Essential
Nutrition Actions
(ENA)
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Contents
ENA
– What is ENA?
– When to intervene?
– What actions to take?
• Seven action areas
– Where to take these actions?
• Six contact points
– Key program components
• Importance of harmonization
– Lessons learned
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• Action oriented approach to
addressing nutrition problems of
mothers and children for all sectors
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Over all Goals of ENA
To be able to prioritize the key nutrition
behaviors which meet the health and
nutrition needs of children and women
in vulnerable communities, and
integrate these behaviors into:
– Ongoing interventions in health facilities
and communities,
– Pre-service training, and
– Policies
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• Over past 30-40 years nutrition
interventions were often
– Not integrated
– Viewed as separate vertical programs
– In compitition with one another
– Not action oriented
– Focused only on GM/P activities
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• In the past 10 years growing consensus is
that nutrition interventions need to be…
Integrated conceptually & programatically
Infant & Young Child feeding
Maternal nutrition
Micronutrients
Based on proven impact
Action oriented with clear guidance « who
should take what action when »
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• When should we intervene?
– Majority of the growth faltering occurs
during the first year of life
– Many babies are born malnourished due
to poor maternal nutrition before &
during pregnancy
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Points of no return in the life
cycle
• At birth
• At about three years of age
• Next generation
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The “window of opportunity” for
improving nutrition is very small... Pre-
pregnancy until 18-24 months of age
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What to Integrate?
Seven action areas !
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Seven action areas !
1. Breast feeding 5. Vitamin A
2. Complementary 6. Iron
feeding 7. Iodine
3. Feeding of sick
children
4. Women’s Nutrition
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Breast-feeding
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Promotion of Breastfeeding
Exclusive breast
feeding for the
first six months of
life
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Promotion of Breast-feeding
Key messages
Early Initiation of BF
Exclusive BF until 6 months
BF day and night at least 10 times
Correct positioning & attachment
Empty one breast and switch to the other
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Complementary Feeding
to BF
Complementary
feeding has to be
initiated at the age
of Six months
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Complementary feeding to
BF
Key Messages
• Continue breast feeding until 24
months of age
• Increase the number of feeding
with age
• Increase the density, quantity and
variety with age
• Responsive feeding
• Food hygiene 17
Feeding the sick child
Key Messages
• Increase BF and
complementary feeding
during and after illness
– IMCI-Integrated
management of child
hood illnesses
• Appropriate therapeutic
feeding
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Women’s Nutrition
Key messages
• During pregnancy and lactation
– Increase feeding
– Iron/folic acid supplementation
– Treatment and prevention of
Malaria
• Deworming during pregnancy
• Vitamin A capsule after
delivery up six weeks post
partum
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Control of Vitamin A
deficiency
Key messages
• Breast feeding : source of
Vitamin A
• Vitamin A rich foods
• Maternal supplementation
• Child supplementation
• Food fortification
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Control of Anemia
Key messages
• Supplementation for women
and children
( IMCI)
• Deworming for pregnant
women and children
(twice/year)
• Malaria control
• Iron rich foods
• Fortification
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Control of iodine deficiency disorders
(IDDs)
• Access and consumption
by all families of iodized
salt
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Where to integrate ?
• Seven proven behaviors !
• Six critical contact points !
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Six critical contacts in the life
cycle
1.PREGNANCY:TT
,ANC,Iron/folate, 2. DELIVERY: safe
deworming,antim delivery, EBF,
alarial,diet,EBF,ri Vitamin A
sk signs, ,Iron/folic acid,
FP,STI diet, FP, STI
Prevention, safe referral
delivery, iodized
salt
3.POSTNATAL 4.IMMUNIZATION:
AND FAMILY Vaccination,
PLANNING: Vitamin A,
EBF, Diet, Deworming, assess
iron/folic ,diet, and treat infant’s
FP, STI, anemia, FP, and
Prevention, child’s STI referal
vaccination
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Six critical contacts in the life
cycle…
5.WELL CHILD 6. SICK CHILD :
AND GMP: Monitor growth
Monitor growth, ,assess and treat per
assess and IMCI counsel on
counsel on feeding, assess and
feeding, iodized treat for anemia,
salt, check and check and complete
complete Vitamin A
vaccination /Immunization/dewo
/Vitamin A rming
/Deworming
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Where to integrate?
Other sectors and contacts
health sector at facilities&
communities
•Antenatal visit
•School programs
•Delivery
•Agriculture extension
•Post natal visit
•Emergency
•Immunization
•Community
•Well baby visit/GM
development
•Sick child visit
•Mico-credit project
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ENA
• Health facility level: integrate ENA
actions into existing health contacts
at all health services
• Community-level: work with
community based organizations and
networks from all sectors and
• Behavioral change: re-enforce ENA
actions through behavior change
communication at all levels, including
inter-personal communication, mass
media and community mobilization
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Need to Harmonize
Health sector, policies ,protocols and approaches
REPRODUCTIVE HEALTH
CHILD SURVIVAL Women’s Nutrition
EPI+ Lactation Amenorrhea
Community IMCI method
Health facilities IMCI
INFECTIOUS DISEASE
ENA
Control of Malaria NATIONAL IMMUNIZATION
Mosquito net and DAYS
treatment Polio
Tuberculosis Measles
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Need to Harmonize
Health sector, policies ,protocols and approaches
Schools Agriculture
Adolescent nutrition Food diversification
De-worming Food security
Iron supplementation Women’s farmer clubs
School lunch
Micro-credit
ENA Emergency
Women to women
Income generation Support
Nutrition education Sanitation
Prevention of
diarrhea ,
malaria ,ARI
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• Need to harmonize at all levels
National
•Planners
•Donors
•Academia
•Journalists
Regional
•District MOH Team
•NGOs
•Hospital Administration
Districts
Health Facilities Health workers
• Public
• Private
•Community Leaders
Communities •Community volunteers
(families) •Existing Groups
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ENA
• How to harmonize?
Partnership at all levels
Coordination of working groups
Policies, protocols, guidelines
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How to harmonize?
IEC-BCC Materials
Same key messages
Mass Media
Reinforce same messages
Training
Pre-service
In-service
Communities
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Lessons learnt
By ENA
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• The ENA strategy has given a clear
framework for specific action to
improve nutrition
• The ENA strategy is pulling together
all the existing vertical programs in a
sensible “action oriented” way
– nothing new except packaging
• The ENA strategy has greatly
expanded “nutrition” contacts far
beyond the traditional GMP programs
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Adequate nutrition for human and
sustainable development
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Thank
you !!!
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