Cws MNP Program
Cws MNP Program
Cws MNP Program
LESSONS OF A MICRONUTRIENT
POWDERS SUPPLEMENTATION
PROGRAM AND FORMATIVE STUDY
HOME FORTIFICATION WORKSHOP
JAKARTA 8 MAY 2014
Overview
Background
CWS Indonesia MNP Program
(implementation strategy and result)
CWS HKI UNICEF MNP Formative
Research in Timor Leste
Lesson Learnt
Founded in 1946
Mission: end hunger, promote peace and justice
Supported by 37 member communions
Program areas: food, water, assisting refugees
and the vulnerable
Active in more than 30 countries
cwsglobal.org
Background
2003 CWS nutrition rehabilitation program
micronutrient supplementation, nutrition
promotion and education in Indonesia.
2003 2006 in collaboration with HKI brought
VitalitaTM, MNPs tailored to Indonesias context
2007 2008 CWS delivered MNPs to around
4,700 children in post-tsunami areas of Sumatra
2008-2009, CWS delivered VitalitaTM to around
5,300 children in three districts with support from
H.J. Heinz Foundation and Heinz ABC Indonesia.
Background
Initial results of earliest MNP work
positive impact on children nutritional
status
significant cuts in anemia (based on
hemoglobin measurement) in TTS and
Nias District.
Anemia cut by 15 percent in TTS, 11
percent in Nias
Background
2011: CWS proposed to H.J. Heinz
Foundation to continue supporting the
VitalitaTM Program as we have seen the
positive
Beside two previous areas TTS (East
Nusa Tenggara Province and Nias (North
Sumatera Province), CWS proposed new
intervention area in Central Sulawesi
Province
Background
Chronic malnutrition (36.1%) and acute
malnutrition (14.8%) amongst under-5
children in Central Sulawesi
(National Basic Health Research 2010)
The goal
to improve nutritional
status of children
under-5 years of age
through sustainable
community marketbased micronutrient
powder supplements
PROGRAM IMPLEMENTATION
STRATEGY
Amount
Vitamin A
400 g RE
Vitamin C
30 mg
Vitamin D
5.0 g
Vitamin E
5 mg a-TE
Vitamin B1
0.5 mg
Vitamin B2
0.5 mg
Vitamin B6
0.5 mg
Vitamin B12
0.9 g
Folic Acid
150 g
Niacin
6 mg
Iron
10 mg
Zinc
4.1 mg
Copper
0.56 mg
Iodine
90 g
Maltodextrin*
5.0 mg
VitalitaTM Composition
Program monitoring
Conducted by CWS staff, midwives and cadres
Home visit for 10% of the total children
Data on: #VitalitaTM distributed, consumed,
perceived changes, perceived challenges
Program results
By the end of June 2012, a total of 934,905 Vitalita
sachets had been distributed to a total of 11,954
children under the age of five.
300,180 Vitalita sachets had been distributed to 3,329
children in Poso
529,995 sachets had been distributed to 7,394 children in
TTS
104,730 sachets to 1,231 children in Nias
Program results
79.8% of children (N=3198) consumed at
least 60 sachets of VitalitaTM in 6 months.
Mothers fed their children food mixed with
VitalitaTM daily (46.8%) or every other day
(53.2%) (N=3050).
Program results
To support the social marketing and the
health & nutrition promotion
250 flipcharts
12,300 promotional brochures
1,000 food and nutrition flash cards
750 Q & A cards
Program results
A series of health and nutrition trainings
focusing on IYCF, were conducted for 496
health workers and cadres in 3 locations.
Livelihood trainings were conducted for
544 mothers focusing on art and craft
using plastic materials, like used VitalitaTM
sachets .
66,3
60,1
60
50
Better appetite
40
37,9
35,2
Active, cheerful
30
26,9
Lost appetite
26
24,3
Susceptible to illness
20
Weak, sluggish
9,4
10
3,9
2,7
0,3
0,4
1,7
0,9
80,0
76,9
70,0
60,0
45,3
40,1
39,8
40,0
33,2
30,0
Others
20,0
16,1
12,0
8,9
10,0
3,9
5,6
1,7
3,3
8,8
2,3
2,2
0,0
Objective:
Methodology
Study area: 3 villages, Laulara Sub-district, Aileu
District
A qualitative study:
4 FGDs with mothers of children 6 23 months
56 IDI and Key Informant Interview (KII)
Mothers (n=18)
Fathers (n=14)
Grandmothers (n=14)
Health workers (n=8)
Catholic Catechists (n=2)
Methodology
Study timeframe: Dec 2010 September
2011
FGDs and IDI: 28 March 8 April 2011
to understand the sociocultural factors that influence
breastfeeding and complementary feeding practices
to explore caregivers knowledge and perceptions
regarding anemia, iron and vitamin A
to assess if caretakers knew about or had ever used
MNP, whether they would like to use the product,
to elicit their preferences for the name, packaging
design, promotional messages, and distribution
channels of MNP
Methodology
The usability trail: 26 April 13 May 2011
to assess product acceptance, potential
difficulties, perceived health benefits, and side
effects of MNP
To assess family and community members
responses on the MNP supplementation whether
it should be continue or not.
Methodology
Usability trial
14 days of MNP supplementation
45 children
Inclusion criteria
Daily consumption
Methodology
Usability trial
Each child was provided with 14 sachets of MNP and
an insecticide-treated bednet.
Daily consumption
Prior to the usability trial, mothers/caregivers were
informed about the MNP composition and benefits,
how to tear and mix the MNP to the food, and as well
as an on-site demonstration on how to mix and feed
MNP to their children.
Same information were also provided to community
health volunteers, government health workers,
Catholic catechists, and head of villages
Home visit on day 1-3, day 7-9 and , and day 14-17
Methodology
Study materials:
FGD guideline
IDI set of question
MNP information sheet written in Tetun and Mambae
A short video demonstrating how to mix MNP with
food
Different MNP sachets (MixMe, Babyfer(Ghana),
SuppleForte (Canada and Israel), Vitalita(Indonesia),
Chispitas (Bolivia), Sprinkles plus (Heinzin India), and
others used in China, Haiti, Mongolia,and Nepal.
A chart of seven colors (green, red, blue, yellow,
orange, purple, and brown) with different color
gradation
MNP MixMe (DSM): 15 vitamins and minerals
Results
Results
Results
Results
Results
Results
Results
Preferred distribution channel:
SISca and or government health facilities
Lessons Learned
and Next Steps
STRENGTH
Using Posyandu or SISCa (Servisu Integrado
Saude Comunitaria) for the distribution point helps
in reaching the children and increases the
attendance of monthly growth monitoring
Engagement of government health workers and
cadres is crucial for product acceptability. It is also
important for institutionalizing the program.
Intensive nutrition education, home visit and
counseling is crucial to increase the acceptance
and compliance
Tailored product packaging and name will increase
the acceptance too
Lessons Learned
and Next Steps
CHALLENGES
Product supply chain
Financial challenge for free distribution however it
is also a challenge to create market-based MNP in a
very poor community.
Simple, practical, inexpensive but accurate
micronutrients measurement tools to assess the
micronutrient deficiencies and program impact
Reaching out remote areas
Food insecure areas
Changes in food color and taste, in particular when it
is mixed with smaller amount of food.
Lessons Learned
and Next Steps
OPPORTUNITIES
At some extent, mothers are aware the
importance of micronutrients supplementation
i.e vitamin A
The needs and markets are high
We have a scientific proven product for home
fortification MNP
We have the momentum for SUN
Lessons Learned
and Next Steps
What we can do?
NGOs
Support the government MNP Program by
Enhance social marketing to create demands and
product acceptance.
Support outreach to the remote areas
Support the promotion of proper MIYC feeding and
care
Lessons Learned
and Next Steps
What we can do?
Private sector
ensures product/supply chain
provide expertise in product marketing
build capacity for small business management
use company CSR to invest in nutrition-specific
and /or nutrition-sensitive actions
Special thanks to
the Heinz Foundation
for their support!