Stories from the Field

Reaching children in emergencies with lifesaving vitamin A

Working with Afghanistan government to produce high-quality iodized salt locally

Solving hidden hunger amidst instability in Afghanistan

• The mortality rate of children under the age of five is 97 per 1,000 live births.
• The infant mortality rate is 77 per 1,000 live births.
• The maternal mortality rate is 327 per 100,000 live births.
• More than 60% of children 6-59 months old have stunted growth.
• 72% of children and 75% of women of child-bearing age are iodine deficient.
• 72% of children aged 6-59 months are iron deficient.

• Sustain at least 90% coverage of preschool children with vitamin A supplementation.
• Help pilot a new distribution program for vitamin A supplementation as National Immunization Days come to an end.
• Scale up zinc supplementation for treatment of diarrhoea.
• Increase the amount of raw Afghan salt that is iodized (as opposed to importing iodized salt).
• Scale up the distribution and use of multiple micronutrient powders.
• Increase the number of women receiving and properly taking iron and folic acid supplements.
• Increase access to fortified wheat flour.

Video: The Micronutrient Initiative in Afghanistan: Solving Hidden Hunger

MI supplies vitamin A capsules for twice-yearly supplementation activity through National Immunization Days. We are also actively involved in national planning for vitamin A supplementation and are providing technical assistance to help build capacity for data collection and management to better monitor where children are being reached and where the gaps in coverage are. As the country prepares for the eradication of polio and the subsequent end to National Immunization Days, we are also supporting the pilot of a new vitamin A supplementation strategy, including newborn supplementation through the Basic Package of Health Services program.

Field Story: Reaching children in emergencies with lifesaving vitamin A in Afghanistan

MI serves as an active member of the government´s zinc working group to support the scale-up of zinc supplementation activity. Thanks to the efforts of the working group, major donors supporting the health sector are now including therapeutic zinc in their calls for proposals for funding. As part of the CIDA-supported “Life- saving Micronutrients in Emergencies” program, MI provided zinc and oral rehydration salts (ORS) for the treatment of childhood diarrhoea with appropriate counselling to the mothers of 72,500 children in 2009 and 2010. We are preparing to support the use of zinc and ORS through all possible channels, particularly through Community Health Workers in the future.

MI is currently providing zinc and low osmolarity ORS in ten districts of two provinces of Afghanistan through the Basic Package of Health Services, and is working with the Ministry of Public Health to introduce zinc and ORS for the treatment of diarrhoea through private sector partners in five major cities of Afghanistan.

MI is providing technical support to the government for the monitoring of salt iodization. To support local salt production, MI completed an assessment of Afghan salt mines and lakes, and has developed plans to support the establishment of plants to process raw Afghan salt. MI also supported the Ministry of Public Health in developing a management information system for salt and flour fortification.

Field Story: Working with Afghanistan government to produce high-quality iodized salt locally

With MI´s provision of multiple micronutrient powders (MMNPs) as part of the “Life-saving Micronutrients in Emergencies” program, MNPs are now part of the National Nutrition Policy for refugees, internally displaced people and marginalized and isolated pockets of the population in emergency situations. We are undertaking a study to evaluate the effectiveness of MNP programming to date and are working to support the MNP program scale-up. MI is currently providing MNPs to children in four districts of the Bamyan and Badakhshan provinces of Afghanistan.

MI is providing technical assistance to partners implementing the Basic Package of Health Services program for the provision of iron and folic acid supplementation. We are also providing staff to work at the Ministry of Public Health to support this programming. In selected provinces, MI is also providing the supplements along with programming support.

MI is an active member of the technical working group for flour fortification in Afghanistan. We continue to provide premix to roller mills, and are helping develop the capacity of both millers and the Ministry of Public Health to monitor fortification activity through the establishment of a management information system. We are also facilitating the development and enforcement of national legislation, and are helping steer the development of a national standard for wheat flour fortification.

MI placed a National Consultant in the Public Nutrition Department to support the Ministry of Public Health in developing policy, strategy and guidelines; building the capacity of nutrition personnel at NGOs and in government departments that implement the Basic Package of Health Services (BPHS); advocating for micronutrient interventions and monitoring the micronutrient programs offered through the BPHS and the private sector.

• 80% of children 6-59 months old receive vitamin A supplementation.
• 61% of households have access to iodized salt.
• Coverage of the Basic Package of Health Services increased dramatically from 9% in 2003 to 85% in 2010.
• Coverage of iron and folic acid supplements for pregnant women is sporadic.
• There is no comprehensive intervention to tackle iron deficiency among children.

Contact MI in Afghanistan

Dr. M Ibrahim Shinwari Country Director, Afghanistan c/o Canadian Program Support Unit (CPSU) Wazir Akbar Khan 15th Street 6th Lane on the left, House Number 730 Kabul, Afghanistan