell coordinated and monitored. 'oreover, the total estimated cost o" the NNP1?P ((J 2::3 to 2:11) "or the interventions in 243 GpaFila $as !&. 1,251 crore, $hereas it $as implemented in a3out 153 GpaFilas in phases coverin onl% 34= o" the entire population. !he )nnual Pro ram 0evie$ ()P0) o" HNPSP in 2::< recommended that to scale up the nutrition interventions the onl% option is to mainstream the critical nutrition interventions in the services provided throu h D/HS and D/(P. ," the present model o" NNP is continued countr% $ide 3% contractin N/?s, the cost "or NNS interventions $ill 3e a3out !&. 5:::.:: crore and it $ould not possi3le to achieve 'D/ tar et 3% 2:15 $ith the implementation o" the eBistin model. ,n li ht o" this situation, the /overnment o" #an ladesh is plannin to accelerate the pro ress in reducin the persistentl% hi h rates o" maternal and child under nutrition 3% mainstreamin the implementation o" nutrition interventions into health (D/HS) and "amil% plannin services (D/(P), scalin 1up the provision area13ased communit% nutrition, updatin the National Plan o" )ction on Nutrition in the li ht o" "ood and nutrition policies, amon st other important priorit% actions. !o achieve this, nutrition has 3een made a priorit% "or the proposed sector pro ram and a variet% o" &e% strate ies and actions $ill 3e pursued. !he mainstreamed pro ram $ill 3e uided 3% 2 main principles8 !he pro ram $ill "ocus on those activities $ithin its mandate and $here it has the capacit% as $ell as the comparative advanta e to act. !he &e% activities that lie outside the mandate o" the health sector, NNS $ill pla% a coordination as $ell as advocac% role and ensure active en a ement $ith other the &e% sectors ("or eBample, 'inistries o" ) riculture, (ood and Disaster 'ana ement, 'inistr% o" ,ndustr%, etc) !he nutrition pro ram $ill see& to intervene at the di""erent sta es o" the li"ec%cle K durin pre nanc%, at deliver%9neonatal, post natal, childhood, adolescence, ne$l% $eds K 3ut $ith a stron "ocus on the L$indo$ o" opportunit%A, that is, pre nanc% throu h "irst t$o %ears o" li"e.

Gnder the HPNSDP, the mainstreamed nutrition pro ramme aims to deliver the nutrition services countr% $ide throu h the eBistin D/HS and D/(P set up $ill costs onl% a3out 14<:.:: crore !M, $hich $ill 3e cost1e""ective and more sustaina3le in "uture. Since '?H(* 3ein implemented S*)p in a sustaina3le manner "rom 1<<6 $hich covers almost all HPN services, it $ill not 3e $orth% to have a separate proIect "or the nutrition services $ith onl% /?# resources, as 3ecause DPs $ill not "und "or the parallel proIect outside the scope o" HPNSDP. i* %odalities of ,nstitutional +rrangements 12

!he stren thened nutrition service $ill 3e housed in the D/HS and implemented throu h an ?P titled LNational Nutrition Service (NNS)A. !he overall leadership o" NNS $ill 3e provided 3% the .ine Director, NNS, $ho $ill oversee the deliver% o" the pro ram, mana e the 3ud et and maintain liaison $ith other .Ds o" D/HS and D/(P implementin nutrition activities. Director, ,nstitute o" Pu3lic Health Nutrition (,PHN) $ill carr% out the responsi3ilit% o" .ine Director1NNS to ensure e""ective coordination. ,n addition to a"orementioned responsi3ilities, the .D1NNS $ill also serve as the 'em3er Secretar% o" the multisectoral Steerin +ommittee chaired 3% the Secretar% and Nutrition ,mplementation +oordination +ommittee chaired 3% the D/HS. ,n order to implement nutrition services at the "ield level and coordinate amon di""erent entities dealin $ith service deliver%, three (3) Pro ram 'ana ers (P') $ill 3e $or&in under the supervision o" the .D1NNS. Deput% Director o" ,PHN $ill 3e the P'1D/HS, $ho $ill 3e responsi3le "or pro ramme implementation and tas&ed $ith overseein activities o" "ive (5) Deput% Pro ram 'ana ers (DP's). !he Pro ram 'ana er K D/(P (deputed "rom D/(P) $ill 3e responsi3le "or pro ramme implementation in D/(P, and oversee three (3) DP's. !he third Pro ram 'ana er P'1 'ultisectoral $ill oversee t$o (2) DP's, one "or ,ntrasectoral +oordination and the other "or ,ntersectoral +oordination (!he or ano ram o" the proposed NNS structure is sho$n in )nneB ,). )ll P's shall 3e located in the o""ice o" the .D1NNS. -Bpertise developed in NNP $ill 3e utiliFed in NNS ()nneB). Selection o" the "emale communit% volunteers to provide communit% services in the selected areas $ould 3e carried out Iointl% 3% .D1NNS and respective GH(P?s9G(P?s. !hese communit% volunteers $ill $or& under the supervision o" respective +H+Ps and +ommunit% 'ana ement /roup in phases. ,n each phase, 25= o" the upaFilas $ill 3e covered. ii* %odalities of ,mplementation +rrangements (Nutrition Service Deliver(* Nutrition service deliver% $ill 3e mainstreamed at the deliver% levels o" health and "amil% plannin services and the communit% clinics 3ein the "irst contact point $ith the health s%stem. Ho$ever, $here +ommunit% +linic is not availa3le and in hard to reach areas, special intervention modalit% $ould 3e implemented. -Bistin +hild Nutrition Gnits (+NG) $ill 3e stren thened and one unit $ill 3e esta3lished in each health "acilities includin tertiar%, district and upaFila level. ii*!a! Nutrition Service Deliver( at District Hospital-%./.-%edical .ollege Hospital- 0evel )t the district hospital9'+*+9'edical +olle e level, NNS $ill provide nutrition services includin ,J+( pac&a e, #++ services "or pre nant and lactatin mothers, S)' mana ement $ith on oin other nutrition services and "acilitatin nutrition activities at the upaFila level and 3elo$. ii*!b! Nutrition Service Deliver( at 1pa2ila Health .omple3 0evel !he GpaFilla Health and (amil% Plannin ?""icer (GH(P?) $ill have overall responsi3ilit% "or the deliver% o" health and nutrition services in the GH+. ?ne o" the 'edical ?""icers $ill 3e trained and tas&ed $ith the overall responsi3ilit% o" overseein the deliver% o" health centre1 3ased nutrition services in the GH+ as $ell as monitorin health centre13ased nutrition interventions in all unions and ++;s as a $hole. !he actual deliver% o" the speci"ic interventions in GH+s $ill 3e done 3% Doctors, Nurses and (*>s 3ased in those "acilities. !he GH(P? $ill 3e supervisin NNS activities in GH+, ++ and at communit% levels. 13

!he main activities to 3e implemented at GH+s $ill include8 !reatment o" complicated cases o" severe and acute malnutrition, provide "eed3ac& to "acilities "rom $here patients are re"erred. ,J+(8 counselin to all $omen $ith under t$o children $ho come to ?PD ("or eBample "or ,mmuniFation, (P methods and at the ?0! corner and ,'+, +orner) "or an% reason, "or eBclusive 3reast "eedin until 4 (16: da%s) months o" a e, proper complementar% "oods and advice on adeCuate nutrition a"ter siB months o" a e, $ei ht and hei ht measurements. Screenin "or malnutrition ('G)+, ro$th monitorin ), nutrition advice "or all children under "ive, classi"ication and cate oriFation o" re"erred children 3% level o" malnutrition, treatment o" severe acute 2 moderate malnutrition, "ollo$1up o" re"errals "rom the communit% , monitor 2 "ollo$1up visits to children under treatment. #ehaviour +han e +ommunication (#++)8 ,n addition to #++ messa es on ,J+(, nutrition education and counselin $ill 3e provided to adolescents, pre nant and lactatin $omen on topics such as, personal h% iene and cleanliness especiall% durin preparation o" "ood and "eedin o" in"ants and %oun children, eneral nutrition, health and nutritional importance o" de$ormin and consumption o" micronutrient supplements (>it. ), ,ron, (olate etc)

'icronutrients8 Provide advice uidance to households on iodine, iron, and vitamin ), advocac% and monitor "ollo$1up and compliance o" use o" iron1"olic acid 3% pre nant $omen, provision o" Finc in addition to ?0S durin treatment o" diarrhea, provision o" de1 $ormin medication and post1partum vitamin ) supplementation. ii*!c! Nutrition Service Deliver( at 1nion 4acilit( 0evel !he '? assi ned $ith pu3lic health and nutrition services at the GH+ level $ill "reCuentl% visit union level GH2(*+s and provide nutrition services and supervise S)+'?9') and (*>s assi ned in the GH2(*+ to deliver the "ollo$in nutrition1related services8 ,J+(8 counselin all $omen $ith D2 children $ho visit GH2(*+ "or an% reason ("or eBample "or immuniFation, "amil% plannin , etc.) "or eBclusive 3reast "eedin until 4 months o" a e, proper complementar% "oods and advice on adeCuate nutrition a"ter siB months o" a e, and $ei ht and hei ht measurements o" children. #ehaviour +han e +ommunication (#++)8 ,n addition to #++ messa es on ,J+( nutrition education and counselin $ill 3e provided to adolescents, pre nant and lactatin $omen visitin the GH2(*+ on topics such as, personal h% iene and cleanliness especiall% durin preparation o" "ood and "eedin o" in"ants and %oun children, eneral nutrition, health and nutritional importance o" de$ormin and consumption o" micronutrient supplements (>it. ), ,ron, (olate etc) 'icronutrients8 Provide advice and uidance to adolescent "emales, pre nant $omen, and mothers o" under15 children on iodine, iron, and vitamin ), advocac% and monitor "ollo$1up and compliance o" use o" iron1"olic acid 3% pre nant $omen, provision o" Finc in addition to ?0S durin treatment o" diarrhea, provision o" de1$ormin medication, and post1partum vitamin ) supplementation. Service providers in GH2(*+ $ill also provide micronutrients to their tar et roups (e. . ,ron "olate to adolescents, etc.) and re"er complicated cases to primar% level (i.e. GH+) $ith appropriate "ollo$ up. 14

ii*!c! Nutrition Service Deliver( at .ommunit( .linic 0evel !he deliver% o" nutrition services in communit% clinics $ill also 3e under the supervision o" the 'edical ?""icer (Pu3lic Health and Nutrition) $ho $ould have 3een trained and assi ned the responsi3ilit% o" overseein the implementation o" nutrition activities throu h the +ommunit% 'ana ement /roup no$ called +ommunit% /roup (+/) in their desi nated area. H)s, (*)s, and +ommunit% Health +are Providers (+H+P) and other relevant personnel $or&in at that ++ $ill have the responsi3ilit% o" deliverin the nutrition services. !$o or three "emale +ommunit% Health >olunteers $ill 3e selected "or each communit% clinic area. !he main activities to 3e implemented in ++ $ill include8 ,J+( and #++8 counselin all $omen $ith children on eBclusive 3reast "eedin until 4 months o" a e includin positionin and attachment, supportin "or trou3le1shootin "or an% 3reast"eedin pro3lem, proper complementar% "oods and advice on adeCuate nutrition a"ter siB months o" a e, $ei ht and hei ht measurements. ,n addition, #++ messa es on ,J+( nutrition education and counselin $ill 3e provided to adolescents, pre nant and lactatin $omen on topics such as, personal h% iene and cleanliness especiall% durin preparation o" "ood and "eedin o" in"ants and %oun children, eneral nutrition, health and nutritional importance o" de$ormin and consumption o" micronutrient supplements. Screenin and 0e"erral8 +onduct screenin "or malnutrition ('G)+, ro$th monitorin ), provide nutrition advice "or all children, re"erral "or complicated cases to primar% level care "acilit% (i.e. GH+), and "ollo$1up o" re"errals "rom the communit% and monitor "ollo$1 up visits to children under treatment. 'icronutrients8 Provide advice uidance to households on iodine, iron, and vitamin ), advocac% and monitor "ollo$1up and compliance o" use o" iron "olic acid 3% pre nant $omen, ,provision o" Finc in addition to ?0S durin treatment o" diarrhea, provision o" de1$ormin medication, iron1"olic acid supplements, post1partum vitamin ) supplementation. Service providers at the ++ level (viF. +HP, H), (*)) $ill also provide micronutrients li&e ,ron "olate ta3lets to tar et roups. ii*!d! Nutrition Service Deliver( at .ommunit( 0evel !he communit% level $ill 3e the "ocus o" all area 3ased +ommunit% Nutrition activities9 interventions. )t the communit% level, nutrition services $ill 3e delivered 3% Health )ssistants, (amil% *el"are )ssistants and +H+P in addition to their usual duties. !hese activities $ill 3e supervised 3% their respective supervisors and $ill 3e carried out throu h roup counselin @ one1to1one counselin durin home visits to pre nant $omen, ne$ mothers, ro$th "alters (that is, pre nant $omen, in"ants and %oun children). !he H)s, (*)s and +H+Ps $ill receive supervision and uidance "rom Health9(amil% Plannin ,nspectors and (amil% *el"are >isitors ((*>s) to carr% out nutrition services alon $ith other health and "amil% plannin responsi3ilities. ,n addition, services o" communit% volunteers $ill 3e availed $herever the% are availa3le and $henever necessar%. !he &e% tas&s at the +ommunit% level $ill include8 15

,n"ant and Joun +hild (eedin Practices (,J+()8 advocac% "or the main ,J+( practices as $ell as appropriate nutrition and health9nutrition 3ehaviors "or pre nant and lactatin $omen, ro$th monitorin and promotion. Speci"ic ,J+( messa es, 3ehaviours and practices to 3e promoted and re1en"orced $ill include8 eBclusive 3reast"eedin "or 4 months, introduction o" culturall% appropriate complementar% "oods o" adeCuate nutritional Cualit% and Cuantit% at the appropriate a e $ith continued 3reast"eedin up to 2 %ears o" a e, appropriate in"ant and %oun child "eedin practices durin illness, etc. #ehaviour +han e +ommunication (#++)8 ,n addition to #++ messa es on ,J+( nutrition education and counselin $ill 3e provided to adolescents, pre nant and lactatin $omen on topics such as, personal h% iene and cleanliness especiall% durin preparation o" "ood and "eedin o" in"ants and %oun children, eneral nutrition, health and nutritional importance o" de$ormin and consumption o" micronutrient supplements (>it. ), ,ron, (olate etc) +')'8 screenin "or malnutrition ('G)+, ro$th monitorin ), nutrition advice "or all children, re"erral to appropriate "acilit% "or severe and moderate malnutrition, H)s, (*)s, and +ommunit% Health Providers provide "ollo$1up visits to children under treatment. 'icronutrients8 Provide advice uidance to households on iodine, iron and vitamin )@ advocac% and "ollo$1up "or use o" iron9"olic acid and calcium supplements, 3% pre nant $omen and post1partum vitamin ) supplementation +oordination8 H)s, (*)s, and +ommunit% Health Providers $ill pla% a &e% role in promotin and ensurin conver ence and coordination durin the implementation o" nutrition sensitive interventions 3% other sectors in the communities that the% $ill 3e $or&in in. -Bamples o" nutrition sensitive activities include, "ood securit% proIects (includin nutrition ardens and livestoc&9"isheries proIects), livelihoods proIects, $ater, sanitation9h% iene activities, etc.

#! b )elated strateg( in P,P Gse the eBistin health and "amil% plannin in"ra structure to deliver nutrition services to the tar et roups ,ntensive communit% 3ased support 3% Health, "amil% plannin and nutrition $or&er as peer counselor to ensure improved nutrition amon $omen and children. +ommunit% clinics $ill 3e the main contact points "or nutrition services and nutrition services $ill 3e provided in all communit% clinics in an inte rated $a% $ith -P,, Satellite clinic and other health and "amil% plannin pro rams. )ll Health and (amil% Plannin nutrition services $or&ers $ill 3e trained in nutrition to stren then

+ommunit% 3ased volunteers $ill 3e identi"ied and support throu h trainin 9orientation to per"orm essential nutrition services and achieve adeCuate covera e 14

)dvocac% at the national and communit% level to ain and maintain the commitment and support "or nutrition activities Polic% communication to create a supportive polic% environment "or nutrition strate ies to address eBistin and emer in nutrition pro3lems ,nclusion o" nutrition in curriculum o" primar%, secondar% school, medical, nursin and paramedical institute to increase nutrition related &no$led e amon all levels o" the societ% #++ at the communit% and household level to address maternal, in"ant, child and adolescent carin practices "ocusin on &e% 3ehaviors impactin on nutritional status Supplementation o" vitamin ), iron "olate and other micronutrients to control ni ht 3lindness, anaemia, ,DD and other micronutrients de"icienc% diseases. (ood 3ased approach and "ood "orti"ication $ill also 3e considered De$ormin "or D5 children and adolescent irls and 3o%s to reduce $orm load , prevention o" aneamia and improve $ei ht ain and ro$th Protection, promotion and support ,n"ant and Joun +hild (eedin (,J+() activities to promote earl% initiation o" 3reast "eedin , eBclusive 3reast "eedin "or the "irst siB months and appropriate complementar% "eedin on completion o" siB months 0e"erral lin&a e $ill 3e stren then 3et$een communit% 3ased and hi her level health and "amil% plannin services (,'+,, -P,, )N+, PN+ services) 0e"erral s%stem $ill 3e esta3lished "or mana ement o" severel% malnourished children $ith complications "ollo$in the national strate % "or S)' )dvocac% and support "or "ormulation o" le islation "or "ood "orti"ication and "ood sa"et% $ill 3e underta&en 0evie$ and redesi nin o" communit% 3ased nutrition services modalit% to implement in speci"ic areas includin hard to reach areas. Provide ur3an nutrition services in colla3oration $ith '?./0D+ -sta3lish an e""ective intra and inter sectoral mechanism at local level and national level to coordinate a $ide variet% o" nutrition services ("amil% plannin , a riculture and "ood, sanitation, education pro rams etc.) Health, "amil% plannin and nutrition $or&er $ill 3e provided $ith trainin on nutrition in emer enc%, so that the% can response timel% durin the period o" an% emer enc% (c%clone, "lood etc.) and can ensure nutrition in in"ants, children and mothers (or 3etter coordination $ith other ministries and departments, pro ram implementation9coordination committees $ill 3e "ormed at directorate and ministr% level 15

) Steerin +ommittee, multisectoral in composition and headed 3% the Secretar% , and a Nutrition ,mplementation +oordination +ommittee headed 3% the D/HS $ill 3e esta3lished $ith speci"ic !?0 -sta3lish an e""ective lin&a e and coordination $ith overnment or aniFations, development partners, non1 overnmental or aniFations and private sector "or interventions and monitor impact activities -""ective nutrition surveillance $ill 3e underta&en "rom ,PHN.

$5! (+* Priorit( ,nterventions and +ctivities of the National Nutrition Services
$5! +!$ Gro6th %onitoring and Promotion (G%P*: /'P, the re ular measurement, recordin and interpretation o" a child;s ro$th chan e in order to counsel act and "ollo$1up on results, $ill 3e implemented to detect ro$th "alterin o" in"ants and %oun children earl% and enhance the trans"er o" nutrition in"ormation in order to ta&e the preventive and curative actions needed. /'P is an important process o" assessin the nutritional state o" a child. !his process $ill also include the anal%sis o" the cause o" malnutrition or illness and action to 3e ta&en "or improvement o" the situation. !here is also opportunit% to re assess the child durin "ollo$ up and ta&e necessar% steps. /'P $ill 3e done in 3oth "acilit% and communit% levels. )ll "acilities $ill 3e eCuipped $ei hin machine, calculator and ro$th charts and the capacit% o" health $or&ers $ill 3e developed so that the% can mana e the /'P session e""icientl%. !he child;s $ell13ein $ill 3e assessed 3% $ei hin the child, plottin the $ei ht a ainst his9her a e on the ro$th chart indicatin standard ro$th patterns "or a e. !he health $or&er $ill help the mother to understand the curve o" the ro$th chart indicatin the nutritional status o" the child and over the time, the traIector%. !he child;s mother and health $or&er $ill anal%Fe the causes o" not ainin adeCuate $ei ht, ro$th retardation and discuss the neBt step to 3e ta&en to address the pro3lem. )ll children a ed :124months livin in the catchment area o" a communit% clinic $ill 3e $ei hed once ever% 3 months up to the a e o" 2 %ears. +ounselin o" mothers $ill also "ocus on the appropriate messa e a3out child care, child nutrition etc. durin /'P session. !o &eep the num3er o" children mana ea3le and cover the tar et roup, each communit% clinic area $ill 3e divided into three su31area or cluster and children o" each area $ill 3e assi ned one da% to attend communit% clinic "or $ei ht monitorin . Health $or&ers $ill "ollo$ up all children not attendin the $ei hin session and $ei ht at home and motivate to come at communit% clinic re ularl%. !he ro$th chart $ill 3e &ept $ith the mother o" the child and 3rou ht $hile comin in /'P session. !he /'P session represent the most important re ular contact 3et$een the health $or&er and the mother $hen an e""ective interpersonal communication can 3e achieved. !he children not attendin the reCuired $ei ht "or successive t$o months or ro$th "altered or have an% illness $ill 3e re"erred to the ph%sician.

16

!he 3irth $ei ht o" a ne$3orn $ill 3e recorded 3% the health $or&er immediatel% or at least $ithin 52 hours a"ter 3irth. )lon $ith, health $or&ers $ill help parents "or 3irth re istration and ta&e the opportunit% to counsel the mother on 3reast "eedin , colostrums "eedin , child care, mother;s nutrition, "amil% plannin etc. and also ive a hi h dose vitamin ) to the mother. $5!+!' &ehavior .hange .ommunication to Promote Good Nutritional Practices: #++ is the core strate % "or achievin NNS o3Iectives. !he o3Iectives o" #++ "or NNS are 1 a)to 3rin positive chan es in maternal, in"ant and child carin practices, 3) to increase demand and utiliFation o" health services, c) to help to develop the capacit% o" the communit% to understand and address the malnutrition pro3lems, d) to stren then the capacit% o" the health service providers to train and support the communit% $or&ers to per"orm their #++ activities, e) advocac% "or polic% support to provide nutrition service 3% motivatin polic% ma&ers and opinion leaders. #++ under NNS $ill include polic% communication, advocac% and social mo3iliFation, interpersonal communication in the communit% level pro ram. ) #++ strate % and operational plan $ill 3e developed "or a national advocac% and polic% development campai n $ith a technical support "rom health education 3ureau and #++ unit o" D/(P. NNS $ill provide support "or material development, and production to stren then social mo3iliFation approach. 'ass media campai ns, social mo3iliFation and 3ehavioral chan e and communication activities at health "acilit% and communit% levels $ill 3e implemented to promote ood health and nutrition practices. +onsistent dissemination o" &e% messa e to create social a$areness $ill 3e ensured in mass media, printin media etc. Speci"ic 3ehaviors to 3e tar eted $ill include8 counselin pre nant $omen on adeCuate diet and care, promotion o" eBclusive 3reast "eedin "or 4 months and continued 3reast"eedin up to 2 %ears@ introduction o" complementar% "oods o" adeCuate nutritional Cualit% and Cuantit% a"ter the a e o" 4 months@ improved h% iene practices includin hand $ashin , and health% practices amon adolescents. !raditional methods as street theater, drama, Iari1shari, court%ard drama etc. $ill also 3e considered. ?ther important strate ies to implement #++ activities are K 1. 0e ular communication pro ram $ith nutrition "ield eneral population and sta&eholders in

2. ,nvolvement o" ministr% o" in"ormation in raisin a$areness a3out nutrition 3. )$areness creation a3out health% eatin ha3it to prevent under and over nutrition 4. ,nvolvin reli ion leaders on advocac% re ardin nutrition issue. 5. ?r aniFin nation$ide nutrition da%9$ee& annuall% on important nutrition themes throu h nutrition "air, "estival, "ol&son s, "ilm sho$, de3ate, essa% competition etc. at di""erent level 4. 'aBimum utiliFation o" mass media includin nutrition advocac% and education television, radio, ne$spaper "or

5. #++ messa e should include in"ormation on production and consumption o" sa"e "ood, health% dietar% practices, "ood securit% etc.

1<

NNS $ill 3e the national resource center "or all nutrition related in"ormation. !he materials, messa es on nutrition issue developed in NNS $ill 3e used universall% 3% the sta&eholders $or&in in nutrition "ield. -Bistin li3rar% o" ,PHN $ill 3e enriched and up raded $ith latest in"ormation, 3oo&s, Iournals, ma aFines etc. on health and nutrition. ) media "orum $ill 3e "ormed includin di""erent media personnel and enrich #++ pro ram o" NNS $ith the ,deas o" ne$ dimension "or disseminatin nutrition messa es.

$5!+!" %icronutrient supplementation: a* 7itamin + supplementation #an ladesh has had much success in attainin as $ell as sustainin hi h covera e o" >itamin ) supplementation. !his hi h covera e has 3een attained throu h 3i1annual >itamin ) campai ns "or children 415< months. Hi h dose (2::::: ,G91::,::: ,G) vitamin ) capsule are distri3uted amon 415< months children durin the national vitamin ) campai n. +hildren a ed 4111 months $ill 3e provided $ith >itamin ) capsules (1::::: ,G) durin vitamin ) campai n. >itamin ) capsule is also iven therapeuticall% to the children su""erin "rom vitamin ) de"icienc% (ni ht 3lindness). >itamin ) should also 3e provided to all D5 %ears children in emer enc% situations ("lood or c%clone) and to the children su""erin "rom measles, diarrhea, severe malnutrition. ) hi h dose o" vitamin ) capsule $ill 3e iven to a mother $ithin 42 da%s o" deliver%. (ield $or&ers $ill ensure post partum vitamin ) supplementation durin their home visit. NNS $ill strive to increase "urther and stren then covera e and ensure that areas or population roups that have not 3een reached are 3etter tar eted. NNS $ill "acilitate modi"ication in policies and uideline to encoura e use o" communit% 3ased non1health personnel to help $ith distri3ution in hard to reach areas and 3uild capacit% to improve the use o" covera e data to detect lo$ per"ormin areas and help tar et resource to "ill in aps. b* ,ron folate supplementation #an ladesh has one o" the hi hest prevalence o" maternal anemia in the $orld. !he countr% has a polic% o" providin iron1"olic acid supplements to pre nant $omen (durin )N+) in order to reduce the incidence and prevalence o" anemia. !hree hi h ris& roups have 3een identi"ied "or intervention name as children a ed 4123 months, Pre nant and lactatin $omen, )dolescent irls and ne$l%$ed $omen. /roups at hi h ris& o" aneamia $ill 3e provided $ith iron supplements to prevent anaemia. NNS $ill support the coordinated nation$ide e""ort "or iron "olate supplementation avoidin duplication. National strate % "or anaemia prevention and control $ill 3e "ollo$ed in the pro ram and an action plan $ill 3e developed. ,ron "olate ta3let or multiple micronutrient supplements $ill 3e provided to the children a ed 4123 months, pre nant $omen, lactatin mothers "or "irst three months a"ter deliver%, adolescent irls and ne$l%$ed $omen in the recommended doses. Pre nant $omen and lactatin $omen $ill 3e counseled on importance o" ta&in iron "olate re ularl%, so that increased compliance can 3e achieved. Ho$ever, poor covera e, compliance and stoc&1 outs have a""ected the e""ectiveness o" this intervention. !here"ore the pro ram $ill@ help set up s%stems to ensure adeCuate procurement and suppl% o" ,() ta3lets at all levels o" the health s%stem and@ train health $or&ers includin H)s, +HPs and (*)s to develop their s&ills to counsel $omen to ena3le "ull compliance. 2:

(or sustaina3le improvements, inta&e o" iron rich "ood is important. +han es o" "ood ha3it throu h chan es o" 3ehavior can improve not onl% the anaemia status, 3ut the nutrition in eneral. #reast "eedin , appropriate complementar% "eedin , increased inta&e o" animal "ood, reen lea"% ve eta3les etc. $ill 3e encoura ed. *orm in"estation, diarrhea, malaria are important causes o" anaemia. !he intervention pro rams $ill also 3e stren thened to control anaemia. c* ,ron Supplementation and De6orming of +dolescent Girls NNS $ill endeavor to provide structures #++ sessions "or adolescent irls to provide them $ith the necessar% &no$led e on reproductive and nutritional health throu h individual and roup counselin . !he irls $ill also 3e provided $ith de$ormin ta3lets and iron1"olate ta3lets $hen the% come into contact $ith the health s%stem and thou h communit% 3ased nutrition activities. d* 8inc Supplementation during 9reatment of Diarrhea !he incidence o" diarrhea amon #an ladeshi children is amon st the hi hest in the su31 continent, hence contri3utin to in"ant and %oun child malnutrition. Ninc supplementation durin treatment o" diarrhoea has 3een sho$n to have 3oth curative (reduction in the severit% o" diarrhoea) as $ell as preventive ("e$ "uture episodes). !here"ore, NNS $ill promote and stren then support that the provision (includin procurement) o" Finc supplements alon $ith ?0S is part o" the protocol "or the mana ement o" diarrhea as it has alread% started in the on oin pro ramme. !he #++ component o" the pro ram $ill educate care ivers and other household decision ma&ers on the importance and 3ene"its o" "ull compliance $ith ta&in Finc supplements "or the "ull 1: da%s durin treatment9 mana ement o" diarrhea. e* 7itamin D, .alcium Supplementation +alcium de"icienc% is a common pro3lem amon elderl% or post menopausal $omen $hich leads to osteoporosis, osteoarthritis diseases. +alcium is also essential "or pre nant $omen "or ro$in "oetus. !hus promotional pro ram $ill 3e desi ned to advocate "or consumption o" calcium rich "ood and calcium supplementation durin pre nanc% and a"ter 4: %ears o" a e. >er% recentl% disa3ilit% amon children due to de"icienc% o" calcium and9or vitamin D is also "ound in some poc&et areas o" #an ladesh $hich are suspected as 0ic&ets cases. Special pro rams "or +alcium and >itamin D supplementation "or speci"ic cases $ill 3e underta&en. $5!+!: .ontrol of ,odine Deficienc( Disorder (,DD* and Salt ,odi2ation Program #S+,+ o" 'inistr% o" ,ndustr% is responsi3le "or iodiFation o" salt. NNS $ill "acilitate and cooperate activities relatin to salt iodiFation, includin production, Cualit% control. NNS $ill support #S+,+ to underta&e initiative "or introduction o" appropriate technolo % "or salt production, improvin salt iodiFation plants and en"orcin salt iodiFation la$s. !he salt iodiFation pro ramme $ill continue to 3e stren thened and eBpanded throu h advocac% at household and national level. !he #++ component o" the pro ram, "or eBample, $ill promote a$areness o" and increased use o" iodiFed salt 3% households and help sustain consumer demand o" the product. $5!+!; %anagement of Severe +cute %alnutrition (S+%* and .ommunit( %anagement of +cute %alnutrition (.%+%* 21

'ainstreamin the implementation o" nutrition interventions into health and "amil% plannin services $ill ensure more coordination in the treatment o" moderate and severe acute malnutrition at the health "acilit% as $ell as communit% level. )t the health "acilit% level, children havin severe acute malnutrition $ith medical complications $ill 3e treated accordin to national uidelines and internationall% recommended protocols.. ,n #an ladesh severel% malnourished children are 3ein mana ed at the "acilit% level throu h inpatient therapeutic care. #ut still there are limited &no$led e, s&ill and "acilities at hospitals. (acilit% 3ased in patient care is essential in case o" severe acute malnutrition $ith complications. !he service providers $ill 3e trained on mana ement o" severe acute malnutrition cases and esta3lish S)' mana ement centre in all hospitals "rom primar% to tertiar% level, so that severel% malnourished children re"erred "rom the communit% can 3e success"ull% treated even in upaFila or district hospitals $ith limited resources. )t the communit% level, the /?# $ill address communit%13ased mana ement o" acute malnutrition throu h the communit% 3ased ,'+, pro ram 2 communit% clinic services. ," there is no medical complication, then the case can 3e e""ectivel% mana ed at communit% level, there"ore, to et maBimum covera e and access to care "or severel% malnourished children a com3ined "acilit% 3ased and communit% 3ased approach has 3een adopted. National uidelines "or the mana ement o" severel% malnourished children as $ell as +ommunit% 'ana ement o" )cute 'alnutrition (+')') in #an ladesh have 3een desi ned "or Doctors, nurses, other senior health pro"essionals, and ,'+, providers. $5!+!< Nutrition during =mergencies #an ladesh is the most vulnera3le to natural disasters and ever% %ear natural calamities upset people;s lives in some part o" countr%. !he maIor disaster are "lood, c%clone, storm, drou ht, tornado, land slide etc, !he eBtreme natural disasters adversel% a""ect the $hole environment includin human 3ein , their shelters 2 resources essential "or livelihoods "ollo$in a disaster impacts on human and enerall% mani"ested in the "orm o" inIuries, deaths and diseases. -""ect on nutritional status comes out as dela%ed impacts o" disaster. Nutritional 3lindness and other de"icienc% diseases are common. Health pro"essional have precise responsi3ilities and opportunities in post disaster disease prevention and emer enc% mana ement. Pre nant $omen, children, people $ith illness, persons over 4: %ears are the most nutritionall% vulnera3le durin disaster. Health $or&ers should 3e trained su""icientl% to ta&e care o" these vulnera3le roups durin and a"ter disaster to prevent malnutrition. NNS $ill provide technical support and $or& $ith other relevant ministries to ensure that nutrition situation is monitored and the most vulnera3le roups are properl% tar eted. 0elie" distri3utin a encies should 3e care"ul in selectin "ood as relie" particularl% "or the in"ants and %oun children. ,t must correspond to the nutritional need and "ood ha3it, le islation (#'S code), su""icient in Cualit% and Cuantities, read% to eat. 0ation should 3e iven to the hi h ris& roups on a priorit% 3asis. ,nclude supplementation o" micronutrients particularl% iron, vitamin1), Finc should 3e in ration. NNS $ill have a "unctional coordination s%stem $ith '?) and '?(2D' to remain prepared "or emer enc% situations and mo3iliFe its $or&"orce speci"icall% to provide essential nutrition services (e. . "ood and micronutrient supplementation in the a""ected areas, mana ement o" severe and acute malnutrition amon $omen and children, etc.) in the a""ected areas. ,n colla3oration $ith the 'inistr% o" (ood 2 Disaster mana ement, a uideline "or disaster preparedness to prevent malnutrition a"ter disaster $ill 3e developed and all health $or&ers $ill 3e trained, so that the% $ill 3e a3le to respond to the nutritional needs o" the population 22

durin an% emer enc% condition. Health *or&ers must promote, protect and support 3reast"eedin amon under t$o children. $5!+!> .ommunit( based nutrition services -ach communit% clinic $ill 3e eCuipped su""icientl% to provide adeCuate nutrition services alon $ith other health and "amil% plannin services. H), (*), +H+P and communit% volunteers $ill 3e trained on nutrition, thus the% $ill 3e a3le to 3rin a3out chan es in the nutritional situation o" the area. (emale communit% volunteers $ill 3e selected "rom the communit% level and $or& under the supervision o" respective +H+Ps. !his service provision involvin communit% volunteers $ill 3e rolled out across the countr% in phases, $ith 25= o" the upaFilas coverin in each phase. !he +#N services under NNS include 1 1. 0e ular ro$th monitorin "or children under 2 %ears o" a e. 2. Nutrition education "or mothers, adolescent irls, ne$l%$ed $omen 3. ,ndividual counselin o" parents "or concernin care, immuniFation etc. child ro$th 2 development, child

4. Pre nant $omen counselin "or sel" care, $ell13ein and health% "actors, "ood etc. 5. ,mproved supplementar% "ood (Pushti Packet) "or selective and tar eted population roups. 4. 'icronutrient supplementation (>it. ), ,ron (olate) 5. De$ormin "or children and adolescent irl 6. 0e"erral "or S)' and other illness o" children and pre nant $omen )N+, PN+.

$5!+! Nutrition interventions in hard to reach areas, chars, hill?tracts8 N/?s $ill 3e assi ned to partner nutrition intervention in hard to reach areas, chars, hill tracts and the areas $here ++ is not availa3le. ) pac&a e o" services $ill 3e prepared $hich $ill 3e provided to the population resided in remote areas throu h selected N/? $or&ers. !he mode o" N/? selection $ill 3e decided upon 3% '?H(*. (leBi3le 2 diversi"ies pro ram desi n to accommodation $ith realities $ill 3e underta&en in these areas. $5!+!# =arl( .hildhood Development (=.D* -arl% +hildhood Development re"ers to the man% s&ills and milestones that children are eBpected to reach 3% the time the% reach the a e o" "ive. !he development o" a child starts "rom the mother;s $om3 and it includes 3oth ph%sical and mental development o" the child. !hus it is important to ta&e necessar% steps "or health% development o" the child $ithin the a e :15 %ears. NNS in close coordination $ith the -+D proIect o" GN,+-( under 'inistr% o" *omen and +hildren a""air, $ill disseminate important messa es related to -+D to the "amilies and communit%, campai n "or a$areness, ensure )N+ and nutrition "or pre nant $omen. Health $or&er $ill also ive technical support and nutrition related in"ormation to school mana ement committee "or earl% childhood development o" school children. $5!+!$5 .oordination 6ith ,%., program: 23

NNS $ill ensure maternal and child;s health throu h necessar% support to implement ,'+, pro ram. NNS $ill participate in the plannin , revie$ and sharin meetin s at various levels and carr% out monitorin and supervision o" activities alon $ith their o$n responsi3ilities. NNS personnel $ill underta&e relevant +')', +1,'+,, and 'N+H9,'+, trainin and provide technical support "or conductin !?! and oversi ht the technical interventions under ,'+,. Necessar% maternal and child nutrition related issues, messa es $ill 3e incorporated in the trainin module o" ,'+,. -Bclusive 3reast "eedin , earl% initiation o" 3reast "eedin , immuniFation, Finc therap% durin diarrhea, vitamin ) supplementation, de$ormin o" children, control o" anaemia, consumption o" iodiFed salt, re"erral "or )N+ and PN+ under NNS pro ram $ill 3e considered as priorit% activities to "acilitate ,'+, activities. $5!+!$$ .limate change: +limate chan e is li&el% to alter the eo raphical locations "rom "ood source $hich ma% a""ect nutritional status. ) riculture adaption to climate chan e $ill lead to the development o" ne$ crop 3reeds to survive in di""icult climatic conditions or in ne$ eo raphic areas. ,t is important to ensure that crop 3reedin should "ocus on maintenance o" nutrient content. +han es in ho$ "oods are ro$n, processed, stored, prepared and coo&ed ma% a""ect nutritional content o" the "ood. !he sa"et% o" "ood varies 3% "ood t%pe and $here it is produced. +limate chan e ma% also lead to alter chemical and patho enic characteristic o" "ood. +limate chan e ma% increase the demand "or irri ation o" $ater, increasin patho en ris&s. (loodin is one $a% "or transportin patho ens and chemicals on to a ricultural land. -levated temperature ma% increase "ood 3orne patho en. (ood transport, stora e and processin a""ect "ood sa"et% ris&s, 3ut there is insu""icient in"ormation on ho$ these $ill alter under climate chan e. !hrou h coordination $ith relevant ministries (a riculture, disaster mana ement, $ater resources, environment etc.) "ollo$in measures can 3e underta&en to reduce the e""ects o" climate chan e8 +onsumption o" health% diets e. . reducin inta&e o" meat, su ar% "ood and drin&s and ta&e more seasonal and locall% produced "ruit and ve eta3le. -nsurin adeCuate %ears1round consumption o" a variet% o" "ruit and ve eta3le is important. -nhance monitorin o" "ood source. Provide dietar% uidelines to individuals. 'echanisms that ma% 3e e""ective in some circumstances include le islation, mass media campai n, social mar&etin , and communit% pro rams. !rain stu"" to help people chan e their 3ehavior. ,mposin rules, re ulations and mar&et structure supportin the provision o" sa"e and nutrition "ood. Polic% to support pro1environmental 3ehavior and provision o" in"ormation to modi"% attitudes and &no$led e.

$5!+!$' Geriatric nutrition: +han es associated $ith normal a in increases nutritional ris&s "or old and adults. Nutritional needs o" the older individuals are determined 3% multiple "actors, includin speci"ic health pro3lem, level o" activit%, ener % eBpenditure, caloric reCuirement and personal "ood pre"erence. 'icronutrient de"icienc% is common pro3lem in elderl% people due to num3er o" "actors8 reduced "ood inta&e, lac& o" variet% o" "oods the% eat, medications 24

that inter"ere nutrient(s) a3sorption and create side1e""ect, "ood choices. !he% ma% su""er "rom anoreBia due to a in leadin suppressed hun er, $hich ma% cause caloric de"icit and malnutrition. ) num3er o" chan es ma% occur in the a in person;s social and ps%cholo ical status, potentiall% a""ectin appetite o" nutrition status, depression, memor% impairment, social isolation. -""orts $ill 3e underta&en to create a nutrient uideline to address the nutritional need o" increasin elderl% population. $5!+!$" Non?.ommunicable Disease (N.D*: Diet related N+Ds li&e o3esit%, dia3etes mellitus, h%pertension, and coronar% heart diseases are 3ecomin common due to epidemiolo ic transition and have 3een emer ed as dou3le 3urden o" disease in the developin countries. ?3esit% in childhood is shi"ted to adult o3esit% in almost 5:= cases. Dietar% modi"ication can pla% stron role in the prevention o" N+Ds and NNS $ill assist relevant line directorates in promotin health% li"est%le as $ell as nutrition durin the sector pro ram. Other NNS Core Activities: $5!+!$: 9raining-.apacit( &uilding: +apacit% 3uildin and various "orms o" trainin and orientation $ill 3e a maIor priorit% "or NNS 3ecause o" t$o main reasons8 "irstl%, the $ea& capacit% to su""icientl% and e""ectivel% supervise and monitor the implementation o" the NNP has 3een identi"ied as a &e% hindrance to e""ectiveness o" the current pro ram. Secondl%, the mainstreamin process $ill reCuire health and "amil% plannin service personnel ("rom GpaFila throu h +ommunit% .evels) to per"orm duties and responsi3ilities "or $hich the% had not received an% or su""icient trainin . !here"ore, NNS $ill develop and implement a capacit% 3uildin strate % to enhance the capacities (human as $ell as institutional) o" NNS as $ell as that o" other line directorates $ith the responsi3ilities "or deliverin nutrition service9intervention. !rainin s $ill 3e in the "orm o"8 special courses "or eBperts (Nurses and 'edical ?""icers) on specialiFed topics such as ,J+( counselin , 'ana ement o" )cute 'alnutrition, Nutrition +ounselin , etc@ inclusion o" core nutrition modules "or pre1 and in1service trainin o" H)s, (*>s. and +H+Ps@ re"resher trainin o" H)s, (*>s and +H+Ps. ?rientation trainin "or overnment and non1 overnment personnel at district level and 3elo$, $hich $ill help in "acilitatin and updatin their &no$led e, chan e o" attitudes and help them in deliverin and coordinatin nutrition services. NNS $ill "ollo$ the strate ies mentioned 3elo$ to achieve the trainin o3Iectives8 1. .apacit( development of individuals? di""erent "ocal personnel $or&in "or NNS at national and su31national levels needs capacit% enhancement in order to e""ectivel% implement the interventions. 2. @ob training1 ) pre service trainin "or ne$l% recruited or involved as nutrition service provider $ill 3e iven to increase technical &no$led e, communication and mana ement s&ill etc. 3. ,n service training1 0e ular in service trainin "or "ield "unctionaries $ill 3e arran ed to re1en"orce the s&ill developed in Io3 trainin and providin continuous communit% interaction in "eed3ac&. 4. Orientation1 #ecause o" multisectoral involvement in nutrition services, a num3er o" personnel "rom various departments o" /?# and N/?s $ill 3e oriented on nutrition activities. 25

5. @oint training1 !o ensure s%ner % amon health, "amil% plannin , and "ield $or&ers o" other departments that deliver nutrition activities@ develop understandin and team spirit "or deliver% o" ood services, Ioint trainin $ill 3e or aniFed. 4. Specific program and theme based training 1 trainin on ,J+(, mana ement o" malnutrition, adolescent nutrition, nutrition counselin , micronutrients, emer in pro3lems etc $ill 3e iven to the pro ram mana ers $ho $ill su3seCuentl% train the sta""s o" their $or&in areas. 5. /orAshop- seminars-conferences1)dvocac% $or&shop, pro ram related seminars and con"erences $ill 3e arran ed "or developin and stren thenin pro ram related s&ills amon polic% and decision ma&ers and "ield "unctionaries. Dissemination o" academic and technical advances and pro ram per"ormances to the polic% planners and decision ma&ers $ill 3e or aniFed. 6. Overseas training for doctors and nurses 1 !o stren then capacit% and update &no$led e on modern technolo % o" the service providers, opportunit% "or overseas trainin or courses in the "ield o" nutrition $ill 3e eBplored. Nutrition 9raining Plan: 'aIor !opics to 3e covered8 'ainstreamin nutrition 'aternal nutrition ,n"ant and Joun +hild (eedin (,J+() Severe )cute 'alnutrition (S)') and +ommunit% 'ana ement o" )cute 'alnutrition (+')')

Sl. No: 1 2

Category of personnel87evel Po$ic- $eve$ (1ationa$ 7eve$)

'irectors; Program anagers; Administrators; C!; ''FP ('ivisiona$ 7eve$); anagers of "rban hea$th #rograms

No of *ays 1 1

Topics
ainstreaming n"trition; * ! code ainstreaming n"trition ainstreaming n"trition; !A +ACF; !A ; aterna$ n"trition; * ! Code; aterna$ n"trition ainstreaming n"trition; +ACF; * ! Code; !A ; aterna$ n"trition; aterna$ n"trition +ACF; * ! Code; C A ; aterna$ n"trition ainstreaming n"trition; +ACF; Anaemia icron"trients; C A ; aterna$

Type Orientation Orientation

.esponsibility 11! 11!; '85!; '8FP '85!;'8FP;

'85!; +!=; 5!

3 %B 5

'octors from hos#ita$s 8O&18O

'octors from Pediatric and Obstetric 'e#artment of hos#ita$s at district $eve$ and above

2;5 da-s 2;5 da-s 3<5 da-s

=raining =raining =raining

1"rses ('istrict and 3#4i$$a 7eve$)

'85!; 11!

6 (

edica$ Officers (35C) One edica$ Officer from each 35C (3#a4i$a 1"trition Foca$ #oint)

3 da-s 15 da-s

=raining =raining

'85!; 11! 11!

24

, 0 1/

F@9s and 5+ (3#a4i$a&3nion $eve$) C5CP; F@A; 5A (Comm"nit- 7eve$ Comm"nit- C$inic management gro"#

2 da-s 5da-s 1 da-

n"trition +ACF; C A ; aterna$ n"trition +ACF; C A ; aterna$ n"trition +ACF; C A ; aterna$ n"trition

=raining =raining Orientation

'8FP; 11! '8FP; '85!; Comm"nitc$inic #roject Comm"nitc$inic #roject

$5!+!$; School nutrition education Program: NNS $ill provide children and adult o" all a e $ith nutrition education materials on ho$ to improve their diets and their lives. NNS $ill also provide trainin and technical assistance "or nutrition education, includin on school ardenin , "or school children and their care ivers and school and communit% support "or health% eatin and ph%sical activities. NNS $ill develop nutrition messa es and supportin contents and uideline "or health% diets "or children. ?3esit% is an emer in pro3lem in #an ladesh. 'an% children in ur3an school are over$ei ht. NNS $ill $or& to "ormulate diets $hich $ith eBercise can &eep a person;s $ei ht under control allo$in them to enIo% health% and active li"est%le. $5!+!$< 4ood Bualit( C food safet( -ach %ear millions o" citiFens su""er "rom "ood insecurit% 2 3outs o" illness "ollo$in the consumption o" unsa"e "ood. )side "rom acute e""ects arisin "rom "ood contaminated 3% micro3ial patho ens, lon term health impacts ma% result "rom consumption o" "ood tainted 3% chemical su3stances and toBins. #% minimiFin consumer;s eBposure to unh% ienic, contaminated and adulterated "ood it is possi3le to si ni"icantl% reduce the mor3idit% and mortalit% associated $ith unsa"e "ood. !here are various ministries ('?(D', '?) 2 '?*+)) that oversee sectors o" the "ood securit%, "ood suppl% chain, and it is important the% continue to $or& to ether (throu h re ular meetin s o" the National (ood Sa"et% )dvisor% +ouncil) to eliminate aps in "ood control, as $ell as duplication o" e""ort and result in improved pu3lic health and nutrition. (urther enhancement o" the roles and responsi3ilities o" the D/HS is essential so it ta&es a strate ic role in mana in "ood sa"et% in colla3oration $ith the cit% corporations and municipal authorities. 'easures $hich raise a$areness o" "ood securit% 2 sa"et% $ill lead to reductions in "ood contamination and reduce the 3urden o" "ood 3orne illness. )ctivities8 0aisin a$areness on "ood sa"et%, h% ienic practices, hand $ashin etc. Developin an action plan "or implementation o" "ood sa"et% polic% $ith eBistin polic%9policies o" the countr%. )ctivities o" this action plan $ould include 3uildin lin&a es $ith on oin initiatives li&e L,mprovin "ood sa"et%, Cualit% and (ood +ontrol in #an ladeshA. Gp radation o" eBitin la3orator% o" ,PHN in colla3oration $ith ,PH. -nsure Cualit% o" 3a3% "ood as per #'S act 1<64. 25

$5!+!$< .oordination of Nutrition +ctivities across Different Sectors: 'alnutrition is intrinsicall% multi1sectoral, and hence achievin sustaina3le nutrition securit% is "undamentall% a multi1sectoral cross1cuttin challen e reCuirin a coordination o" policies and strate ies o" di""erent sectors9ministries on a sustained 3asis. !here"ore, the NNS $ill develop mechanisms "or e""ective coordination o" nutrition and nutrition1related activities in other sectors and that are capa3le o" s%ner istic impact on nutrition, "or eBample, "ood securit%, "ood sa"et%, "orti"ication o" staple "oods, livelihoods pro rams includin income eneration initiatives, etc. !his $ill 3e achieved $ith the uidance o" the multi1sectoral Steerin +ommittee headed 3% the Secretar%, '?H(*. !he Steerin +ommittee $ill 3e entrusted $ith overall uidance, polic% direction, stoc&1ta&in and coordination o" nutrition activities. !he committee $ill have representation "rom all relevant ministries at appropriate level (not 3elo$ the level o" Ooint Secretar%), development partners, technical or aniFations, civil societ% or aniFations and others. .ine Director KNNS $ill 3e the 'em3er Secretar% o" the +ommittee. (urther, a Nutrition ,mplementation +oordination +ommittee headed 3% the D/HS and $ith mem3ership "rom relevant .Ds (-SD, 'N+H, NNS, +#H+, N+D, ',S, '0)H1D/(P and others) $ill 3e esta3lished. !he committee $ill especiall% monitor mainstreamin o" nutrition activities. !he .D1NNS $ill 3e the 'em3er1Secretar% o" the +ommittee. NNS $ill coordinate $ith development partners and other sta&eholders includin N/?s to develop a comprehensive mappin as $ell as rollout plan to document nutrition interventions in #an ladesh $ith the provision o" re ular (annual) updates. 'oreover, in colla3oration $ith ministr% o" in"ormation, nutrition &e% messa es $ill 3e disseminated 3% usin all possi3le channels o" in"ormation. !o prevent illness and diseases and environmental sustaina3ilit%, lin&a e $ill 3e esta3lished $ith development pro ram, sanitation pro ram, and appropriate technolo % "or improvin sources and "orms o" "ood etc. -sta3lish lin&a e $ith a ricultural pro rams $hich can assists small "armin household in producin their "ood reCuirements. ?n the other hand NNS $ill provide health education and orientation to the $or&ers o" a riculture sectors to promote nutritious "ood production, sa"e "ood production $ith minimum use o" insecticides. (or increased availa3ilit% and access to protein rich "ood, promotion "or "ish culture, poultr% rearin and dair% amon 3ene"iciaries $ill 3e encoura ed alon $ith the relevant pro ram under ministr% o" "isheries and live stoc&. ?n the assumption that malnutrition is caused 3% lac& o" &no$led e a3out "ood needs at various sta es o" li"e, the nutrition value o" di""erent "oods etc. introduction o" nutrition into the curriculum o" "ormal and non1"ormal education is essential. NNS $ill $or& in this issue alon $ith ministr% o" education. ./-D is responsi3le "or implementin the ur3an health proIects in the cit% and municipalit% areas. Meepin liaison $ith 'inistr% o" ./-D, NNS $ill ensure and provide technical support to implement nutrition activities in ur3an areas. NNS $ill also assist to "ind out the $a% "or improvin nutrition services in ur3an areas. $5!+!$> Procurement of eBuipments, micronutrients, and de6orming tablets: *hilst the nutrition services $ill 3e provided at the "acilit% and communit% levels 3% a num3er o" line directorates, NNS $ill 3e ensurin the suppl% o" vitamin ) supplements ("or mothers and children), iron9"olic acid supplements, calcium, de$ormin ta3lets, and measurin eCuipments to esta3lish S)'9nutrition corners at the GpaFila Health +ompleB 26

level and /'P9nutrition education corner at the +ommunit% +linics. NNS $ill also 3e procurin eCuipments and re1a ents to "unctionaliFe the (ood Sa"et% .a3orator% at ,PHN. $5!+!$ %onitoring, Surveillance, )esearch and =valuation !he availa3ilit% and use o" Cualit% data is essential "or evidence13ased decision ma&in to improve nutrition pro rammin . !he lac& o" accurate and timel% data can 3e an impediment to pro ress in implementation. !he monitorin and evaluation component o" the pro ram $ill provide important data on the cope, covera e and e""ectiveness on the nutrition pro ram;s activities. !he '2- data $ill 3e used to monitor pro ress in &e% nutritional outcomes (anthropometric indicators) as $ell as provide data on inputs, outputs (covera e). !he pro ram monitorin 2 evaluation s%stem $ill provide in"ormation that serves as a 3asis "or &eepin the proIect on trac& in relation to oals and o3Iectives. 'onitorin involves the process o" assessin the operational aspects o" proIect implementation, particularl%, the assessment o" deliver%, covera e, and the use o" proIect resources. -valuation covers the assessment o" inputs into process, output, outcome, e""ects and impact o" proIect intervention 3ased on in"ormation athered durin the course o" monitorin . !his $ill 3e carried out 3% an independent entit%. (urther, impact evaluations on nutrition $ill 3e o3tained "rom the national sector $ide surve%s. $5!+!$# %anagement ,nformation S(stem (%,S*: )n internal mana ement in"ormation s%stem (',S) 3ased on service records and reports at the communit% level $ill ena3le the mana ement to monitor the pro ress o" activities underta&en accordin to tar et, monitor i" the o3Iectives are 3ein achieved or scope o" opportunit% "or improvement and to assess the improvements o" the tar et roups as a result o" interventions. !he data enerated "rom "ield need to 3e anal%Fed, processed and s%nthesiFed to trans"orm it into in"ormation, to provide mana ement $ith appropriate in"ormation at the appropriate time "or their decision ma&in needs. 'onitorin o" nutritional status $ill also provide "eed3ac& to the communities, pro ram mana er and polic% ma&ers. +overa e and e""ectives o" national level nutrition intervention $ill also continue to 3e monitored throu h periodic surve%, nutrition surveillance etc, )ctivities leadin to development o" ',S and so"t$are, capacit% development o" personnel, net$or&in and lin&a e $ith ',S o" 3ureau o" Health education. .in&a e $ill 3e esta3lished to eBistin H',S tools and s%stems o" the /?# and other sta&eholders. a! Operations research : ?perations research and special studies $ill 3e underta&en to reveal cost e""ectiveness and e""icienc% to current strate ies and to eBplore ne$ one. /ebsite development : -Bistin $e3site o" ,PHN $ill 3e up raded and updated $ith current development nutrition situation and pro ram. b! o"

c! Nutrition Surveillance: +ontinues monitorin o" nutritional status $ill 3e underta&en throu h nutrition surveillance $ith technical support "rom non overnment or aniFation. Surveillance o" nutritional status o" the population should o hand in hand $ith the "ormulation and eBecution o" polic%. ,t is a continuous process and provides on1 oin in"ormation a3out nutritional condition o" the population and "actors that in"luence them. !his in"ormation $ill serve as the 3asis "or decision related to polic% ma&in , plannin and mana ement o" nutrition pro ram. 2<

(urther technical and "inancial cooperation $ith other overnment, development partners, research and academic or aniFations and non1 overnment or aniFations in terms o" research, surve%, special stud% etc. $ill 3e esta3lished. $5!+!'5 )eferral )n e""ective re"erral s%stem $ill 3e esta3lished "or malnourished children $ith complications and children $ho "ail to ain desired $ei ht. !hese children $ill 3e re"erred to appropriate health "acilit%. -ach hospital "rom primar% to tertiar% level $ill 3e eCuipped and trained so the% $ill 3e a3le to mana e the severe acute malnutrition cases. $5!+!'$ 4ood fortification NNS $ill provide technical support "or "ood "orti"ication, $hich entails addin nutrients to universall% consumed "oods to serve as vehicle or carrier "or certain minerals or nutrients. Salt ,odiFation to prevent ,DD in #an ladesh is a success"ul pro ram in reducin ,DD. )ddition o" >itamin ), ,ron etc to oil, "lour, su ar, "ruit Iuice etc ma% 3e considered. $5!+!'' %ainstreaming Gender into Nutrition Programming /ender and nutrition are closel% associated in #an ladesh, and there are stron lin&a es 3et$een a $oman;s status and 3oth her health and her children;s nutritional outcomes. !here"ore, 3oth the health "acilit% and the communit%13ased nutrition interventions $ill involve all communit% and household mem3ers $ho are responsi3le "or decision ma&in and those $ho can in"luence maternal, in"ant and %oun child "eedin practices as $ell as other nutrition 3ehaviors. Such an approach $ill ensure that the concerns o" men and $omen, $hen it comes to household "ood and nutrition securit%, are considered as the Ioint responsi3ilities "or the nutritional $ell13ein o" all household mem3ers o" men, $omen and the communit% as a $hole, $ith an emphasis on nutritional status o" adolescent irls in the countr%. $5!+!'"! ,nstitutional Development ,nstitutional +apacit% Development $ill entail identi"%in and selectin core institutions and provide support "or institutional capacit% development, viF. curriculum revie$ and9or update to include nutrition "or 'ed +oll, ')!S, Nursin , ,S!, etc., stren thenin lin&a es 3et$een tertiar% "acilities and outreach services, stren thenin ,PHN and relevant a ricultural institutions, colla3oration $ith other ministries, and support to ,PH "or "ood sa"et% 2 Cualit% (includin la3orator%) activities. )ttitude and perception in developin countries a3out "ood and nutrition pro3lems have chan ed over the %ears. 'alnutrition is not health pro3lem 3ut reco niFed as a development pro3lem, $hich can 3e overcome 3% the inclusion o" nutrition o3Iectives in national development plan. ,mprovin nutrition via national development pro ram $ill need "or directin adeCuate attention to e""ective plannin , implementation and pro rammin as $ell as the creation o" appropriate or aniFation, support "acilities and services at all levels o" administration. !he main concern o" mana ement o" nutrition pro ram $ill 3e to direct di""erent activities in order to maBimiFe contri3ution to improvement o" nutrition usin availa3le resources, personnel and "und.

3:

!he .ine Director, NNS must reco niFe the various components, tas&s, and resources needed "or accomplishin tas&s and "or achievin o3Iectives set "or speci"ied implementation period. ,n desi natin speci"ic person to underta&e various activities, eBpertise to per"orm assi ned tas&s should 3e considered. +learl% de"ined tas&s, operatin procedures, adeCuate trainin o" $or&ers and availa3ilit% o" tools and eCuipments are to 3e "acilitated to accomplish the assi ned tas&s. ,nternal coordination in 3et$een di""erent unit is important. )n implementation plan $ill 3e prepared "or smooth implementation o" activities $ithin the "iscal period. +oordination o" other pro ram and sectors is essential "or multi sectoral pro ram li&e nutrition. Political commitment stresses the need to inte rate nutrition issue in the national and local level development plans. ?rientation and trainin on "ood and nutrition $ill 3e iven to political leaders, reli ious leaders, polic% ma&ers, "ield level service providers o" Health, ) riculture, .ivestoc&, +ooperatives etc. >olunteers and private sectors $ill also need some tas& oriented and practical trainin . '5!+!':! .omplementar( feeding (Pushti Packet* to address %+% !he NNS $ill eBplore options to develop and provide supplementar% "ood ( pushti packet) throu h evidence and research in respect to its "orm, content, recipe and distri3ution modalit% to e""icientl% address +')' amon children and pre nant $omen. !he tar et roup "or supplementar% "eedin $ill include undernourished children and $omen in vulnera3le areas or communities particularl% durin the lean seasons. !he services $ill 3e carried out 3% communit% volunteers under the supervision o" respective +H+Ps in phases. ,n each phase, 25= o" the upaFilas $ill 3e covered. !he pushti packets $ill 3e prepared 3% outsourcin .

9he follo6ing table summari2es the Ae( NNS activities 6ith responsibilities at different level of services in the health sector program:
)esponsibilit(-Service deliver( and supervision-monitoring +ctivit( /ro$th 'onitorin and Promotion (/'P) District level (DH-%./.* Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and supervision: CS/DDFP Technical Support 1pa2ila Health .omple3 Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support 1nion Heath 4acilit( Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support .ommunit( .linics -.ommunit( Delivery: LD!CC Supervision: .D1 ++ TS & Logistics: .D1NNS Delivery: LD!CC Supervision: .D1 ++ TS & Logistics: .D1NNS Delivery: LD!CC Supervision: .D1 ++ TS & Logistics:

'aternal nutrition and ,J+( Services

#++

31

)esponsibilit(-Service deliver( and supervision-monitoring +ctivit( District level (DH-%./.* & Logistics: .D1 NNS >itamin ) supplementation o" children 415< months Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and 1pa2ila Health .omple3 & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UF Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and 1nion Heath 4acilit( & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UF Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UF Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and .ommunit( .linics -.ommunit( .D1NNS Delivery: LD!CC Supervision: .D1 ++ TS & Logistics: .D1NNS Delivery: LD!CC Supervision: .D1 ++ TS & Logistics: .D1NNS Delivery: LD!CC Supervision: .D1 ++ TS & Logistics: .D1NNS Delivery: LD!CC Supervision: .D1 ++ TS & Logistics: .D1NNS Delivery: LD!CC Supervision: .D1 ++ TS & Logistics: .D1NNS Delivery: LD!CC Supervision: .D1 ++ TS & Logistics: .D1NNS Delivery: .D1++ Supervision: .D1 ++ Logistics: .D1NNS Delivery: LD!CC Supervision: .D1 ++ TS & Logistics: .D1NNS Delivery: LD!CC Supervision: .D1 ++ TS & Logistics: .D1NNS Delivery: .D1H,S,

,ron1(olic )cid supplementation "or pre nant and lactatin $omen, and adolescent irls Prevention and control o" anemia in children under 5

De$ormin o" children (115 %rs) and adolescent irls

?ther 'icronutrients supplementation o" pu3lic health importance (Nn,+a etc.) 'ana ement o" severe and moderate acute malnutrition ("acilit% and communit%) Promotion o" use o" ,odiFed salt

Nutrition durin -mer encies

!rainin and +apacit% #uildin

'2-9Nutrition

32

)esponsibilit(-Service deliver( and supervision-monitoring +ctivit( Surveillance District level (DH-%./.* supervision: CS/DDFP Technical Support & Logistics: .D1 NNS Delivery and supervision: CS/DDFP Technical Support & Logistics: .D1 NNS 1pa2ila Health .omple3 supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS 1nion Heath 4acilit( supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS Delivery and supervision: UHFP /UFP Technical Support & Logistics: .D1 NNS .ommunit( .linics -.ommunit( .D1NNS Supervision: .D1 H,S, .D1NNS Logistics: .D1H,S, .D1NNS Delivery: LD!CC Supervision: .D1 ++ TS & Logistics: .D1NNS

'ainstreamin /ender

33

$5 (&* Priorit( activities of the OP

Sl. No. 1 2 3 % 5 6 ( , 0 1/ 11 12 13 1% 15 16 1( 1, 10 2/ *ehavio"r Change Comm"nication (*CC) 5"man reso"rce deve$o#ment (5.') Contro$ of 9itamin<A deficienc- disorder Contro$ D #revention of Anaemia Contro$ of +odine deficienc- 'isorder Other icron"trient #rob$ems of P"b$ic 5ea$th im#ortance ( 4inc; vitamin G';H ca$ci"m etcB) Comm"nit- D faci$it- based management of severe ac"te ma$n"trition (!A D C A ) +nstit"tiona$ Ca#acit- 'eve$o#ment a) Orientation & Advocac- of 'ivision; 'istrict; 3#a4i$a managersB Protection; Promotion D !"##ort of *reastfeeding& +nfant and Ao"ng Chi$d Feeding (+ACF) inc$"ding *F5+ D * ! Code =echnica$ !"##ort on Food fortification (!a$t +odi4ation; fortification of oi$&other food )ith 9itamin GAH; iron etcB) !choo$ 1"tritiona$ Ed"cation Program Food I"a$it- and Food !afetonitoring; Eva$"ation; O#erations .esearch; !"rve1"trition !"rvei$$ance Program Estab$ishment of n"trition "nit (13) and strengthening of e6isting 13 Comm"nit- based 1"trition (C*1) in se$ected area "$ti sectora$ co$$aboration 1"trition in emergenc- & 1C' 1"trition re$ated chronic diseases Estab$ishment of n"trition !ervice in CC D 8 P Name of the components

$$! )elevant )esults 4rame6orA ,ndicators ()4/* and OP 0evel ,ndicators

$$!$ )elevant )4/-P,P ,ndicators !he activities under this ?P contri3ute to ensurin the Cualit% and eCuita3le health, population 2 nutrition care "or all citiFens o" #an ladesh. !he% $ill help to achieve 0esult 1.1, increased utiliFation o" essential HPN services@ 0esult 1.3 improved a$areness o" health% 3ehavior, and 0esult 1.4, and improved PH+1++.

In!icators(s"

Pro$ecte! Target

34

;nit of Meas,rement .0< In!icators Preva$ence of "nder)eight among chi$dren "nder 5 -ears of age Preva$ence of st"nting among chi$dren "nder 5 -ears of age E of chi$dren (6<50 months ) receiving 9itamin A s"##$ementation in the $ast 6 months .ate of e6c$"sive breastfeeding in infants "# to 6 months E of chi$dren 6<23 months fed )ith a##ro#riate infant and -o"ng chi$d feeding (+ACF) #ractices PIP In!icators 1"mber of 9itamin A Ca#s"$e distrib"tion among 6<50 months chi$dren 1"mber of CC )or?ers trained in n"trition services de$iverPercentage of 35Cs having a f"nctiona$ 1"trition Corner estab$ished 1"mber of 5ea$th service #roviders trained in n"trition services de$iverE of =ertiar- 5os#; '5s; C@C; 35Cs; 35F@C; 3nion 5ea$th !"b<Center having a f"nctiona$ 1"trition "nitB Observance of 1ationa$ *reastfeeding )ee?; Cam#aign #romoting breastfeeding cond"cted d"ring 1ationa$ *F )ee? E6c$"sive *reast Feeding (E*F) for 6 months Com#$ementar- Feeding (CF) for 6 months 1"mber of schoo$&madrasa teachers received orientation on 1"trition ed"cation 1"mber&batches of media #ersonne$ oriented on 1"trition iss"es (for dissemination) anagement of !A D A Percentage Percentage Percentage Percentage Percentage Percentage 1"mber of #eo#$e Percentage 1"mber of #eo#$e Percentage Percentage Percentage Percentage 1"mber of #eo#$e 1"mber of #eo#$e Percentage

+aseline 9ith so,rce %1B/E *'5! 2//( %3B2E *'5! 2//( ,,B3 E *'5! 2//( %3E *'5! 2//( %1B5 E *'5! 2//( 0/ E K 1A 21 1A 1A 5/ E "nit of '85!; '8FP D 3rban hea$th %3E %2 E 1A 1A 1A

(Mi!2/1( " < < < < < 0/ E K 2(;/// (6/ E) 12/ (6/E) 6;/// 6/ E (5 E "nit of '85!; '8FP D 3rban hea$th %6 E %6 E %/ E 6/ E 6/ E of tertiar-; 'istrict; certain 3: hos#ita$ Chi$dren M5A2 32E; Ado$escent gir$< 23E Pregnant )omen<35E

(Mi!2/1(%" 33E 3,E 0/E 5/E 52E 0/ E K %/;5// (1//E) 2// (1//E) 1/;/// 0/ E 0/ E "nit of '85!; '8FP D 3rban hea$th L5/ E L5/ E L5/ E ,/ E 6/ E of tertiar-; 'istrict; certain 3: $eve$ hos#ita$ .ed"ction in the #reva$ence of anaemia in M 5 A chi$dren; ado$escents and in #regnant )omen (/ E 6/E CC staffed )ith trained 5A; F@A; C5CPs on n"trition servicesB

.ed"ction in the #reva$ence of anaemia in M 5 -ears chi$dren; ado$escents and in #regnant )omen

Percentage

=raining of 5+&A5+ on +'' *AA. In!icator 1"trition im#$ementation committee headed b'85! estab$ished and meetings he$d to monitor n"trition activities in the concerned 7's

1"mber of #eo#$e

Chi$dren M5 A2 %,E; Ado$escent gir$2 3/E Pregnant )omen<%6E (1ationa$ Anemia s"rve2//1<3) 1A 1A

5/ E 2 meeting& -ear

35

$$!' OP level indicators (Output-Process*

Sl. 1 2 In!icators Coverage of 9itamin A Ca#s"$e administration among 6<50 months chi$dren 1"mber of CC )or?ers trained in n"trition services de$iver1"mber of Os trained in n"trition services de$iverPercentage of 35Cs having a f"nctiona$ 1"trition Corner estab$ished Observance of 1ationa$ *reastfeeding )ee? (Cam#aign #romoting breastfeeding cond"cted d"ring 1ationa$ *F )ee?) 1"mber of schoo$&madrasa )ith teachers receiving orientation on 1"trition ed"cation anagement of !A b- estab$ishing !A management s-stem =raining of 5+&A5+ on +'' E of #regnant )omen at the comm"nitc$inics co"nse$ed on e6c$"sive breast feeding "# to 6 month fo$$o)ed ba##ro#riate com#$ementar- feeding at 6 month E of comm"nit- c$inics having stoc? of a) vitamin A ca#s"$es and b) iron fo$ate tab$ets ;nit of Meas,rement Percentage 1"mber of #eo#$e 1"mber of #eo#$e Percentage i$estone +aseline 9ith so,rce 0/ E (CE!) 1A (11! =raining .e#ort&Adminst rative .ecord) / 5E Aes; b- '85! Pro$ecte! Target id< 2/1% id 2/16 0/ E K 0/ E K 2(;/// (6/ E) %,2 6/E Aes; a$$ sta?eho$ders "nder o5F@ 1/E 3/E of tertiarand district hos#ita$s; se$ected 35C 5/E 5/E %/;5// (1//E) 06% 1//E Aes; o5F@ and other sta?eho$ders across re$evant ministries 5/E 6/E of tertiar-; 'istrict; certain 3: $eve$ hos#ita$ 0/E 0/E

3 % 5

6 (

1"mber of #eo#$e i$estone

1A 1A

, 11

1"mber of #eo#$e Percentage

1A /E (2/11; Comm"nitC$inic ProgramHs onitoring .e#ort) /E (2/11; Comm"nitC$inic ProgramHs onitoring .e#ort) /E (5+!) 1A

12

Percentage

%/E

(/E

13 0

E of "#a4i$as #roviding month$- #rogress re#ort on n"trition services according to data >"a$it- assessment #rotoco$ 1"trition im#$ementation committee headed b- '85! estab$ished and meetings he$d to monitor n"trition activities in the concerned 7's ('AA. +ndicator)

Percentage i$estone

1//E 2 meeting& -ear

1//E 6/E CC staffed )ith trained 5A; F@A; C5CPs on n"trition servicesB

$$!" Source and methodolog( of data collection !hrou h routine ',S (service data), surve%, and nutrition surveillance, reCuired in"ormation $ill 3e collected. )nnual pro ress report $ill 3e prepared and pu3lished 3ased the collected data and in"ormation throu h surve% and re ular nutrition surveillance.

34

$'! =stimated budget

(/.( =stimated summar( of development budget:

Project Aid 1ame of the Com#onents Economic Code 8O* .PA =hro"gh 8O* 1 a) .even"e com#onent !a$ar- of officers !a$ar- of staff A$$o)ancesJ !"##$- D services .e#air D aintenance !"btota$ (.even"e com#onent) b)Ca#ita$ com#onent Ac>"isition D P"rchase of Assets .ef"rbishment )or?s C'&9A= !"btota$( ca#ita$ com#onent) -ran! total 6,// (/// (0// 656B3, 1///B// (02B// 2%%,B3, /6#/6.11 1535B3% /B// /B// 1535B3% 6#1##.36 /B// /B// /B// /B// 1.11 ,//B// /B// /B// ,//B// 3# /% 2001B(2 1///B// (02B// %(,3B(2 ( 5115.36 3B2, 1// %5// %6// %(// %,// %0// 66B// 1%/B// 355B5/ 253,,B62 120B5/ 26/(0B62 /B// /B// 1,/B// ,23,3B5% 056B5/ ,352/B/% /B// /B// /B// /B// /B// /B// /B// /B// /B// 3%626B// /B// 3%626B// 66B// 1%/B// 535B5/ 1%230,B16 1/,6B// 1%%225B66 06B(2 2 3 % 'PA Others 5 6 ( , =ota$ E of the tota$ cost

J=hese a$$o)ances com#rise costs associated )ith training; trave$; etcB; )hich fa$$ o"tside the sa$ar- and festiva$ a$$o)ances

35

(/. / &stimate! *etaile! +,!get (Inp,t <ise"

36

3<

4:

41

42

43

44

45

44

45

46

4<

(3. =ear 9ise physical an! financial target !,ring OP perio!

5:

No. of Co mp. (

Total Physical an! financial target Name of S,b2components Physical >ty8 ,nit 3 Total cost <eight # 0inancial

0= /1((2/1(/ Physical ? of item ' ? of Pro$ect 6 0inancial

0= /1(/2/1(3 Physical ? of item (1 ? of Pro$ect (( 0inancial (/

0= /1(32/1( Physical ? of item (3 ? of Pro$ect ( 0inancial

0= /1( 2/1(% Physical ? of item (% ? of Pro$ect ('

/ +ehavior Change Comm,nication (+CC": (*CC materia$ for n"trition; hea$th- eating&feeding for a$$ age gro"# )o"$d be deve$o#ed and incor#orated thro"gh mass media and other different channe$sB *CC <Pac?age for #o$icma?er; managers&im#$ementers; service #rovider; beneficiar-) @,man reso,rce !evelopment (@.*":(Pre#aration of ca#acitb"i$ding g"ide$ine; training mod"$e in re$evant cases; formation of master and core trainer team; training of re$evant service #roviders at home D abroad) Control of Aitamin2A !eficiency !isor!er: (A)areness creation abo"t food based a##roach; training of service #rovider; s"##$ementation in ro"tine service D in 1+' among t)o(2) crore chi$dren) Control B prevention of Anemia: (A)areness creation abo"t food based a##roach; training of service #rovider; s"##$ementation to #regnant )omen; $actating mother; chi$dren; ado$escent) Control of Io!ine !eficiency *isor!er: (A)areness creation abo"t food so"rce D cons"m#tion of +odi4ed sa$t; training of service #rovider) Other Micron,trient problems of P,blic @ealth importance (Cinc: vitamin D*:E calci,m etc.": (A)areness creation abo"t food based a##roach; training of service #rovider; s"##$ementation to v"$nerab$e gro"#) Comm,nity B facility base! management of severe B Mo!erate ac,te maln,trition (SAM8MAM": ('eve$o#ment of g"ide$ine; training mod"$e; man#o)er trained for !A D A management at a$$ faci$ities and comm"nit-) Instit,tional Capacity *evelopment (incl,!ing Pay B Allo9ances": (Organogram deve$o#ment; de#$o-ment of s?i$$ man#o)er; training of de#$o-ed man#o)er in both technica$ D manageria$ as#ect; estab$ishment of n"trition "nit at tertiar-; district and 3#a4i$a $eve$B) Infant an! =o,ng Chil! 0ee!ing

(#

1ation)ide (7!)

(///

/B/5

12//

11B0(E

/B56E

1(//

%B/0E

/B10E

1(//

%B/1E

/B10E

2%//

%B36E

/B2/E

1ation)ide (7!)

,03/

/B/6

1///

0B0(E

/B6/E

2%/,B/6

5B(0E

/B35E

2521B0%

5B05E

/B36E

3///

5B%5E

/B33E

1ation)ide (7!)

13(//

/B/0

1%%%B66

1%B%1E

1B32E

3/(5

(B%/E

/B6,E

3/(5

(B25E

/B6(E

61/5B3%

11B1/E

1B/2E

1ation)ide (7!)

(,//

/B/5

%6,

%B6(E

/B2%E

2(12B15

6B52E

/B3%E

2610B,5

6B1,E

/B32E

2///

3B6%E

/B10E

1ation)ide (7!)

202/

/B/2

1(5B2

1B(5E

/B/3E

,%%B/(

2B/3E

/B/%E

,31B/1

1B06E

/B/%E

1/60B(2

1B0%E

/B/%E

1ation)ide (7!)

1(//

/B/1

165

1B65E

/B/2E

305

/B05E

/B/1E

305

/B03E

/B/1E

(%5

1B35E

/B/2E

1ation)ide (7!)

%5//

/B/3

3%,

3B%(E

/B1/E

1/3,

2B5/E

/B/,E

1/3,

2B%5E

/B/(E

2/(6

3B((E

/B11E

3B05E %( Persons 7&!

,65,

/B/6

510B%,

5B1,E

/B3/E

31/2B(2

(B%6E

/B%3E

2,6%B/1

6B(5E

/B30E

21(1B(0

51

/B23E

0orm,la:
EstB cost of each res#ective item @eight of each item N <<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< =ota$ cost of a$$ #h-sica$ item

I"antit-& n"mber targeted in each -ear Ph-sica$ #ercentage of itemN<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< =ota$ >"antit-&n"mber of res#ective item for )ho$e OP

O 1//

Ph-sica$ #ercentage of tota$ OPN @eight of each item 6 E of itemB

52

( . 7ocation29ise brea)2,p of the component (Attache! AnneF,re"

(=a?a in $a?h)

Name of the components A$$ com#onents a) *ehavio"r Change Comm"nication (*CC) b) 5"man reso"rce deve$o#ment (5.') c) Contro$ of 9itamin A deficienc- disorder d) Contro$ D #revention of Aneamia inc$"ding de)orming e) Contro$ of +odine deficienc- 'isorder f) Other icron"trient #rob$ems of P"b$ic 5ea$th im#ortance (4inc; vitamin G';H ca$ci"m etcB) g) Comm"nit- D faci$it- based management of severe ac"te ma$n"trition (!A ) h) +nstit"tiona$ Ca#acit- 'eve$o#ment i) Protection; Promotion D !"##ort of *reastfeeding& +nfant and Ao"ng Chi$d Feeding (+ACF) inc$"ding *F5+ D * ! Code j) Food fortification (!a$t +odi4ation; fortification of oi$&other food )ith 9itamin GAH; iron etcB) ?) !choo$ 1"tritiona$ ed"cation Program $) Food I"a$it- and Food !afetm) onitoring; Eva$"ation ;O#erations .esearch; !"rven) 1"trition !"rvei$$ance Program o) Estab$ishment of n"trition "nit (13) and strengthening of e6isting 13 #) Comm"nit- 1"trition (C*1) Com#onent (3rban D ."ra$) >) Cons"$tanc- !ervice r) "$ti sectora$ co$$aboration s) 1"trition in emergenc- & 1C' t) Estab$ishment of n"trition !ervice and 8 P in CC

National 1ationa$ P P P P P P

&stimate! cost 20,/1

Name of *ivision ( 'ivB a$$ Q Q Q Q Q a$$

&stimate! cost 15/0

Name of *istrict 6% 'istB a$$ Q Q Q Q Q a$$ Q Q Q Q Q Q Q a$$ a$$ Q Q

&stimate! cost 13(06

Name of ;paCilla %,2 3#a4i$$a a$$ Q Q Q Q Q a$$ Q Q Q Q Q Q Q a$$ a$$ Q Q

&stimate! cost 1/30/3B3, 2/2// 1(53/ 23(// (,// 202/ 2/// 5,// ,65, 3011

P P P P P P P

Q Q Q Q Q Q Q a$$ a$$

2%// (516 22// 3/// %1// (5%, 112/3 115% 2/12 115%B3, 2/12

P P

Q Q

53

$;! Organogram of National Nutrition Services (NNS*: +ttached as +nne3ure ,

$<! 0og 4rame: +ttached as +nne3ure ,,

$>! +nnual Procurement Plan for Goods, /orAs, Services (Separate table for a! Goods, b! /orAs, c! Services*: +ttached as +nne3ure? ,,, a, b, c

$ ! 0ist of %achiner(, =Buipment, +ttached as +nne3ure?,7

$#! 4urniture?4i3ture C 7ehicle: +ttached as +nne3ure? 7

'5! 7ehicle: +ttached as +nne3ure?7,

54

'$! 0ist of 9raining and =stimated .ost (!rainin Plan)

!a&a in .a&hs Sl. No. 1B 2B 3B %B 5B 6B S,b$ect Orientation for master trainer =raining of trainers (=O=) *asic training for fie$d service #roviders anagement training for #rogram managers Orientation for committees =raining for ca#acitdeve$o#ment Orientation training for #rofessiona$s Coint training @or?sho#& seminar Participants +P51 #ersonne$; doctors of medica$ co$$ege; 'Ps; ministr- #ersonne$B 'istrict<C!; OC!; doctors of district hos#ita$; '' (FP);A'CC; O (c$inic); O ( C) O ( C); 3#a4i$$a< =5DFPO; . O; O (1"trition) 5A; F@A; C5CP !"#ervisor gro"#< (i) 5+; A5+; FP+; F@9; !nF@9 (ii) O; A; !AC O 7';P ; 'P of 11! embers of comm"nit- c$inic management committee and members of "#a4i$$a deve$o#ment committee&3#a4i$a hea$th committee aB Com#"ter training R #ersonne$ of +P51 bB Proc"rement R #ersonne$ of +P51 cB Financia$ anagement < #ersonne$ of +P51 dB 'ata anagement < #ersonne$ of +P51 Pediatrician; 8-neco$ogist; 1"rses; =eachers; (2 from each edica$ co$$ege& 'istrict hos#ita$&"#a4i$a& schoo$) ''; A' of '8A; '87!; '8F; '8FP; '85!; '8Ed; '8 'isaster; '8 Food Fie$d )or?ers of '8A; '87!; '8F; '8FP; '85!; '8Ed; '8 'isaster; '8 Food Personne$ from different ministr-& de#artments& division Personne$ re$ated to 11!&doctors&n"rses& n"tritionist 'o Personne$ of +P51& 11! & ministr-& P$anning Commission& directorate& fie$d officers& E.' %/ 6%/ 1%52 655// 3/ 1%//// 1%52/ 1/ No. of trainee 2 26 50 262/ 1 5/// %,% < +atch *,ration 5 da-s /( da-s 3 da-s 1 da-s 1 da-s 2, da-s 1 da21 da-s 7evel Centra$ Centra$ 3#a4i$$a Centra$ 3#a4i$$a Centra$ &st. cost 1/ 3// %/// 5 1/// 1/

(B ,B 0B

15// 3/ 1%5// 1/// 25 3/ 1//

6/ 1 %,% 2/

2 da-s 2 da-s 2 'a-s 1 da1<% 3<6 m (<1% da-s

Centra$ 'istrict Cetra$ 3#a4i$a Centra$

12/ 1/// 5// 5,5

1/B Overseas st"d-&training2 7ong co"rse (Ph' S 3; master 22) !hort co"rse (di#$oma) E6#erience sharing for #o$icma?er and im#$ementers&!t"dto"r internationa$ conference&&seminar&)or?sho# 11B =raining for internee doctors 12B Total

1/

+nternee doctor

125//

5/

3 da-s

Centra$

1/// 6#31

55

''! )elated Supporting Documents (if an()8 +nne3ure 7,,,?+: )ction Plan "or 'ainstreamin Nutrition services +nne3ure 7,,,?&: +omponents and estimated cost summar% +nne3ure 7,,,?.: ,mplementation o" speci"ic nutrition interventions +nne3ure 7,,,?D: -stimated Detailed #ud et (,nput *ise) +nne3ure 7,,,?=: Sta&eholder mappin "or nutrition interventions in #an ladesh '"! Name C Designation of officers responsible for the preparation of this OP: a. Pro"essor Dr. (atima Parveen +ho$dhur%, Director, ,PHN 3. Dr. )shra" Hossain Sar&ar, Ounior +linician, ,PHN c. Dr. !ahmina Hossain !alu&der, )ssistant Director, NNP d. Dr. S' 'usta"iFur 0ahman, 'em3er, PP+ e. )3dur 0aFFa& 'ollah, )ssistant Director ()ccounts), NNP PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP Pro"essor Dr. (atima Parveen +ho$dhur% Director, ,nstitute o" Pu3lic Health Nutrition ':! )ecommendation and Signature of the Head of the ,mplementing +genc( 6ith seal C date:

DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD Director /eneral o" Health Services Directorate /eneral o" Health Services 'inistr% o" Health and (amil% *el"are ';! )ecommendation of the Signature of the Secretar( of the sponsoring %inistr( 6ith seal C date:

TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT

Secretar% 'inistr% o" Health and (amil% *el"are

54

Organogram for NNS

7ine *irector (7*" *ir.IP@N

(+nne3ure ,*

P% ? $ Deput( Director ,PHN

P% ? '

'ultisectoral
(Deputation*

P% ? " ( Deputed from DG4P*

*PM2( (A* IP@N" +ACF<!A Food fortification

*PM 2/ (Clinical N,tritionist :IP@N" Micron,trients

*PM 23 GApplie! N,tritionist: IP@N H +CC

*PM2 G*ivision Chief 7A+:IP@NH 0inance

*PM 2# G*ivision Chief 0iel!: IP@NH MB&

DP%?<
(Deputation* ,ntrasectoral

DP%?>
(Deputation* %ultisectoral E

*PM26
(Deputation*

*PM25
(Deputation*

*PM2(1
(Deputation*

55

ANN&I;.&2II

7ogical 0rame
Narrative summar) GOA!4 Nutritional status of ,omen and children improved in Bangladesh Ob3ectivel) verifiable ndicators 67 Reduced prevalence of under,eight children from 869 to :89 !y ;<6= ;7 Reduced prevalence of stunted children from 8:7;9 to :> 9 !y ;<6= :7 Reduced incidence of lo, !irth ,eight to 6;9 !y ;<6= 87 Prevalence of aneamia among pregnant ,omen0 adolescent girl and children reduced !y 6?:rd @7 Prevalence of night !lindness among children A@ sustained A69 =7 Prevalence of iodine deficiency Burinary iodine e%cretion A:<Cg?dlD reduced !y 6?: P"RPO#$4 Sustaina!le improvements 6D =<9 of all children are e%clusively !reastfed in !irth ,eight and nutritional status of ;D Appropriate complementary feeding initiated for =@9 of all infants !y = ,omen and children achieved !y months of age and maintain until age ; years !ehavior change through community :D E@9 of pregnant ,omen report more food inta#e during pregnancy participation and pu!lic private 8D @<9 of pregnant ,omen have had three or more antenatal contact partnership7 O"TP"T#4 67 $ain streaming nutrition and community !ased nutrition services implemented in all upa(ilas 676 Social mo!ili(ation and infrastructure development achieved 67; Nutrition services addressing caring practices implemented 67676D ><9 of community committees annually reporting at least t,o management !y e%ception actions7 6767;D F<9 of o!served health ,or#er provide counseling during ,eighing and feeding session and conducting home visit as appropriate 6767:D F<9 of supervisors present at ,eighing session 67678D 6<<9 of ,omen group providing supplementary food as per center need 6767@D ><9 of unmarried adolescent girls in community participating in monthly forum 67;76D )$P coverage ,ould !e at least ><9 of the country 67;7;D F@9 of !irth ,eight recorded ,ith E; hours and F@9 of infants identified as 1B" receive special care 67;7:D F<9 of mother in feeding responding that food inta#e should increase during pregnancy and that the food should !e additional to regular diet 67;78D F<9 of health ,or#er deliver #ey messages on e%clusive !reast feeding up to = month follo,ed !y appropriate complementary feeding at = month ;7676D An effective system to monitor B HI status of hospital?health facilities and adherence to B$S code ;767;D 1egal action ta#en against ><9 of B$S code violation identified through monitoring ;767:D *NSAID?"H'? *nicef guideline on !reastfeeding and HI- adapted and disseminated 1eans of verification Nutrition surveillance0 BDHS Special study IDD survey Night Blindness survey BDHS Anemea Survey Nutrition surveillance 4uarterly 'P report Program monitoring Performance !udget0 procurement and dis!ursement plan $onthly?quarterly?ann ual progress revie, Periodic participatory Bclient and providerD program constraints assessment mportant Assumption Improved nutritional status ,ill ultimately contri!ute improving productivity0 !etter health and educational performance

+nsured sustaina!le support from $'H " and DPs Pregnancy ,eight gain ,ill !e improved Incidence of 1B" ,ill !e reduced Ne, !ehavior ,ill !e practiced Interest of the communities ,ill !e gro,n up and share program responsi!ility Nutritional change ,ill !e sustaina!le Institutional arrangement ,ill !e effective &rained staff ,ill !e utili(ed properly Supportive supervision ensured Coordination ,ith community people and other local government agencies esta!lished

;7 National level nutrition services ;767I.C ;7;7 Availa!ility of vitamin A capsul and iron folate ta!let ensured

$onthly performance report Nutrition surveillance

HPN service providers at all level health facilities ,ill !e trained on I.C *se of infant formula ,ill !e reduced

Performance !udget0

56

according to national guideline ;7:7 Iodine fortification of non2 commercial salt support ;787 $icronutrient fortification of edi!le oil7 "heat flour and other appropriate foods ;7@7 ood quality and safety

:7 /ey nutrition related !ehavior change messages understood and correctly recalled !y target audiences

87 An effective program management system in place 8767IPHN ,ill !e strengthen ,ith clear responsi!ility0 adequate authority and high cali!er staffing 87;7 +ffective lin#age of nutrition service delivery and management system ,ith those of HPNSSP and other ministries 87:7 Capacities of communities and local govt7 units for management of area2!ased community nutrition services strengthen @7 NNS activities and strategies further develop and adapted on the !asis of a learning process0 integrated management information0 operations research and evaluations @767 NNS monitored !y a performance improvement oriented $IS system @7;7 Independent monitoring performed special assessment? studies0 nutritional surveillance

;7;76D-itamin A capsules procured and distri!uted in adequate amount for t,ice annual preventive supplementation and therapeutic use for children and postnatal supplementation ;7;7;D Iron2folate ta!lets procured and distri!uted in adequate amounts for IDA prophyla%is among pregnant and lactating ,omen ;7:76D ><9 of salt mills using improved drying technology ;7:7;D ><9 of iodi(ed facilities monitored ;7876D $'H " guideline and draft legislation allo,ing fortification according to $'H " guideline prepared ;7@76D ><9 of population a,are of unsafe food ;7@7;D A,areness developed among ><9 of food producer0 processor and food handler7 ;7@7:D IPHN la!oratory capacity improved :76D =<9 of infants are e%clusively !reastfed for first = months :7;D Appropriate complement initiated for =@9 of all infants !y = months of age and maintained until age ; years :7:D E@9 of pregnant ,omen report more food inta#e during pregnancy :78D @<9 of pregnant ,omen have had three or more antenatal contact :7@D Hygienic !ehavior focusing on prevention of diarrhea and ,orm infestation practiced !y @<9 of target group :7=D F<9 of children are fully immuni(ed :7ED GF<9 of children aged 6;2@F months have received vitamin A cap :7>D F<9 of ne,ly delivered ,omen received -itamin A cap :7FD ><9 of severely malnourished children ,ith complication and failing to respond referred to appropriate place :76<D ><9 of referred cases properly managed as per protocol 87676D 6<<9 e%isting manpo,er of NNP along ,ith IPHN transferred to NNS as per organogram 8767;D ><9 procurement made ,ithin first year of program starting 8767:D Satisfactory performance per S'P on annual audit 87;76D ><9 of severely malnourished children ,ith complication and failing to respond referred to appropriate place 87;7;D ><9 of referred cases properly managed as per protocol 87:76D @<9 of communities monitor the coverage and quality of CBN services in their areas 87:7;D ><9 of management committees oriented on management !y e%ception @7676D An $IS system meeting defined monitoring?feed!ac# and decision ma#ing requirements of program clients0 communities and program manager at central and field level developed and fully operational @767;D 6<<9 upa(ilas assessed monthly? quarterly according to data quality assessment protocol @7;76D Independent nutritional surveillance functioning @7;7;D ><9 of local level decision ma#ing informed !y data @7:76D ><9 of identified 'R pro5ects completed on time @7876D $id2term and end of program surveys complete ,ith comprehensive evaluation report

procurement and dis!ursement plan Periodic ood inspection report

Increase a,areness of food safety ,ill lead to reduction in food contamination and reduce food !orne illness

$onthly performance report Nutrition surveillance Survey

Improved nutrition status of children increases childrenHs active learning capacity Improved maternal nutrition ,ill ensure !irth of a healthy child Reduced child mortality and mor!idity

Program monitoring $onthly?quarterly?ann ual progress revie, Periodic participatory Bclient and providerD program constraints assessment

&echnical people and system in place

Information generated !y program learning activities and $IS ,ill !e used for planning and management

5<

@7:7 'perations research conducted to strengthen NNS operations @787 Impact of NNS interventions evaluated =7 Sectoral human resources developed to meet NNS program requirements NP"T#5A&T % T $# nput5 ActivitiesBComponent ,iseD aD NNS mainstreaming and program management

6<<9 of nutrition managers0 community level health0 P and nutrition service providers trained as per training plan 2 IPHN ,ill !e strengthen ,ith clear responsi!ility0 adequate authority and appropriate staffing 2 +sta!lish effective lin#age of nutrition service delivery ,ith HPNSDP and other ministries 2 6<<9 e%isting manpo,er of NNP along ,ith IPHN transferred to NNS as per organogram 2 ><9 procurement made ,ithin first year of program starting 2 Satisfactory performance per S'P on annual audit done 2 Nutrition education for mothers0 adolescent girls0 ne,ly ,ed ,omen 2 Individual counseling for concerning child gro,th 3 development0 child care0 immuni(ation etc7 2 Pregnant ,omen counseling for self care0 ,ell2!eing and healthy factors0 food etc7 2 Pushti pac#et distri!ution to targeted population 2 BCC for nutrition education 2 Introduce gro,th monitoring to all health service facilities including community clinic 2 Introduce monthly gro,th monitoring for children up to ; yrs of age 2 ><9 of management committees oriented on NNS management 2 Procurement of -AC and ensure distri!ution through clinics and health services B+PID 2 BCC for -AC Supplementation 2 Iron2folate ta!lets procured and distri!uted in adequate amounts for IDA prophyla%is among pregnant and lactating ,omen 2 +nsure distri!ution and use of iron2folate ta!lets 2 BCC for use of iron2folate ta!lets to prevent anemia 2 +nsure supply of anti2helminthes ta!let to all clinics0 community clinics and satellite clinics BCC for -AC de2,orming 2 Referral for SA$ and other illness of children and pregnant ,omen ANC0 PNC 2 Supervision of salt mills to ensure appropriate use of potassium2iodate BCC for use of iodi(ed salt to prevent !oth visi!le and invisi!le BpalpateD goiter 2 Prepare plan for other micro2nutrient supplementation in coordination ,ith $inistry of Industry 2 Initiate micronutrient fortification of edi!le oil0 ,heat0 flour and other appropriate foods $onthly performance report Procurement and dis!ursement plan 'rganogram Io! aids

&rained staff ,ill !e utili(ed properly and ensure effective implementation of the program Nutrition services successfully mainstreamed Support received from Health0 amily Planning and Community clinics for nutrition services

!D )ro,th $onitoring and Promotion B)$PD cD -itamin A supplementation of children =2@F months dD Iron2 olic Acid supplementation for pregnant and lactating ,omen0 and adolescent girls

4uarterly 'P report

Staff trained on )$ )$ card printed and supplied

4uarterly 'P report 4uarterly 'P report Procurement done in time

eD De2,orming of children B62@ yrsD and adolescent girls fD $anagement of severe acute malnutrition Bfacility and communityD gD Promotion of use of Iodi(ed salt hD 'ther $icronutrients supplementation of pu!lic health importance

4uarterly 'P report 4uarterly 'P report 4uarterly 'P report 4uarterly 'P report

Procurement done in time Referral system esta!lished

Support received from $'I

4:

iD &raining and Capacity Building 5D $3+?Nutrition Surveillance and communication

2 6<<9 of nutrition managers0 community level health0 P and nutrition service providers trained as per plan 2 Sectoral human resources developed to meet NNS program requirements 2 An $IS system developed and fully operational 2 6<<9 upa(ilas assessed monthly?quarterly according to data quality assessment protocol 2 Independent nutritional surveillance functioning 2 $id2term and end of program surveys complete ,ith comprehensive evaluation report 2 'perations research conducted to strengthen NNS operations 2 Development of ,e!site

4uarterly 'P report 4uarterly 'P report

Staff trained on NNS &echnical people and system in place

41

AnneF,re2 III P.OC;.&M&NT P7AN 0O. *&A&7OPM&NT P0.OJ&CT8P.O-.AMM& inistr-&'ivision AgencProc"ring Entit- 1ame D Code Project&Programme 1ame D Code Pac?ag e 1oB 'escri#tion of #roc"rement #ac?age as #er PP&=APP -OO*S 2 +ron D Fo$ic Acid =ab$et 'e)orming =ab$et 9itamin A Ca#s"$e Comm"nication&*CC materia$s +! materia$s @eighing !ca$e 3AC =a#e Com#"ter D accessories; #rinter; 3P! Photoco#ier; Fa6 machine Air Conditioner =e$e#hone =e$e#hone (PA*OK%/ $ine) 9ehic$e 7C ! ! sca$e =a#e #c #c #c #c #c #c #c 3nit inistr- of 5ea$th and Fami$- @e$fare C !' +P51 1ationa$ 1"trition !ervices (11!) I"antitProc"rement method D (=-#e) 5 1C* 1C* +C* 7ot 7ot 2///// 2///// 3/ 12 22 3/ 1 15 1 1C* 1C* +C*& 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' Contract A##roving A"thorit6 !o"rce of f"nds EstdB cost in 7a?h =a?a 1ot "sed in 8oods 0 1o 1o 1o 1o 1o %////B// %//B// 3/B// 2%B// 10B6/ 6B// 1B5/ 6//B// 25/B// 1o 1o 1o 1o 1o 1o 1o 1o 1o Project Cost (in $a?h =a?a) 1%0//0B3, =ota$ 8O* 2,52,B// PA 12/%,1B3, +ndicative 'ates +nvitation for =ender 1/ 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 !igning of Contract 11 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 Com#$etion of Contract 12 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16

1 8'1 8'2 8'3 8'% 8'5 -*% -*' -*6 -*5 -*(1 -*(( -*(/ -* (3 -*(

3 =ab =ab ca#

( .PA& 8O* .PA& 8O* .PA& 8O* .PA& 8O* .PA& 8O* .PA& 8O* .PA .PA& 8O* .PA& 8O* .PA& 8O* .PA .PA .PA& 8O* .PA

42

-*(# -*(% -*(' -*(6 -*(5 -*/1 -*/( -*// -*/3 -*/ -*/# -*/% -*/' -*/6 -*/5 -*31 -*3( -*3/ -*33

7ab E>"i#ments icro#hone (hand set) icro#hone (fi6ed set) 1ote boo? com#"ter 'es? ca$c"$ator C' riter !canner 7aser #rinter Co$or 7aser Printer 9ideo Camera (digita$) 'igita$ camera "$tiedia #ane$ (7C+) !$ide Projector !creen A"dio Cassette P$a-er =9 9C.&9C'&'9' #$a-er FAO machine otor c-c$e set !et Pc Pc Pc Pc Pc Pc Pc Pc Pc Pc Pc Pc Pc Pc Pc Pc

7ot 1 1 2/ 1// 3/ 2 3/ 5 2 2 2 2 2 2 % 2 % 1/

1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C* 1C*

7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7' 7'

.PA .PA .PA .PA .PA .PA .PA .PA .PA .PA .PA .PA .PA .PA .PA .PA .PA .PA .PA&8O*

,1B1/ 2B// 3B// 12B// /B2/ 1B5/ 2B%/ 15B// 5B// 1B2/ /B,/ %B// 3B// /B%/ /B1/ 2B%/ /B%/ 2B%/ 1,B//

1o 1o 1o 1o 1o 1o 1o 1o 1o 1o 1o 1o 1o 1o 1o 1o 1o 1o 1o

'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15

ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15

C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16

43

AnneF,re2 III (b" P.OC;.&M&NT P7AN 0O. *&A&7OPM&NT P0.OJ&CT8P.O-.AMM& inistr-&'ivision AgencProc"ring Entit- 1ame D Code Project&Programme 1ame D Code Pac?ag e 1oB 'escri#tion of #roc"rement #ac?age as #er PP&=APP <or)s 2 3nit inistr- of 5ea$th and Fami$- @e$fare Project Cost (in $a?h =a?a) 1%0//0B3, =ota$ 8O* 2,52,B// PA 12/%,1B3, !o"rce of f"nds EstdB cost in 7a?h =a?a , 1ot "sed in 8oods 0 +ndicative 'ates +nvitation for =ender 1/ !igning of Contract 11 Com#$etion of Contract 12

I"antit-

Proc"rement method D (=-#e) 5

Contract A##roving A"thorit6

1 @P<1 @P<2 @P<3 @P<%

44

AnneF,re2 III (c" P.OC;.&M&NT P7AN 0O. *&A&7OPM&NT P0.OJ&CT8P.O-.AMM& inistr-&'ivision AgencProc"ring Entit- 1ame D Code Project&Programme 1ame D Code Pac?ag e 1oB 'escri#tion of #roc"rement #ac?age as #er PP&=APP Services 3nit inistr- of 5ea$th and Fami$- @e$fare C !' +P51 Project Cost (+n $a?h =a?a) =ota$<1%0//0B3, =ota$ 8O* 8O*<2,52,B// PA PA<12/%,1B3, =a?a in $a?h I"antitProc"rement method D (=-#e) Contract A##roving A"thorit1ationa$ 1"trition !ervices (11!) ( .PA&'PA &8O* .PA&'PA .PA&'PA &8O* .PA&'PA &8O* .PA&'PA &8O* .PA&'PA .PA&'PA EstdB cost in 7a?h =a?a 1ot "sed in 8oods 0 1o 1o Aes Aes Aes 1o 1o +ndicative 'ates

1 !P<1 !P<2 !P<3 !P<% !P5 !P6 !P(

2 =raining O#erations .esearch&!#ecia$ st"dC*1 activities (se$ected area) *CC +ACF 1"trition !"rvei$$ance 1ationa$ D +nternationa$ Cons"$tant (need based)

5 1C* 1C* 1C* 1C* 1C* 1C* 1C*

6 7' 7' 7' 7' 7' 7' 7'

, ,53/B// 2,//B// (12/2B55 ,2//B// 150,%B// 2,//B//

+nvitation for =ender 1/ 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15 'ec 2/11 C"$- 2/12<15

!igning of Contract 11 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15 ar 2/12 'ec 2/12<15

Com#$etion of Contract 12 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16 C"ne 2/12 C"n 2/13<16

45

AnneF,re2IA

7ist of &K,ipments
(=a?a in 7a?h)

Sl No 1B 2B 3B %B 5B 6B (B ,B 0B 1/B 11B 12B 13B 1%B 15B 16B 1(B 1,B 10B 2/B 21B 22B 23B 2%B 25B /%. /'. /6. /5. 31. 9otal

Name of the &K,ipments @eighing !ca$e 3AC ta#s Air conditioner ()indo) t-#e) Air Conditioner (s#$it t-#e) icro#hone (hand set) icro#hone (fi6ed set) Com#"ter (inc$"ding net)or?ing cost) 1ote boo? Com#"ter 'es? ca$c"$ator C' )riter !canner 7aser Printer Co$o"r 7aser Printer 9ideo Camera ('igita$) 'igita$ Camera Photoco#ier "$timedia Pane$ (7C+) !$ide Projector !creen A"dio Cassette P$a-er =9 9C.& 9C'& '9' P$a-er Fa6 machine =e$e#hone ('irect $ine for office &residence) obi$e #hone =e$e#hone (PA*O K %/ $ine) Overhead Projector otor c-c$e 9ehic$e 7ab e>"i#ment

;nit Price (Ta)a" 2/// 2// ,//// 1/////

>,antity 0(5// #ieces 1 ($a?h) 12 #ieces 1/ #ieces 1 set 1 set 3/ #ieces 2/ #ieces 1// #ieces 3/ #ieces 2 #ieces 3/ #ieces 5 #ieces 2 #ieces 2 #ieces 12 #ieces 2 #ieces 2 #ieces 2 #ieces 2 % 2 % 3/ #ieces 15 #ieces 1 2 #ieces 1/ "nit 15 "nit

1////// 6//// 2// 5/// 12//// 5//// 1///// 6//// %//// 2///// 2///// 15//// 2//// 5/// 6//// 2//// 6//// 15/// 1//// 15////B// 2//// 1,//// %//////

&stimate! Cost 105/ 2// 0B6 1/ 2 3 3/ 12 /B2 1B5 2B% 15 5 1B2 /B, 2% % 3 /B% /B1 2B% /B% 2B% %B5 1B5 1B5 /B% 1, 6// ,6B%2 2991.72

44

AnneF,re2A

7ist of 0,rnit,re an! 0iFt,res

(Ta)a in 7a)h" Sl No 1 2 3 % 5 6 ( , 0 Name of the 0,rnit,re 9isitor Chair Conference Chair .evo$ving Chair Com#"ter chair *oo? she$f Fi$e Cabinet !tee$ A$mirah C"rtain !ofa !et Total 1///// ;nit Price 3/// %/// 6/// 3/// 15/// 15/// 22/// >,antity %/ 5/ 2/ 3/ 2/ 2/ 15 7O= 5 &stimate! Cost 1B2/ 2B// 1B2/ B0/ 3B// 3B// 3B3/ 1B20 5B// 2/B,0

AnneF,re2AI (a"

7ist of Assets (Carrie! over"

S7 No. /1 /2 /3 /% /5 /6 /( /, /0 /0 1/ 11 12 13 1% 15 16 1( Name of -oo!s Cee# Pic? 3# icro *"s Com#"ter 5P<*rand CP3 Com#"ter 5P<*rand onitor 15U 7C' 5P<*rand onitor 15U onitor 8ate)a- *rand 1(U 7aser Printer E#son 62// 5P 7aser Cet Printer Photoco#ier =oshiba 2/3/ Photoco#ier !har# 3/25 Photoco#ier Fonica ino$ta *i4h"b Fa6 achine !canner 5P 7a#to# "$timedia Projector Overhead Projector =9 !on>,antity /5 /1 /1 /, /3 /5 /2 /1 /3 /2 /1 /1 /2 /1 /1 /2 /2 /2 Present con!ition +n )or?ing condition +n )or?ing condition 1ot in )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition +n )or?ing condition

45

AnneF,re2AI (b"

0ist of Damaged +ssets

S7 No. /1 /2 /3 /% /5 /6 /( /, /0 1/ 11 12 13 1% 15 16 1( 1, 10 2/ 21 22 23 2% 25 26 2( 2, 20 3/ 31 32 33 Name of -oo!s Cee# icro *"s Com#"ter CP3 Com#"ter onitor 7aser Printer E#son 62// 5P 7aser Cet Printer 7aser Printer 5P %2// 7aser Printer 5P %25/ 7aser Printer 5P %/5/ Printer 5P 7aserCet <5 Printer 5P 7aserCet <11// Co$or Printer E#son<6// 7aser Printer 1EC<,6/ 'ot Printer E#son 7I<21(/ 'ot Printer E#son 7I<1// Canon Printer *CC<1/// 7aser Printer Canon 7'P<,1/ Canon Printer C"m Photoco#ier<121/ Photoco#ier =oshiba 2/3/ Photoco#ier !har# 111, Photoco#ier !har# !F<2/3/ Photoco#ier 1ash"atec 3322! Photoco#ier !e$e6 8.<165/ Photoco#ier =oshiba<131/ Photoco#ier Oero6<5,55 Photoco#ier 8E!=E=1E.<2(15: Fa6 achine Panasonic Fa6 achine =oshiba Fa6 achine 1ash"atec P<306 !canner 5P 7a#to# 5P Com#ac 1O<0/1/ 7a#to# =oshiba !atte$ite<P1 "$timedia Projector +nfoc"s *amage! /3 /1 %2 3( /3 /1 /3 // /5 /1 /% /1 /1 /1 /3 /1 /1 /2 /1 /1 /1 /1 /2 /1 /1 /1 /1 /1 /1 /1 /1 /1 /1

46

AnneF,re AIII2 A

Action Plan for Mainstreaming N,trition services

Sl a" Chil! N,trition 1 2 3 % E6c$"sive breast feeding Com#$ementar- Feeding !"##$ementar- Feeding 8ro)th onitoring and Promotion (8 P) 9itamin A s"##$ementation A1C; P1C; *CC; !afe 'e$iver-; A*C1 <do< <do< A*C1 A1C; P1C; *CC; !afe 'e$iver-; + C+; CC; <do< <do< + C+ (faci$it- D comm"nit- based); EP+; CC EP+ (M1 -r) EP+&19AC (12<50 ); + C+ Comm"nit-<+ C+; CC Comm"nit- D FR+ C+; CC <do< Fi$ariasis&19AC EP+ *CC (5E*) and sector #rograms Comm"nit- D F<+ C+; E!'; CC '85!; '8FP; 11P <do< <do< '85!;11P '85!; '8FP <do< <do< '85!; Activity &Fisting Service !elivery Propose! .esponsibility C,rrent Propose!

EP+ (M1 -r) EP+&19AC (12<50 ) A*C1; +C'P Comm"nit- D F<+ C+ 1i$ Fi$ariasis&19AC EP+ *CC (5E*)

'85!; +P51

'85!;

6 ( , 0 1/ 11

+ron s"##$ementation ( icron"trient #o)der) :inc s"##$ementation )ith O.! Other icron"trients ( 9it '; Ca$ci"m etcB) 'e)orming +mm"ni4ation *CC (Persona$ h-giene; hand )ash; schoo$ hea$th; other *CC) =hera#e"tic management of severe ac"te ma$n"trition (faci$it- and comm"nit-) +ron<Fo$ic Acid s"##$ementation for #regnant and $actating )omen Ear$- initiation of breastfeeding Persona$ h-giene 9itamin A R#ost #art"m +dentification and management of 7o) *irth @eight (7*@) @eight monitoring of #regnant )omen

'85!;'8FP <do< <do< '85! '85! '85!; '8FP

'85!; '8FP <do< <do< '85!; '85!; '85!; '8FP

12

Pi$ot intervention is ongoing in se$ective districts thro"gh 18Os A1C; P1C; A*C1

'85!; '8FP

'85!; '8FP

b" Maternal an! Ne9born N,trition 1 A1C; P1C; CC '85!; '8FP;11P '85!; '8FP

2 3 % 5 6

A1C; E1C; P1C; !*A; C!*A; + C+ *CC .5; C.5; P1C; A*C1 P1C; E1C; + C+; A*C1 A1C; A*C1

A1C; E1C; P1C; !*A; C!*A; + C+; CC *CC (5E*) and sector #rograms .5; C.5; P1C; CC; P1C; E1C; + C+; CC; A1C; CC

'85!; '8FP '85!; '8FP '85!; '8FP;11P '85!; '8FP;11P '85!; '8FP; 11P

'85!; '8FP '85!; '8FP '85!; '8FP '85!; '8FP '85!; '8FP;

4<

Sl ( s,

Activity &Fisting Food inta?e (>"antit- and >"a$it-) *CC

Service !elivery Propose! *CC; A1C *CC (5E*) and sector #rograms !choo$ 5ea$th; CC; sector ado$escent for"m; +C'P !choo$ 5ea$th *CC; A*C1 *CC

.esponsibility C,rrent '85!; '8FP;11P '85!; '8FP Propose! '85!; '8FP '85!; '8FP

c" A!olescent N,trition 1 Anemia ( +ron and Fo$ic Acid) A*C1; +C'P '85!; '8FP;11P '85!; '8FP

!trengthening n"trition com#onent of schoo$ hea$th and n"trition Persona$ h-giene 'e)orming *CC (1"trition ed"cation and co"nse$ing) Food Fortification (iodi4ed sa$t; edib$e oi$ )ith vitB A etc)

!choo$ 5ea$th

'85!

'85!

3 % 5

*CC A*C1; Fi$ariasis; !choo$ 5ea$th; C.5 *CC;A*C1

*CC (5E*) and sector #rograms +C'P; !choo$ 5ea$th; CC; Fi$ariasis; C.5; *CC (5E*) and sector #rograms inistr- of +nd"stries (#roject im#$ementation); o5DF@ (Coordination; #o$ic- form"$ation; monitoring) +P51 +P51 o5DF@

'85!; '8FP '85!; '8FP '85!; '8FP;11P

'85!; '8FP '85!; '8FP '85!; '8FP

!" -eneral Pop,lation 1 inistr- of +nd"stries; o5DF@ '85!; O5F@ '85!; O5F@

2 3 %

Food h-giene and safet'ietar- g"ide$ines +nter<ministeria$ coordination )ith OF' ; Agric"$t"re; +nd"stries; Fisher- D7ivestoc?; Ed"cation; O@CA; 78.'; !ocia$ @e$fare; +nformation 7egis$ation D #o$icform"$ation

+P51&*!=+ +P51; +1F!; *11C o5DF@

'85!; O5F@ *11C *11C; O5F@

'85! *11C *11C; O5F@

o5DF@

o5DF@

+P51; O5F@

+P51; O5F@

5:

ANN&I;.& AIII2+

Components an! &stimate! cost s,mmary

=a?a in 7a?h)
Sl. No. Name of the components -O+ Pro$ect Ai! .PA Thro,gh Other -O+ s *PA -ran! Total ? of the total cost

1 2 3 % 5 6 (

*ehavio"r Change Comm"nication (*CC) 5"man reso"rce deve$o#ment (5.') Contro$ of 9itamin<A deficienc- disorder Contro$ D #revention of Anaemia Contro$ of +odine deficienc- 'isorder Other icron"trient #rob$ems of P"b$ic 5ea$th im#ortance ( 4inc; vitamin G';H ca$ci"m etcB) Comm"nit- D faci$it- based management of severe ac"te ma$n"trition (!A ) +nstit"tiona$ Ca#acit- 'eve$o#ment a) Orientation & Advocac- of 'ivision;'istrict;3#o4i$a managersB Protection; Promotion D !"##ort of *reastfeeding& +nfant and Ao"ng Chi$d Feeding (+ACF) inc$"ding *F5+ D * ! Code Food fortification (!a$t +odi4ation; fortification of oi$&other food )ith 9itamin GAH; iron etcB) !choo$ 1"tritiona$ ed"cation Program Food I"a$it- and Food !afetonitoring; Eva$"ation; O#erations .esearch; !"rve1"trition !"rvei$$ance Program Estab$ishment of n"trition "nit (13) and strengthening of e6isting 13 Comm"nit- based 1"trition (C*1) in se$ected area Cons"$tanc- !ervice "$ti sectora$ co$$aboration 1"trition in emergenc- & 1C' Estab$ishment of n"trition !ervice in CC D 8 P Total

1/// 313/ 52// 1,// (2/ 1,/ 15// 6%%6

%/// %/// 165// %/// 12// 12/% 33// 12//

2/// 1,// 2/// 2/// 1/// 616 1/// 1/12

(/// 1(53/ 23(// (,// 202/ 2/// 5,//

13B56 11B(6 15B01 5B23 1B06 1B3% 3B,0

,65,

5B,1

5(/

2///

13%1

3011

2B62

1/ 11 12 13 1% 15 16 1( 1, 10 2/

1// %,/ 2%/ 2// 13// 262, 1%%/ 15% 1%/ 2// 5// /6#/6.11

1125 2/36 25/ 1,// 1,// 302/ 36%, B3, ,(2 1/// 1//// 6#1##.36

11(5 5/// 1(1/ 1/// 1/// 1/// 6115 1/// 1/// 1536 2121 ";:'<

2%// (516 22// 3/// %1// (5%, 112/3 115%B3, 2/12 2(36 12621 ( 5115.36

1B61 5B/% 1B%, 2B/1 2B(5 5B/( (B52 /B(( 1B35 1B,% ,B%( (11

1ote 2

8O* N 2,52,B// (=a?a in $a?h) .PA ,5/55B3, (=a?a in $a?h) 'PA N 35%26B// (=a?a in $a?h) =ota$ N 1%0//60B3,(=a?a in $a?h)

51

+NN=F1)= 7,,,?.

,mplementation of specific nutrition interventions

N,trition Intervention Infant and Young Child Feeding .esponsibility +m#$ementation 7ine *irectorate (OP" 5! ; E!'; C*5C; 1CA5 C<.A5; FPF!' !"##ort !ervices Growth Monitoring and Promotion (GMP +m#$ementation 11!; C*5C 11! 1CA5;E!'; C*5C; 5! .esponsible @ealth <or)force O; 1"rses; A (in faci$ities) 5A; C5CP (in CC and comm"nit-) F@9; !AC5 O; F@A Comm"nit- 9o$"nteers 7'; P O; 1"rses; A (in faci$ities) 5A (in CC and comm"nit-) F@9; !AC5 O; F@A C<.A5; FPF!' 11!; C*5C; 3P5CP !"##ort !ervices 11! 5A; F@A; C5CP +m#$ementation of domici$iar- 8 P activities in hard<to<reach areas (and those -et to have a f"nctiona$ CC) and in 3rban areas Comm"nit- 9o$"nteers 7'; Program anager Proc"rement of )eight and height meas"rement e>"i#ment (sca$es; 3AC ta#es etc)V 'eve$o#ment of 8 too$sV Po$ic- 'irectives and 8"ide$inesB Ca#acit- deve$o#ment of concerned service #roviders and introd"ction of a str"ct"red referra$ s-stemB Core Activities +ACF co"nse$ing d"ring A1C; P1C cons"$tationsV *ab- Friend$- 5os#ita$ +nitiativeV 1"trition CornersV +ACF co"nse$ing d"ring im#$ementation of comm"nit-<based n"trition activities +m#$ementation of domici$iar- 8 P activities in hard<to<reach areas (and those -et to have a f"nctiona$ CC) and in 3rban areas =echnica$ s"##ortV Po$ic- 'irectives and 8"ide$inesV Ca#acit- deve$o#ment of concerned service #roviders .eg"$ar )eight and height meas"rements of chi$dren /<50 months d"ring faci$it-<based service contacts ( Os ;!AC5 O& As; 1"rses and F@9) and d"ring comm"nit-<based n"trition activities (F@A; 5A; C5CP)

!CC to Promote Good Nutritional Practices

+m#$ementation

5EP; +EC; 11! 1CA5; E!';C*5C; 5! ; C<.A5; FPF!'

'irectorate $eve$ Fie$d $eve$ ( O; F@9; !AC5 O; F@A; 5A; F@A; C5CP)

Co$$aborative deve$o#ment of *CC materia$s Promotion of good n"tritiona$ #ractices thro"gh n"trition ed"cation d"ring faci$it-<based service contacts ( Os ;!AC5 O& As; 1"rses and F@9) and d"ring comm"nit-<based n"trition activities (F@A; 5A; C5CP)

52

N,trition Intervention

.esponsibility

7ine *irectorate (OP"

.esponsible @ealth <or)force

Core Activities +m#$ementation of domici$iar- n"trition activities in hard<to<reach areas (and those -et to have a f"nctiona$ CC) and in 3rban areas

11!; C*5C !"##ort !ervices 11!

Comm"nit- 9o$"nteers 7'; P 'eve$o#ment and #roc"rement of *CC materia$sV ass edia Cam#aigns and organi4ing nationa$ events (eg; breastfeeding and n"trition )ee?sV =echnica$ +n#"ts to other OPs (eg in deve$o#ment of *CC materia$s)V Po$ic'irectives and 8"ide$ines Coordination )ith 18Os and other !ta?eho$ders invo$ved in the im#$ementation of *CC activities Other ass edia Cam#aigns as )e$$ as +PC in co$$aboration )ith 11!

5EP; +EC Iron"Folate Su##lementation for #regnant and lactating women (including MNPs +m#$ementation 1CA5; C*5C 11! C<.A5;

'irector 7eve$ as )e$$ as in 3#a4i$a 5ea$th !-stem(35!) O; 1"rses; 5A; !AC5 O& A; F@9; F@A; 5A; C5CP Provision of Fe&Fo$ate s"##$ementation d"ring A1C; P1C; PAC and other faci$it-<based service contacts ( Os ;!AC5 O& As; 1"rses and F@9) and d"ring comm"nit-<based n"trition activities ( F@A; 5A; C5CP) Po$ic- 'irectives and 8"ide$inesV Coordination )ith the concerned 7's to ens"re avai$abi$it- of Fe&fo$ate tab$ets at a$$ $eve$sV 'eve$o# 1ationa$ 8"ide$ines for Fe&Fo$ate !"##$ementation Proc"rement of +ron&Fo$ate tab$ets

!"##ort !ervices

$itamin A su##lementation % #reventive and curative

+m#$ementation !"##ort !ervices

1CA5; C<.A5 11! 11!

5A ;C5CP ;C5P ;5ea$th D FPB@or? force

'istrib"tion and administration of 9A ca#s"$es for #revention and c"re of 9A' re$ated com#$ications Proc"rement of 9A ca#s"$esV ass media cam#aigns (in co$$aboration )ith E!'; 5! )V 'istrib"tion of ca#s"$es "# to 3#a4i$a $eve$V Com#i$ation of !tatsV Po$ic- 'irectives and 8"ide$ines

53

N,trition Intervention Control of I&& and Salt Iodi'ation

.esponsibility +m#$ementation !"##ort !ervices

7ine *irectorate (OP" inistr- of +nd"stries 11!

.esponsible @ealth <or)force !a$t +odi4ation; .eg"$ations 7'; P ; (in co$$aboration )ith !anitar- +ns#ectors&5ea$th +ns#ector) O; A; 1"rses 7'; P

Core Activities

'eve$o#ment of *CC materia$sV onitoringV >"a$it- ass"rance&fie$d testing of sa$tV Po$ic- 'irectives and 8"ide$ines Coordination )ith the inistr- of Commerce +m#$ement s#ecia$ interventions for #oc?et areas at high ris? of +''s Provide the :inc s"##$ement d"ring treatment of diarrhea Proc"rement of :inc s"##$ements Coordination )ith other 7's to ens"re :inc s"##$ements are avai$ab$e in hea$th faci$ities at a$$ $eve$sV Po$ic- 'irectives and 8"ide$ines Proc"rement of 4inc s"##$ements

(inc Su##lementation during treatment of &iarhhoea

+m#$ementation !"##ort !ervices

1CA5; E!'; 5! ; 11!

Prevention and control of Fe deficienc)"anemia in children under*+,s

+m#$ementation

1CA5; E!'; 5! 1CA5; E!'; C*5C; C<.A5 ; 5! 11!

7' $eve$ O; 1"rse; !AC5 O& A; 5A; F@9; F@A; C5CP 7'B P +ron !"##$ementation d"ring faci$it-<based service contacts ( Os ;!AC5 O& As; 1"rses and F@9) and d"ring comm"nit-<based n"trition activities ( F@A; 5A; C5CP) Proc"rement of +ron tab$ets and +ron s-r"#V Po$ic- 'irectives and 8"ide$ines Proc"rement of +ron tab$ets

!"##ort !ervices

Iron Su##lementation and &eworming of Adolescent Girls(and children

+m#$ementation !"##ort !ervices

1CA5; E!'; C*5C; C<.A5 E!' in co$$aboration )ith OE 11! 1C' (+P5); '85! 11! 1CA5; E!'; 5! 11!

7' $eve$ 5ea$th Professiona$s invo$ved in 1+'s 7'; P !anitar- +ns#ectors 7'; P O; !#ecia$ists; 1"rses 7'; P Provision of de)orming tab$ets d"ring 1+'s !choo$ 5ea$th Program 1ationa$ cam#aign for de)orming (19ACK)V Po$ic- 'irectives and 8"ide$ines !am#$e Co$$ection; Food testing; Ca#acit- 'eve$o#ment Po$ic- 'irectives and 8"ide$inesV .eg"$ator- !"##ort and onitoringV A)areness cam#aigns !tr"ct"red .eferra$; =reatment and .ehabi$itation Po$ic- 'irectives and 8"ide$inesV +nstit"tiona$ and 5"man Ca#acit'eve$o#mentV Proc"rement of dr"gs and ens"ring that $ogistics as #er

-nsuring Food Safet) and Food .ualit) /reatment of Severe Acute Malnutrition (Including CMAM

+m#$ementation !"##ort !ervices +m#$ementation !"##ort !ervices

54

N,trition Intervention

.esponsibility

7ine *irectorate (OP" 11! +!=; C*5C; =.' (1+PO.=) 11! 7'

.esponsible @ealth <or)force

Core Activities management of !A are in #$ace

/raining and Ca#acit) &evelo#ment

+m#$ementation

=raining of 'octors; Paramedics; 1"rses; 5As; F@9s; C5CP and 18O )or?ers =echnica$ !"##ort for deve$o#ment of training mod"$esV =raining of aster trainers (at district $eve$) for CC )or?ers on n"trition service de$iver-V 'eve$o# and im#$ement a n"trition ca#acit- b"i$ding strateg-V Estab$ish a nationa$ reso"rce center on n"tritionV Estab$ish a nationa$ n"trition s"rvei$$ance s-stemV Cond"ct reg"$ar n"trition s"rve-s&research Co$$ect ro"tine information on n"trition service contacts and anthro#ometric meas"rementsB

!"##ort !ervices

7'; P

Monitoring and -valuation"Nutrition Surveillance"0esearch

+m#$ementation

11!

7'; P

!"##ort !ervices 1r2an Nutrition +m#$ementation

!"##ort !ervice

5+!<E5; +!<FP 11!; 5+!<E5 and +!<FP 11!; E!'; FPF!'; inistr- of 7oca$ 8overnment and 3rban 'eve$o#ment 11!

7' $eve$ 7' $eve$ 7'; P ; 7'<E!'; 7'<FPF!'; P'<3P5CP

Estab$ish $in?ages )ith ro"tine data so"rces to get #eriodic +! information b- 11! Providing technica$ s"##ort to; and coordinating )ith the inistr- of 7oca$ 8overnment in im#$ementing n"trition interventions in "rban areasB

7'; P

!"#ervising 18Os that are engaged to im#$ement n"trition activitiesV Po$icdirectives and 8"ide$ines

55

+NN=F1)= 7,,,?D

=stimated Detailed &udget (,nput /ise*

(Ta)a in 7a)h"
Total Physical an! financial target No. of Comp. Name of components8 Ma$or activities ( / +ehavior Change Comm,nication (+CC": (*CC materia$ for n"trition; hea$th- eating&feeding for a$$ age gro"# )o"$d be deve$o#ed and incor#orated thro"gh mass media and other different channe$sB *CC <Pac?age for #o$ic- ma?er; managers&im#$ementers; service #rovider; beneficiar-) @,man reso,rce !evelopment (@.*":(Pre#aration of ca#acit- b"i$ding g"ide$ine; training mod"$e in re$evant cases; formation of master and core trainer team; training of re$evant service #roviders at home D abroad) Control of Aitamin2A !eficiency !isor!er: (A)areness creation abo"t food based a##roach; training of service #rovider; s"##$ementation in ro"tine service D in 1+' among t)o(2) crore chi$dren) Control B prevention of Anemia: (A)areness creation abo"t food based a##roach; training of service #rovider; s"##$ementation to #regnant )omen; $actating mother; chi$dren; ado$escent) Control of Io!ine !eficiency *isor!er: (A)areness creation abo"t food so"rce D cons"m#tion of +odi4ed sa$t; training of service #rovider) Other Micron,trient problems of P,blic @ealth importance (Cinc: vitamin D*:E calci,m etc.": (A)areness creation abo"t food based a##roach; training of service #rovider; s"##$ementation to v"$nerab$e gro"#) Comm,nity B facility base! management of severe B Mo!erate ac,te maln,trition (SAM8MAM": ('eve$o#ment of g"ide$ine; training mod"$e; man#o)er trained for !A D A management at a$$ faci$ities and comm"nit-) Instit,tional Capacity *evelopment (incl,!ing Pay B Allo9ances": (Organogram deve$o#ment; de#$o-ment of s?i$$ man#o)er; training of de#$o-ed man#o)er in both technica$ D manageria$ as#ect; estab$ishment of n"trition "nit at tertiar-; district and 3#a4i$a $eve$B) Infant an! =o,ng Chil! 0ee!ing (I=C0" incl,!ing +0@I B +MS Co!e2 (Estab$ishing 1"trition corner in faci$ities from tertiar- $eve$ to 345C; Cam#aign for +ACF "# to comm"nit- c$inic D comm"nit-; breast feeding )ee? and 0inancial Physical >ty8 ,nit 3 1ation)ide (7!) -O+ .PA # *PA % Total cost ' 0= /1((2/1(/ Physical Physical 6 1ation)id e (7!) 0inancial 5 0= /1(/2/1(3 Physical Physical (1 1ation)ide (7!) 0inancial (( 0= /1(32/1( Physical Physical (/ 1ation)ide (7!) 0inancial (/ 0= /1( 2/1(% Physical Physical ( 1ation)ide (7!) 0inancial (#

1///B//

%///

2///B//

(///

12//

1(//

1(//

2%//

1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!)

313/B//

%///

1,//B//

,03/

1ation)id e (7!) 1ation)id e (7!) 1ation)id e (7!) 1ation)id e (7!) 1ation)id e (7!)

1///

1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!)

2%/,B/6

1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!)

2521B0%

1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!) 1ation)ide (7!)

3///

52//B//

65//B/

2///B//

13(//

1%%%B66

3/(5

3/(5

61/5B3%

1,//B//

%///B//

2///B//

(,//

%6,

2(12B15

2610B,5

2///

(2/B//

12//B//

1///B//

202/

1(5B2

,%%B/(

,31B/1

1/60B(2

1,/B//

0/%B//

616B//

1(//

165

305

305

(%5

1ation)ide (7!)

15//B//

2///B//

1///B//

%5//

1ation)id e (7!)

3%,

1ation)ide (7!)

1/3,

1ation)ide (7!)

1/3,

1ation)ide (7!)

2/(6

, 0

%( Persons 7&! 1ation)ide (7!)

6%%6B// 5(/B//

12//B// 2///B//

1/12B// 13%1B//

,65, 3011

%( Persons 7&! 1ation)id e (7!)

510B%, 23%B66

%( Persons 7&! 1ation)ide (7!)

31/2B(2 113/B53

%( Persons 7&! 1ation)ide (7!)

2,6%B/1 1113B/%

%( Persons 7&! 1ation)ide (7!)

21(1B(0 1%32B((

54

1/ 11

12

13

thro"gh ass media cam#aign) 0oo! fortification: (!a$t +odi4ation; fortification of oi$&other food )ith 9itamin GAH; iron etcB) School N,tritional e!,cation Program: (A)areness deve$o#ment cam#aign for teachers; =O= for se$ected teachers; !ma$$ f"nd a$$ocation for schoo$&madrasHs) 0oo! >,ality an! 0oo! Safety: (.aising a)areness on food safet-; h-gienic #ractices; hand )ashing etcB; deve$o#ing an action #$an; !"##ort to Food !afet7aborator- of +P5 and strenthen co$$aboration )ith other food safet- $aboratoriesB) Monitoring: &val,ation: Operations .esearch: S,rvey: ('eve$o#ment of onitoring too$ ; Estab$ish $in?age )ith centra$ +!; Estab$ishment of a nationa$ reso"rce centre for n"trition; !"rve- as #er #rogram need)

1ation)ide (7!) 1ation)ide (7!)

1//B// %,/B//

125B// 036B//

11(5B// 5///B//

1%// 6%16

1ation)id e (7!) 1ation)id e (7!) +P5; *!=+; +1! etcB

1%% %5/

1ation)ide (7!) 1ation)ide (7!)

31% 2%(%B5

1ation)ide (7!) 1ation)ide (7!)

31% 2%01B5

1ation)ide (7!) 1ation)ide (7!)

62, 1///

+P5; *!=+; +1! etcB

5%/B//

25/B//

1(1/B//

25//

132

+P5; *!=+; +1! etcB

6(6

+P5; *!=+; +1! etcB

602

+P5; *!=+; +1! etcB

1///

+! of 11!</1 3rban s$"m 6/3; 3nder served1,/ 3; 5=. 1,/ 3 =ertiar-<25; 'istrict<50; 35C<%2(

5//B//

,//B//

1///B//

23//

+! of 11!</1 3rban s$"m 6/3; 3nder servedm< 1,/ 3; 5=.1,/ 3 =ertiar-< 25; 'istrict< 50; 35C< %2( 1ation)id e (7!)

1,/

+! of 11!</1 3rban s$"m 6/3; 3nder served1,/ 3; 5=.1,/ 3 =ertiar-<25; 'istrict<50; 35C<%2(

53/

+! of 11!</1 3rban s$"m 6/3; 3nder served1,/ 3; 5=.1,/ 3 =ertiar-<25; 'istrict<50; 35C<%2(

53/

+! of 11!</1 3rban s$"m 6/3; 3nder served1,/ 3; 5=.1,/ 3 =ertiar-<25; 'istrict<50; 35C<%2(

1/6/

1%

N,trition S,rveillance Program (NSP": (*ase$ine !"rve-; mid<term D end eva$"ation)

13//B//

1,//B//

1///B//

%1//

2%6

15/2

1(66B,3

5,5B1(

15

&stablishment of n,trition ,nit (N;" an! strengthening of eFisting N;: (P$anning of n"trition "nit at 35C; F"nctioning of 13) Comm,nity base! N,trition (C+N" as selecte! area: (CC )o"$d be e>"i##ed for n"trition service de$iver-; introd"ce gro)th monitoring; ma##ing of targeted areas for C*1; revie) and "#date C*1 #ac?age; im#$ementation of #ac?age in targeted areas thro"gh o"tso"rcing) Cons,ltancy Service: (+m#$ementation s#ecia$ist; n"trition e6#ert; finance e6#ert) M,lti 2sectoral Collaboration: (Formation of 1ationa$ 1"trition Coordination Committee for coordination among ministries; 8O< 18Os; 'Ps and a$$ re$evant organi4ation) 1"trition of EmergencEstab$ishment of 1"trition !ervice and 8 P in CC Total

262,B//

,66B//

1///B//

%%0%

%52

1%1/B5

161/B5

1/21

16

1ation)ide (7!)

1%%/B//

%16/2B//

6115B//

%015(

6(2

1ation)ide (7!)

12121B25

1ation)ide (7!)

12121B25

1ation)ide (7!)

2%2%2B5

1( 1, 10 2/

5% @ith other ministries 1ation)ide 7!

15%B// 1%/B// 2//B// 5//B// /6#/6.11

1///B3, ,(2B// 1///B// 1////B// 6#1##.36

1///B// 1///B// 1536B// 2121B// 3# /%.11

215%B3, 2/12 2(36 12621 ( 5115.36

5% 7! 1ation)id e 7!

60B2 12/ 16% 1,%2 (11/%./1

5% 7! 1ation)ide 7!

021B5, ,(3 11%3 310%B(5 (#%%.((

5% 7! 1ation)ide 7!

1121B2 0(3 13%3 32,5B0, / 1'.((

5% 7! 1ation)ide 7!

%2B% %6 ,6 %20,B2( ##115.5%

+NN=F1)= 7,,,?=

55

StaAeholder mapping for nutrition interventions in &angladesh

1B Comm"nit- *ased Organi4ations (in !$"ms; 9i$$ages) 2B +ron or +odine or !#rin?$es& 1P 3B Food P$anning and onitoring Committee; inistr- of food and disaster mgmtB %B Advocac- and F"nding 5B 8$oba$ F"nd for A+'!; ="berc"$osis and a$aria 6B Coordination&management&s"b<contracting; technica$ s"##ortV deve$o#ment of #rograms and #o$icies (B +m#$ementation; monitoring D eva$"ationV ed"cation; training & ca#acit- b"i$ding ,B On$- vitamin A 0B Additiona$$- @or$d9ision; Care; Caritas 1/B On$- food<based a##roach 11B inistr- of 5ea$th and Fami$- @e$fare 12B 18O For"m for 'rin?ing @ater !"##$- D !anitation 13B 9i$$age Organi4ations 1%B Fortified f$o"r 1ote2 Additiona$$-; research instit"tions; s"ch as +CC'.; * or Eminence strong advocates&#o$ic- ma?erV 1ote2 issing interventions on this s$ide2 $atrines; n"trition ed"cationB

56

!o"rce2 !ta?eho$der technica$ >"estionnaires; *C8 ana$-sis2 .EAC5 !ta?eho$der Ana$-sis 2/1/

5<

6:

61