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Improving Delivery and Uptake of Essential Nutrition Interventions Through the Health and Food System and in the Community Project

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Improving Delivery and Uptake of Essential Nutrition Interventions Through the Health and Food System and in the Community Project Improving delivery and uptake of essential nutrition interventions through the health and food system and in the community Project Satkhira and Barisal Project Completion Report Reporting Period: June 2013 to May 2015 Submitted to UNICEF Submitted by CARE Bangladesh Prepared By: Reviewed by: Md. Anowarul Arif Khan Dr. Sheikh Shahed Rahman Acting Program Manager – Nutrition National Nutrition Coordinator CARE Bangladesh CARE Bangladesh Table of Contents 1.0 Executrive summary ………………………………………………………………………3 2.0 Effective coverage of direct nutrition interventions: ...................................................... 4 3.0 Signing of Project Cooperation Agreement between United Nation Children's Fund and CARE Bangladesh: .............................................................................................................. 14 4.0 Activities performed during the project period: ........................................................... 14 A. SYSTEM STRENGTHENING ACTIVITIES:................................................................. 14 B. CAPACITY BUILDING INTERVENTIONS: ................................................................. 27 C. COMMUNITY MOBILIZATION INTERVENTIONS: ................................................ 29 D. FACILITATION ACTIVITIES RELATED TO SERVICE DELIVERY: ................... 37 5.0 Project sustainability: ...................................................................................................... 41 6.0 Lessons Learned ............................................................................................................... 41 7.0Conclusion……………………………………………………………………………………………………………………………………….43 8.0 Annex: .................................................................................................................................... 44 Project Completion Report _IAHBI Project_CARE B Page 2 1. Executive summary: Maternal and child nutrition during the first 1,000 days – from conception through the age of two – shapes a child’s future. Women’s nutrient needs increase during pregnancy and lactation. Some of the increased nutrient requirements protect maternal health while others affect birth outcome and infant health. If the requirements are not met, the consequences can be serious for women and their infants. During this critical window of opportunity, nutrition can have a measurable lasting impact on growth and brain development and disease. The impacts of malnutrition during the first 1,000 days, if not appropriately addressed, are largely irreversible—but these consequences are preventable. With adequate nourishment in the earliest years of life, children have an opportunity to grow, learn, become productive adults and break the cycle of poverty. Despite commendable improvement in nutrition situation in last one decade, still the rates of malnutrition in Bangladesh are among the highest in the world. About 36% children are stunted, 33% are underweight and 14% are wasted among children under 5. Prevalence of micronutrient deficiency and chronic energy deficiency among women is still around 50%. To address these high rates of undernutrition among women and children, we do need to consider delivering appropriate information, services. Mainstreaming nutrition is highly recommended to ensure optimal nutrition services for universal coverage and high risk group of population in country. Operationalization of mainstreaming nutrition through Gob health system is identified as one the major focuses of this project. Integrated Agriculture and Health Based Interventions (IAHBI) is a large project jointly implemented by UNICEF and FAO, funded by United States Assistance for International Development (USAID). Primary objective of this project is to improve the delivery, monitoring and uptake of essential nutrition interventions and practices through the local health and food system and the community under Assasuni, Shyamnagar of Satkhira and Muladi sub-districts of Barisal during the period of June 213 to May 2015. The major focus of this project were threefold: i) To strengthen and improve capacity of health system to deliver direct nutrition services from community clinics, family welfare centers (FWC) and upazila health complex (UHC) under Ministry of Health and Family Welfare (MOH&FW) ii) Addressing nutrition sensitive interventions though key sectors like agriculture and livelihood iii) Community mobilization through community support system and engaging different community groups and support groups like adolescent girls, religious leaders, mother to mother support groups (MTMSG) at lower tier of communities. iv) Addressing mutisectoral approach at subdistrict and below level Project Completion Report _IAHBI Project_CARE B Page 3 Community mobilization efforts were targeted to promote social and behavior changes related to infant and young child feeding (IYCF) practices, consumption of iron and folic acid (IFA) tablets, inclusion of adolescent girls in promoting nutrition interventions, promotion of hygiene practices, food and care during pregnancy and increase service uptake from community clinics, and family welfare centers. Engagement with community support system was to improve skill and capacity of the support groups to foster mainstream nutrition efforts effective and create opportunities for participation of those groups into nutrition governance activities thereby resulting into health system strengthening as a whole. Nutrition sensitive intervention was implemented by Food and Agriculture Organization (FAO) to complement towards the results envisioned achieving within results framework of IAHBI project. Global evidences suggest that only nutrition specific intervention can result into reduction of undernutrition by one fifth of total burden of undernutrition. And CARE Bangladesh experiences suggests that community based nutrition programming essentially requires engagement of community support system and active participation of support groups will ensure increased participation of communities, improved nutrition service uptake, create an enabling environment for improving access to services and participatory governance to ensure measurable nutrition security within communities. It has become increasingly clear that engagement of community support system for health and nutrition has unique advantage. Role of community support system in improving health and nutrition outcomes is crucially important in several ways. Firstly, it is required to bring community actors and systems into full partnership with health systems and in particular to ensure to develop wide array of relationship between community and health system to improve overall situation. Secondly, community engagement in improving nutrition outcomes can be greatly enhanced through mobilization of key affected populations and community networks. Thirdly, in order to have real impact on nutrition outcome, however community support systems must have effective and sustainable systems in place to support their activities for the development of an enabling and responsive environment. Therefore, strengthening community support system approach can be effective for the prevention, treatment and care of undernourished population who are also most marginalized and vulnerable group in the society. Essentially targeting this group, increasing access to essential nutrition services will bring real impact on nutrition outcome. Effective and sustainable support systems together with increased availability and coverage of direct nutrition interventions and supporting integration of nutrition sensitive intervention were CARE’s approach under IAHBI. A strong focus on capacity building of service providers, creation of demand for essential nutrition services in the communities, enabling community actors to play full and effective roles are the key focus of this project. 2.0 Effective coverage of direct nutrition interventions: Project achievement at a glance: According to Project Cooperation Agreement (PCA), the project has selected 14 indicators and fixed the target benchmark for project period. After successfully completion of project activities, Project Completion Report _IAHBI Project_CARE B Page 4 the project has evaluate the results and found that most of the indicator has reached its target successfully except four indicators. Present status was collected from service statistics which may differ from actual figure and project expected that during the project end evaluation all indicators will reach its target according the PCA. Table 1: Status of key indicator as per PCA till April 2015 in three project upazilas: Indicator Targe Present status t (April/15)* %of women consume at least 100 IFA tablets during pregnancy 60% 70% % of children 06-59 months supplemented with Vitamin A bi-annually 90% 98% % of children 24-59 months dewormed 90% 91% % of children 6-23 months supplemented with micronutrient powders 60% 24% % of adolescents girls in targeted youth clubs supplemented weekly with 90% 100% IFA tablets % of children 6-59 months suffering from diarrhea received ORS with 60% 100% zinc % of children under 5 suffering from severe acute malnutrition received 60% 20% appropriate treatment % of HHs are consuming iodised salt 60% 97% % of caregivers can cite at least 5 optimal IYCF practices 80% 62% % of children are exclusively breastfeed from 0-6 months 80% 86% % of children 6-23 months are receiving a ‘minimum acceptable diet 50% 84% % of PLWs consume an adequate maternal diet in quantity and quality, 50% 84% during pregnancy
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