National Nutrition Policy of Sri Lanka, 2010

National Nutrition Policy of Sri Lanka Ministry of Healthcare and Nutrition Suwasiripaya 385, Rev. Baddegama Wimalawansa Thero Mawatha Colombo 10 Sri lanka 2010 National Nutrition Policy of Sri Lanka National Nutrition Policy of Sri Lanka is Published in the extraordinary gazette No. 1639/5 of Democratic Socialist Republic of Sri Lanka dated 2010.02.02 CONTENTS Page Section 1. Preamble 2 Section 2. Nutrition Status in Sri Lanka 3 Section 3. Vision 4 Section 4. Goals & Objectives 4 4.1 Goal 4 4.2 Objectives 4 Section 5. Policy Statements 4 5.1 Ensuring optimal nutrition throughout the life cycle 4 Policy Statement 5.1.1 Pregnant women 4 Policy Statement 5.1.2 Lactating mothers 5 Policy Statement 5.1.3 Infant & young child 5 Policy Statement 5.1.4 Pre-school & school children 5 Policy Statement 5.1.5 Adolescents 5 Policy Statement 5.1.6 Adults & elderly 5 5.2 Enhancing capacity to deliver effective & appropriate interventions 5 Policy Statement 5.2.1 Behaviour change communication 5 Policy Statement 5.2.2 Capacity building 5 Policy Statement 5.2.3 Community empowerment 5 Policy Statement 5.2.4 Media 5 5.3 Ensuring effective management of adequate nutrition to vulnerable populations 6 Policy Statement 5.3.1 Vulnerable populations 6 Policy Statement 5.3.2 Emergencies/ conflict 6 Policy Statement 5.3.3 Illness/ PLWHA 6 5.4 Ensuring food and nutrition security for all citizens 6 Policy Statement 5.4.1 Food based approaches 6 Policy Statement 5.4.2 Dietary diversification 6 Policy Statement 5.4.3 Nutrient enhancement 6 Policy Statement 5.4.4 Food safety 6 5.5 Strengthen advocacy, partnerships and networking 7 Policy Statement 5.5.1 Political commitment 7 Policy Statement 5.5.2 Inter agency partnerships 7 5.6 Strengthen research, monitoring and evaluation 7 Policy Statement 5.6.1 Nutrition surveillance 7 Policy Statement 5.6.2 Evidence based review 7 Section 6. Implementation 7 Section 7 National Nutrition Strategic Plan Section 8 National Nutrition Strategic Plan Matrix Annexure - Drafting Committee of the Policy 9 DDG - Deputy Director General MOE - Ministry of Education FHB - Family Health Bureau HEB - Health Education Bureau MRI - Medical Research Institute NCD - Non Communicable Diseases NCU - Nutrition Coordination Unit DNUT - Director/ Nutrition Division D/E&UH - Director/Estate and Urban health PLWHA - People Living With HIV & AIDS PIH - Pregnancy Induced Hypertension UN - United Nations NGO - Non Governmental Organization LBW - Low Birth Weight MoH - Ministry of Health IYCF - Infant & Young Child Feeding MCH - Maternal & Child Health NA - Not available AFC - Adolescents’ friendly clinics NP - Nutrition Promotion PI - Process indicator OI - Output indicators DHS - Demographic & Health Survey GSN - Grama Sewa Niladari 1. PREAMBLE Good nutrition is essential for achieving and maintaining good health, improving quality of life, and enhanced socio-economic development of the country. At national level, nutritional status is the outcome of the interrelationships between health, environment, community and economic development. The nutritional status of individuals is inter-related as they pass through different stages of the lifecycle. Poor maternal nutrition leads to under nutrition in-utero, followed by low birth weight and its’ consequences of increased neonatal and infant morbidity and mortality, as well as increased risk of chronic diseases in later life. A comprehensive nutrition policy will lead the way to optimum nutrition through all stages of life cycle reducing the inter generational impact of malnutrition. The Nutrition Policy for Sri Lanka was first developed in 1986. There is now an urgent need to revise it as a sound nutrition policy is an essential prerequisite for implementing future strategies and action plans in accordance with the former, while building upon the related policies already in existence. The nutritional well-being of a population is influenced by determinants that cut across the areas of responsibilities of different sectors and agencies. Household food insecurity, for example, is influenced by factors such as health, education, employment, food availability and food affordability, and leads to malnutrition. These factors are under the purview of many sectors and extends beyond the health sector. The proposed National Nutrition Policy (NNP) will provide a platform for inter-sectoral coordination in order to accelerate efforts to achieve optimum nutrition for all. The policy will also provide overall guidance for the development of national strategic plans of action for nutrition activities. A concerted effort by relevant sectors, including Planning, Agriculture, Fisheries, Livestock, Health, Women’s Affairs/Empowerment, Education, Social Services, Poverty alleviation, Trade and Industry, and Media, the government, non-governmental agencies, international development partners, and the cooperation of the public will be mandatory for effective implementation of the policy and for acceleration of national development. The NNP will be updated in 2013 and revised in 2018. 2. NUTRITION STATUS IN SRI LANKA Health and social status of Sri Lanka has shown a significant progress over the last several years. Life expectancy of Sri Lankans is 68 years for males and 76 years for females in 2006 (Central Bank Annual Report. 2008), Maternal mortality rate is 39.3 per 100,000 live births (FHB. 2006), and Infant mortality rate is 10 per 1000 live births (Registrar General’s Dept. 2006), Under five mortality is 12.1 per 1000 births (Registrar General’s Dept.2006). However, improvement of nutrition indicators has not kept pace with the others. Despite the relatively high literacy rate (90.8% in 2006) in the country (Central Bank Annual Report. 2008), and achievements in economic growth, the nutritional status of children is not satisfactory, and neither is that of adolescents and women. According to the Demographic & Health Survey 2006/2007 data, low birth weight prevalence is 16.6%. Among the under five children, 21.1% are underweight (compared to 22.8% revealed by DHS 2000), and about 14.7% under 5 years are wasted (15.5% in 2000). Stunting levels have declined from 18.4% in 2000 to 17.3% in 2007 (DHS). The nutrition status shows a wide variation across the districts & as for wasting, it ranges from 10.5% to 28.1% substantiating the geographical disparity. Undernutrition leads to sub-optimal growth, poor cognitive development and poor academic performance in children resulting in decreased work capacity and productivity in adult life. Sri Lanka is dependent upon well-nourished healthy children to grow up and contribute effectively to the well-being of the nation. However, if the current figures of undernutrition in non-pregnant women are a proxy indicator (DHS. 2007 revealed that 16.2% of women aged 15-49 years are undernourished with Body Mass Index below 18.5 kgm 2 ), the goal of achieving optimum nutrition status faces a great challenge. This picture is further deteriorated by comparatively high micronutrient deficiencies particularly anaemia and vitamin A deficiency. The prevalence of anaemia among children under- five years, primary school children, adolescents, non pregnant women and pregnant women were 29.9%, 20.9%, 22.3%, 31.6% and 30.3% respectively (MRI. 2001). The last Vitamin A deficiency survey (2006) shows that about 29% of under-five children are biochemically vitamin A deficient. According to the Food Balance Sheets published by the Department of Census and Statistics (2000-2005) it has been shown that there is an increasing trend in the production of rice, vegetables, milk, meat and fruits over the last five years. Accordingly, per capita availability of calories and proteins (g/day) has increased. This generally implies an improved food security situation even though it does not necessarily follow at household level. Inequity of household food distribution, insufficient knowledge, inappropriate feeding and caring practices add to the problem of compromising nutrition security of the individual. Inappropriate infant and young child feeding practices especially short duration of exclusive breast-feeding & inappropriate complementary feeding still persist. Nevertheless exclusive breast-feeding has been increased from 57.6% in 2000 (predominant breast-feeding (0-4 month)) to 75.8% (0-5 month) in 2007 (DHS). Inadequate knowledge and time constraints on the part of caregiver are major contributory factors for poor feeding practices than the economic hardships. As the child grows into an adolescent, and then to an adult, lifestyle changes are influenced by marketing strategies, convenience factor and peer pressure leading to unbalanced dietary patterns resulting in nutritional deficiencies on one hand and overweight and its’ consequences on the other. Imbalanced diets, sedentary lifestyles, and lack of physical activity are risk factors leading to a high prevalence of overweight (about 31.2% in females aged 15-49 years (DHS.2007)), and other diet-related non-communicable diseases such as diabetes mellitus, cardiovascular disease, hypertension and certain types of cancer. Comparatively high prevalence of overweight is seen in urban areas (7.6% in urban adolescents aged 11-19 years (MRI.2001)). Overweight and obesity are emerging challenges leading to a double burden. Although a wide range of programmes (e.g. Thriposha programme, growth monitoring and promotion of children, micronutrient supplementation etc.) have been ongoing for several years, it is imperative that they are evaluated and strengthened to reap the full benefit. A strong political commitment and concerted social action are needed to address the multi causal problems simultaneously. Different ministries and stakeholders of various sectors and agencies are required to act urgently, in a coordinated manner. A well-defined policy and a workable action plan will serve as a guideline to the relevant stakeholders in planning and management of nutrition programmes with effective integration ensuring efficiency and sustainability. 3. VISION Every Sri Lankan has access to appropriate and adequate food and nutrition irrespective of their geographical location and socio-economic status. 4. GOAL AND OBJECTIVES 4.1 Goal To achieve and maintain the nutritional well-being of all Sri Lankans enabling them to contribute effectively towards national socio-economic growth and development. 4.2 Objectives 1. To ensure optimal nutrition throughout the life cycle 2. To enhance capacity to deliver effective & appropriate interventions 3. To ensure effective management of adequate nutrition to vulnerable populations 4. To ensure food and nutrition security for all citizens 5. To strengthen advocacy, partnerships and networking 6. To strengthen research, monitoring and evaluation 5. POLICY STATEMENTS 5.1 Ensuring optimal nutrition throughout the life cycle Nutritional status throughout the stages of the life cycle is interrelated. Fetal malnutrition due to poor maternal nutrition sets-up a vicious cycle affecting all stages of life and even future generations. Thus, in-order to reduce this inter-generational impact of malnutrition, the National Nutrition Policy will focus on a life-cycle approach and aims to: Policy Statement 5.1.1: Ensure appropriate and adequate nutrition and related services for all pregnant women throughout the pregnancy enabling a delivery of a healthy baby with an adequate birth weight. Policy Statement 5.1.2: Ensure supportive family environment, services and regulatory safety nets to enable mothers to provide optimal care including exclusive breastfeeding for 6 months and continuation of breast feeding for 2 years and beyond. Policy Statement 5.1.3: Ensure a good foundation for all infants and young children during their early childhood years by providing optimal nutrition through provision of exclusive breast-feeding for 6 months followed by complementary feeding together with continued breast feeding for 2 years and beyond. Policy Statement 5.1.4: Ensure all pre-school and primary school children have access to adequate and safe nutrition, which will optimise their growth and development. Pregnant Women Infant and Young Child Lactating Mothers Pre-school and School Children Policy Statement 5.1.5: Reduce undernutrition and obesity (malnutrition) among adolescents enabling them to be healthy and productive adults. Policy Statement 5.1.6: Promote appropriate nutrition for adults and elderly to ensure prevention and control of nutrition related Non-Communicable Diseases. 5.2 Enhancing capacity to deliver effective and appropriate interventions Empowerment of all stakeholders can only be achieved through capacity building, which is vital for successful interventions. National Nutrition Policy therefore aims to: Policy Statement 5.2.1: Promote behaviour change communication to all sections of population enabling them to make right food choices and care practices. Policy Statement 5.2.2: Strengthen capacity building of health staff and community–based workers for effective behaviour change communication with regards to nutrition promotion in all sections of the community. Policy Statement 5.2.3: Empower the community by reorganizing grass root level community organizations, in programme planning, implementation and monitoring of nutrition intervention programmes. Policy Statement 5.2.4: Ensure dissemination of appropriate nutrition messages and promotion programmes through media in a responsible and ethical manner. 5.3 Ensuring effective management of adequate nutrition to vulnerable populations Vulnerable populations are worst affected particularly during man made and natural disasters as well as during illnesses. Hence National Nutrition Policy aims to: Policy Statement 5.3.1: Ensure targeting of nutritional interventions to underserved areas, plantation community, urban poor and areas identified by the nutrition surveillance system. Policy Statement 5.3.2: Ensure access to adequate nutrition for people affected by emergencies (conflict or natural disasters) and ensure emergency preparedness and response plans to adequately address the basic nutrition needs of all people. Adolescents Adults and Elderly Emergencies / Conflict Behaviour Change Communication Capacity Building Community Empowerment Media Vulnerable Populations Policy Statement 5.3.3: Ensure adequate nutrition during and after illness with special considerations on those affected with chronic diseases and people living with HIV / AIDS (PLWHA). 5.4 Ensuring food and nutrition security for all citizens Food and nutrition security is a major factor in achieving nutritional wellbeing at individual and household level. National Nutrition Policy aims to: Policy Statement 5.4.1: Ensure access to adequate, nutritious, safe and quality food at affordable price throughout the year. Policy Statement 5.4.2: Promote consumption of a wide variety of foods ensuring intake of all macro and micronutrients to prevent deficiency disorders and diet related chronic diseases. Policy Statement 5.4.3: Promote and facilitate improvement of quality of commonly consumed food items (eg. food fortification) to ensure micronutrient supplementation for vulnerable groups. Policy Statement 5.4.4: Enact and implement of appropriate legislations and other regulatory mechanisms to ensure provision of safe nutrition to all citizens of Sri Lanka. 5.5 Strengthen advocacy, partnerships and networking Appreciating the cross-cutting nature of nutrition interventions, measures will be taken to advocate incorporation of nutritional objectives and components into national development and other relevant policies and programmes and aims to: Policy Statement 5.5.1: Establish a mechanism for regular consultation and dialogue between political leadership, policy planners and other stakeholders to ensure sustainability of programmes in coherence with other nutrition related policies. Policy Statement 5.5.2: Strengthen partnerships and networking with relevant sectors and stakeholders including private sector for undertaking collaborative programmes to improve nutrition at community level. Illness / PLWHA Food Based Approaches Dietary Diversification Nutrient Enhancement Food Safety Political Commitment Inter Agency Partnership 5.6 Strengthen research, monitoring and evaluation Timely information and updated knowledge is vital for evidence based programme planning and management. The National Nutrition Policy will; Policy Statement 5.6.1: Promote establishment and operation of National Nutrition Surveillance System providing policy makers, programme managers, and nutrition care providers with evidence needed for better programme management. Policy Statement 5.6.2: Prioritise and support research oriented activities and utilize evidence for regular monitoring and periodic evaluations of nutrition programmes. Nutrition Surveillance Evidence Based Review 6. IMPLEMENTATION The National Nutrition Policy (NNP) upon adoption will serve as the base document on which the strategic approaches will be developed leading to the phase of implementation. Effective and sustainable institutional framework is a mandatory requirement for smooth implementation of this policy. Identifying and promoting establishment of required institutions and mechanisms are important to ensure efficient administration of policy and action plan. Comprehensive action plan will be drawn up inline with the NNP identifying responsibility for each activity with a pre-determined time line for implementation and a means of verification. The policy will be implemented through bodies with well-defined responsibilities. The following bodies will be established in order to accomplish this objective. 1. National Nutrition Steering Committee (NNSC) This committee will make nationally important policy decisions and monitor the activities and will comprise of high-level representatives of relevant ministries 2. National Nutrition Co-ordination Committee (NNCC) This committee will make key technical decisions and review the action plan periodically and prioritize activities and will comprise of nutrition professionals of different sectors 3. Nutrition Coordinating Committee at Provincial level (NCCP) This committee plans and manages the nutritional interventions and other programmes within the province 4. Nutrition Co-ordination Unit (NCU) NCU functioning as a secretariat will be responsible for coordination between implementing agencies ensuring smooth implementation of key decisions made by the NNSC and NNCC. Monitoring and evaluation system will be developed to ensure that the NNP is being implemented and the objectives are met. The problems faced in implementing as well as monitoring will be identified, and the information will be shared with the respective institutions/ bodies at provincial/district level in order to take necessary actions. 7. National Nutrition Strategic Plan 2009-2013 Introduction Government of Sri Lanka is committed to ensure optimal nutrition for all Sri Lankans irrespective of their geographical locations, socio-economic status, or physiological status. In order to achieve the desired objectives it is imperative that cooperation of all relevant sectors should be sought and this includes commitment of Government agencies, development partners, non government agencies and the private sector. National Nutrition Policy was a long felt need and has been possible to finalize after several rounds of deliberations. This document out lines the strategic plan based on the policy guidelines. It identifies goals and objectives, expected outcomes, key action areas and major activities. Provinces and agencies may develop their action plans based on the guidelines provided in this document. Goal To achieve and maintain the nutrition and well being of all Sri Lankans enabling them to contribute effectively towards National socio-economic growth and development. Policy Objectives 1. Ensuring Optimal Nutrition throughout the lifecycle 2. Enhancing capacity to deliver effective and appropriate interventions 3. Ensuring effective management of adequate nutrition to vulnerable populations 4. Ensuring Food and Nutrition Security for all citizens 5. Strengthening advocacy, partnerships and networking 6. Strengthening Research, Monitoring and Evaluation Policy Objective 1 - Ensuring Optimal Nutrition throughout the lifecycle Expected Outcome Key Action Areas 1.1 Low birth weight prevalence reduced 1'1'1 Reducing under nutrition and micronutrient deficiencies among women of reproductive age 1.1.2 Controlling and managing of antenatal causes of foetal malnutrition (i.e. infectious diseases, PIH) 1.2 Malnutrition among children under 5 years of age reduced 1'2'1 Promoting, protecting and supporting exclusive breastfeeding for the first six months of life and continuation of breast feeding for 2 years and beyond 1'2'2 Strengthening complementary feeding practices 1'2'3 Strengthening Growth Monitoring and Promotion 1'2'4 Promote psychosocial development of children during early childhood years 1'3 Morbidity due to ARI and diarrhoea among children under 5 years reduced 1'3'1 Strengthening Integrated Management of Childhood Illnesses 1'4 Malnutrition among school age children, adolescents & youth reduced 1'4'1 Create a good nutrition enabling environment in schools 1'4'2 Enhance for a in delivering nutrition services to non-school going adolescents 1'4'3 Regular nutritional status assessments of non school going adolescents & youth 1'5 Nutrition-related disorders among adult population reduced 1'5'1 Regular nutritional status assessment of adults & elderly 1'5'2 Updating and implementing national food based dietary guidelines 1'5'3 Promoting healthy workplace 1'5'4 Establish regular monitoring of nutritional status among adult populations Policy Objective 2 - Enhancing capacity to deliver effective and appropriate interventions Expected Outcome Key Action Areas 2'1 Stakeholder capacities on delivering nutrition services improved 2'1'1 Promote behaviour change among all sections of population & enabling them to make right food choices and care practices 2'1'2 Build and empower the community organizations, in programme planning, implementation and monitoring of nutrition intervention programmes 2'1'3 Infrastructure facilities improved at all levels 2'1'4 Effect a behaviour surveillance system at all levels Policy Objective 3 - Ensuring effective management of adequate nutrition to vulnerable populations Expected Outcome Key Action Areas 3'1 Disparities in nutritional status reduced 3'1'1 Ensure targeting of nutritional interventions to underserved areas, plantation community, urban poor and conflict affected areas 3'2 Quality of life of patients improved through optimum nutrition interventions 3'2'1 Effective hospital nutrition system established Policy Objective 4 - Ensuring Food and Nutrition Security for all citizens Expected Outcome Key Action Areas 4'1 Accessibility and consumption of adequate, safe and nutritious foods at the household level improved 4'1'1 Ensure access to adequate, nutritious, safe and quality food at affordable prices throughout the year 4'1'2 Ensure provision of safe food 4'2 Ensuring improvement of quality in commonly consumed food through nutrient enhancement (Food fortification) 4'2'1 Ensuring intake of all macro and micronutrients to prevent deficiency disorders and diet related chronic diseases Policy Objective 5 - Strengthening advocacy, partnerships and networking Expected Outcome Key Action Areas 5'1 Nutrition components included into other relevant national and Provincial policies and strategic plans 5'1'1 Mainstreaming nutrition in other related national and provincial policies 5'2 Coordinated action for nutrition within the Ministry of Health is strengthened 5'2'1 Establishing an effective coordinating system 5'3 Intersectoral coordination for nutrition is strengthened 5'3'1 Establish a high- level Intersectoral coordination mechanism 5'3'2 Enhance coordination and harmonization of partners and stakeholders who work for food and nutrition in the country (i.e. UN agencies, bilateral agencies, NGOs/civil societies) 5'3'3 Strengthen partnerships and networking with relevant sectors and stakeholders for undertaking collaborative programmes to improve nutrition of community at Provincial' District, Divisional and Community level Policy Objective 6 - Strengthening Research, Monitoring and Evaluation Expected Outcome Key Action Areas 6'1 Timely availability of evidence for decision making 6'1'1 Strengthen National Nutrition Surveillance System 6'1'2 Establish National Nutrition Management Information System 6'1'3 Strengthen the support for research in nutrition and the use of its outcomes 6'1'4 Strengthen monitoring and evaluation of the impacts of nutrition intervention programs Policy Objective 5: Strengthening advocacy, partnerships and networking Expected Outcomes Key action areas Major activities Outcome indicator/s Baseline Targets Responsible national Organization Partners 5.1 Nutrition components included into other relevant national and provincial policies and strategic plans 5.1.1 Mainstreaming nutrition in other related national and provincial policies 5.1.1.1 Include nutrition components in relevant national and provincial policies and strategies (ie. Development , poverty reduction, agriculture, education, transport % of other relevant policies formulated inline with nutrition policy& strategic plan Zero 75% 5.2 Coordinated action for nutrition within the Ministry of Health is strengthened 5.2.1 Establishing an effective coordinating system 5.2.1.1 Establishing a central management unit within the MOH bringing together related divisions, bureaus and units who are responsible for food and nutrition Availability of a central management unit None Available 5.3.1 Establish a high- level intersectoral coordination mechanism 5.3.1.1 Establishment of a high level intersectoral & interministerial steering committee for nutrition involving concerned Ministries 5.3.2 Enhance coordination and harmonization of partners and stakeholders who work for food and nutrition in the country (UN agencies, bilateral agencies, NGOs/civil societies) 5.3.2 .1Establish a food and nutrition coordination committee including UN agencies, bilateral agencies, NGOs/civil societies & universities 5.3.3.1.Promoting development of nutrition improvement strategies at Provincial level 5.3.3.2.Promote planning, implementing and District, Divisional agencies to formulate integrated nutrition improvement communication plans with all relevent stakeholders 5.3 Intersectoral coordination for nutrition is strengthened None Available Other relevant governmental partners, Academic departments, Media, UN agencies, other NGOs DDG/PHS, FHB, MRI,D/Nutrition , HEB D/Planing, D/Nutrition Coordination Division, Provincial Health Administration Availability of an inter-ministerial committe 5.3.3 Strengthen partnerships and networking with relevant sectors and stakeholders for undertaking collaborative programmes at Provincial, District, Divisional & community level to improve nutrition of the community 6 Policy Objective 1: Ensuring Optimal Nutrition throughout the lifecycle Expected Outcomes Key action areas Major activities Outcome indicator/s Baseline Target Responsible national Organization Partners 1.1.1.1 Implementation of a package of interventions to pre-pregnant women (Implementation of Integrated Nutrition Package) 1.1.1.2 Strengthening of the implementation of the intervention package delivered to the pregnant women through the MCH program (annex) 1.1.1.3 Implement a special package of interventions to high risk mothers as defined in H512 1.1.2.1 Strenghthening screening for Pregnancy Induced Hypertension, Diabates Melliatus, Heart Diseases and other conditions causeing fetal malnutrition 1.1.2.2 Promote specialized institutional care 1.2.1.1Antenatal preparation to ensure proper breast feeding practices 1.2.1.2 Promote supportive family environment and services and ensure regulatory safety nets (Full implementation of Breast Feeding Code and BFHI, maternity leave, etc) to mothers to provide optimal breast feeding 1.2.1.3 Provide and implement a set of guidelines for optimal nutrition for lactating mothers including counseling services for breast feeding problems 1.2.1.1 Develop and implement a country specific IYCF strategy 1.2.2.2 Improve family capacity for timely, appropriate and safe complementary feeding of infants and young children while continuing breast feeding 1.2.2.3 Strengthening food and micronutrient supplementation programs Prevalence of iron deficiency anemia among infants at 6 – 11/12 Iron deficiency 57% (MRI 2001) reduced by 30% 1.2..2.4 Building capacity of health workers and caregivers on feeding sick children 1.2.2.5 Introduction of and sustain nutrition rehabilitation programs to manage children with moderate and severe wasting 10% reduction from the current level 1.2.3.1 Improve coverage and capacity for growth monitoring 1.2.3.2 Improve capacity of health workers and care givers in correct interpretation of growth curves and other related information 1.2.3.3 Strengthen capacity of health and community workers for nutritional interventions 1.2.4 Promote psychosocial development of children during early childhood years 1.2.4.1Sustain and Strengthen psychosocial development activities of ECCD program 1.1 Low birth weight reduced 10% reduction from the current level 90% (0- 6 months) 1.1.1 Reducing under nutrition and micronutrient deficiencies among women and reproductive age LBW rate 1.2 Malnutrition among children under 5 years of age reduced 16.6% (DHS 2006) 1.1.2 Controlling and managing antenatal causes of fetal malnutrition (i.e. infectious diseases, PIH) Exculsive Breast Feeding Rate at 6 months 75.8% (0-5 months DHS 2006) FHB, Provincial Health Administration MRI,HEB, Ministry of Education, Food and Drug Control Authority, Ministry of Youth affairs, Minisrty of Labour, Unagencies and NGOs 15% 17% Reduced to 11%. 10% reduction from the current level 1.2.3 Strengthening Growth Monitoring and Promotion 1.2.2 Strengthening complementary feeding practices 1.2.1.Promoting, protecting and supporting exclusive breastfeeding for the first six months of life and continuation of breast feeding for 2 years and beyond % underweight, % stunting 21.1% 17.3% % Wasting % Stunting 1 Continue Policy Objective 1: Ensuring Optimal Nutrition throughout the lifecycle Expected Outcomes Key action areas Major activities Outcome indicator/s Baseline Target Responsible national Organization Partners 1.3.1.1 Enhance capacities of healthcare providers to practice Integrated Management of Childhood Illnesses protocols % under 5 children with acute respiratory track infections 4.40% 10% reduction from the current level 1.3.1.2 Improving hygiene and sanitation in household and preschools 1.3.1.3 Strengthening access to safe drinking water % under 5 children with diarrhea 3.50% 10% reduction from the current level 1.4.1.1Enhancing awareness and capacity building of the school community 1.4.1.2 Providing supportive school nutrition and health services ( school canteen policy, health promoting schools/healthy schools/nutrition friendly schools concepts to be rationalized) % Stunting (Adolescents) 15% (Adolescents ) 14% 1.4.1.3 Improve the nutrition and health-promoting school curriculum % Overweight (Adolescents) 4.9% (Adolescents) < 1% 1.4.2.1 Identify institutions and fora that provide services to non school going adolescents and device and implement a nutrition promotion program % Anemic (School going children) 20% 15% 1.4.2.2 Launch an effective communication campaign on healthy life styles % Under-weight ( School going children) 48% 35% 1.4.3 Regular nutritional status assessments of non-school going adolescents & youth 1.4.3.1 Carryout regular nutritional status assessments targeting non-school going adolescents and youth 1.5.1 Regular nutritional status assessments of adults & elderly 1.5.1.1 Carryout regular nutritional status assessment targetting Adults and elderly Director Nutrition Division, D/YEDD 1.5.2.1 Updating and implementing national food based dietary guidelines 1.5.2.1 Implementing the updated National food-based dietary guidelines % of reproductive age women over-weight 31.2%(15-49 yr women) 10% reduction from the current level Provincial Health Administration % of reproductive age women anemic 31.6 (15-49yr women) 10% reduction from the current level 1.3 Morbidity due to ARI and diarrhea among children under 5years reduced 1.4 Malnutrition among school age children, adolescents and youth reduced Provincial Health Administration 16.2% (15-49 yr women) 1.5.3.1 Formulate, disseminate and implement guidelines for healthy work place which includes an effective component on nutrition 10% reduction from the current level % of reproductive age women under-weight MRI,HEB, Ministry of Education, Food and Drug Control Authority, Ministry of Youth affairs, Minisrty of Labour, Unagencies and NGOs 1.5.3 Promoting healthy workplace 1.5 Nutrition-related disorders among adult population reduced FHB, D/YEDD 1.3.1 Strengthening Integrated Management of Childhood Illnesses 1.4.1 Create a good nutrition enabling environment in schools 1.4.2 Enhance fora in delivering nutrition services to non-school going adolescents 2 Policy Objective 2: Enhancing capacity to deliver effective and appropriate interventions Expected Outcomes Key action areas Major activities Outcome indicator/s Baseline Targets Responsible national Organization Partners 2.1.1.1 Building capacity on nutrition promotion in the preventive and curative sector health and nutrition workers on effective communication % of health workers (PHM,PHI,HENO) reached competency level NA 85% 2.1.1.2 Promote development of behaviour change communication plans at District, Divisional, and health worker level 2.1.1.3 Build partnerships with the corporate sector to promote good nutrition 2.1.1.4 Implement a media surveilance programme to ensure an ethical advertising No of media channels reviewed monthly NA 40% 2.1.2Build and empower the community organizations, in programme planning, implementation and monitoring of nutrition intervention programmes 2.1.2.1 Implement a evidence based community nutrition package through community workers % GSN divisions implement the package NA 60% 2.1.3.1 Increasing infrastructure facilities available for nutrition promotion activities % of resource centres at MCH clinics & hospitals developed NA 60% 2.1.3.2 Improving tools and media for effective communication No. of communication materials developed 15 100 2.1.3.3 Improving mobility to deliver effective nutrition programs % of transport available PHM, PHI, PHNS, MOH, HEO NA 100% 2.1.4 Effect a behaviour surveilliance system at all levels 2.1.4.1 Implement an evidence based nutrition related behaviour surveilliance system for different levels of the community % of behaviour surveillance programs conducted annually at community, PHM & MOH level NA 60% 2.1.1. Promote behaviour change among all sections of population & enabling them to make right food choices and care practices Other relavent governmental partners, Other nutrition promotion sectors of MoH,Universities, Professional collegesUN agencies, Other NGOs, Media 2.1.3 improving infrastructure facilities at all levels 2.1 Stakeholder capacities on delivering nutrition services improved HEB, FHB, MRI Provincial Health Administration NA 80% % of BCC plans being implemented with quarterly follow ups 3 Policy Objective 3: Ensuring effective management of adequate nutrition to vulnerable populations Expected Outcomes Key action areas Major activities Outcome indicator/s Baseline Target Responsible national Organization Partners 3.1.1.1 Base line surveys for vulnerable populations to identify causes for vulnerability 3.1.1.2. Strengthen nutrition surveillance system in order to obtain timely information on vulnerable populations 3.1.1.3. Build capacities and formulate mechanisms to access resources to target specific nutrition intervention programs to vulnerable communities D/E & U Health, D/Nutrition Division, MRI 3.2.1.1 Formulate and disseminate nutrition guidelines for in and out patients as well as for patients living with chronic non-communicable diseases including HIV and AIDS Provincial health administration 3.2.1.2 Ensuring optimal hospital based diet for in patients 3.2.1.3 Develop human resource and infrastructure capacities within hospitals from nutrition promotion to palliation District specific levels published in DHS 2006 3.1 Disparities in nutritional status reduced 3.1.1 Ensure targeting of nutritional interventions to underserved areas, plantation community, urban poor and conflict affected areas 3.2 Quality of life of patients improved through optimum nutrition interventions 3.2.1 Establishing an effective hospital nutrition system Districts with highier levels of wasting & stunting than the National average to reach national levels Other governmantal partners, Academic departments, UN agencies, other NGOs 50 % of each category of hospitals using nutrition guidelines Percentage of hospitals using nutrition guidelnes 0% Under 5 year wasting and stunting % at District level 4 Policy Objective 4- Ensuring Food and Nutrition Security for all citizens Expected Outcomes Key action areas Major activities Outcome indicator/s Baseline Targets Responsible national Organization Partners 4.1.1.1 Implementing skill enhancing training through nutrition education/ behaviour change programmes to related aspects of nutrition through organized sessions about importance of nutrition in relation to dietary diversification, cooking and storage 4.1.1.2. Support implementation of other related policies eg. agriculture, poverty alleviation, Gamanaguma Nutrition Coordination Division, 4.1.2.1 Implement 10 steps of food safety policy Provincial Health Administration 4.1.2.3 Facilitating access to adequate, nutritious, safe and quality foods (vegetable and fruit home and farm gardens, domestic poultry farming livestock and fisheries) 4.2.1.1 Strengthen Iodine deficiency disorders elimination program Total goitre rate 3.8% (MRI 2005) 10% reduction from the current level MRI, 4.1.1.2 Assess and implement other micronutrient deficiency disorders programs Prevalence of Vitamin A deficiency 29.3% (6-71 months, MRI 2006) 10% reduction from the current level Provincial Health Administration 4.1.2.2 Mainstream nutrition in food production and importation 4.1.2 Ensure provision of safe food 4.2.1 Ensuring intake of all macro and micronutrients to prevent deficiency disorders and diet related chronic diseases 4.1 Accessibility and consumption of adequate, safe and nutritious foods at the household level improved 4.2 Ensuring improvement of quality in commonly consumed food through nutrient enhancement (Food fortification) 4.1.1 Ensure access to adequate, nutritious, safe and quality food at affordable prices throughout the year 25% 24% Other relavant governmental partners,UN Agencies, other NGOs Proportion of population below minimum level of dietary energy Anemia prevelance (<5yr) 50.7% (DHS2006/07) 29.9% (MRI 2001) 5 Policy objective 6: Strengthening Research, Monitoring and Evaluation Expected Outcomes Key action areas Major activities Outcome indicator/s Baseline Targets Responsible national Organization 6.1.1.1 Expand the National Nutrition surveillance system to the whole Island 6.1.1.2 Strengthen the utilization of the reports for decision making at National and divisional level 6.1.1.3 Effect an appropriate behaviour surveilliance mechanism No. of behaviour research conducted anually 0 2 HEB 6.1.2.1 Link surveillance data to National Nutrition information system 6.1.2.2 Consolidate nutrition related data being collected by various organization (i.e. MRI, FHB, NCD etc) 6.1.2.3 Generate National Nutrition reports in regular intervals for decision making 6.1.3.1 Identifying the gaps in nutrition knowledge and set research priorities leading to formulation of a research agenda 6.1.3.2 Strengthening the research capabilities of concerned institutions 6.1.3.3 Ensure effective utilization of research findings for nutrition program designing and policy and strategy development 6.1.4.1 undertake periodical review and evaluation of the impact and effectiveness of nutrition intervention programs 6.1.4.2 Support measures to establish and for the functioning of National, Provincial & deivisional Steering/Coordinating Committees including developing TORs 6.1.4.3 Capacity building of Provincial health system for planing nutritional programs and support identifying targets relevant to each province/divisions Not available 6.1 Timely availability of evidences for decision making % Provinicial/local authorities using serveillance data for planing nutrition programs None % Provincial & divisional bodies with laid-down evaluation programs 6.1.4 Strengthen monitoring and evaluation of the impacts of nutrition intervention programmes 50% 75% 6.1.1Strengthen National Nutrition Surveillance System 6.1.2 Establish National Nutrition Management Information System 6.1.3Strengthen the support for research in nutrition and the use of its outcomes Nutrition Coordination Division, Distric development committee/Agricultural committee, Department of Census & Statistics Availability of periodical reports None Periodical reports available information not available 75% MRI Provincial Health Administration % completion of the formulated research agenda Partners FHB, HEB,Academic departments, Department of Census and Statistics, Ministry of Agriculture, UN agenceis, other NGOs