REACH : um modelo para fortalecer o planejamento nutricional?

Transcrição

1 REACH An inter-agency renewed effort to end child hunger and undernutrition WFP WHO UNICEF FAO REACH : um modelo para fortalecer o planejamento nutricional? i Seminario Internacional sobre Nutricao na Atencao Primaria Painel 4 Planejamento, Monitoramento e Avaliacao

2 A Epidemiologia nutricional mostra um mundo em transição 1

3 Carga de doenças segundo 10 principais causas (2000) Países em desenvolvimento renda abaixo da média 1-Underweight Unsafe sex Unsafe water 4-Indoor smoke 5-Zinc deficiency 6-Iron deficiency 7- Vit A deficiency 8-Blood pressure 9-Tobacco Overweight Source: WHO Thousands of DALY's 2

4 Carga de doenças segundo 10 principais causas (2000) Países em desenvolvimento renda acima da média 1-Alcohol Blood pressure Tobacco Underweight 5-Overweight Cholesterol 7-Low f&v 8-Indoor smoke 9-Iron deficiency 10-Unsafe water Source: WHO Thousands of DALY's 3

5 Carga de doenças segundo 10 principais causas (2000) Países desenvolvidos 1-Tobacco Blood pressure Alcohol Cholesterol 5-Overweight Low f&v 7-Physical inactivity Illicit drugs Unsafe sex 10-Iron deficiency Source: WHO Thousands of DALY's 4

6 11 mihões de crianças morrem todos os anos antes dos 5 anos: 1 em cada 3 estava desnutrida. 1 em cada 6 recém-nascidos nos países em desenvolvimento tem baixo peso ao nascer comprometendo sua saúde futura; 1 em cada 4 pre-escolares tem baixo peso para a idade e um número ainda maior baixa estatura para a idade, com efeitos em seu desenvolvimento 1 em cada 3 pessoas no mundo tem alguma carência de micronutriente As 40 milhões de pessoas vivendo com HIV/AIDS estão expostas a um alto risco de desnutrição Nos países que enfrentam situações de emergência, a desnutrição afeta quase 40 milhoões de pessoas e é uma das principais causas de morte e doenças. Mas este é apenas um lado do problema 5

7 DCnT são responsáveis por 60% das mortes globalmente e por quase 50% de toda a carga de doença. 66% destas mortes ocorrem em países desenvolvidos. A maior parte das DCnTs são associadas a dieta. Mais de um 1 bilhão e meio de adultos no mundo tem sobrepeso, destes, meio milhão são obesos. A desnutrição e o sobrepeso e a obesidade já ocorrem nas mesmas comunidades, as vezes até nas mesmas famílias. 6

8 Um assunto chave: a hipótese de Barker O retardo do crescimento fetal e durante a primeira infancia são relacionados com o estado de saúde na vida adulta. Pessoas previamente desnutridas tem maior risco de desenvolverem doenças crônicas metabólicas quando expostas a dietas inadequadas. A eficiencia metabólica que foi útil nas condições de desnutrição (fetal ou na infancia) torna-se maladaptativa sob estas exposições, levando ao desenvolvimento de um perfil lipídico anormal, metabolismos de glicose e insulina alterados e obesidade. A nutrição no início da vida tem um impacto substancial ao longo do curso da vida, principalmente quanto ao risco para DCnTs. 7

9 Baixo peso ao nascer Falta de aleitamento materno Alimentação complementar inadequada Baixa estatura para idade (stunting) Inatividade física Baixo consumo de frutas e vegetais; Alto consumo de sal; Alto consumo de gorduras saturadas e trans; Hipertensão arterial; Hipercolesterolemia; Sobrepeso e obesidade. Solucoes comuns e acoes integradas 8

10 Se melhoras de renda ocorrerem (MDG 1) sem a redução da desnutrição e a melhora da qualidade das dietas, a saúde da população vai deteriorar ainda mais, com um custo elevado para todos os países. 9

11 Aprovada pelos Estados Membros na 55th World Health Assembly, 2002 (WHA55.) 10 10

12 Aprovada pelos Estados Membros na 57th World Health Assembly, 2004 (WHA57.17) 11

13 O DESAFIO : fazer as coisas certas e nao fazer as erradas - renovar esforços conjuntos de forma coordenada e com foco para o combate prioritario a desnutrição materna e infantil com abordagem do ciclo vital e da promocao da alimentacao saudavel - apoiar os paises para identificar e implementar solucoes efetivas respaldadas por politicas adequadas, dirigidas ao ti trinomio i alimentos saudaveis/saude/cuidados d / id d - implementar em larga escala 12

14 Alimentos : demanda e oferta igualmente críticas Uma questão de escolha individual? Urbanização e industrializacao Novos padrões de emprego Demanda por "conveniência" Propaganda cria desejo por alimentos associados a um status social mais alto Afeta disponibilidade, preços e estratégias de marketing Define o ambiente no qual a demanda é estabelecida A escolha saudável tem que ser a escolha disponível, acessível e desejada. 13

15 As grande 5 areas de solucoes-chave que podem ser operacionalmente integradas e efetivas. Seguranca alimentar do domicilio Promocao do aleitamento materno e alimentacao complementar Suplementacao com micronutrientes para maes e criancas <5 anos e fortificacao de alimentos Tratamento da desnutricao severa Promocao da higiene e controle de parasitas Promocao da alimentacao saudavel e fortelecimento da mulher 14

16 quando respaldadas por politicas adequadas Tecnologia Mudanças tecnológicas na produção de alimentos, processamento e distribuição reduzem custos Globalização Liberalização do setor financeiro facilita as mudanças na produção e comercialização dos alimentos Marketing promocional encoraja a convergência de culturas de consumo Aparato regulatório (qualidade sanitária e nutricional) encoraja a convergência de padrões de identidade d e qualidade d de alimentos Políticas agrícolas Políticas de comercialização (e.g. bolsas de commodities) Políticas de suporte de preços (e.g.subsidios) Políticas tarifárias (e.g. sobretaxas, incentivos para exportação) Crédito diferenciado 15

17 Fortalecendo o planejamento em nutricao : REACH Uma parceria em formacao entre WFP, UNICEF, WHO and FAO Outras agencias UN - SCN, IFAD, UNV Sociedade civil - SCF, WVI, Rotary International, GAIN, Helen Keller Intl, CRS, JAM, Africare, MSF, ACF Academia: Tufts, George Washington Univ, outras Setor privado : Boston Consulting Group, Governos (Mauritania, Laos, etc & alguns doadores) REACH tem sido procurada continuamente por novos potenciais parceiros REACH e facilitada por uma pequena equipe inter-agencial, baseada no PMA em Roma para promover o apoio coordenado : - A processos nacionais de planejamento operacional de solucoes intergradas para o combate a desnutricao e identificacao de brechas e oportunidades, - A processos supra-nacionais identificados como necessarios pelos paises participantes (ex. Advocacia, networking, mobilizacao de recursos) - Ao fortalecimento dos setores de nutricao das organizacoes parceiras 16

18 REACH Overview Vision & Goals Ending child hunger and undernutrition By 2015: REACH MDG 1, Target 3 (half the proportion of underweight children under 5) Beyond 2015: Achieve sustainable acceleration of the rate of reduction in child underweight Action areas Country action planning and coordination to support national capacity to scale up evidence-based solutions Knowledgesharing Financing and resource mobilization Communications and advocacy Outcomes Increased awareness of the problem and of potential solutions Strengthened national policies and programmes Increased capacity at all levels for action Increased efficiency and accountability 17

19 REACH promove a acao coordenada de parceiros sob a lideranca dos governos nacionais UN Agencies/IFIs Government (lead) Bilaterals Reach MDG 1 and end maternal and child undernutrition Through a coordinated, solution focused approach to scale-up activities in nutrition in the life-cycle Private Sector/ Corporations NGOs Academia 18

20 REACH oferece apoio aos paises em dois niveis 1 Troca de informacoes e networking 1 Todos os paises Assess, mobilize, set up working structure Laos/Mauretania WHO landscaping countries 1 Troca de know-how sobre como atuar em escala Networking Compilacao e disseminacao de informacoes sobre os progressos alcancados 2 Apoio ao planejamento operaconal e mobilizacao de recursos Detailed action planning & coordination Pilots in: Lao PDR Mauritania 2 Paises prioritarios Analise de situacao, competencias e compromisso para atuar em escala Apoio a gestao estrategica e mapeamento de demandas e ofertas Identificacao de necessidades nao preenchidas e mobilizacao de apoio e recursos locais e globais Apoio para o monitoramento dos processos e avaliacao de impacto 1. Burkina Faso, Ghana, Guatemala, Madagascar, Peru, South Africa and Timor Leste 19

21 atividades sao mobilizadas em 4 areas fundamentais capacitando paises para implantacao de solucoes em escala Gestao estrategica e coordenacao Troca de informacoes e networking Mobilizacao de recursos Advocacia e comunicacao Analise de Compilar e Monitorar fontes Desenvolver situacao, disseminar de recursos ferramentas e competencias e informacaoes capacidades compromisso o Prover apoio para advocacia Priorizar acoes Prover servicos para visando Estimar custos e ferramentas desenvolvimento promover Mapear para networking de propostas investimentos demandas/oferta e necessidades M&A Lideranca e gestao estrategica Facilitar contatos entre ciencia e pratica para mobilizacao de recursos Mobilizar recursos globais governamentais e de doadores em solucoes integradas efetivas 20

22 Testes- piloto iniciados em Julho na Mauritania e no Laos Proposed typical REACH country process: 1-3 months 3 months 9-12 months Ongoing Prepare Assess, mobilize, set-up working structure Detailed action planning Ongoing REACH activities Regional information/ mobilization Country request for REACH support Country preparati on Explorator y interviews & mobilizatio n (country phase) First assessment Set-up of working modus Detailed country analysis & action planning Resource planning & matching Implementation and monitoring Global REACH involve- ment: Inform and sequence Laos 1 Initiate an mobilize Provide process experience and know how Mauritania Provide best practices, coach country process Raise local needs to global partnership Support "match making", monitor results 1. Laos process may or may not be completed in 1 year, based on need to perform mobilize phase activities Source: BCG, REACH analysis 21

23 Facilitators support national teams to do the following Prepare Assess, mobilize, set-up working structure Detailed action planning Ongoing REACH activities Finalize stock-taking Define interventions Set-up operational plan Plan delivery Advocacy and channels Quantify cost funding strategy Mobilize resources & commitment Assess readiness, willingness and ability to act at scale Situational and current response analysis, identify intervention gaps Identify locally required set of interventions and targets Define appropriate delivery channels and operational mechanism Estimate costs and resource gaps Define advocacy and fundraising strategy Mobilize resources locally, regionally and globally Metrics, and information system Develop tracking system, including indicators, sources, and processes Ongoing communication & advocacy Develop communication processes and content 22

24 Progress in each area to be reported via key sentinel indicators complemented by a broader set of M&E indicators Backup Action area Sentinel indicator Improve breastfeeding and complementary feeding % of <6 month olds that are exclusively breastfed Increase micronutrient intake % of 6 to 59 month olds fully covered with 2 doses of VAS in the last year Improve diarrhea and parasite control % of preschool children at risk treated with deworming tablets in the last year 3 TBD Increase treatment of severe acute malnutrition # of countries with severe TBD wasting rates > 10% 4 5 Improve household food security Proportion of population below minimum level of dietary energy consumption 5 20% (823M) 17% (820M) 15% (800M) 10% (582M) 1. Data available from WHO Global Databank on Infant and Young Child Feeding. 2. Data available from WHO 3. Data available from WHO Partners for Parasite Control; reflects % of preschool children receiving preventive chemotherapy against soil-transmitted helminthiasis in a given year; note that provisional 2007 data reflects only 10.7%; Note that the global target established at the World Health Assembly 2001 is to achieve 75% coverage of school-aged children at risk of STH and/or SS by Data available from WHO. 5. Official indicator of MDG1 target 1C 23

25 Building on existing processes in Laos Laos NNS/NPAN Workplan NNP dissemination workshops Sector/agency consultations Provincial/district consultations Etblih Establish management structure t Establish nutrition surveillance system Finalize strategy and plan of action Dissemination of NNS/NPAN REACH workplan Current country situation stock-taking High level action planning RTM pre-session Detailed action planning Advocacy & funding strategy Other key events Round Table Meeting EC Food Security RFP Month Milestones Toda ay Feedback on NPAN compiled from dissemination workshop 1. Sector workplans complete 2. Technical approval of workplans 3. Sector workplans integrated into FY2010 budgets in each ministry TBD Working structure t finalized TBD NNS/NPAN documents finalized Dissemination workshops complete Stock-taking analysis complete High-level action plan complete Consultation conducted prior to RTM Detailed action plan complete 1. Advocacy/funding strategy draft 2. Detailed advocacy/funding strategy 24

26 Mauritania is taking stock of "who does what " Example UN agency activities Preliminary Interventions FAO UNICEF PAM OMS PASN Gouvernement Treat severe acute malnutrition Therapeutic feeding Improve breastfeeding and complementary feeding Increase micronutrient intake Exclusive breastfeeding Complementary feeding Micronutrient suppl. and fortification Only Vitamin A, and Iodized Salt Improve household food security 1 Supplementary feeding Conditional cash transfers Local homestead food production 2 Covers Vitamin A, and Iron Household water treatment 3 Improve diarrhea and parasite control Handwashing with soap Bednets and IPTp HWT not covered by any UN agency? Deworming Diet diversification 1. WFP also intervenes in Food Security throgh SAVS 2. VCT cooperation with NGOs; 3. Small pilot for monitoring water quality; Need to detail Government-direct and FAO interventions 25

27 ...along with a picture of "where they do it"... Legend Organization Symbol UNICEF 1 PAM CRI/CPSSA PASN PASN 1. Couverture sur la carte pour la Alim. Thérapeutique; pour AME et Alim Complémentaire et Vitamine A la couverture est Nationale; pour les Aliments enrichis mêmes 8 régions sauf Tagant 26

28 Tracking progress in Mauritania Taux de diversification agricole % ménages producteurs agricoles Pauvreté Préval. palu. chez Mères enceintes % de Mères qui reçoit TPI % Mères E qui utilisent MII % ménages qui dispose de MII % enfants < 5ans utilisant MII Prévalence paludisme <5 ans % popn. avec eau amélioré à boire % ménages traitant d'eau % population avec assainissement % de mères lavent mains correct. Non - existant Existant # = # intervention Score de diversification alimentaire Taux de Insécurité Alimentaire Couverture Fer Mères E&A Prévalence anémie chez Mères E&A Utilisation sel iodé Couverture Zinc < 5 ans Couverture Vitamine A <5 ans Couverture Fer enfants < 5ans Couverture déparasitage Prévalence parasites Prévalence mal. diarrhéiques Mortalité à cause de mal. diarr. % population consommant en dessous du minimum quotidienne 4 Couverture Vitam. A Mères PP Prévalence MAM chez Mères E&A Faible poids a naissance Carence Iode <5 ans Carence Zinc < 5 ans Carence Vitamine A <5 ans Pé Prévalence anémie chez les <5 ans Mortalité <5ans pour paludisme % Allaitement immédiate % Allaitement exclusif % 6-24 mois encore mise au sein % 6-24 mois reçoivent alim. compl. 3 % 6-24 mois reçoivent 2 repas/ j + 3 Prévalence MAM < 5 ans % enfants MAM admis CRENAMs Taux de guérison CRENAMs 5 Prévalence MAS < 5 ans % enfants MAS admis CRENIs Taux de guérison CRENIs 1 Mortalité pour MAS Mortalité chez les enfants < 5ans

29 Beneficiaries: Children 1 5 in high worm burden areas P&L women in high worm burden areas Source: Expert interviews; literature review; REACH analysis REACH_SP_Summary_v1.ppt Drugs against soiltransmitted helminths Drugs against waterborne schistosomiasis Hygiene education to induce behavior change to avoid reinfection Government Ministry of Health Ministry of Health Ministry of Health Ministry of Health, Education Deworming Other 1 NGOs, UNICEF, NGOs, UNICEF, WFP NGOs, UNICEF, WFP NGOs, UNICEF, WFP 1. WHO responsible for normative guidance on deworming. 2. Most common channel, but typically focused on 5+ children. Potentially can be expanded to reach <5s and P&L women if used as a community center. Source: "Understanding Behavior Change for Safe W ater: Lessons from the Field." Water Network Working Meeting at Johns Hopkins Bloomberg School of Public Health, REACH_SP_Handbook_HWT_v1.ppt Note: The data is from the Ghana handwashing business plan, not actual data Source: "Ghana washes her hands: A public-private-partnership." CWSA, 2002.; "Your health in your hands. Ghana public-private partnership for handwashing.", CWSA presentation REACH_Success Practices_Handwashing_v9.ppt REACH_Success Practices_Handwashing_v9.ppt 1. PPC 2005 attendants with potentially practical implementation knowledge; addresses available in document 2. WHO Global burden of disease database REACH_Successful practices_deworming_v11.ppt Source: "Ghana washes her hands: A public-private-partnership." CWSA, 2002.; "Your health in your hands. Ghana public-private partnership for handwashing.", CWSA presentation 1. WHO Factsheet Nr "School Deworming." World Bank, WHO. 4. "W hat works? Interventions for maternal and child undernutrition and survival." Bhutta et. al., "Antenatal anthelmintic treatment, birthweight, and infant survival in rural Nepal." Christian et. al., REACH_Successful practices_deworming_v11.ppt 38 Name Organization and title Area of expertise Contact details Charles Adam s Rotary International Im plem ent charles@ taeria.com Amparo Araujo PPPHW Columbia Implement lavam araujo@ hotmail.com Angela Armstrong W orld Bank Implement aarmstrong@worldbank.org Abdul Badru W SP-Tanzania Implement abadru@ worldbank.org Nancy Bock Soap & Detergent Association Imp lem ent nbock@ sdahq.org Know-how operacional tem sido sistematicamente compilado Serie Atuando em Escala Delivery overview: Deworming Community Deliverable mobilization to and participation creates awareness Intervention mother/child Key delivery channels Key/typical implementers Examples from large-scale HWT programs Deworming The "Blue Bus" REACH Public health Water testing days Physical component Nicaragua Ending Child Hunger and Indonesia Undernutrition Indonesia UN facilities Education component Mass campaign Promotion at health-events Acting at Scale: Schools Intervention Guide 2 An entertaining vehicle Supplementary for Children feeding learnt about water mobilizing communities for cleanness through experiments healthy behavior Entertainment-education Visited 120 communities in 12 months August 2008 Implement Demonstration of water cleaning technology and benefits during an immunization campaign Draft Work in progress Version 1 Case study: Ghana Direct consumer activities and mass media advertisement comprise the bulk of the program costs 4 Total 50% 2 Public sector/ CWSA Draft Work in progress Successful practice case study (I) Funding Intervention: Funding for 3-year program (US$M) Program name: 25% Location: Start year: Target group: 1 Total costs: Metrics: 1 Handwashing with soap Expenses for 3-year program (US$M) Ghana Public-Private Partnership 73 for % Handwashing Expenses Atuando em escala : guias programaticos Case study: Ghana Ghana, whole country Setting: 0.40 X Rural x Urban 0.30 September 2003 Duration: Ongoing Ongoing? X Yes No M women with children under five M children in primary schools and junior secondary schools 4.00 Target to reach 80% of the target group within 3 years through mass media and direct community contacts 0.60 TV $ 4 M over 3 years Radio Other resources used: N/A District 0.20 Percentage Schools of mothers 0.50 and care-givers of children under five years that wash their hands with soap, especially after cleaning up a child (16% in 2002) and after 0.05 using Health a toilet units(24% in 2002 and 89% in 2005), before and after eating and before feeding babies Soap 0.25 Percentage of school children aged 6-15 years who wash their hands with soap, especially after using the toilet and before eating 27 % Type: Physical component; Education Atuando em escala: Estudos de caso Charles Adam s Rotary International Im plem ent charles@ taeria.com Amparo Araujo PPPHW Columbia Implement lavam araujo@ hotmail.com Angela Armstrong W orld Bank Implement aarmstrong@worldbank.org Abdul Badru W SP-Tanzania Implement abadru@ worldbank.org Nancy Bock Soap & Detergent Association Implement nbock@ sdahq.org John Borrazzo USAID Implement JBorrazzo@ usaid.gov Sandy Callier AED Implement scallier@ aed.org Jason Cardosi W SP-Africa Implement jcardosi@ worldbank.org Carlos Augusto Claux Mora PPPHW Peru Implement caclaux@ worldbank.org Val Curtis LSHTM Research val.curtis@ lshtm.ac.uk Sylvie Debomy World Bank Implement sdebomy@worldbank.org John Borrazzo USAID Implement JBorrazzo@ usaid.gov Sandy Callier AED Implement scallier@ aed.org Jason Cardosi W SP-Africa Implement jcardosi@ worldbank.org Carlos Augusto Claux Mora PPPHW Peru Implement caclaux@ worldbank.org Val Curtis LSHTM Research val.curtis@ lshtm.ac.uk Sylvie Debomy World Bank Implement sdebomy@worldbank.org Katri Kontio W SP Im plem ent Kkontio@ worldbank.org Tim Long Procter & Gamble Implement long.tj@ pg.com Jack Molyneaux W SP-HQ Implement jmolyneaux@ worldbank.org Kaposo Mwambuli W SP-Tanzania Implement kmwambuli@ worldbank.org Harriet Nattabi W SP-Uganda Im plem ent hnattabi@ worldbank.org Basil Safi JHUCCP Center for Comm. Programms Research bsafi@ huccp.org Orissa Samaroo WSP-HQ Implement osamaroo@ worldbank.org Myriam Sidibe Unilever Implement M yriam.sidibe@ Unilever.com Tim Tobery Procter & Gamble Implement tobery.t@pg.com Kate Tulenko W SP Im plem ent ktulenko@ worldbank.org Merri W einger USAID Im plem ent mweinger@ usaid.gov Biblioteca completa Normas tecnicas, guias operacionais, treinamentos, artigos Organizacoes-chave Lista de experts Draft work in progress Description of specific country situation & social context: Intervention description: deworming (II) Typical funding sources & advocates: Advocacy: Partners for Parasite Control (hosted at WHO) Funding: Gates Foundation; Pan American Health and Education Foundation, Japan, CIDA Tablet donation / sales: MedPharm, Bayer, other pharmacos Draft work in progress Typical implementers: Intervention description: deworming (I) In M annual episodes of diarrhea and 15% of children had diarrhea in the past two weeks prior to survey In Ghana an estimated 84 K children die each year from diarrheal diseases about 25% of deaths in children <5 are attribute to diarrhea Ministry of Health, Education (if school program) UN: UNICEF, WFP NGOs Schistosomiasis Control Initiative (SCI); The CORE Group; Project HOPE; International Save the Children Alliance; Save the Children; OXFAM; The Partnership for Child Development Industry External District Mass Direct Development Agency (CWSA) at the DCC ministry program of Works and Housing PR M&E Mgmt. of Overall Total Lead & partner support Lead implementer: activities Community media Water communit and Sanitation organizations: agencies Public implementing partners: MoH y contact (provision costs of existing health staff), MoE program (contribution mgmt. to school program) Implementation assistance: UNICEF (DCC) (assistance (agency) for the school program), LSHTM (consumer and market studies) External funding: World Bank, DFID, program CIDA Private sector: Unilever Ghana, PZ-Cussons (technical assistance for campaign design, testing and implementation) Nga Nguyen PPPHW Vietnam Organization Implement description Nnguyen4@ worldbank.org Chris Nsubuga-Mugga Organization PPHW Uganda Web link Category Implement Description chrismugga@yahoo.co.uk Key activitites Eduardo Perez W ater and WSanitation SP MultilateralImplement International partnership hosted by eperez1@ the Co-adm inisters worldbank.org and provides technical program Program W orld Bank to improve water supply leadership Patricia Poppe JHU Center for Comm. Programms Research ppoppe@ A dministers huccp.org g lobal secretariat of PPP-HW Ida Rafiqah UNICEF W SP-Indonesi MultilateralImplement UN Nations Childrens' Fund irafiqah@ Imp lem ents worldbank.org programs Implements support Eshuchi Rufus World Bank W SP-Kenya MultilateralImplement International development bank reshuchi@ Finances programs worldbank.org - Also through loans Provides management support to PPP-HW Bank/Netherlands W ater www-esd. worldbank.org/bnwpp/ Bilateral Established by government of Provides financial assistance to programs Partnership Netherlands and W orld Bank to improve water security by promoting innovative approaches to Integrated W ater Resources Management Finances global coordina-tion and knowledge sharing of PPP-HW USAID ov Bilateral United States develop ment agency Finances p rog rams in several countries Co-funds PPP-HW secretariat DANIDA Bilateral Denmark's development agency Finances p rog ram s EHP Environmental Health Bilateral USAID program Provides access to a broad range of capabilities for Project missions and bureaus wishing to include health preventive com ponents in program s Researches state-of-the-art p reventive comp onents Hygiene Improvement Bilateral USAID program Implements hygiene programs at scale Project Provides p ublications, tools, project presentations, WELL Bilateral Resource centre funded by the UK Coordinates and provides services for water, htm Departm ent for International sanitation and environmental health programs to Development (DFID), promoting DFID and other agencies environmental health in developing and transitional countries Managed by LSHTM and IRC in W eb site is a focal point of inform ation about water London School of Hygiene Academia Leading research institute in hygiene Provides tools for consumer research and Tropical Medicine research Researches efficacy and effectiveness of HW programs Researches psychology of hygiene behaviour chang e Provides technical input to products A dvocates AED/Hygiene Improvement Academia USAID-funded program that works at Provides technical assistance Project scale to improve and sustain hygiene Provides technical inputs to products A dvocates Center for Disease Control ov A cademia United States public health agency Provides technical assistance for M&E Researches effectiveness of HW Provides technical inputs to products A dvocates University of Leeds Academia Leading research institute in hygiene Researches and trains on health education Health Education Database University of Southhampton Academia Leading research institute in hygiene Researches gender issues in the promotion of rch.html research h ygiene and sanitation amongst the urban poor Global Public-Private lobalhandwashing.org NG O Global initiative of private and public A dvocacy Global M&E Development of standard tools Knowledge exchange Implem entation in several countries IRC International W ater and NGO Independent, non-profit organization Facilitates the sharing, promotion and use of Sanitation Centre supported by and linked with the knowledg e to better support beneficiaries to obtain Advocates change and aims to improve the information and knowledge base of the sector via its web site, docum entation, publications International Scientific care professionals who play an active News) on latest news, research, events and library NGO NGO comprising scientists and health Publishes a newsletter (Home Hygiene and Health Forum of Home Hygiene ter/letter.htm role in hygiene policy and scientific updates in the field of home hygiene research NETWAS Network for NGO A capacity building and information Provides a training course W ater and Sanitation network for Africa focusing on water, sanitation and hygiene Intervention: Deworming Type: Physical component; education Examples of Cambodia school deworming program (MoH) National programs by PPC in Nepal, Guinea, Mexico, Egypt successful Description Nepal of school ~2 bn deworming people (30% program of world (WFP) population) and integration carry two of varieties of Schistosomiasis helminths, or parasitic Control worms: Initiative soil-transmitted (SCI): Burkina helminths Faso, Mali, (STH Niger, or intestinal implementations: (incl. goals & intervention dewormingworms national such Vitamin as hookworm, A supplementation roundworm, (UNICEF) and whipworm) and water-borne Tanzania, Uganda, schistosomiasis. Zambia (at-scale) The intestinal obstruction deprives children of micronutrients, creating undernutrition, which leads to stunting, learning deficiencies and learning deficiencies. STH are mostly treated with either albendazole or mebendazole (alternatives: levamisole or pyrantel). Praziquantel is used for treatment against schistosomiasis rationale/ (bilharzia). The treatment is safe (even when given to uninfected children) and helps to prevent undernutrition as it eliminates the parasites potential Localization impact): Need to select from tablets the childrens' based on intestinal local prevalence system. Albendazole patterns, e.g. treatment schistosomiasis can be very primarily cost effective present in with Sub-Saharan $2-9 per DALY Africa; averted intestinal (DCP worms 2). in issues: sub-saharan Africa, India, China and East Asia REACH target Children under 5; P&L women Costs per $ per child per year group: person/hh: Detail of Deliver tablets to <5s via Metrics Coverage Outcome Impact delivery Public health: health center, hospitals (italics=not # (or %) of children and P&L women Prevalence of STH/schistosomiasis DALYs/deaths associated with intestinal UN facilities: distribute tablets at feeding centers Atuando channels and available): receiving i deworming drugs (PPC databank (PPC dtb databank kdepending di on country) nematode infections/schistosomiasis t i i methods: Mass campaign: National/regional (child) health days; national/regional micronutrient days depending on country) % of highly/moderately infected individuals (WHO 2 ) Often delivered along with immunization, antenatal care, general health Quantity of drugs distributed (PPC databank depending on country) % children<5/ P&L mothers with mild, moderate, severe anemia (MICS2) (program data) Required Tablets: for intestinal worms: treatment 1-3 times per year (depending on the worm burden in the area) with one tablet of albendazole (400mg) or Key materials: Dr Henrietta Allen, mebendazole WHO, Partners (500mg) for per Parasite child/year Control, (cost allenh@who.int per tablet $0.02); dosage regardless of children's size or age implementation Dr Antonio Montresor, for schistosomiasis: WHO, Focal single point dose for helminth of Praziquantel control WPRO, (600mg) MontresorA@wpro.who.int once a year ($0.08 per tablet; $ per treatment); number of pills has to be adjusted to the weight/size of the child for which a dose pole is usually used experts: Dr Donald Bundy, heat-stable World Bank, and require Lead Specialist no cold chain; for School shelf life Health of up and to 4 Nutrition, years Dbundy@worldbank.org Dr Andrew Hall, Training Centre materials for Public for those Health delivering Nutrition, tablets School (e.g. of Integrated teachers, Health, community University workers, of Westminster, healthcare providers) andrew.hall@ceid.ox.ac.uk Ms Rita Bhatia, Educational WFP, Public materials Health to Nutrition, promote awareness Rita.Bhatia@wfp.org and (if employed) hygiene behavior for mothers and children Registration forms to track overall and individual multi-year coverage Scientific evidence of effectiveness & efficacy: Deworming can potentially reduce anaemia by 5-10% in populations with high rates of intestinal helminthiasis 4 One dose of deworming tablets is associated with 0.24kg weight increase and 0.14cm in height (review of 25 studies of children 4 aged 1-16) 4 Infant mortality for children of mothers who received 2 doses albendazole at 6 months fell by 41% in Nepal study 5 Deworming also increases micronutrient status for pregnant women: The mean decline in haemoglobin concentration between first and third trimester in women who received albendazole was 6 6 g/l less than in women who received placebo 4 1 em escala : resumos 3 Abordagem do ciclo vital enfatizada 28