The document summarizes areas of intervention for national nutrition services in Bangladesh. It discusses the major public health nutrition problems the country faces and outlines the life-cycle approach the services will take. It describes the roles of different frontline workers and details components of the nutrition services operation plan, including direct interventions, cross-cutting issues, indicators, budgets, and goals to reduce malnutrition among children and women.

1. Areas of interventions in National
Nutrition Services (NNS)
By
Dr Mustafiz Rahman PPC, MoHFW
Training on Assessment of Nutritional Status 18-22 December 2011
Date : 18 December 2011,
Venue: FPMU Meeting Room
The Training is organized by the National National Food Policy Capacity Strengthening Programme (NFPCSP) . The NFPCSP
is jointly implemented by the Food Planning and Monitoring Unit (FPMU), Ministry of Food and Disaster Management and Food and
Agriculture Organization of the United Nations (FAO) with the financial support of the EU and USAID.

2. Nutrition under MOHFW
• Due to it's multidisciplinary character nutrition
is related with 13 different ministries.
• MOHFW is one of the important ministry
which can address this problem up to certain
level
• This issue incorporated in to constitution in
1972
• Institute of Public Health Nutrition (IPHN)
established in 1972

3. Topics of my presentation
• Areas of interventions in National Nutrition
Services (NNS)
• Scaling up proven direct and Indirect nutrition
interventions

4. Major public health Nutrition problem :
1. Stunting
2. Under weight
3. wasting
4. Protein Energy Malnutrition
5. Iron deficiency Anemia, Iodine deficiency
disorders
6. Vitamin A deficiency, zinc deficiency etc.
7. Low Birth Weight
8. Over nutrition & its complications (diet related
Non- communicable Diseases-NCD)

5. Children Adolescent Girls
Under Two 13-19 yrs
Services
Through
Life-cycle
Newly Wed
In BINP/NNP
Lactating Women
Mothers
Pregnant
Women
NNS would follow life-cycle approach in community service

6. Lactating Forums Under 2
Women Children
Adolescent boys
Mother in law
Post-partum Care Father in law
Vitamin A Growth Monitoring
Husband of
iron folate Care for LBW
newly and
Referral FoodSupplementtionVit
pregnant women
amin A
Referral
Household Survey
followed by update
Home visit
Food Security Components
Nutrition Garden
BCC Services Poultry for Nutrition
perform VGD-NNP Collaboration
Training by a CNP
at CNC
Adolescent
Newly wed Girls/boys
Pregnant
Women Couple
Monthly Forum
Nutrition Nutrition Assessment
Weight Monitoring Assessment IronFolate
Iron Folate Counseling De-worming
Antenatal care IronFolate Weight promotion
Iron Folate IGA, Fruits tree
Food supplementation plantation
Counseling
Referral

7. Job Analysis of Front Line Workers in HNPSP Comparative Matrix
Other
Family Welfare ministries/
Community Nutrition Promoter Health Assistant (HA)
Assistant (FWA) for Services in CC NGOs/private
(CNP) for 1250 population for >5000 population
>5000 population /personal
initiative
 Eligible couple  HH profile update  HPN Services  Geographical  ……….
registration  GMP reconnaissance  …………
 Family  Micronutrient  EPI  ……………
planning Supplementation  Disease …
counseling (Post partum Vit A, IFA for surveillance
 Non-clinical PLW) Adolescent girt &  Health education
contraceptive newly wed women  Epidemic control
distribution &  NID & Vit A week
 Target food
FU
supplementation for PLW,
 Referral for
U2 children
ANC
 Referral for ANC
 Support
 BCC
during
 Food Security interv
 NID & Vit A
 Support during
week
 NID & Vit A week

8. Multi sectoral issues
Due to multisectoral issues many ministries would
contribute to overcome these issues are important:
 Food security at HH level
 Food safety
 Food quality
 Balance diet
 Healthy diet
 Diet culture
 Knowledge about nutrition
 Prevention ,control and management of malnutrition
( NNS-OP, MOHFW)

9. Intervention so far under MOHFW
• Through IPHN since 1974
• Through IPHN & BINP (59 Uz): 1996-2001
• Through IPHN & NNP(167Uz) : 2001-2011

10. What next in MOHFW ?
• National Nutrition Services (NNS) to
mainstream the nutrition issue in all regular
service delivery points of DGHS & DGFP
• GO-NGO model would be in practice to ensure
nutrition service in urban slum, haor- baor
-char, hard to reach, underserved and where
Community Clinic (CC) is not available
• Inter-sectoral collaboration/coordinated
collaboration among all stakeholders

11. General Objective
The overall objective of NNS OP is to reduce the
prevalence of malnutrition particularly among
children and women and also achieve sustainable
improvements in the nutritional status of the
population of Bangladesh.
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12. 1. To implement a mainstreamed, comprehensive
package of nutrition services to reduce maternal and
child nutrition and ensure universal access
2. To develop and strengthen coordination mechanisms
with key sectors (especially Ministry of Food and
Disaster Management, Ministry of Agriculture,
Ministry of Livestock and Fisheries, Ministry of Local
Government and Rural Development and
Cooperatives) to ensure a multi-sectoral response to
malnutrition
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13. Cont.
3. To strengthen the human resource capacity to
manage, supervise and deliver nutrition services
at the different levels of the health system
4. To strengthen nutrition information systems and
operations research to ensure an evidence-
based response.
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14. Component of OP
 Behavioural Change and Communication to Promote
Good Nutritional Practices
 Institutional capacity building
 Human resource development (HRD)/
Training/Capacity Building
 Food security, quality & food safety
 Management of severe acute malnutrition (facility
and community)
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15. Cont.
• Monitoring and Evaluation / Nutrition
Surveillance
• Mainstreaming Gender into Nutrition Program
• Nutrition during Emergencies & climate change
• Community Based Nutrition (CBN) as selected
area (urban, hard to reach)
• Coordination of Nutrition Activities across
Different Sectors
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16. Cont.
• Procurement of equipments, micronutrients, and
deworming tablets etc.
• School Nutritional education Program
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17. Service delivery
 Growth Monitoring and Promotion (GMP)
 Protection, Promotion and support of Breastfeeding/
Infant and Young Child Feeding (IYCF)
 Vitamin A supplementation of children 6-59 months &
lactating mother
 Iron-folic acid supplementation for pregnant women
 Iron Supplementation and Deworming of Adolescent
Girls
 Iodine deficiency disorder & Salt Iodization
 Zinc Supplementation during treatment of diarrhea
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18. Cross –cutting issues
Given the nature of this , this OP is highly dependent with
other Ministry activities which are articulated in the
Action Plan of the Strategic Document.
• Effective Integration of priority nutrition Interventions in
the field level at all service delivery points of DGHS and
DGFP. OP-1,2,3,9.18,20
• Strengthening HR resources necessary for provision of
nutrition services. OP-11, 12, 29, 25
• Establish effective facility and pop based nut surveillance.
OP-1,2,3,14, 22, 6
• Providing nutrition education OP-15, 23, 2,3
• Strengthening sectoral collaboration regarding nutrition
and food safety. MODM, Food Div, MOFLS, MOWCA, MOI
and other.
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19. Indicator
1. Prevalence of night blindness among <5
2. % of children 6-59 m receiving Vit-A
3. % of vit-A supplementation in postpartum women
4. Rate of EBF in infants under <6 months
5. % of children 6-23 months fed with all infant and
Young Child Feeding (IYCF ) practices
6. Prevalence of iodine deficiency
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20. Cont.
7. Prevalence of anemia among pregnant women
8. Prevalence of anemia among children 6-59m
9. # of MOs trained in nutrition services delivery
10. # of CC workers trained in nutrition services
delivery
11. % of UHCs having a functional Nutrition Corner
established
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21. Budget for the following activities
1. Behavior Change Communication (BCC)
2. Human resource development (HRD)
3. Control of Vitamin-A deficiency disorder
4. Control & prevention of Anemia
5. Control of Iodine deficiency Disorders
6. Other Micronutrient problems of Public Health
importance ( zinc, vitamin ‘D,’ calcium etc.)
7. Community & facility based management of severe
acute malnutrition (SAM)
8. Institutional Capacity Development
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22. Cont.
9. Protection, Promotion & Support of
Breastfeeding/ Infant and Young Child Feeding
(IYCF) including BFHI & BMS Code
10. Food fortification (Salt Iodization, fortification
of oil/other food with Vitamin ‘A’, iron etc.)
11. School Nutritional education Program
12. Food security, Quality and Food Safety
13. Monitoring, Evaluation, Operations Research,
Survey
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23. Cont.
14. Nutrition Surveillance Program
15. Establishment of nutrition unit (NU) and
strengthening of existing NU
16. Community based Nutrition (CBN) ) as selected area
17. Multisectral Collaboration
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24. Thanks
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