NUTRITIONAL POLICIES IN THE HEALTH SECTOR

The problem of malnutrition is complex, requiring a combination of various policies

and programs to effectively alleviate it.

A multi-sectoral approach is often required to address the problem of malnutritionespecially the underlying causes.

The best means of channeling sectoral efforts at malnutrition control in an active

manner is through an inter-sectoral national nutrition policy.

An analyses of causes, resources & power is also necessary in order to understand

the political economy of nutrition better, & come up with realistic policies.

Policies should be based on knowledge from relevant research and be constantly

evaluated for their real impact on food and nutrition security in communities.

The "ultimate decision on the choice of priorities however mainly rests with the
politician".

What is a policy?
A POLICY is a plan of action, statement, ideals, etc. proposed or adopted by a government,
political party, an organization, etc (Dictionary def.).
An effective national nutrition policy describes the problem, with quantified data, and contains
sectoral plans of action for malnutrition control.
Most attempts to improve food and nutrition security in most developing countries have been
ineffective. Why?

Because govts concentrate too much on providing food and too little on enabling
people to meet their nutritional needs themselves. Hence the needs to revise most
countries Food & Nutrition policies.

We therefore need the political will & vision to initiate & push thru programs, often at
community level to effectively address the underlying causes of malnutrition.

The present status of National Nutrition Policy

A declaration made by the head of a state referring to the serious consequences of

malnutrition in the country, and stating the determination of the government to take
suitable measures to eradicate or control the problem

A compilation of all ongoing or proposed sectoral measures in nutrition and nutrition

related areas within the national socio-economic plan of the country (Check the
national development plan)

A statement or an official resolution of the government indicating measures that each

sector is proposing to take to tackle the problem. (This is often implied in the nutrition
plan of action of 1994 and various government departments within which nutrition
activities fall)

A properly developed national nutrition policy prepared as a result of an inter-sectoral

review followed by programme planning. (This is what we currently lack here in
Kenya)

NUTRITIONAL POLICIES IN HEALTH

1. National Policy on Infant and Young Child Feeding Practices
2. Growth Monitoring and Promotion
3. Integrated Health and Nutrition Interventions
4. Selective feeding programs- children; pregnant & lactating women
National Policy on Infant and Young Child Feeding Practices.
Summary Statement
Every facility providing maternal and Child Health (MCH) services should:
1.

Adhere to the national Infant Feeding Policy which should be routinely communicated
to all health staff and strategically displayed

2. Train all health care staff in skills necessary to implement this policy
3. Provide information to all pregnant 7 lactating mothers & their partherns on the benefits
& management of Breastfeeding
4. Assist mothers initiate breastfeeding within within the first 30 minutes of birth
5. Give newborn infants no food or drink other than breastmilk unless medically indicated
(see specific guidelines on infants of HIV infected mothers)
6. Show mothers how to breastfeed and to maintain lactation even if they should be
separated from their infants
7. Practice rooming in, allow infants to remain together with the mother 24 hrs a day
8. Encourage breastfeeding on demand
9. Encourage & actively promote excluysive breastfeedingfor infants up to 6 months
10. Provide information and demonstrate to mothers how to introduce & prepare
appropraitae nutritious com[lementary foods to their infants after 6 months.

11. Encourage mothers to breastfeed for at least 24 months ( see guidelines for HIV
infected mothersd)
12. Foster establishement of breastfeeding support groups and other support groups and
refer mothers to them on discharge from hospital or clinic
13. Not accept any free samples and supplies of breastmilk substitutes
14. Not allow any publicity by manufacturers or agents of breastmilk substitutes
15. Not give any feeds using bottles or teats.
UN POLICY STATEMENT ON HIV AND INFANT FEEDING (2001)

When replacement feeding is acceptable, feasible, affordable, sustainable and safe,

avoidance of all breastfeeding by HIV infected mothers is recommended.
Otherwise, exclusive breast-feeding is recommended during the first six months of life.
To minimize HIV transmission risk, breast-feeding should be discontinued as soon as
possible taking into account local circumstances, the individual womens situation and
the risks of replacement feeding.

FEEDING OPTIONS FOR HIV POSITIVE MOTHERS

Breastmilk substitutes
Home-prepared formula
Unmodified cows milk
Commercial infant formula

Modified breastmilk
Early cessation of breastfeeding
Expressed and heat treated breastmilk

Other breastmilks
Breastmilk banks
Wet-nursing

INTEGRATING NUTRITION IN HEALTH SERVICES

Nutrition interventions should be part of all health contacts with pregnant and lactating women and
children under 2 years. Health workers should give the appropriate nutrition supplements or nutrition
counselling at all contacts with these target groups in health facilities and during outreach in
communities. Health workesr should support community based workers and private providers to reach
the priority target groups not attending clinics.
Important contact points
Prenatal care
Delivery
Postpartum care
Immunization contacts
Well baby visits
Sick child care
Nutrition protocols to be implemented include:
Ten steps of the BFHI to support breastfeeding in maternity services
Implementing the code of marketing of BM substitutes
Following infant and young child feeding recommendations of IMCI
Using micronutrient supplementation protocols correctly
Implementing appropriate measures in diagnosing & treating sick/malnourished children.
Providing appropriate guidance to HIV positive mothers about feeding options.
Nutrition interventions in Maternal Health services
Give prenatal iron/folate supplements to all pregnant women where anaemia or iron deficiency
is a risk
Promote adequate diets and reduced workloads during pregnancy and after delivery
Implement the ten steps of BFHI wherever births take place
Protect the public and mothers from promotion of products under the scope of the international
code of marketing of breastmilk substitutes
Give postpartum vitamin A to women at delivery in areas at risk of Vitamin A deficiency.
Give mebendazole for hookworm, prophylaxis for malaria
Routinely screen for severe anaemia
Nutrition interventions in child health services
1. Observe and assess breastfeeding provide individual counseling
2. Assess complementary feeding and counsel
3. Give preventive doses of vitamin A supplements every 4-6 months to all children 6-59 months
where anaemia is a risk.
4. Weigh all children to see if they are growing adequately
5. Screen, treat and refer children for severe malnutrition, severe anemia and clinical signs of
Vitamin A deficiency.