STRATEGIC DIRECTION: IMPROVE THE NUTRITIONAL STATUS OF THE AFGHANISTAN POPULATION

Brief Description/Rationale and Current Situation

Improving the nutritional status of the Afghan population, in particular pregnant women and young children, has been one of the priorities of the priority . Although progress has been made in lowering acute malnutrition, over 50% of Afghan children are stunted, between 5 to 10% suffer from acute malnutrition and an estimated 70% suffer from micronutrient deficiencies (MoPH Public Nutrition Policy and Strategy, 2009-2013; refer to the same MoPH strategy, p.8, The Conceptual Framework of Malnutrition, adapted from UNICEF – 1992, for a better understanding of malnutrition and the causes).

“An estimated 500,000 Afghan babies are born each year with intellectual impairment caused by iodine deficiency in pregnancy … Approximately 50% of Afghanistan’s children grow up with lowered immunity, leading to frequent ill health and poor growth. Cause: vitamin A deficiency … 2,600 young Afghan women every year (die) in pregnancy and childbirth. Cause: severe iron deficiency anemia (The Micronutrient Initiative & UNICEF, VITAMIN & MINERAL DEFICIENCY A damage assessment report for AFGHANISTAN, p. 3)

There are a number of reasons for this critical situation that include:

• Inadequate knowledge and skills among the general population related to good health and nutrition (e.g. requirements for women during pregnancy and for young children and why these are important for optimal growth and development).
• Poor dietary diversity and low micronutrient intake associated with limited quality and low coverage of current micronutrient interventions
• Exposure of the public to unsafe foods and unhygienic food practices
• Limited capacity in public health nutrition among Afghan health professionals and practitioners from other nutrition-related sectors (e.g. there is currently no cadre of nutritionists in Afghanistan and little education among professionals from the health, agriculture, education and social sectors about nutrition and its importance).
• Limited access to quality treatment for severe malnutrition

Inadequate Infant and Young Child Feeding (IYCF) programs and limited community outreach of current IYCF counselling and support

• Recurrent food crises/emergencies and low assessment and response capacity
• Low availability of reliable nutrition data
• Weak monitoring and evaluation of nutrition interventions

AARDO  Health Strategic Plan,

Advocate for the establishment of a high level national nutrition committee that includes representatives from other sectors such as education and agriculture

• Develop core nutrition messages and disseminate these strategically and consistently to the general public at all levels (e.g. national, provincial, district, facility) through a number of channels (e.g. the media, schools, health facilities)
• Advocate for the integration of nutrition messages into school curricula
• Provide nutrition counselling and practical support at the community level through Community- Based Growth Monitoring and Promotion (C-GMP) and other community level structures
• Food Fortification: Work with industry and relevant government departments to fortify salt (with iodine), flour, oil and ghee (with vitamin A and D) and facilitate their availability and access in rural, as well as urban areas at an affordable price
•  Supplementation:  Provide increased access to iron and folic acid supplements to women in the prenatal and postpartum phases and vitamin A and C supplements to women in postpartum as well as to children.
•  Public Education: Develop and disseminate health messages (under SO-1) that include the importance of micronutrients to women of childbearing age and young children in particular and how they may be obtained (e.g. through foods including diversifying diet and supplementation)
• Promote Community Mobilization around identifying, referring and providing therapeutic feeding to those children who need it.
•  Improve case detection of Acute Malnutrition at Health Facility and Community Levels.
•  Strengthen the referral system between Therapeutic Feeding Units and other BPHS/community for complicated cases.
•  Strengthen and expand Community-Based Management of Severe Acute malnutrition using Ready to Use Therapeutic Foods (RUTFs)

• Strengthen nutrition surveillance as part of HMIS at the health facility level and the Disease Early Warning System (DEWS) (e.g. consult with DEWS as to whether it can collect data on nutritional status including the establishment of a NEWS [Nutrition Early Warning System]) o Advocate for an emergency response team to conduct rapid nutrition assessments in emergency situations
  • Monitoring & Evaluation:  o Ensure nutrition pro
  • grams are evidence-based and that lessons learned from nutrition programs and services are regularly documented and integrated into future planning   Establish an effective monitoring system for key nutrition interventions including: supplementation, Infant and Young Child Feeding (IYCF) and Severe Acute Malnutrition (SAM) treatment
  • Ensure the appropriate use of food assistance (i.e. that food rations are culturally acceptable, safe, meet the needs of and are effectively targeted to the most vulnerable groups).
  • Enhance the management and prevention of Severe Acute Malnutrition (SAM), Moderate Acute Malnutrition (MAM) and chronic malnutrition
  • Strengthen coordination within the nutrition cluster and with other clusters
  • Develop and disseminate appropriate regulations and guidelines to support implementation of the National Infant and Young Child Feeding Strategy 2009-2013
  • Promote and support awareness raising and behaviour change strategies at the community level so families adopt improved breastfeeding and complementary feeding practices
  • Integrate Infant and Young Child Feeding (IYCF) promotion and counselling in the BPHS and EPHS
  • Expand the “Baby-Friendly Hospital Initiative” to more health facilities
  • Promote and support in-service trainings in IYCF practices and IYCF counselling skills for doctors, nurses, midwives and CHWs (e.g. integrate into Integrated Management of Childhood Illnesses [IMCI] trainings)