uplb review_nut prog mgt

Nutrition Program Management

Some considerations

6/1/2012

Malnutrition exists

Malnutrition has serious implications

to individual & national development

Brain development

Cognitive and educational performance

Growth and muscle mass Body composition

Immunity Work capacity

Metabolic programming of glucose, lipids, protein hormones/ receptors/genes

Early nutrition utero and childhood Diabetes

Obesity Heart disease High blood pressure, cancer, stroke, and ageing

Short-term

effects

Long-term

effects

Violation of

human

rights

Consequences of

malnutrition

Malnourished

children

Inability to concentrate

in school

School

drop-out

Lack skill/

low literacy

Under/unemployed

malnourished adults

Low

productivity

Poverty

Weak resistance

Infections

Early death

Poor health status

Faulty food habits & practices

Lack of education

Large-sized family

Poor environmental conditions

Inadequate food intake

Causes of malnutrition

The program management cycle

Assess the situation

Set objectives

Decide on course of

action

Draw up details of

implementation

Evaluate plan

Implement and

monitor

Importance of nutrition

planning

Allows efficient use of resources

Preventing overlap

Integrating, synchronizing, and

coordinating efforts

Importance of nutrition

planning

Serves as a guide for

Implementing actions for nutrition

improvement

Assessing and evaluating efforts

Generating resources

Advocating for meaningful

participation

What is planning

Setting

objectives

Selecting

course of

action

Identifying

problems

Deciding in advance What, who, when, where,

how long, how often

Planning is

a decision-

making

process

Present to approving

body

Estimate budget

Plan monitoring &

evaluation

Determine the details

Select interventions

Set objectives


Organize planning

team

Steps in

planning


Nutrition problems

Nutrition programs

Resources

Constraints

Assess the situation ---

objectives

Identify nutrition problems, groups

affected, areas affected, and causes

Assess past experiences in

implementing nutrition programs and

projects

Assess available resources and

constraints

Assess the situation --- uses

Decide on Objectives Mix of interventions to pursue and their

design Priority target groups Priority target areas

Sets the basis for monitoring & evaluation

Provide information to motivate politicians, the community and the public

Guide Questions For the

Situational Analysis WHAT are the nutritional problems in

the area?

WHAT is the trend in the nutrition

situation over the years?

HOW many are affected?

WHO are affected?

WHERE are they located?

WHAT FACTORS cause or give rise

to the nutrition situation?

Guide Questions (cont…)

WHAT PROGRAMS and PROJECTS

have been implemented in the past

years? And what lessons can be

learned from their implementation?

WHAT RESOURCES are available to

address these problems?

WHAT CONSTRAINTS can prevent

action for nutrition improvement?

Causal model of

malnutrition

Representation of the factors that lead

to malnutrition

Shows how factors interact with each

other to cause malnutrition

Identifies immediate, intermediate,

and root causes of malnutrition

Causal Model of Malnutrition

Leads to better understanding of the

malnutrition problem

Facilitates increased participation and

opinion-sharing among team members

Allows thorough discussion of malnutrition

and its causes

Results to identification of data to be

gathered and relevant interventions

Uses

Building a causal model of

malnutrition

Identify the problem and affected

groups

Underweight among children 0 – 5

years old

Stunting among children 0 – 5 years

old

Vitamin A deficiency among children 0

– 5 years old

etc


malnutrition

Brainstorm or list possible causes

Inadequate food in the household

Poor environmental sanitation

Low family income

Unsafe water supply

Declining breastfeeding

Poor complementary feeding practices

Lack of money to buy food

Poor soil for growing food


malnutrition

Branch out to at least two immediate

causes

Underweight children,

0-5 years old

Low food

intake

Poor health

status


malnutrition For each immediate cause, identify

factors that lead to it by asking a series

of WHYs Underweight children,

0-5 years old

Low food intake Poor health status

Decline in

breastfeeding

Lack of food in

the family

Poor environ-mental

sanitation

Low use of health

services


malnutrition When to stop

When an activity or project to address the

problem has been identified

When action is beyond the decision-

making capability of the planning group

Some tips

Keep it simple --- no horizontal lines, no

feedback loops, if needed repeat a cause

Be specific

Stick to the local situation

Situational Analysis --- Data

collection

QUANTITATIVE: Numerical

Census

Surveys

Special studies

Routine administrative

monitoring reports


collection

QUALITATIVE: Descriptive

Coping mechanisms

Food habits

Perception on nutrition and

government programs and

projects


collection

QUALITATIVE: Descriptive

Key informant interviews

Focused/focus group discussion

In-depth interview

Ocular inspection

Observation


collection

Factors Data/Indicator

Malnutrition among

preschool children

Prevalence of

Underweight-for-age

Stunting

Wasting

Frequent illnesses Morbidity rate

Diarrhea

Acute respiratory infections

Inadequate health services Ratio of health personnel to

population


collection

Factors Data/Indicator

Poor environmental

sanitation

% of households with

sanitary toilet

% of households with

potable water

Low household income Average household income

Low wages Minimum daily wage rate

Inadequate livelihood

opportunities

Unemployment and

underemployment rate

•

Data Analysis Gives MEANING to data collected by

applying statistical tools

Simple counting (frequencies)

Rates

Percent

Data are analyzed/interpreted based on

OBJECTIVES of nutritional assessment

Plan on how to analyze data is done at

START of project planning

Helpful to refer to CAUSAL MODEL`

Data Analysis

Prevalence, rates, averages, proportions

Trends

Comparison with known standards

Rank and set cut-offs

Mapping

Cross-tabulations

Use of statistical treatments

Data analysis WHAT ARE THE NUTRITION PROBLEMS?

Get prevalence, proportions or averages Prevalence

(No. of severely and moderately underweight/preschoolers x 100 No. of children weighed

Compare with standards

Example

National prevalence 8.4%

Regional prevalence 9.8%

Municipal prevalence 10.3%

Data analysis

YEAR BGY 1 BGY 4

1995 18.2 4.4

1996 17.5 5.0

1997 16.5 6.5

1998 14.9 7.2

1999 13.3 8.0

WHAT IS THE TREND?

Calculate percent change

BEFORE-AFTER X 100

BEFORE

Data analysis

WHO ARE AFFECTED?

Get prevalence by age group/

physiologic group

Preschool children

School children

Pregnant women

Get prevalence by socio-economic

group or functional classification

Data analysis

WHERE ARE THEY LOCATED?

Identify clustering of areas with high

levels of malnutrition

Identify common characteristics

Coastal areas

Upland

Lowland

Urban poor area

Data analysis

HOW MANY ARE AFFECTED?

Get number of malnourished

Barangay Prevalence No.

Malnourished

A 20% 20

B 5% 5

Assuming a population of 100

Data analysis

WHAT FACTORS AFFECT

MALNUTRITION?

Describe population groups and areas

more affected

Data analysis

WHAT PROGRAMS AND PROJECTS

HAVE BEEN IMPLEMENTED IN THE

PAST?

Consider efficiency Coverage

Targeting

Timeliness of service delivery

Timeliness and adequacy of supplies

and other resources

Beneficiary participation and acceptance

Data analysis

WHAT PROGRAMS AND PROJECTS

HAVE BEEN IMPLEMENTED IN THE

PAST?

Consider effectiveness in reducing

levels of malnutrition

Data analysis

WHAT RESOURCES ARE AVAILABLE

TO ADDRESS THE PROBLEM?

Human --- type, number, expertise

Physical facilities/equipment --- markets,

health center, schools, means of

transportation and communication

Natural --- source of water, fuel, land

Financial

Political

A little more on assessment

Start with the causal model to guide

data collection and analysis

Collect and analyze data

Review the causal model and update

if needed, based on the analysis

Objective Tree

Uses

describe a situation that would exist

after solving the problems

Identify means-ends relationships

between the objectives

Visualize these means-ends

relationships in a diagram

Objectives

Statements of what one wishes to

achieve

Characteristics of a good objective

• Specific

• Measurable

• Attainable

• Realistic

• Time-bound

Types or levels of objectives

Goal - a general statement of vision

Outcome – an effect

• Input objective – resources used to

produce

• Output objective – goods or services to

create

Setting Objectives

Setting Objectives

agree on nutrition problems to be given

priority

agree on priority target groups

review national, regional and local policies

on nutrition which may have bearing on

objectives to be set

review trends in the nutrition situation

assess available resources

How to set objectives

Selecting Interventions

1. Relevance – potential of the

intervention to correct the nutrition

problems in the area

Criteria in selecting interventions


2. Feasibility – extent to which an

intervention may be implemented

with success



3. Integrated into a similar existing

program • allows integration of intervention with

existing infrastructure and sectoral

programs which does not require

setting-up of new structures



4. Effectiveness – extent to which

objectives can be attained e.g.,

nutritional impact, socio-economic

impact, stimulation of participation

and increased self-reliance



5. Ease in targeting – consider ease

in defining, identifying, and

actually reaching the target

groups



5. Cost-effectiveness – allows one

to value the total cost or cost per

beneficiary relative to the output



7. Ease in evaluation – possibility of

evaluating the impact of the

intervention



8. Likelihood of becoming a long-

term ongoing program – potential

for the intervention to be

sustained and become self-

propelling


Planning Programs

What type of programs and projects shall be

implemented to meet the plan objectives?

What will be the core service?

Who will be the project targets and

beneficiaries? What will be their

participation?

Where will the project be implemented?

When? How long? How often?

Planning Programs

What type of programs and projects shall be

implemented to meet the plan objectives?

Who will implement?

What resources will be needed? Where will

these come from?

How monitor and evaluate?

How organize?

revnutint.ppt

Monitoring – regular and timely collection

of information on progress of program,

project, or activity

Evaluation – systematic

appraisal of success or

extent to which objectives

were met

Monitoring and Evaluation


determine how well objectives were met

determine reasons for success and failure

decide if will continue, modify, or stop

levels of evaluation

effort

efficiency

effectiveness of performance

adequacy of performance

process


Preparation of periodic accomplishment

reports

Field visits to project sites

Periodic meetings to track progress of

implementation

Special studies

1. Planning

2. Organizing

3. Staffing

4. Directing

5. Controlling

Functions of Management


Planning

Define roles and missions

Determine key results areas

Identify and specify indicators of

effectiveness

Select and set objectives

Prepare action plans

Policy making

Establish procedures

Organizing

• Structuring

• Integrating

Staffing

• Determining personnel needs

• Selecting personnel

• Developing personnel


Directing

• Assigning

• Motivating

• Communicating

• Coordinating


Controlling

• Establishing standards

• Measuring performance

• Taking corrective action


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