The Ministry of Public Health
General Directorate of Preventive Medicine
The Public Nutrition Department
FACTSHEET
Background
According to National Nutrition Survey 2004 the nutrition indicators are alarming in Afghanistan. Among children 6-59 months Stunting is 60.5%; underweight is 33.7% and wasting is 8.7%. From micronutrients perspective, Iodine deficiency is 71.9%;iron deficiency is 71.5%;iron-deficiency anemia is 33.4%; zinc deficiency is 54-72% among children 6-59 months. Underweight (BMI<18.5) is 20.9% among non-pregnant women; iodine deficiency is 78.9% among pregnant women and 74.7% among non-pregnant women. 65.3% of pregnant women have iron deficiency.These figures simply tell us that the nutrition situation in Afghanistan, especially that of women and childrenis a serious public health concern.
The goal and objectives of PND
The public nutrition department has been established in 2003 by support of Unicef and technical assistant of Tufts University to address the major concerns of public health in terms of nutrition. According to the public nutrition policy & strategy 2009-2013 the goal of the public nutrition department is to reduce nutrition related mortality amongst mothers and children by protecting and promoting healthy nutrition for all Afghans, and by preventing chronic malnutrition and associated micronutrient deficiency disorders. To achieve this goal the department has the operational objective of increasing access to and utilization of quality preventive and curative nutrition services provided at community level and through health facilities.So the major responsibilities of the department in terms of public nutrition are promotion of healthy nutrition, prevention of malnutrition and treatment of acute malnutrition in the country.
To reach the operational objective, the department has prioritized the following 8 areas for its interventions: 1) Nutrition promotion using several channels of communication to raise awareness of the public; 2) Infant and young child feeding that is prevention of malnutrition during the first two years of age through evidence-based interventions; 3) Micronutrients to address the hidden hunger or vitamin and mineral deficiencies through interventions at the national, community and family level; 4) Adequate care during severe acute malnutritionboth at the health facility and community level; 5) Food safety and quality control by setting standards and enforcing standard quality and safety measures during production, storing, processing and importing food items; 6) Effective nutritional surveillance and monitoring to have knowledge of the nutrition status of Afghans through continuous data collection and monitoring as well as periodic surveys and studies; 7) Adequate prevention and response to moderate acute malnutrition and / or chronic malnutrition during the emergency situation, or in situation where the global acute malnutrition rate is higher than 10% due to any reason; 8) Capacity development for public nutritionto enable the department achieve its objectives and engage in a multisectoral approach with other partners for addressing the underlying causes of malnutrition.
Partners
The nutrition activities are supported financially and technically by several partners. UN partners (Unicef, WHO, WFP, FAO); donors (World Bank, USAID, EU and CIDA); NGOs (Micronutrients Initiative, BASICS , ACF, Save the Children, Oxfam, and BPHS implementers); and private sector (salt factories, Media) are among the key partners.
Unicef’s involvement in nutrition is regulated through program of cooperation document signed by the unicef representative and the minister of public health. According to this cooperation document unicef is committed to support the community based and facility based treatment of acute malnutrition, promotion of micronutrients intake, and prevention of malnutrition through IYCF approach. Additionally, Unicef leads the nutrition cluster and enhance the capacities to respond to emergencies in terms of nutrition activities. The cluster is composed of several UN agencies and NGOs.
WHO’s involvement is regulated through Joint Program Review Mission (JPRM) document that is made jointly with the MoPH. Training in management of severe acute malnutrition, adaptation of training guidelines and translation of new WHO growth monitoring chart are the main areas supported by WHO. The new JPRM will contain some more activities and involvement of WHO in terms of nutrition with MoPH. WHO has promised to support salary of two staff members in the department, but this is not documented yet.
WFP’s involvement in nutrition activities is regulated by a memorandum of understanding signed by the representative of WFP and the Minister of Public health. According to this document WFP provide food items to TB patients, and supplementary food for moderately malnourished children and women. WFP will support salary for one staff member in the department to improve coordination of activities.FAO is leading the MDG-fund project which is a joint initiative of several UN agencies in coordination with the MoPH and the Ministry of Agriculture and Irrigation. This project has two objectives: to implement nutrition and food security interventions in 2 districts of 4 underserved provinces and to strengthen the system within the relevant ministries.
The World Bank supports BPHS and EPHS in 11 provinces and strengthens the stewardship of the MoPH. In terms of nutrition it provide support to salary of three staff members in the department through SHARP project, and is committed to support the nutrition part of BPHS.
The USAID support BPHS and EPHS in 13 provinces and strengthen the capacity of MoPH at national and provincial level through several other projects such as Tech Serve, BASICS and HSSP. In terms of Nutrition the USAID supports BASICS to pilot and scale up a community based growth monitoring and promotion project. BASICS also support the department in conducting workshops and advocacy events.
The European Union (EU)supports BPHS and EPHS implementation in 10 provinces. EU has started to provide additional fund for BPHS implementers to integrate nutrition in the BPHS project and also support the capacity building of the department through a diploma course.
CIDA is in negotiation with the MoPH to decide on financing a nutrition project. This activity is under review and hopefully covers some gaps in terms of nutrition components of BPHS.
Micronutrient Initiative is helping the department by seconding a staff member to work in the department and support implementation of micronutrients programs.
GAIN (Global Alliance for Improved Nutrition) is addressing the micronutrient deficiency through food fortification (flour fortification and oil fortification) through a sustainable way of public-private partnership.
Other NGOs implement nutrition projects in several provinces in coordination with the department. Most of these NGOs are global partners of the Unicef and receive fund from Unicef to implement the community-based management of severe acute malnutrition, nutrition surveys and surveillance.
To enhance coordination and effectiveness of program we need to develop a joint evaluation plan to improve the coordination, accountability, effectiveness, quality and coverage of the services.
As addressing the problem of malnutrition is beyond the capacity of the MoPH and requires involvement of other sectors, therefore, a multisectoral approach is needed. Fortunately, with technical support of the World Bank discussion on this issue has been started already and a multisectoral plan of action for nutrition is drafted. The plan of action will bring other ministries together such as Ministry of Agriculture, irrigation and livestock (MAIL); the Ministry of Rural Rehabilitation and Development (MRRD); the Ministry of Education (MoE) and the Ministry of Commerce and Industry (MoCI) together to agree on activities to reduce malnutrition and its underlying causes in partnership with international partners and UN agencies. So far the activity is going on smoothly, but need strict support and commitment especially from the leadership of the MoPH to lead this initiative.
Current activities
Currently the department is supporting nutrition projects in all over the country by a core team in the PND and a focal person (Provincial Nutrition Officer) in each province. The main activities are:
- Assessment of Nutrition Situation
Nutrition Surveys: The updated national nutrition survey is from 2004. However, small scale surveys conducted in Takhar, Balkh, Faryab, Samangan, Sarepul, Paktia and Badghis.
Nutrition surveillance: Inclusion of nutrition indicators in DEWS is in the process. Community based sentinel sites report from Badakhshan, Balkh and Faryab. MDG-Fund project collect data from 2 districts of five provinces (Badakhshan, Nengarhar, Dikundi, Bamyan and Kabul City). The BPHS implementers report acute malnutrition identified in the Health facilities. A Rapid Assessment Tool (RAT) has been established for conducting rapid nutrition assessment in emergencies.
- Prevention of Malnutrition
Public awareness: A public awareness campaign has been conducted in 2008 and another campaign is planned for year 2012.
IYCF (Infant and Young Child Feeding): Baby friendly hospital initiative (BFHI) has been implemented in three hospitals of Kabul City (Malalai, Rabea Balkhi and Khairkhana hospitals). Promotion of breastfeeding (Early initiation, exclusive breastfeeding, complementary feeding at the age of six months, continuation of breastfeeding for two years) is part of BPHS. Code of Breastmilk substitutes is legalized through a regulation and followed.
- Treatment of Acute malnutrition
TFU (Therapeutic Feeding Units), which provide in-patient care to children with Severe Acute Malnutrition (SAM). Currently there are 48 TFUs in all provinces, except Farah and Nooristan Provinces.
CMAM (Community based Management of Acute Malnutrition), is active in 15 provinces. CMAM is an emergency response mechanism and activated only where the rate of Global Acute Malnutrition is higher than 10%. CMAM is a part of BPHS, but only in EU supported provinces we have CMAM projects. The other provinces are supported through Nutrition cluster and we hope to activate CMAM in all provinces as part of BPHS.
- Micronutrients
Micronutrients supplementation: Supplementation of Iron and Folic acid to pregnant women through all health facilities and health posts; supplementation of Vit A capsules during post partum visits; supplementation of Vit A to children under five through NIDs; supplementation of Zinc with ORS for children with diarrhea; supplementation of multi vitamins and menrals (sprinkle) to all malnourished children through CMAM and TFUs.
Food Fortification: Salt Iodization is done through 30 salt factories in 12 provinces of the country. Flour fortification with Vit A, D and Iron is being done through 7Silos in major cities of the country . Fortification of cooking oil is in the process. Home based food fortification is done through distribution of sprinkles.
Food diversification: Promotion of diversified food rich in vitamins and minerals through health facilities, health posts and other channels. A recipe booklet has been established to guide families in feeding of children over age six months. Another guidebook for families has been developed jointly with the MAIL, FAO and Unicef.
- Multi sectoral Nutrition Action Framework
The action framework has been drafted by different ministries to support nutrition related activities. The ministries of education, Agriculture, Comers, Ministry of Rural Rehabilitation and Development are the partners of this approach.
- Strengthening the stewardship role
Reviewing all nutrition related proposals, developing the guidelines, strategies and policies, monitoring and evaluation of nutrition program and improving communication and coordination with the provincial nutrition officers and conducting trainings on different topics of concern. The projects are monitored and feedback to the implementer and donor will be sent.
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