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SANCADI Southern African Nutrition Capacity Development Initiative David Sanders Director: School of Public Health University of the Western Cape SANCADI Global initiative to develop human capacity in nutrition Spearheaded by UNU and IUNS Established as the first of the African nutrition capacity development initiatives. Developed as a “learning co-operative”, comprised of institutions in the region, which would provide a mechanism for mutual transfer of expertise and capacity. From 2005 funded by USDA and facilitated through University of the Western Cape (RSA) Focus: Botswana, Zambia, Mozambique, Malawi, South Africa Inform: Namibia, Swaziland Rates of childhood stunting Sub-Saharan Africa 80 70 Cl VAD 60 SCl VAD 50 Anem NP 40 Anem P 30 Anem kids TGR 20 uwt 10 0 1985 1990 1995 2000 2005 Sub-Saharan Africa South Asia 80 70 70 Cl VAD 60 SCl VAD 50 60 Cl VAD 50 SCl VAD Anem NP Anem NP 40 40 Anem P 30 30 Anem kids 20 TGR TGR 10 uwt 20 uwt 0 1985 10 0 1985 1990 1995 2000 Anem P Anem kids 1990 1995 2000 2005 2005 South America S E Asia 60 70 Cl VAD 50 60 SCl VAD 40 Anem NP 50 30 40 30 20 20 10 10 0 1985 0 1985 1990 1995 2000 2005 Anem P Anem kids TGR uwt 1990 1995 2000 2005 National Trends in Underweight Prevalence 35 30 Lesotho 25 Malawi Mozambique (6 Provinces) Zambia 20 Prev (%) 15 Zambia (S. Prov.) Zimbabwe 10 5 Se p9 Au 1 g9 Ju 2 n9 M 3 ay -9 Ap 4 r9 M 5 ar -9 Ja 6 n9 D 7 ec -9 N 7 ov -9 Se 8 p9 Au 9 g00 Ju l-0 M 1 ay -0 Ap 2 r03 0 Date Global HIV prevalence 40 million people around the world live with HIV - more than the population of Poland. Nearly two-thirds of them live in Sub-Saharan Africa, where in the two hardest hit countries HIV prevalence is almost 40%. The global HIV/Aids epidemic killed more than 3 million people in 2003 there are emerging and growing epidemics in China, Indonesia, Papua New Guinea, Vietnam, several Central Asian Republics, the Baltic States, and North Africa. The AIDS debate, BBC News Progress in the area of Infant Feeding and HIV/AIDS There has been growing recognition and understanding of the complex dilemma facing HIV+ mothers re: infant feeding. In 1998, the perception in the HIV community was that formula milk should be provided to all HIV+ women to avoid infant transmission – it was a heated dialogue. New evidence from programs and research have highlighted the risks (social, nutritional, health) with this intervention. In most countries (though not all), the focus has shifted toward promotion of HIV-free survival & finding ways to make breastfeeding safer. Numerous guidelines and tools have been developed (HIV & IF Framework for Action, Global IYCF strategy, policy & program guidelines, counseling tools, reference guide, training courses) to strengthen infant feeding counseling in PMTCT program But there is a LONG way to go – a far more energetic effort and more resources are needed to seriously make these tools and knowledge available on the ground to reach affected communities & individuals. Progress in the area of Nutrition and HIV/AIDS The role of nutrition in HIV/AIDS has long been recognized but action was limited. In 1999, most focus was on AIDS-related wasting only. Now there is growing understanding of that HIV affects nutrition early in the course of infection and that there are multiple entry points. Likewise, the important associations between food & nutrition insecurity and HIV are better understood today. A comprehensive review of the evidence on nutrition & HIV/AIDS was completed last year. Two consultations in Durban last year highlighted this issue and charted a “way forward”. Many tools and materials for capacity development & implementation have been developed in Africa and shared between countries. WHO Executive Board and other resolutions have increased global commitment to addressing this issue. Several agencies have been actively involved. But, like with infant feeding, these tools and knowledge must be put into practice. Implementation lags far behind. Human resources are a serious constraint. The nutrition community has been slow to respond to this crisis. CFRs in hospitals: Implementing the WHO guidelines for severe malnutrition saves lives. Country Case fatality (%) BEFORE Case fatality (%) AFTER Malawi 55 16 South Africa 30 35 46 25 45 6 20 21 18 8 Ghana 20 18 AFRICA Research, Education and Training Products. SANCADI Objectives - Nutrition and HIV/AIDS Management of severe malnutrition Nutrition programming and advocacy Nutrition and food security SANCADI Objectives (1) Nutrition and HIV/AIDS - Disseminate learning module - Training of trainers - Monitor and evaluate use of module - Support and mentoring of trainees SANCADI Objectives (2) Management of severe malnutrition - Assessment of current practices - Capacity development where required SANCADI Objectives (3) Nutrition programming and advocacy - Audit - Identify institutions and organisations to facilitate support and mentoring SANCADI Objectives (4) Nutrition and food security - Enhance visibility and sustainability - Strengthen government support through • evaluating & spreading of WHO/FAO training course • advocacy and marketing by SANCADI Regional capacity building training courses on Intersectoral Food & Nutrition Policies Main Aim: Providing support to countries in strengthening and implementing national intersectoral food and nutrition plans & policies to address emerging & re- emerging nutrition issues, i.e. the double burden of malnutrition, through: ► bringing together concerned sectors (health, agriculture, education, finance/planning) ► incorporating various on-going work and international commitments (MDGs, poverty eradication, child survival, FIVIMS, etc.) Capacity building training courses on intersectoral food and nutrition plans and policies Anglophone Nairobi, February 2002: Eritrea, Ethiopia, Kenya, Liberia, Seychelles, Sierra Leone, Zimbabwe (7 countries) Cape Town, Feb 2003: Lesotho, Malawi, South Africa, Tanzania, Uganda, Zambia, Zimbabwe (7 countries) Cape Town, Oct 2004: South Africa, Botswana, Zimbabwe, Namibia, Nigeria, Ghana (6 countries) Francophone Cotonou, May 2004: Benin, Burkina Faso, Burundi, Cameroon, RDC, Guinée, Niger, Togo (8 countries) Main outcomes of the review meeting 1. Training course to become a WHO/FAO/UNICEF training course through strengthening food access concept & incorporating issues related to MDGs and child survival 2. Further strengthen the sections on advocacy and partnership (including civil society) 3. Encourage synergy with other existing training courses aiming to support action at different levels, (i.e. to design and implement specific programmes & projects at local & community levels) Common actions recommended by all Regions • strengthen the mechanisms for following up with the course participants & countries to review their implementation status after the training courses • strengthen communications between regional institutions, networks and partners involved in food & nutrition issues • develop a forum for discussion through internet to allow exchange of experiences, ask for information/questions on how to overcome any specific problems encountered, etc. • ensure sustained funding for regional/country training workshops to provide continued support for countries in strengthening and implementing national food & nutrition policies and strategies. NEXT STEPS • Appoint coordinator • Undertake rapid audit of CD activities on nutrition programming and advocacy • Select institutions/ organisations to facilitate and support ongoing CD (eg using UWC manuals/modules, RCQHC Tanzania) • Disseminate the learning module developed by RCQHC on Nutrition and HIV/AIDS • Evaluate effectiveness of/disseminate current CD approaches to Food Security challenges (eg WHO/FAO/UNICEF course ) • Assess and improve current practice at 1st level (district) hospitals on Management of severe malnutrition in selected countries (eg using WHO 10 steps plus RUTF) • Develop an advocacy and marketing strategy for SANCADI