Action Plan Reduction of Chronic Malnutrition in Belize Prepared by: Ministry of Health with support from PAHO/WHO December P a g e

Transcription

1 Action Plan Reduction of Chronic Malnutrition in Belize Prepared by: Ministry of Health with support from PAHO/WHO December P a g e

2 Contents Acronyms Introduction The Situational Analysis The Issues The Objectives The Action Plan Next Steps ANNEXES P a g e

3 Acronyms AWP BAHA BBS BFLA - Annual Work Plan - Belize Agricultural Health Authority - Belize Bureau of Standards - Belize Family Life Association COMBI - Communication for Behavioral Impact DAVCO - District Association of Village Councils FANCAP-Nutrition Foundation for Central America and Panama FAO - Food and Agriculture Organization INCAP - Institute of Nutrition for Central America and Panama MAF - Ministry of Agriculture and Fisheries MOEY - Ministry of Education and Youth - Ministry of Health MHST - Ministry of Human Development and Social Transformation NAVCO - National Association of Village Councils NFNSC -National Food and Nutrition Security Commission NWC - National Women s Commission PAHO - Pan American Health Organization RD SIF SSB - Ministry of Rural Development - Social Investment Fund - Social Security Board 3 P a g e

4 UB - University of Belize UNFPA - United Nations Population Fund UNICEF- United Nations Children Fund WHO WIN YES - World Health Organization - Women Issues Network - Youth Enhancement Services 4 P a g e

5 1. Introduction Belize is an independent, democratic country on the Caribbean coast of Central America. The country is bordered on the north by Mexico, the west and south by Guatemala and is divided into six (6) districts: Corozal, Orange Walk, Belize District, Cayo, Stann Creek and Toledo. It is a small state with only 8,867 square miles and an estimated population of 333, The majority of the population (approximately 66,700) is centered particularly in its commercial capital of Belize City. Food security and nutrition has been an area of concern for some time and is underscored in several initiatives, including but not limited to Belize s obligations under the Convention of the Rights of the Child, National Plan of Action for Children and Adolescents, the Millennium Development Goals, the National Poverty Elimination Strategy Action Plan. In February 2001, the government of Belize ratified a Food and Nutrition Security Policy for Belize and established the National Food and Nutrition Security Commission which focused on six programme areas: Information, Education and Communication on Food Production, Preparation and Nutrition Diversified Food Production, Food Processing, Marketing, Storage and Credit Mobilization Maternal and Child Care, School Feeding and Nutrition for the elderly and the indigent Creation of Employment and Income Generating Opportunities at the local level Food Safety Analysis and Reform of National Policies for Food and Nutrition Security Despite these various policy recommendations and initiatives implemented over the years such as the Roving Care Givers Program, feeding programs and school garden programs, and those implemented by the Ministry of Health in collaboration with various agencies (micro nutrient supplementation to women during pregnancy and lactating period and children, growth promotion and development, deworming, health education, among others), Belize continues to grapple with chronic malnutrition in children. 1 Statistics Institute of Belize, 2009 mid-year population estimates 5 P a g e

6 2. The Situational Analysis Chronic malnutrition is defined as height-for-age of more than two (2) standard deviations below the reference standards of WHO and it is a result of the cumulative effect of nutritional, health and social conditions that impact the growth rate of a child. As a health determinant low height-for-age is one of the primary indicators used in national assessments for health and nutrition in children. (See Figure 1 below) Figure 1: National Height Census, 1996, 2009 Ministry of Health The first height census among school aged children (Standard 1 class) resulted with growth retardation prevalence rate of 13.7% in 2006 and 12.2% in The Living Standard Measurement Survey (LSMS 2001) indicated stunting rates in children under five years of age 17.9% countrywide and 45% in the Toledo District. 2 2 Statistics provided by Ministry of Health 6 P a g e

7 The Multiple Indicator Cluster Survey (MICS 2006) indicated stunting rates in children under five years of age 17.6% and an exclusive breastfeeding rate among children up to 6months of age at 10.2%. 3 The social and economic conditions (social determinants) that people live under, also impact their nutrition and health and statistics indicate that there has very little improvement in the rate of reduction of chronic malnutrition in Belize over the past 10 years. (See Figure 2). Social determinants include but are not limited to physical environment, education and literacy, income and social status, culture, personal health practice, social support networks, gender and working conditions. Figure 2: Social Determinants to under-nutrition Ministry of Health 3 Statistics provided by Ministry of Health 7 P a g e

8 3. The Issues Recognizing that in Belize, there have been several initiatives and projects at the micro household level over the years that have been implemented to address nutrition related health problems in children and women as well as several policy recommendations, the overarching problem identified is at the macro national level in not recognizing that nutrition is a critical determinant to a country s development and requires a committed intersectorial approach. A SWOT Analysis (strengths, weaknesses, opportunities, threats/see Annex 2) has identified the following seven (7) core issues for Belize to address in its plan to combat chronic malnutrition: 1. Lack of understanding and prioritizing the correlation between nutrition and country development 2. Poor intersectorial coordination and integration of policies, plans and programs to combat chronic malnutrition 3. Insufficient and incomplete national nutrition surveillance system for the early detection of nutrition related health problems in children throughout the life cycle 4. Weak countrywide nutrition programs for the poorest of the poor 5. Limited technical capacities, human resources and management skills in interventions for nutrition and health development throughout the life cycle 6. Weak empowerment of care givers and community participation in advocating for nutrition and health development throughout the life cycle 7. Empowering women to be involved in the policy and decision making efforts on nutrition, health and development Critical to the development of the plan is recognizing the prominent and critical role that the National Food Security and Nutrition Commission has as a leader in the efforts to combat chronic malnutrition in Belize and to generate public awareness on nutrition, health and development as well as best practices that would help in rate of reduction of chronic malnutrition. The Action Plan is aiming at an intersectorial approach for sustainable reduction of chronic malnutrition in children in Belize. Nutrition is a critical determinant in Belize s economic and social development 8 P a g e

9 4. The Objectives To address the issues, the Action Plan has been developed utilizing the Regional Action Plan on the Reduction of Chronic Malnutrition 4 and focusing on six (6) objectives based on actions through policies, plans and programs: Objective 1: To develop, strengthen and implement interministerial policies, plans, and programs for nutrition, health, and development that meet the following requirements: a) a social determinants approach; b) resource allocation; c) interministerial coordination and planning; d) active national, municipal, and local government involvement; e) surveillance, evaluation, and accountability of programs and interventions. Objective 2 To incorporate indicators of nutritional status and its social determinants into health surveillance systems that are not limited simply to compiling health information but include the analysis of this information by gender, ethnicity, and geographical area and permit forecasting and the timely prevention of nutritional problems. Objective 3: To increase the number of integrated, intersectoral, evidence-based programs and interventions rooted in the principles of primary health care renewal, health promotion, universal access, human rights, gender mainstreaming, and interculturalism in the areas of food, nutrition, health and development Objective 4 To boost the technical/administrative and decision-making capacity of health workers and personnel from other sectors for the implementation of integrated intersectorial life-course interventions in the areas of food, nutrition, health, and development. 4 Strategy and Plan of Action for the Reduction of Chronic Malnutrition. CD50/13 (Eng.) 11 August 2010 ORIGINAL: SPANISH 9 P a g e

10 Objective 5 To achieve empowerment of caregivers (with a focus on women) and community participation in health and development planning processes. Objective 6 To improve intersectorial alliances with strategic partners, at the various levels of government to prioritize and advocate for nutrition, health, and development in national plans and budgets. 10 P a g e

11 5. The Action Plan Objective 1: To develop, strengthen and implement interministerial policies, plans, and programs for nutrition, health, and development Action Expected Result Responsible Partners Completion date Social determinants Policies Remove barriers to education (high cost) Update public policies on malnutrition determinants Programs Number of classrooms increased at all levels Resource allocation Policies Analyze budget and other resource allocation for determinant to malnutrition Inter ministerial coordination and planning Plans Conduct intersectoral planning sessions Active national, district and local government involvement Plans Develop intersectoral AWP at 5 most affected localities with undernutrition (stunting rates) Evaluation and accountability Policies NFNSC to oversee implementation of policy and plan Plans Conduct yearly evaluation session Produce quarterly reports on AWP implementation Compulsory education at no cost provided to those in lowest consumption quintile Expansion of preschools Policies on malnutrition determinants updated Every child have a classroom space at all levels of education Annual assessment of budget allocation and other resources to reduce chronic malnutrition Lobby for resource allocation One intersectoral AWP developed and implemented White papers evaluated and presented to Cabinet through Special Envoy for women and children Chronic malnutrition reduced in five selected localities (with highest stunting rates) per district 95% of results achieved by the end of 2015 One intersectoral evaluation of AWP Quarterly reports submitted by implementing agencies MOEY MHDST, SSB End 2015 MHDST, MoH All implementing agencies End 2015 MOEY End 2015 NFNSC NAVCO, MoH NFNSC, MAF University of Belize (Research) All implementing agencies All implementing agencies All implementing agencies All implementing agencies All implementing agencies Yearly Yearly Yearly Yearly Yearly Quarterly 11 P a g e

12 Objective 2: To incorporate indicators of nutritional status and its social determinants into health surveillance systems that include the analysis of information by gender, ethnicity, and geographical area and permit forecasting and the timely prevention of nutritional problems Action Expected Result Responsible Partners Completion date Nutritional status indicators and its social determinants by gender, ethnicity and social sector Policies Develop nutrition surveillance policy Plans Train relevant staff in nutrition surveillance protocols Programs Finalize nutrition surveillance manual Develop nutrition surveillance protocols Nutrition surveillance policy developed Nutrition surveillance protocols developed 100% of staff trained in nutrition surveillance protocols Nutrition surveillance manual developed Protocols established and utilized UB UB BAHA, INCAP, PAHO, ADM Belize BAHA, INCAP, PAHO, ADM Belize, BBS BAHA, INCAP, PAHO, ADM Belize, BBS End 2011 End 2011 End 2012 UB End 2011 UB, MoH End 2012 Develop metadata of malnutrition determinants indicators Define nutrition related data to be obtained through existing HH surveys Include the WHO growth standards into the BHIS Harmonization of malnutrition determinants indicators among partners Schedule of HH surveys producing nutrition related data (number of indicators and frequency of surveys) Nutritional status of clients assessed, results interpreted at each encounter with the health system (public and private), UB SIB, INCAP End 2013 SIB INCAP, PAHO,, UNICEF Private sector, Public sector, End 2011 End P a g e

13 Objective 3: To increase the number of integrated, intersectoral, evidence-based programs and Interventions in the areas of food, nutrition, health and development Action Expected Result Responsible Partners Completion date Feeding through the life cycle Policies Develop food fortification policy based on regional recommendations (food fortification as a regional public good, regional initiative in Central America, Panama and Dominican Republic) Approve nutrition through the life cycle policy Programs Implement BOOST, Food pantry and public assistance programs Implement community and parenting rehabilitation program Implement roving care givers program Review self sustainable agricultural programs Nutrition through the life cycle Programs Increase nutrition related interventions at primary health care level Food fortification legal framework approved and implemented Monitoring and evaluation of level of micronutrients in fortified food Nutrition through the life cycle policy approved and implemented Single Information System of Beneficiaries developed Population in lowest consumption quintile benefited Poorest and vulnerable communities prioritized Infant and young children from poorest and vulnerable communities targeted Access to nutritious food at household level Income generation at family level increased Early identification and management of under nutrition in children Fortified food distributed to children < 2 years of age and women during pregnancy and lactating period COMBI plan implemented (personal sellers) with active community participation Anemia during pregnancy prevalence rate reduced BBS BBS, BAHA, INCAP, FANCAP, BAHA, INCAP, End 2011 Permanent Cabinet First quarter 2011 MHDST MHDST MHDST MHDST Ministry of Agriculture and fisheries Beneficiaries Village councils, Alcalde system, other community leaders, village councils, other community leaders End 2012 End 2015 End 2015 End 2015 FAO End 2015 NHI, UNICEF, PAHO MHDST, INCAP, community leaders, UNICEF Permanent Initiate in early 2011 UNICEF Permanent Permanent 13 P a g e

14 Implement age specific nutrition through the life cycle curricula in schools Health through the life cycle Programs Increase implementation rate of the SRH national strategic plan 100% of public and private sector hospitals and PCP s certified as Mother-Baby friendly Acute and chronic malnutrition rate in children <2 years reduced School age children have access to basics on nutritious foods 100% of teachers trained in nutrition basics Adolescent SRH program developed and implemented Reduction of maternal deaths due to inadequate child spacing UNICEF, NCFC End 2015 MHDST, UNICEF Permanent MOEY MOEY, UNICEF, PAHO, UNICEF, PAHO UNICEF, BFLA, YES, BFLA, private pharmacies Permanent End 2013 End 2015 End P a g e

15 Objective 4: To boost the technical/administrative and decision-making capacity of health workers and personnel from other sectors for the implementation of integrated intersectorial life-course interventions in the areas of food, nutrition, health, and development. Action Expected Result Responsible Partners Completion date Technical and administrative capacity in comprehensive interventions in feeding through the life cycle Policies Review status of policies with a view to strengthen and enforce existing policies Plans Strengthen the implementation of existing plans on food security and nutrition Programs Institute supplemental feeding programs targeted to prioritized areas where the need has been identified Nationally endorsed nutrition policies Targets in national endorsed plans are being met Feeding programs nationally established and institutionalized FSNC FSNC, MOE, MHDST, UNICEF, INCAP, MOE, MHDST END 2011 Yearly FSNC, MOE END 2014 Technical and administrative capacity in comprehensive interventions in nutrition and health through the life cycle Policies Review National Health Agenda MoH Yearly Plans Plan of Action for human resource development in nutrition (national) Programs Completion of primary health care staff Develop clinical protocols for the management of cases in secondary care level Train staff in clinical protocols for the management of malnutrition in children National Health Agenda implemented Human Resource Development plan developed and implemented Scholarships and training in place Primary health care has cadre of staff needed Protocols for the management of hospitalized children due to malnutrition developed and implemented 100% of health professionals in secondary care level trained in the use of clinical protocols on malnutrition in children MOE University of Belize End 2015 INCAP End 2011 INCAP End P a g e

16 Objective 5: To achieve empowerment of caregivers (with a focus on women) and community participation in health and development planning processes. Action Expected Result Responsible Partners Completion date Empowerment of caregivers and community participation in health and development planning processes. Policies Strengthen gender policy to provide for input in decision making in health and development Programs Empowerment programs for women in health and development planning processes Remove barriers for girls and women to have access to education Gender Policy promotes the role of caregivers and community participation in decision making in health More women involved in decision making process for health Compulsory education for all enforced Percentage of trained teachers increased MHDST NWC End 2011 MHDST MOEY MOEY WIN, NWC, UNFPA, NGOs Ongoing End 2015 End 2015 End P a g e

17 Objective 6: To improve intersectorial alliances with strategic partners, at the various levels of government to prioritize and advocate for nutrition, health, and development in their plans and budgets. Action Expected Result Responsible Partners Completion date Intersectorial alliances with strategic partners to prioritize and advocate for nutrition, health and development in their plans and budgets Policies Update NFNSC policy and strategic plan NFSC plan is updated and implemented FNSC, End 2011 Plans Develop national advocacy campaign to develop awareness of chronic malnutrition in Belize and importance of nutrition to country development Programs Increase the number of fortified food items Prioritize projects benefitting poorest and vulnerable communities Nutrition is prioritized in national budget allocations Increased public awareness on nutrition and health and best practices Rice and sugar fortified with micronutrients (vitamins and minerals) Access to safe water increased Improved housing conditions Solid fuel consumption rate decreased FNSC UN agencies Yearly SIF Ministry of Housing NAVCO BBS, INCAP, WFP, FANCAP, RD DAVCO, NAVCO,, SIF, RD End 2012 End 2015 End 2015 End P a g e

18 6. Next Steps Nutrition is an important link between health and the economy and is a critical determinant in the country s development. The plan to address chronic malnutrition in Belize, therefore, has to be approached in an intersectoral, integrated manner. This Action Plan should be presented to the various implementing agencies reflected in the plan for their review and additional input. A monitoring and evaluation plan should be established to ensure action steps are being executed. Project proposals should be developed to seek funding for those plans and programs that will require additional resources for implementation. Finally, a decision on the lead authority or agency that will have oversight of this action plan (or if a separate and specific committee is required for such oversight) should be made to ensure the plan is acted on to reduce the rate of chronic malnutrition in Belize. 18 P a g e

19 ANNEXES 19 P a g e

20 Annex 1 Participants at Planning Meeting, December 17 th Natalia Beer Ministry of Health 2. Abigail McKay University of Belize 3. Robyn Daly Nutritionist, Ministry of Health 4. Lorraine Thompson INCAP/PAHO, INCAP Coordinator 5. Rhonda Tillett Standards Inspector, Belize Bureau of Standards 6. Ramon Figueroa Social Security Board, GM- National Health Insurance 7. Lliani Arthurs Deputy Director Human Services, Ministry of Human Development and Social Transformation 8. Fernando Tzib - Coordinator, NFNSC, Ministry of Agriculture 20 P a g e

21 ANNEX 2 STRATEGY AND PLAN OF ACTION FOR THE REDUCTION OF CHRONIC MALNUTRITION SWOT ANALYSIS BELIZE Objective 1 To develop, strengthen and implement interministerial policies, plans, and programs for nutrition, health, and development that meet the following requirements: a) a social determinants approach; b) resource allocation; c) interministerial coordination and planning; d) active national, municipal, and local government involvement; and e) surveillance, evaluation, and accountability of programs and interventions. Indicator Policies, plans, and interministerial (health, agriculture, education, labor, environment, housing, women, development and finances) programs, with resources allocated to the national, municipal, and local levels for the prevention of chronic malnutrition and the promotion of development approved. Dimensions Social determinants Resource allocation Interministerial coordination and planning Active national, district and local government involvement Evaluation and accountability Policies S Convention on the rights of the child International cooperation Ending hunger and Undernutrition in children policy in development Single Information system of beneficiaries in development Community Health Workers Geographical Information System W Almost one third of children do not have access to safe water Insufficient classrooms Limited optimization of resources at all levels Ineffective interministerial mechanisms e.g. National Food and Nutrition Security Commission Poor coherence among policies Public policies and programs in nutrition needs to be revisited Poor monitoring and evaluation systems Nutrition needs to be more visible in reports to the nation by PM. High cost of education Increased poverty rates Weak coordination at local level National statistic system have incomplete indicators for nutritional status, health and development determinants 21 P a g e

22 Dimensions Social determinants Resource allocation Interministerial coordination and planning Active national, district and local government involvement Evaluation and accountability O Overcrowding conditions reduced Social policy based loans T Increasing used of solid fuels Increased violence rate in pockets of susceptible in urban settings Youth affected by violence not having access to education Reduction in fund available at UN agencies Plans S National plan of action for children and adolescents Toledo Children and Adolescents Committee Poor capacity in the development and management of community projects Poor managerial skills Regional Initiatives e.g. Food fortification as a regional public good, RESSCAD, COMISCA W Poor knowledge of stakeholders on the role of main social determinants of nutrition National poverty elimination strategic action plan Incomplete human resource training plan that prioritize intersectoral interventions for addressing nutrition, health and development. Absence of a bulletin on nutrition and limited information in the health statistics abstracts O T Programs S Rural development program W Limited resources for sustainable application of integrated life cycle interventions in food, nutrition, health and development Goals and targets available only at country level Insufficient staff at national level Poor accountability mechanisms.e.g. external evaluations 22 P a g e

23 Dimensions Social determinants Resource allocation Interministerial coordination and planning Active national, district and local government involvement Evaluation and accountability O International internship programs T Political polarization Objective 2 Incorporate indicators of nutritional status and its social determinants into health surveillance systems that are not limited simply to compiling health information but include the analysis of this information by gender, ethnicity, and geographical area and permit forecasting and the timely prevention of nutritional problems. Indicator: Eight countries have up-to-date, timely, reliable, and sustainably obtained information on the prevalence and trends in malnutrition and its social determinants. Dimensions Strengths Weaknesses Opportunities Threats Nutrition surveillance system analyzing nutrition information by gender, ethnicity and geographical area Belize Health information system surveillance Officer Disaggregated nutrition related data available through household surveys Nutrition surveillance system not in place Nutrition indicators not prioritized and has no metadata Forecasting and timely prevention of nutritional problems 23 P a g e

24 Objective 3 Increase the number of integrated, intersectoral, evidence-based programs and interventions rooted in the principles of primary health care renewal, health promotion, universal access, human rights, gender-responsiveness, and interculturalism in the areas of food, nutrition, health,and development. Indicator: 50% of vulnerable municipalities, as determined by the extreme poverty rate or by a prevalence of low height-for-age in excess of 15%, are implementing sustainable, integrated, intersectoral programs or interventions in the areas of food, nutrition, and health. Dimensions Food Nutrition Health Development S Welfare programs: BOOST, Food pantry, public assistance Community and parenting rehabilitation Roving care givers program Public Health Act National Health Insurance scheme SRH policy Breastfeeding policy Regulatory Public utilities Commission Social Investment Funds Rural development program Undernutrition plan National health insurance scheme W Insufficient self-sustaining agricultural programs Insufficient number and technical capacity of human resources at local level Food fortification is not mandatory Nutrition through the life cycle interventions are incomplete and weak at and MOE O Community Based Organizations Faith based Organizations Non-governmental organizations Readiness of rice producers to fortify rice with folic acid and other micronutrients Technical support from World Food Programme, INCAP T Economical crisis Inadequate infant and young child feeding practices 24 P a g e

25 Dimensions Food Nutrition Health Development Unplanned pregnancies Invisibility of hunger and Undernutrition as a problem at local and household level Natural disasters Low exclusive breastfeeding rate Objective 4 Boost the technical/administrative and decision-making capacity of health workers and personnel from other sectors for the implementation of integrated intersectoral life cycle interventions in the areas of food, nutrition, health, and development. Indicator: 50% of health workers and personnel from other sectors in vulnerable municipalities (as determined by the extreme poverty rate or by a prevalence of low height-for-age in excess of 15%) trained in the social management of intersectoral programs for the prevention of malnutrition. A key component of technical cooperation is the development of goals that have gap reduction as a condition. To this end, the Bureau should capitalize on the experience of countries such as Brazil, which has achieved significant reductions in malnutrition rates and has bridged gaps between geographical areas and populations that previously exhibited striking inequalities. Dimensions Intersectoral technical, administrative and decision making process to implement integrated intersectoral life cycle interventions S W O T Food, Nutrition, Health, Development Limitations in funding of the national strategic plan of action of the National Food and Nutrition Security Commission Poor knowledge and management skills of programs or interventions in the areas of food, nutrition and health throughout the life cycle 25 P a g e

26 Objective 5 Achieve women s empowerment and community participation in health and development planning processes. Indicator: 50% of vulnerable municipalities as determined by the extreme poverty rate or by a prevalence of low height-for-age in excess of 15% have established mechanisms for community participation throughout the planning and implementation of their health and development plans. Dimensions Women empowerment Community participation in health Development planning process S W Gender policy Few women in decision making positions Poor women empowerment and other local leaders to for nutrition, health and development planning and management O T Objective 6 Establish intersectoral alliances with strategic partners, at the various levels of government that prioritize nutrition, health, and development in their plans and budgets. Indicator: Fifty percent of vulnerable municipalities, as determined by the extreme poverty rate or by a prevalence of low height-for-age in excess of 15%, have established intersectoral alliances with strategic partners and prioritized nutrition, health, and development interventions in their work plans and budgets. Dimensions Intersectoral alliances Integrated plans and budgets in nutrition, health and development at local level Vulnerable municipalities S Community based organizations e.g. TOLCA W Nonintegrated plans and programs for nutrition health and development at municipal and local level with a life cycle approach O T 26 P a g e

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