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Annex 2.3 Page 1 of 5

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A. EX!STING PROGRAMS AND DONOR COORDINATION

1.    The Government has demonstrated its concerns over micronutrient deficiencies by taking several actions. Iodine deficiency contro] was part of the past and present Five Year Plans. Strategies formulated by the Plans provide for a pilot project for iodized oil and supplementation. Another pilot program for vitamin A deficiency has entered its second phase and covers eight provinces. Operational strategies include mass distribution of vitamin A capsules, health center based medical treatment of children at risk, and increasing vitamin A intake through food produced through borne and school gardening. Iron deficiency receives attention through systematic detection and treatment of anemia by health workers, and free distribution of ferrous folate to pregnant women during prenatal consultations. However, access to supplements is limited to outside urban areas, largely due to supply problems.

2.    The two main donors already involved in the fight against micronutrient deficiencies are UNICEF and USAID. For Iodine Deficiency Diseases (IDD), UNICEF will start iodation of water wells on a pilot basis next year in some enclaved areas. Also for IDD, an intemadonal NGO Medicus Mundi helped the MOH in 1990-93 undertake operational research comparing two methods of iodine delivery: injectable iodine through using the EPI deiivery system, and orał doses using health centers and PHC workers. The coverage achieved was about 68% using the injectable, and 58% using the orał doses. For Vitamin A, UNICEF and USAID cover 8 provinces with the help of the International NGO Helen Keller International; however, coverage is expected to be only 30% for children under five, children 6-10, and breast feeding mothers. This project also aims at increasing by 20% the number of children under five eating vitamin A-rich food at least four times a week; and 90% of children at risk who visit health centers will also receive vitamin A. USAID has been financing the development of a nutrition communication strategy which includes messages on vitamin A, with the help of the consulting firm Academy for Educational Development (AED). FAO has also been involved in developing media products and a radio strategy for vitamin A. The Canadian govemment proposed to finance a pilot test on an “integrated micronutrient deficiency control project" from 1993-96 to address all three micronutrients, but the proposal bas not yet been approved.

3.    For the design of a national food and nutrition strategy, the Govemment has set

up a working group composed of representatives from the various ministries (Plan, Agriculture, MSASF), NGOs, bilateral donors, UNICEF, and WHO. A strategy document was produced and presented at the International Conference on Nutrition in Romę in December 1992. Major elements of the strategy will aim at increased household food security, reduction of morbidity, nutrition surveillance, and the control of micronutrient deficiencies. The MOH has prepared a first draft of the national program for the control of micronutrient deficiencies, parts of which will be financed by the proposed PDSN project.