4th National Seminar on and Nutrition(Theme: Child and Maternal Nutrition)

Road Map towards a nutrition action plan Cambodia

CARDH.E. Srun Darith, Deputy Secretary General

1. Background• Stagnating child and maternal malnutrition rates (at unacceptable

high levels) in Cambodia

• High malnutrition impairs seriously the development of human capital, labor productivity and future social and economic development

• There are (evidence based) solutions which need to be introduced/scaled up in Cambodia

• Nutrition is a cross-cutting issue and coordinated efforts of many sectors are required

• Community based (integrated) programs have proved to be effective to make a change

2. Challenges• Nutrition not sufficiently prioritized in Cambodia and insufficient

provision of resources (RGC, DP) for nutrition

• Difficulties to provide effective overall guidance and coordination between sectors at national level

• Fragmented implementation and insufficient coordination at sub national level

• Previous nutrition investment plans not fully implemented and currently no integrated planning framework for nutrition

• Insufficient motivation and capacities at national and decentralized level to design, implement and monitor interventions

3. Recommendations from Working GroupsScaling up health sector nutrition interventions

1. Test new structure for community based program2. Secure financing for the provision of campaign materials

to NGOs; CARD to coordinate dialogue between MoH and Ministry of Information and private sector

3. CARD to coordinate creation of Oversight Board4. Develop scale up plan with procurement arrangements

for multi-micronutrient powder specified.5. Health Information System includes indicator for weight

gain during pregnancy; Track progress on Low birth weight; Include ANC in the delivery package ($ 15 for 4 ANC visits and live birth at health facility)

Recommendations from Working GroupsAgriculture production and Food-based Approaches to Improve Child and

Maternal Nutrition

1. Awareness raising on nutritional values of local agricultural products to community and mainstreaming nutrition in agriculture extension

2. Promotion of integrated farming systems (rice, fish farming, animal raising, and home garden) at household level, community and school (school gardening) with wide diversity of crops

3. Development of food preparation and processing/preservation recipes using local foods for pregnant and lactating mothers and young children

4. Reinforcement of the implementation of the related laws and regulations to promote agriculture productions and nutrition for better health and environment.

Recommendations from Working Groups Enhancing food fortification and regulations

1. Develop national policies, technical guidelines and relevant regulations for food fortification with micronutrients and enhance implementation of legislation / existing regulations to be effective

2. Expand food fortification to other appropriate vehicles and ensure the quality, safety and appropriate quantity required.

3. Enhance to add the dose or level of each micronutrients in a list of the national standard.

4. Additional analysis of data on food consumption and micronutrient deficiencies is required.

5. Promote the use of fortified food through awareness raising on the importance of of food fortification with micronutrients in local areas and nationwide.

6. Improve the quality control and quality assurance of the fortified product (Iodine salt and iron fortified fish sauce and soy sauce) for both local and imported product.

Recommendations from Working GroupsImprove access to safe water, sanitation and hygiene

1. Include Safe Water, Sanitation and Hygiene program in Child and Maternal Nutrition at all level

2. Focus on educational activities and BCC campaigns by linking to Maternal and Child Nutrition Program

3. Integrate national investment plan and strategic plan into National Maternal and Child Nutrition Program.

4. Strengthen Water Supply and Sanitation Community based Management at village level on O& M on existing facilities.

Recommendations from Working GroupsSSN (CT) to complement nutrition interventions

1. Institutional arrangementCARD, NCDD, MEF, MP, MH, MRD, MEYS should form as policy level on SP:

• To clarify the size and objectives of CT Pilot as well as framework and capacity of line ministries/ village volunteers

• To organise on a high level including to continue in the region to see the link between SP/ CT and nutrition

• To ensure M&E to provide evidence for sustainable financing.2. Sustainable financing

Source of financing for initial CT Pilot should be identified and long term commitment for phase out strategy should be endorsed by the government:• CT Pilot: WB/ AusAID Trust Fund and Donor financed health projects as source of CT; HEF and

NGOs for health supply side; D&D, commune sangkat/ district funds for local supply side (guideline should be developed).

• Phase out strategy: Convince policy makers for a long run and dialogue with MEF on medium-term financing for scale-up; Government draws a map and DPs coordinate funding.

3. Implementation modalityMore integrate approach on the existing SP program with consideration of • Awareness raising of the CT Pilot approach• Community-based approach and motivation for the success of the project• Using existing MFI for safety and effective CT• Capacity building at all levels for sustainability• Cost effectiveness for scaling up ability• Linkage between SP/ CT and nutrition in the region.

• Implement the recommendations raised by Samdech Techo Hun Sen which were discussed and endorsed by the Seminar.

• Develop an official RGC endorsement on the outcome of the 4th NSFSN to implement recommendations

• Reinforce cross-sectorial coordination and collaboration between RGC, DP and NGO:– Strengthen CARDs authority and the councils capacities to

effectively oversee FSN and to develop applicable national strategies

– CARD to organize trainings of planners and decision makers at both national and sub-national level on food security and nutrition

– DPs to use the existing TWG-FSN as the RGC/DP coordination structure for improving FSN

– Strengthen sub national coordination through existing structures

4. Conclusions and next steps

• Develop a joint planning and investment framework (nutrition action/investment plan) to scale up evidence based nutrition interventions and ensure its financing through RGC and DP through a program based approach

• Agree on key indicators and establish a multisectorial m+e system to track progress in child and maternal nutrition

• Develop a national and integrated community based nutrition program coordinated by CARD and implemented through local Government