Ministry of Public Health

GD of Preventive Medicine
Public Nutrition Directorate

Community Based Nutrition Package (CBNP)

1
 Levels of Nutrition Interventions Implementation in the
Provinces
Two levels of Nutrition Interventions Implementation:

1. Health Facility Level:

Nutrition SOP training guideline (available)

2. Community Level:
Community based nutrition package (unavailable)
 Objectives of the CBNP

1. Increasing awareness of the people on nutrition programs and interventions in

the community
2. Building the capacity and improving the behavior and key practice of the
people on nutrition of children, PLW and family members
3. Involving community people in nutrition programs and their implementation
by themselves in the community
4. Early identification of malnutrition cases in the community
5. Strengthening community role in decreasing the number of malnutrition cases
6. Strengthening linkage between HF and community
 Temporary and Permanent Implementers
Temporary and Permanent Supporters
Temporary Implementers: they are NGOs who are granted a one year CBNP project
implementation, such as; CHA, AADA, AKF, SCA, HAADAF, IRC, CAF
Temporary Supporters: they are organizations who supports implementation of CBNP
projects during one year, such as; BPHS IP, UNICEF and USAID/IHSAN
Permanent Implementers: they are BPHS IPs who take over implementation of the
CBNP program in their relevant provinces and continue it till their existence.
Permanent Supporters: they are organizations who continuously supports
implementation of CBNP program, such as; Public Nutrition Directorate (PND)/MoPH,
Provincial Health Directorates as well as other relevant directorates (directorates of
Agriculture, Irrigation and Livestock, Rural Rehabilitation and Development, education
and etc.).
 Phases of CBNP

Phase-1:
Building the capacity on CBNP

Phase-2:
Implementation of CBNP
 Phase-1
Building the capacity on CBNP
 Steps of Building the capacity on CBNP

Step-1: ToT on national level (12 provinces) for Provincial Nutrition Facilitators
Step-2: Training of Nutrition Mobilization Team (NMT)
Step-3: Conducting “Community Mobilization Session (CMS)”
Step-4: Refresher training for CHWs/volunteers
 Steps of Building the capacity on CBNP

Step-1: ToT on national level (12 provinces) for Provincial Nutrition Facilitators:

 Duration: 4 days
 Facilitators: PND Facilitators
 Guideline: Using CBNP “Facilitators’ Manual”
 Location: National or regional level
 Participants: Provincial nutrition team (PNO, NO, CBHC Off/PPHD & BPHS, CBO/PPHD & BPHS)

Note: Step-1 is done by the support of UNICEF and USAID/IHSAN for 12 provinces
 Steps of Building the capacity on CBNP … continue
Responsibilities of Provincial Nutrition Facilitators in the Provinces:
1. Preparation of the list of the total HFs, total HPs and total CHWs (males, females)
2. Orienting all the provincial nutrition and health team members (PPHD, BPHS and
etc.), HFs staff, especially the HF in charge and the CHS on the concept of the CBNP
3. Follow up and support the CHS in selection process of the NMTs members
4. Ensuring that the NMTs selection guide is used during the selection process
5. Monitoring the selected NMTs in all HFs using the developed checklist
6. Preparation of the CBNP trainings and implementation plan with the CBNP IP for the
whole project duration
7. Facilitating the NMTs trainings
 Steps of Building the capacity on CBNP … continue
Responsibilities of Provincial Nutrition Facilitators in the Provinces:
8. Supporting NMTs in conducting 2 days CMSs and 2 days CHWs/Volunteers training
9. Ensuring that proper people are selected as “Volunteers” during the CMSs
10.Ensuring that NMTs are supporting the CHWs/Volunteers in preparation,
implementation and revising/assessing of community nutrition plans of HPs
11.Ensuring that facilitators’ and community kits are kept and maintained well in both
provincial and HP levels
12.Urgently replacing the NMTs member if anyone is leaving the team and training
him/her on CBNP
13.Reporting each training batches to PND, PPHD, and BPHS regularly
Steps of Building the capacity on CBNP … continue

Guide for Selection of NMT Members

 Steps of Building the capacity on CBNP … continue

Step-2: Training of Nutrition Mobilization Team (NMT):

 Duration: 3 days
 Location: On provincial level
 Facilitators: Provincial CBNP Trainers, trained on
 Guideline: Facilitator’s Manual (the same as used in the ToT)
 Participants: Nutrition Mobilization Team (NMT) (it has averagely 9 members,
from each HF catchment area (Health shura, CLTS facilitators, ARCS volunteers,
Extension officers of relevant directorates, CDC, CHS). Participants from at least 4
HFs catchment areas should be included in one session
 Steps of Building the capacity on CBNP … continue

Order of NMTs Selection and Arrangement:

Number # of NMT Small Group of # of Each Small NMT # of HPs To Be Covered

Province Name of HF
of HPs Members NMTs Group Members By Each Small Team
Baba-e-Barq
14 12 4 3 3.5
CHC
Manara CHC 18 15 5 3 3.6
Herat Gozargah CHC 7 6 2 3 3.5
Nawabad CHC 10 9 3 3 3.33333
Hawza-e-Karbas
10 9 3 3 3.33333
BHC
 Steps of Building the capacity on CBNP … continue
Responsibilities of NMT:
 Attending training on provincial level
 Conducting 2 days community mobilization session
 Selecting 2 volunteers among participants
 Helping CHWs/volunteers in preparation of community nutrition plan during 2
days session and revising it after each 6 months
 Conducting 2 days training for CHWs/volunteers once per each year
 Supporting and mentoring of the CHWs/volunteers on monthly base
 Monitoring the implementation of the nutrition community plan on monthly
base
 Will work as a bridge between CHWs/volunteers and HF.
 Steps of Building the capacity on CBNP … continue
Step-3: conducting “Community Mobilization Session (CMS)”:
Duration: 2 days
Frequency: Once at each HP
Facilitators: NMTs members, trained at provincial level in step-2
Guideline: Field Manual
Location: HP
Participants: Averagely 40 male and female community members
(CHW, FHAG, HP shura members, Religious scholars, schools
Teachers/principles, Community leaders, Shopkeepers, Businessmen, NID staff,
Youth, parents, grandparents, etc.)
 Steps of Building the capacity on CBNP … continue
Actions to be done during CM session:
1. Village mapping
2. Using community growth chart
3. Listing of all HH with under 2 year children
4. BCC for “Good nutrition is good behaviour”
5. Demystify nutrition cultural norms and practices
6. Focus group discussions on breast feeding
7. Food diversity
8. Complementary feeding
9. Cooking demonstration
10. Hand washing & proper handling of food
11. Preparation of the community nutrition plan
12. Nomination of 2 community members: (1 female,1 male)
Steps of Building the capacity on CBNP … continue

Guide for Selection of Volunteers

Steps of Building the capacity on CBNP … continue

Step-4: Refresher training for CHWs/volunteers:

Duration: 2 Days (only once)
Facilitators: At least 3 members of NMT
Guideline: CHWS/Volunteers Training Manual
Location: HP/HF/Regional
Participants: 4 persons from each HP (2CHWs + 2volunteers who are
selected at the end of the last day, among the participants of the 2 day CMS
mentioned in step-3)
 Order of CWHs/Volunteers Selection and Arrangement:

Number of # of CHWs & Total # of CHWs &

Province Name of HF
HPs Volunteers In Each HP Volunteers In Each HF
Baba-e-Barq CHC 14 4 56
Manara CHC 18 4 72
Herat Gozargah CHC 7 4 28
Nawabad CHC 10 4 40
Hawza-e-Karbas BHC 10 4 40
Steps of Building the capacity on CBNP … continue

Responsibilities of CHWs in Support of Volunteers

 Phase-2:
Implementation of CBNP
 Steps of CBNP Implementation

Step-1: Implementation of CBNP in Community

Step-2: Monitoring of Implementation
Step-3: Conducting review meeting/assessment
 Steps of CBNP Implementation

Step-1: Implementation of CBNP in Community:

• Implementation by: 4 (2 CHWs & 2 volunteers), trained in step-4/phase-1

• Support by: NMTs Members
• Implementation Plan: The plan already developed during 2 days CMS
• Location: Relevant HP catchment area
• Guideline: CHWs/Volunteers Training Manual
 Steps of CBNP Implementation …Continue

Step-2: Monitoring of Implementation:

• Implementation of what? Community nutrition plan

• Monitoring By: All NMT members, especially CHS
• Duration: Regularly, at least once in a month
 Steps of CBNP Implementation …Continue

• Step-3: Conducting review meeting/assessment:

• Assessment of the community nutrition plan implementation during the
last 6 months
• A review meeting to be held after every 6 months
• Discussing challenges/Problems faced with during the last 6 months
• Finding ways of solution for faced challenges/problems
• Discussing ways forward (amendment in the community nutrition plan for
the next 6 months
 A Sample of Community Nutrition Plan
Issue Action to be taken By when to Who will do it Support
be completed Required
Listing of all U2 Children, Registering of all U2s, pregnant Within one CHWs and Register
Pregnant and Lactating women and lactating mothers week Volunteers
of women
Monitoring of pregnant House hold visits to counsel and Weekly Volunteers Counselling
mothers check if proper care is being taken and FHAG cards
Improving Weekly cooking Demonstration Weekly/ CHWs/ FHAG
Complementary feeding and Feeding U2s By-weekly Members
Improving Visits to HHs with children U2 Weekly CHWs/ FHAG
Complementary Feeding years Members
Poor HH hygiene and Home visits to families with Weekly CHWs Flip cards
sanitation Practices Children below 2 years
Growth Monitoring Weighing every child below 2 years Monthly CHWs/ Community Growth
at a central place Volunteers Chart/ weighing
scale, scoring sheet
 REFRESHER TRAINING - 2 Day for 4 persons

MAKING MALNUTRITION VISIBLE

(CHW/volunteers) from each HP

2 CHWs:
1 female: 1 male

COMMUNITY
2 Day Community NOMINATION:
1 female: 1 male
mobilization Implementation 2
Community CHW/2
Nutrition Plan volunteers

MOBILIZATION TEAM

facilitators; Extension
TRAINING OF

9 per HF (2 Health

officers; CDC;CHS
– 3 DAYS A review
NATIONAL TOT – 4 DAYS
meeting/assessment of
MASTER TRAINERS shura; CLTS implementation after 6
3 per Province (CBHC trainers
months
from BPHS implementers &
HPD)
SOP
Manual for Facilitators and NMTs Training
Field Manual for Conducting CMS
2-Days CMS
 2-Day CWHs/Volunteers Training Manual
• Reflection of the two day community
mobilization process
• Why children become malnourished
• Factors that contribute to good nutrition
• Weighing & screening using MUAC tapes
• Making malnutrition visible
• Counselling & communication skills
• (role play maternal & IYCF)
• Nutrition education and Cooking demonstration
• Home visits
• Recording
• 6 months plan
 Information and Reporting System in CBNP
Pictorial growth monitoring card –take home:

CHW/Volunteers reporting forms:

• Child nutrition tracking register Relevant HF
• Monthly pictorial reporting forms for CHW
Main Responsibilities of CHS:
• Supportive supervision
• Feedback mechanism
Supervisors/CHSs should Do:
• Monthly meetings with
Monthly report from health post CHS & CHW???
• Quarterly review meetings
with CHS & CHW???
 Facilitators Kit

1. Community Growth Chart, large, boys & girls

2. Community Growth Chart boys – English
3. Community Growth Chart girls – English
4. Complementary food for babies dos and don'ts
5. Food Cards (complete)
6. Food Seasonality chart A1 Pre press English
7. Nutrition for pregnant & lactating women dos and don'ts
8. Nutritional pie Wheel A2 Pre Press
9. Nutritional pie Wheel A4 Pre Press
10.Bag for keeping materials
 Community/HP kit

1. Community Growth Chart boys

2. Community Growth Chart girls
3. Complementary food for babies dos and don'ts
4. Food Seasonality chart A1 Pre press
5. Nutrition for PLWs, Dos and Don'ts
6. Nutritional pie Wheel A2 Pre Press
7. Nutritional pie Wheel A4 Pre Press
8. Salter scale (25 kg)
9. Bag for keeping materials
 Type and Number of Kits for Different Levels

At Least # of
# of CHWs
Total # of Small At Least # of At Least # of Facilitators
# of &
Province Name of HF NMT Group of Facilitators CHWs Kit Per Kit for Prov.
HPs Volunteers
Members NMTs Kit for NMTs HP CBNP
In Each HP
Trainers
Baba-e-Barq
14 12 4 4 4 1 3
CHC
Manara CHC 18 15 5 5 4 1 3
Herat Gozargah CHC 7 6 2 2 4 1 3
Nawabad CHC 10 9 3 3 4 1 3
Hawza-e-
10 9 3 3 4 1 3
Karbas BHC
Checklist for Monitoring Selected NMTs

Check List for NMT Members .docx

Database for the Entry of Selected NMTs

Open file