The Republic of South Sudan

M AT E R NA L , I N FA N T A N D YOU NG C H I L D N U T R I T ION

M I YCN
ST R AT EGY
COV ER P HO TOGRAPG H: © UN ICE F/IRWIN

2017-2025
 The Republic of South Sudan

M AT E R NA L , I N FA N T A N D YOU NG C H I L D N U T R I T ION

M I YCN
ST R AT EGY
COV ER P HO TOGRAPG H: © UN ICE F/IRWIN

2017-2025
 Contents
ACKNOWLEDGMENTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 CHAPTER 13
Key strategic actions of the
FOREWORD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 MIYCN strategy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Definition of term(s):. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 13.1 Strategic Action 1: Endorse and disseminate key policies
and regulations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Acronyms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 13.1.1 Develop a national nutrition policy. . . . . . . . . . . . . . . . . . . . . . . . . 32
EXECUTIVE SUMMARY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 13.1.2 Adoption of the International Code of Marketing of
Breast-Milk Substitutes and related relevant World Health
Assembly Resolutions (WHAs) (The Code). . . . . . . . . . . . . . . . . 32
CHAPTER 1
13.1.3 Issue protocols and guidelines for all health facilities
Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 offering maternity services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
13.1.4 Adaptation of the ILO Convention 183. . . . . . . . . . . . . . . . . . . . . . 33
CHAPTER 2
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 13.1.5 Fortification of staple foods and oil, salt iodization. . . . . . . . . . 33
13.1.6 Issue other food regulations and standards. . . . . . . . . . . . . . . . . 33
CHAPTER 3 13.2 Strategic Action 2: Improve maternal nutrition. . . . . . . . . . . . . . 33
Global recommendations on maternal, infant 13.2.1 Provide counselling and support for appropriate nutrition. . . . 33
and young child nutrition interventions. . . . . . . . . . 18
13.2.2 Daily supplementation with iron and folic acid for women
during pregnancy and post-partum. . . . . . . . . . . . . . . . . . . . . . . . 34
CHAPTER 4
13.2.3 Nutrition care and support for pregnant and lactating
The maternal, infant and young child situation women during emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
in South Sudan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
13.2.4 Reaching optimal iodine nutrition in pregnant and lactating
women. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
CHAPTER 5
Strengths, challenges and barriers. . . . . . . . . . . . . . . . 22 13.3 Strategic Action 3: Protect, promote and support optimal
infant and young child feeding practices.. . . . . . . . . . . . . . . . . . . 34
13.3.1 Nutrition screening, growth monitoring and counselling. . . . . 34
CHAPTER 6
Current efforts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 13.3.2 Establishment of mother-to-mother support groups.. . . . . . . . 35
13.3.3 Setting mother-baby friendly spaces in camp settings. . . . . . . 35
CHAPTER 7 13.3.4 IYCF counselling services at the community and health
Purpose and justification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 facility levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
13.3.5 IYCF messages dissemination at the community and health
CHAPTER 8 facility level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Target users. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 13.3.6 Support and encourage optimal complementary feeding
practices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
CHAPTER 9 13.3.7 Vitamin A supplementation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Goal, objectives and expected outcomes. . . . . . . . 28 13.3.8 Micronutrient supplementation: complementary food
supplements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
CHAPTER 10 13.3.9 Optimal iodine nutrition in young children. . . . . . . . . . . . . . . . . . 36
Beneficiaries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
13.3.10 Deworming administration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
13.4 Strategic Action 4: Support optimal infant and young child
CHAPTER 11
feeding with special needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Delivery platform (s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
13.4.1 Provision of appropriate feeding for eligible infants with no
possibility of breastfeeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
CHAPTER 12
MIYCN: The lifecycle approach and 13.4.2 Preventing and handling BMS donations. . . . . . . . . . . . . . . . . . . 37
interventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 13.4.3 Addressing HIV and infant and young child feeding. . . . . . . . . 37
12.1 Nutrition interventions around the maternal 13.4.4 Complementary feeding during emergencies. . . . . . . . . . . . . . . 38
and child cycle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
13.5 Strategic Action 5: Intra-sectoral integration. . . . . . . . . . . . . . . . 38
13.5.1 Health information systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
13.5.2 Reproductive health/maternal and Child Health. . . . . . . . . . . . . 38
13.5.3 Integration in the Community Based Management of Acute
Malnutrition programme. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
13.5.4 Inclusion of essential MIYCN indicators in the health and
nutrition survey, surveillance and monitoring system.. . . . . . . 39

2 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 CONTENTS

13.6 Strategic Action 6: Improve inter-sectoral integration (food CHAPTER 15

security and livelihood, WASH, protection, education and Institutional framework: Management and
shelter) .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 coordination structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
13.6.1 Water, sanitation and hygiene (WASH).. . . . . . . . . . . . . . . . . . . . 40
13.6.2 Food security and livelihood (agriculture, industry, trade CHAPTER 16
and commerce). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Strategy implementation.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
13.6.3 Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 16.1 Development of an implementation plan. . . . . . . . . . . . . . . . . . . . 53
13.6.4 Social protection and welfare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 16.2 Budgeting and financing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
13.6.5 Shelter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
13.7 Strategic Action 7: Support capacity building and service CHAPTER 17
strengthening. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Strategy review and improvement.. . . . . . . . . . . . . . . . . 54
13.7.1 Identifying and prioritizing target groups for capacity
building activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 BIBLIOGRAPHY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
13.7.2 Implement a diversified set of capacity building strategies. . . 42
ENDNOTES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
[Link] Information dissemination, seminars and orientation.. . . . . . . 42
[Link] Trainings (pre-service and in-service). . . . . . . . . . . . . . . . . . . . . . 43 APPENDICES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Pre-service Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
ANNEX 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
In-service Training.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
[Link] Supportive supervision and mentoring . . . . . . . . . . . . . . . . . . . . 43
LIST OF FIGURES
[Link] Sharing of best practices, experiences and lessons learned.. 43
Figure 1 IYCF practices pre-crisis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
13.8 Strategic Action 8: Roll-out advocacy and social and
behavioral change (SBCC) activities. . . . . . . . . . . . . . . . . . . . . . . . 43 Figure 2 Key phases of the MIYCN development process.. . . . . . . . . . . . 26
13.8.1 Identification of the target audiences. . . . . . . . . . . . . . . . . . . . . . . 44 Figure 3 Main stages in the life cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
13.8.2 Development and implementation of a comprehensive Figure 4 .....Lifecycle and nutrition interventions around the maternal
advocacy and SBCC strategy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 and child cycle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
13.9 Strategic Action 9: Sustain research, information, Figure 5 Republic of South Sudan public health system. . . . . . . . . . . . . . 52
monitoring and evaluation systems. . . . . . . . . . . . . . . . . . . . . . . . 44
LIST OF TABLE(S)
13.9.1 Institutionalizing MIYCN and IYCF standard indicators for
country assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 1 WHO/UNICEF optimal Infant and Young Child Feeding
recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
13.9.2 Conduct regular national nutrition assessments and surveys.. 45
Table 2 Basic maternal and child mortality indicators.. . . . . . . . . . . . . . 20
13.9.3 Supporting formative research. . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Table 3 Basic maternal and child health indicators . . . . . . . . . . . . . . . . . 21
13.9.4 Assessment of infant and young child feeding practice(s).. . . 45
Table 4 Mother to child transmission (women living with HIV). . . . . . . 21
13.9.5 Monitoring and tracking progress during implementation.. . . 46
Table 5 Basic WASH indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
[Link] Monitoring a minimum package of indicators for field level
implementation.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 6 Basic nutritional status indicators . . . . . . . . . . . . . . . . . . . . . . . . . 21
13.10 Strategic Action 10: Mobilizing resources and support. . . . . . 46 Table 7 Salt iodization and micronutrients. . . . . . . . . . . . . . . . . . . . . . . . . 21
13.10.1 Costing the implementation of the MIYCN strategy. . . . . . . . . . 47 Table 8 key pillars of the MIYCN development process. . . . . . . . . . . . . . 25
13.10.2 Social mobilization: Facilitating stakeholders’ agreement Table 9 MIYCN specific objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
and consolidating partnerships. . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table 10 MIYCN strategy expected outcome.. . . . . . . . . . . . . . . . . . . . . . . . 28
Table 11 MYCN strategic actions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
CHAPTER 14 Table 12 MIIYCN Indicators for health facilities and community
Gaps, needs analyses and mapping based interventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
of resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Table 13 Template for gaps analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
14.1 Identifying the gaps to implement MIYCN related actions at
the national and sub-national level. . . . . . . . . . . . . . . . . . . . . . . . . 49 Table 14 Template for SWOT analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
14.2 SWOT analysis for the MIYCN programme.. . . . . . . . . . . . . . . . . 49 Table 15 Mapping MIYCN interventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
14.3 MIYCN implementation coverage and activities. . . . . . . . . . . . . 50

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 3

4 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy
Acknowledgments
The Ministry of Health (MOH) in South Sudan has embarked on relevant processes in developing its first Maternal,
Infant and Young Child Nutrition (MIYCN) strategy and training package based on the National Health Policy, the
Boma Health Initiative (BHI), the Basic Package of Health and Nutrition Service (BPHNS) and the draft National
Nutrition Policy. The MIYCN strategy aim to provide guidance to all government and non-governmental agencies
and organizations working on maternal, infant and young child nutrition.

This MIYCN guideline document is a product of a highly technical, intensive and consultative processes led by
the Nutrition Department of the Ministry of Health in collaboration with the technical nutrition core group com-
prising individuals from the MOH and partners including Dr Samson Baba, Rebecca Alum, Shishay Tsadik TA,
and Rita Juan Demetry; UNICEF Nutrition Section including Vandana Agarwal, Joseph Senesie, Gilbert Dachi
and Priscilla Bayo; WFP Nutrition Unit including Lucas Alamprese; Marina Adrianopoli (WHO); Joyce Akandu
(Save the Children); Gladys Lasu (HPF), Tracy Dube (CWW), Akol Lonyamoi (WVI), Emmanuel Kokole (HTO),
Juliet Vilegwa (UNIDO) and Alessandro Lellamo (Consultant).

The MOH wants to acknowledge especially the financial and technical support provided by UNICEF, the techni-
cal support provided by other UN agencies, INGOs and NGOs that contributed to the development, review and
finalization the MIYCN strategy.

Finally, I would like to express our gratitude to the Senior Management of the Ministry of Health, staff from the
different departments, the state Ministries of Health (SMOH), the relevant line ministries that actively participated
and provided valuable inputs in shaping a MIYCN guideline which will guide, in particular, maternal, infant and
young child programming and capacity building to respond to the needs and situations of women and children of
South Sudan.

The Ministry of Health wished to extend special gratitude to all individuals, national and international organiza-
tions and donors for their unwavering support and commitment in the development of the Maternal, Infant and
Young Child Nutrition strategy as well as training package.

Dr Makur M. K ariom
Undersecretary, Ministry of Health
R epublic of South Sudan

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 5

6 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy
Foreword
The Government of the Republic of South Sudan is committed to prevent maternal and child morbidity and mor-
tality, through improved access to basic health and nutrition services. Strengthening the national health system in
order to improve quality and increase access to the Basic Package of Health and Nutrition Services (BPHNS) to
its citizens. To this end the Ministry of Health updated the National Health Policy (2016-2026), the Health Sector
Strategic Plan (2015-2019) and the Boma Health Initiative (BHI 2016) to provide long-term strategic framework
for strengthening, harmonizing and coordinating the health system and the establishment of a community health
system (the reform).

The Maternal, Infant and Young Child Nutrition Strategy are aligned with the overarching government strategies
and policies of the Ministry of Health, providing a set of concrete, evidence based recommendations, procedures
and protocols that operationalize the maternal, infant and young child nutrition programme as well as guiding all
health workers, social workers, managers and other professionals working in the area of MIYCN, and guiding the
Boma Health Team and Home Health Promoters on how best to support mothers and children.

Infants and young children are the most vulnerable, and during their first two years of life undernutrition can
weaken their resistance and make them more susceptible to diseases and deaths. Focusing our attentions and invest-
ing our resources on improving maternal nutrition and infant and young child nutrition will have a great impact
on a child’s ability to grow, learn, and rise out of poverty. Investing in maternal, infant and young child nutrition
will in the long term contribute to the improvements of the health situation, stability and economy in the country.

I therefore call upon all stakeholders to continue supporting South Sudan in the dissemination, rollout, and
implementation of the strategy, supporting the capacity building initiatives at each level of the health and com-
munity systems.

I call upon all development and implementing partners to work together, in the spirit of collaboration and coop-
eration, so that together we can win the battle against malnutrition and hence saving the lives of women and chil-
dren in South Sudan.

Dr R iek Gai Kok

Hon. Minister of Health
R epublic of South Sudan

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 7

8 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy
Definition of term(s):
Acute malnutrition - Also known as ‘wasting’, acute starts when breast milk or infant formula alone is no
malnutrition is characterized by a rapid deterioration longer sufficient to meet the nutritional requirements of
in nutritional status over a short period of time. In chil- an infant. It is not recommended to provide any solid,
dren, it can be measured using the weight-for-height semi-solid or soft foods to children less than 6 months
nutritional index or mid-upper arm circumference. of age. The target range for complementary feeding is
There are different levels of severity of acute malnu- generally considered to be 6–23 months.
trition: moderate acute malnutrition (MAM) and severe
acute malnutrition (SAM). Chronic malnutrition – Chronic malnutrition, also
known as ‘stunting’, is a form of growth failure which
Basic packages of health and nutrition services develops over a long period of time. Inadequate nutri-
[BPHNS] -These are evidence based, cost effective tion over long periods of time (including poor maternal
health intervention/services made available at health nutrition and poor infant and young child feeding prac-
facilities and in communities for reduction of the bur- tices) and/or repeated infections can lead to stunting.
den of diseases. The Ministry of Health of the Republic In children, it can be measured using the height-for-age
of South Sudan defined the BPHNS. nutritional index.

Body mass index (BMI) – Defined as an individual’s The Code – The International Code of Marketing of
body mass (in kilograms) divided by height (in meters Breast-Milk Substitutes adopted by the World Health
squared): BMI units = kg/m2. Acute malnutrition in Assembly (WHA) in 1981, and regularly updated
adults is measured by using BMI. through subsequent WHA resolutions.

Boma - is the smallest geographical area and adminis- Early initiation of breastfeeding - Provision of moth-
trative unit in South Sudan. It consists of villages and er’s breast milk to infants within one hour of birth is
households. referred to as “early initiation of breastfeeding” and
ensures that the infant receives the colostrum, or “first
Boma health teams - A team of three people who live
milk”, which is rich in protective factors.
in a Boma, selected by their community and recruited
to provide community health services. Exclusive breastfeeding - An infant receives only
breast milk and no other liquids or solids, not even
Breast milk substitutes - Any food marketed or oth-
water, with the exception of oral rehydration salts
erwise represented as a partial or total replacement for (ORS) or drops or syrups consisting of vitamins, min-
breast milk, whether or not suitable for that purpose. eral supplements or medicines. UNICEF recommends
exclusive breastfeeding for infants aged 0-6 months.

Community health workers - shall be solely dedicated

Follow-on/follow-up formula – Breast milk substitute
to provide health promotion, disease prevention and
selected treatment services at the community level formulated for infants aged 6 months or older.
(Boma Health Initiative).
Food fortification – The addition of micronutrients to a

Complementary feeding - The use of age-appropriate,

food during or after processing to amounts greater than
adequate and safe solid or semi-solid food in addition were present in the original food product. This is also
to breast milk or a breast milk substitute. The process known as ‘enrichment’.

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 9

 DEFINITION OF TERM(S):

Food security – Access by all people at all times to Infant formula – A breast milk substitute formulated
sufficient, safe and nutritious food needed for a healthy industrially in accordance with applicable Codex
and active life. (1996 World Food Summit definition). Alimentarius standards. The Codex Alimentarius
Commission was established in 1963 by the Food and
Agriculture Organization (FAO) and WHO to protect
Global acute malnutrition (GAM) – The total number
the health of consumers and to ensure fair practices in
of children aged between 6 and 59 months in a given
the international food trade.
population who have moderate acute malnutrition, plus
those who have severe acute malnutrition. (The word
‘global’ has no geographic meaning.) When GAM is Malnutrition – A broad term commonly used as an
equal to or greater than 15 per cent of the population, alternative to ‘undernutrition’ (stunting, wasting,
then the nutrition situation is defined as ‘critical’ by micronutrient deficiencies), but which technically also
the World Health Organization (WHO). In emergency refers to over-nutrition (overweight and obesity). People
situations, the nutritional status of children between 6 are malnourished if their diet does not provide adequate
and 59 months old is also used as a proxy to assess the nutrients for growth and maintenance or if they are
health of the whole population. unable to fully utilize the food they eat due to illness
(undernutrition). They are also malnourished if they
consume too many calories (over-nutrition).
Growth monitoring and promotion – Individual-level
assessment where the growth of infants and young chil-
dren are monitored over time in order to identify and Micronutrients – Essential vitamins and minerals
address growth faltering and growth failure. required by the body in miniscule amounts throughout
the life cycle.

Health workers – Doctors, nurses, midwives and

nutritionists. Mid-upper-arm circumference – The circumference of
the mid-upper arm is measured on a straight left arm
(in right-handed people) midway between the tip of
Home health promoters – Shall be selected at the ratio
the shoulder (acromion) and the tip of the elbow (olec-
of 1HHP per 30-40 households in densely populated
ranon). It measures acute malnutrition or wasting in
areas (urban), or two HHPs (one woman and one man
children aged 6–59 months. The mid-upper arm cir-
per village) in sparsely populated areas (rural). They
cumference (MUAC) tape is a plastic strip, marked
will work together with the boma health teams on vol-
with measurements in millimeters. MUAC < 115mm
untary basis with a defined basic incentive mechanisms.
indicates 9 that the child is severely malnourished;
MUAC < 125mm indicates that the child is moderately
Infant and young child feeding (IYCF) – Term used to malnourished.
describe the feeding of infants (less than 12 months
old) and young children (12–23 months old). IYCF pro- Mixed feeding - Giving other liquids or foods as well as
grammes focus on the protection, promotion and sup- breast milk to infants under 6 months of age.
port of exclusive breastfeeding for the first six months,
on timely introduction of complementary feeding at six
Minimum dietary diversity - Proportion of children
months and continued breastfeeding for two years or
6-23.9 months of age who receive foods from 4 or more
beyond. Issues of policy and legislation around the reg-
food groups. Dietary diversity refers to the child
ulation of the marketing of infant formula and other
receiving 4+ of the following food groups: 1) grains,
breast milk substitutes are also addressed by these
roots and tubers 2) legumes and nuts 3) dairy products
programmes.
(milk, yogurt, cheese) 5) flesh foods (meat, fish, poul-

10 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 DEFINITION OF TERM(S):

try and liver/organ meats) 6) eggs 7) vitamin A rich Ready-to-use infant formula – A type of BMS that
fruits and vegetables and 8) other fruits and vegetables. is nutritionally balanced and packed in a form that is
ready to use for infants who do not have the option of
Moderate acute malnutrition - Defined as weight-for- being breastfed.
height between minus two and minus three standard
deviations from the median weight-for-height for the Re-lactation – Induced lactation (breastfeeding) in
standard reference population. someone who has previously lactated.

Multiple micronutrient powder – Comes in a little

Social mobilization - Social mobilization is a process
sachet to sprinkle on food which contains most of the
micronutrients needed. Proposed for children aged that raises awareness and motivates people to demand
6–23 or 59 months to improve the quality of comple- change or a particular development. It is mostly used
mentary food, or for pregnant mothers. by social movements in grassroots groups, govern-
ments and political organizations to achieve a par-
ticular goal.
Nutrition surveillance – The regular collection of
nutrition information that is used for making deci-
sions about actions or policies that will affect nutri- Severe acute malnutrition – A result of recent (short-
tion. In emergency situations, nutritional surveillance term) deficiency of protein, energy, and minerals and
is part of early warning systems to measure changes in vitamins leading to loss of body fats and muscle tis-
nutritional status of populations over time to mobilize sues. Acute malnutrition presents with wasting (low
appropriate preparation and/or response. weight-for-height) and/or the presence of oedema
(i.e. retention of water in body tissues). Defined for
Oedema – Bilateral oedema (fluid retention on both children aged 6–59 months as a 1) weight-for-height
sides of the body) is caused by increased fluid reten- below -3 standard deviations (SD) from the median
tion in extracellular spaces and is a clinical sign of weight-for-height for the standard reference popula-
severe acute malnutrition. There are different clinical tion, 2) a mid-upper arm circumference of less than
grades of oedema: mild, moderate and severe. 115 mm or, 3) the presence of nutritional oedema or
marasmic-kwashiorkor.
Outreach –The word “outreach” is used to to describe
a wide range of activities, from actual delivery of ser- Stunting - also known as ‘chronic malnutrition’, is
vices to dissemination of information. As a tool to help a form of growth failure which develops over a long
expand access to health services, practices or products, period of time. Inadequate nutrition over long peri-
outreach is most often designed to accomplish one of ods of time (including poor maternal nutrition and
the following (or some combination): poor infant and young child feeding practices) and/or
• Directly deliver healthy services or products repeated infections can lead to stunting. In children,
it can be measured using the height-for-age nutritional
• Educate or inform the target population, increasing
index.
their knowledge and/or skills
• Educate or inform people who interact with the
Volunteer - members of a community who are chosen
target population (often called community health
by community members or organizations to provide
advisors)
basic health and nutrition services to their communities
• Establish beneficial connections between people
and/or organizations

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 11

 DEFINITION OF TERM(S):

Vulnerable population – populations affected by the Wet nursing – When a woman breastfeeds a baby that
crisis, priority for interventions are pregnant and lactat- is not her own.
ing women, children under 5 years of age, adolescents
and the elderly. Weight for age - Nutritional index, a measure of under-
weight (or wasting and stunting combined).
Wasting - Also known as ‘acute malnutrition’, acute
malnutrition is characterized by a rapid deterioration Weight for height - Nutritional index, a measure of
in nutritional status over a short period of time. In chil- acute malnutrition or wasting.
dren, it can be measured using the weight-for-height
nutritional index or mid-upper arm circumference.
There are different levels of severity of acute malnu-
trition: moderate acute malnutrition (MAM) and severe
acute malnutrition (SAM).

12 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 ACRON Y MS
AIDS Acquired Immune Deficiency Syndrome MICS Multiple Indicator Cluster Survey
ANC Antenatal Care MIYCN Maternal, Infant and Young Child Nutrition
ARV Antiretroviral MMR Maternal Mortality Rate
BCC Behavioral Change Communication MNP Micronutrient Powder
BFCI Baby Friendly Community Initiative MOH Ministry of Health
BFHI Baby Friendly Hospital Initiative MTMSG Mother to Mother Support Group
BMI Body Mass Index MUAC Mid-Upper Arm Circumference
BMS Breast-milk substitutes NGO Non-governmental organization
BSFP Blanket Supplementary Feeding Programme ODF Open Defecation Free
CHVs Community Health Volunteers OTP Out Patient Programme
CLTS Community Led Total Sanitation PDM Post-Distribution Monitoring
CM Community Midwife PHCC Primary Health Care Center
CMAM Community based Management of Acute Malnutrition PHCU Primary Health Care Unit
CRC Convention of the Rights of the Child PLWs Pregnant and Lactating Women
CHWs Community Health Workers POC Protection of Civilian site
DHIS District Health Information System RNA Rapid Nutrition Assessment
DHS Demographic and Health Survey RRM Rapid Response Mission
EBF Exclusive Breastfeeding SAM Severe Acute Malnutrition
EPI Expanded Programme on Immunization SC Stabilization Center
FAO Food and Agriculture Organization SD Standard Deviation
FGD Focus Group Discussion SDG Sustainable Development Goals
FSNMS Food Security and Nutrition Monitoring System SMART Standardized Monitoring and Assessment of Relief and
GAM Global Acute Malnutrition Transitions

GIYCF Global Strategy for Infant and Young Child Feeding SSD The Republic of South Sudan

Hep B Hepatitis B SUN Scaling Up Nutrition

HHPs Home Health Promoters SWOT Strengths, Weaknesses, Opportunities and Threats

IEC Information, Education and Communication TB Tuberculosis

IFA Iron Folic Acid ToT Training of Trainers

HIV Human Immunodeficiency virus TSFP Targeted Supplementary Feeding Programme

HMIS Health Management Information System TWG Technical Working Group

ICN2 Second International Conference on Nutrition UN United Nations

IDPs Internally Displaced Populations UNHCR Office of the United Nations High Commissioner for
Refugees
IFE Infant Feeding in Emergency
UNICEF United Nations Children’s Fund
ILO International Labour Organization
U5MR Under five mortality rate
IMR Infant Mortality Rate
WASH Water, Sanitation and Hygiene
IYCF Infant and Young Child Feeding
WFH Weight for Height
IYCF-E Infant and Young Child Feeding during emergencies
WFP World Food Programme
IOM International Organization for Migration
WHA World Health Assembly
IPC Integrated Food Security Phase Classification
WHO World Health Organization
IRNA Initial Rapid Needs Assessment
ITP In-Patient Programme
KAP Knowledge, Attitudes and Practices
KII Key Informant Interview
MAD Minimum Acceptable Diet
MAM Moderate Acute Malnutrition
MCHWs Maternal and Child Health Workers
MDG Millennium Development Goal

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 13

 Executive summary
On July 9, 2011 the Republic of South Sudan became tion needs and employ proper care practices.
the newest country of the world, and on July 14, 2011
was admitted as a new member of the United Nations. To address the situation in a sustained and effective
way, the Ministry of Health identified the need to
Between 1990 and 2010, there has been great success in develop a common set of strategies, interventions, and
curbing maternal and child mortality. Maternal mortal- actions to guide the implementation of a concerted set
ity decreased from 1,730 to 789 (/100,000 live births). of activities by all stakeholders.
During this period a similar trend has been recorded
for child mortality, in which under-five mortality rates The Maternal, Infant, and Young Child Nutrition
decreased from 253 to 99 (/1000 livebirths), infant and (MIYCN) strategy (2017 to 2025) and guidelines pro-
neonatal mortality also decreased from 150 to 64 and vide the government and its partners a broad menu of
65 to 39 respectively (/1000 livebirths). strategic actions and interventions, that once imple-
mented, will contribute to the prevention of malnutri-
The Maternal, Infant, and Young tion and the reduction of maternal and child mortality
and morbidity in the country.
Child Nutrition (MIYCN) strategy
(2017 to 2025) and guidelines Development of the MIYCN strategy has been char-
provide the government and its acterized by mutual consent of all the stakeholders on
partners a broad menu of strategic the pillars and the phases of the development process.

actions and interventions, that The MIYCN strategy consolidates global and national
once implemented, will contribute recommendations, guidelines and good practices that
to the prevention of malnutrition shall serve as a guide for the government and all other
stakeholders involved in the conceptualization, plan-
and the reduction of maternal and ning, implementation, supportive supervision, and
child mortality and morbidity in monitoring of related programmes. It also includes
the country. preventative interventions to prevent malnutrition,
and reduce morbidity and mortality in women and chil-
The pre-crisis nutrition situation was already challeng- dren to ensure that the population of South Sudan can
ing. Based on the 2010 survey, both acute and chronic develop to its full potential.
malnutrition were serious with stunting above 30% and
wasting above 20%. The goal of the MIYCN strategy is to strengthen
the health status and wellbeing of the population by
In December 2013 a major crisis hit South Sudan, as improving the health and nutritional status of moth-
a result the country faced a worsening nutrition crisis ers, infants, and young children through an effective
on top of the existing critical level of malnutrition. The delivery of the basic package of health and nutrition
conflict in South Sudan exacerbated the rates of acute services (BPHNS). The MIYCN strategy is developed
malnutrition due to many factors, including population using the lifecycle approach, recognizing that good/bad
displacement and the increased morbidity rate caused health and nutrition is cumulative and that the maxi-
by disease outbreaks, lack of access to clean water, san- mum benefit in one age group may be derived from
itation facilities, and basic health services. These, in intervention at an earlier age. Direct and indirect ben-
turn, reduced the ability of vulnerable individuals (e.g. eficiaries belong to different layers of society, as well
children under five years, chronically ill people, and as different sectors. This strategy identifies the differ-
pregnant and lactating women) to meet their own nutri- ent delivery platforms where services and interventions

14 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 EXECUTIVE SUMMARY

need to be rendered and implemented, without limiting structure and builds on the newly developed Boma
it to the health system. Health Initiative, where the Boma Health teams will
function as the primary public health arm at the
A set of 10 strategic actions have been identified and Boma level.
incorporated in the strategy including development
and dissemination of policy and regulations that will The MIYCN strategy proposes that overarching com-
help enable an environment supportive to nutrition, the ponents link to system strengthening, like the integra-
protection of optimal maternal, infant and young child tion of essential MIYCN indicators into the national
nutrition and the improvement of micronutrient supple- health information system, as well as the integration of
mentation. A core element of the strategy is the focus essential indicators in national health and nutrition sur-
on integration within the health and nutrition sector as veys. Attention is provided to the need of stepping up
well as across sectors like WASH, agriculture, educa- advocacy efforts to develop appropriate social behav-
tion, etc. ioral change communication strategies based on con-
text. Resource mobilization remains a high priority of
The management and implementation of the strat- the strategy very much linked to the advocacy efforts of
egy is aligned with the Ministry of Health infra- the whole of government and the development partners.

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 15

 CHAPTER 1

Background
Globally, 45% (more than 3 million) children under 5 die from causes attributed to
undernutrition. These symptoms include fetal growth restriction, stunting, wasting,
and vitamin A and zinc deficiencies, along with suboptimal breastfeeding.1

All forms of Malnutrition are global issues that require breastfeeding for the first six months and continual
immediate and focused attention. It has been found that breastfeeding may prevent 13% of under-five deaths,
stunted children will earn 22% less income than non- primarily from infections resulting in diarrhea, pneu-
stunted children later in life. 2,3 monia, and neonatal sepsis,7 while initiation of breast-
feeding in the first hour would prevent an additional
The global trend in stunting prevalence and burden 22% of newborn deaths.8,9
continues to decrease. Between the years 2000 and
2015, stunting prevalence declined from 33% to 23.2%, Beyond the early childhood period, breastfeeding has
while the burden declined from 197 million to 156 mil- been found to improve children’s quality of life by pre-
lion. In addition, wasting prevalence in 2015 was esti- venting various diseases such as leukemia, asthma,
mated at almost 7.2%.2 ear infections, allergies, and diabetes. It can also sup-
port the achievement of optimal mental development
(Intelligence Quotient).10,11 In fact, 50% of the linear
Exclusive breastfeeding for the growth deficits accumulating between conception
first six months and continual and 36 months of age may occur between six and 24
breastfeeding may prevent 13% of months.12,13

under-five deaths, primarily from In low-income countries, Women with both a low body
infections resulting in diarrhea, mass index and short stature are highly prevalent, this
pneumonia, and neonatal sepsis. may lead to poor fetal development, an increased
risk of complications in pregnancy, and the need for
On the other hand, the global trend in overweight prev- assisted delivery. In sub-Saharan Africa, south-central
alence and burden increased from 5% to 7%, and from and south-eastern Asia, more than 20% of women have
32 to 50 million, between 2000 and 2015.2 a body mass index of less than 18.5 kg/m2. This figure
is as high as 40% in Bangladesh, Eritrea, and India.14
In the African region, the situation is improving but
at a very slow pace. Between the year 2000 and 2015 It is estimated that 42% of all pregnant women and
stunting declined from 38.3% to 31.6%.2 one third of non-pregnant women worldwide have anae-
mia. Anaemia is a condition that significantly increases
Only 57 million (42%) of the 135 million babies born health risks for both mothers and infants.15
every year, are breastfed within the first hour of life, with
38% exclusively breastfed during the first six months, Every year, an estimated 13 million children are born
and 58% breastfed until the age of 2 years.4 In the with intrauterine growth restriction4 and about 20 mil-
African region only 36% of infants less than 6 months lion with low birth weight.5 A child born with low
are exclusively breastfed. 5 birth weight has a greater risk of morbidity and mor-
tality, and is also more likely to develop non-commu-
Sub-optimal breastfeeding is associated with more nicable diseases, such as diabetes and hypertension,
than 800,000 deaths annually worldwide.6 Exclusive in the later stages of life.

16 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

CHAPTER 2

Introduction
The Republic of South Sudan became the newest country of the world on July 9, 2011.
Five days later on July 14, 2011, South Sudan became a member of the United Nations.17

In June 2013, the Republic of South Sudan joined the gramming in recognizing its importance as a life-sav-
Scaling Up Nutrition (SUN) Movement, an initiative that ing measure in the current South Sudan context. Given
brings together governments and heads of states from all the particular deterioration of WASH and health facili-
over the world. SUN is committed to improving mater- ties and services, appropriate IYCF programming was
nal, infant, and young child nutrition (1000 days critical crucial to preventing increased morbidity and mortal-
window), and recognizes its importance for improving ity in infants and young children. In addition, numerous
the nutrition status of the population. reports19 have highlighted the impact that the conflict has
had on women and caretakers, in terms of psychosocial
In December 2013, a major crisis hit South Sudan and as trauma, gender-based violence and sexual violence, and
a result, the country was faced with a worsening nutrition the resulting impact it has on the care and feeding prac-
crisis on top of an already existing critical level of malnu- tices for infants and young children.
trition. Along with a challenging operating environment,
it was clear that the original strategies and actions set for Despite the major efforts and initial success in curbing
achievement by 2014 would not meet the new emergency malnutrition and improving nutrition among infants and
nutrition needs. The conflict in South Sudan exacerbated young children, there is a need to implement a national
the rates of acute malnutrition due to many factors, such as strategy and guidelines on Maternal, Infant, and Young
population displacement and the increased morbidity rate Child Nutrition (MIYCN) to complement the guidelines
caused by disease outbreaks, lack of access to clean water,
sanitation facilities, and basic health services. These, in The conflict in South Sudan
turn, reduced the ability of vulnerable individuals (e.g.
exacerbated the rates of acute
children under five years, chronically ill people, and preg-
nant and lactating women) to meet their own nutrition malnutrition due to many factors,
needs and employ proper care practices. such as population displacement
and the increased morbidity rate
In July 2014, a Scale Up Plan was agreed upon and
implemented. The result was an increased coverage of
caused by disease outbreaks, lack
treatment for acute malnutrition. Activities contributed of access to clean water, sanitation
to treating 53% of the targeted SAM cases, and 40% of facilities, and basic health services.
the MAM cases by the end of 2014.
on Community-Based Management of Acute Malnutrition
In July 2015, 50% and 45% of the SAM and MAM (CMAM 2016). The latter provides guidance on the essen-
cases targeted were reached. At the same time, preven- tial actions and steps within the community and the health
tive interventions like Blanket Supplementary Feeding facilities that help detect, refer, and treat malnourished
Programme (BSFP), vitamin A supplementation, children. On the other hand, the MIYCN strategy and
deworming, and Infant and Young Child Feeding (IYCF) guidelines will provide the government and partners a
messaging have been steadily increased.18 broad menu of strategic actions and interventions that,
once implemented, will contribute to the prevention of
The updated Nutrition Cluster Response Plan of 2015 malnutrition, and the reduction of maternal and child mor-
called to strengthen the implementation of IYCF pro- tality and morbidity in the country.

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 17

 CHAPTER 3

Global recommendations
on maternal, infant and
young child nutrition
interventions
The Convention on the Rights of the Child (1989, CRC) recognizes that all children
have the right to the highest attainable standard of health, specifically the right to good
nutrition (Art.24), including breastfeeding.
All but three governments have ratified the CRC. As The International Code of Marketing for Breastmilk
State Parties, governments are legally bound by the Substitutes (1981, set the standards on the marketing
CRC, and are required to bring national laws and poli- and promotion of Breastmilk Substitutes. Twenty (20)
cies in line with its provisions. The Republic of South subsequent World Health Assembly (WHA) Resolutions
Sudan ratified the CRC in 2015 and is thus obliged provided new recommendations and standards as sci-
to protect the rights enshrined in the Convention, entific evidence that supports breastfeeding practices,
including protection of its citizens from unlawful and mounts concerns about formula feeding rather than
infringement on such rights by third parties, includ- breastfeeding. The International Code and the relevant
ing the private sector. Additionally, governments are WHA resolutions are jointly referred to as the Code.
accountable at both national and international levels.20
This includes regular reporting to the United Nations The Innocenti Declaration (1990, updated in 2005)
Committee on the Rights of the Child, on progress identified the need for a government structure and sys-
made in implementing the CRC, as well as report- tem for the management and support of breastfeeding
ing requirements based on the International Code of programmes. It recommended that all health facilities
Marketing of Breastmilk Substitutes and its subse- with maternity services implement the ten steps for
quent related 20 World Health Assembly (WHA) reso- successful breastfeeding, and reiterated the importance
lutions, the Baby-Friendly Hospital Initiative (BFHI), of implementing the Code and the passage of legisla-
and the Global Strategy for Infant and Young Child tions, in favor of maternity protection in the workplace
Feeding (IYCF). (paid maternity leave for at least 18 weeks, paid breast-
feeding breaks and where possible creche).
TABLE 1 WHO/UNICEF optimal infant and
young child feeding recommendations The International Labour Organization (ILO) adopted the
OPTIMAL INFANT AND YOUNG CHILD FEEDING
Maternity Protection Convention no. 183 in 2000. The
PRACTICES convention recommends a minimum of 14 weeks paid
1. Initiate breastfeeding immediately after birth (within the 1st hour) maternity leave. The accompanying recommendation 191
2. Exclusive breastfeeding for the first 6 months asks ILO members to endeavor up to 18 weeks of paid
3. Complementary feeding: leave, as well as time and space to breastfeed after com-
• TIMELY (introduced at 6 months or 180 days)
• ADEQUATE (energy and nutrients)
ing back to work.
• SAFE (hygienically prepared, stored, used)
• APPROPRIATE (frequency, feeding method, active feeding) The World Health Organization (WHO) and the United
4. Continued breastfeeding from six months up to 24 months or beyond Nations Children’s Fund (UNICEF) endorsed the

18 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 GLOBAL RECOMMENDATIONS ON MATERNAL, INFANT AND YOUNG CHILD NUTRITION INTERVENTIONS

2. Fifty percent (50%) reduction of anaemia in women of

Global Strategy for Infant and Young Child Feeding
reproductive age
(2002), that recommends optimal infant and young
child feeding as (Table 1): 3. Thirty percent (30%) reduction of low birth weight
4. No increase in overweight children
In 2004, the World Health Organization (WHO) issued 5. Increase the rate of exclusive breastfeeding in the first
guiding principles for feeding infants and young chil- six months to at least fifty percent
dren during emergencies.20 The principles reaffirm the
6. Reduce and maintain childhood wasting to less than
importance of protecting, promoting, and supporting
five percent (5%)
breastfeeding during calamities, while limiting and
strictly controlling the use of breast milk substitutes, In 2014, during the second International Conference on
and the role of complementary feeding. Nutrition (ICN2), member states of the United Nations
unanimously agreed that “…special attention should be
In 2007, the IFE Core Group, whose members include given to the first 1,000 days, from the start of pregnancy
UNICEF and WHO, built on WHO’s guiding principles to two years of age, pregnant and lactating women,
by issuing operational guidelines on IYCF in emergen- women of reproductive age, and adolescent girls, by
cies.21 The guidelines assert the importance of support- promoting and supporting adequate care and feeding
ing breastfeeding in difficult situations. practices, including exclusive breastfeeding during the
first six months, and continued breastfeeding until two
In 2009, the IFE Core Group released a technical paper years of age and beyond with appropriate complemen-
that focused on “Evaluating the Specific Requirements tary feeding.”23
for Realising a Dedicated Complementary Feeding in
Emergencies Training Resource” (Module 3). In a position In September 2015, world leaders adopted 17
statement the same year, the World Health Organization Sustainable Development Goals (SDGs). By the year
(WHO), recommended that weekly iron folate supplemen- 2030, all countries aim to mobilize efforts to end all
tation (WIFS) should be considered as a strategy for the forms of poverty.24 “Nutrition” appears as a free-stand-
prevention of: iron deficiency, the improvement of pre- ing element of SDG No.2 (“End hunger, achieve food
pregnancy iron reserves, the improvement of folate sta- security and improved nutrition, and promote sustain-
tus in some women in populations where the prevalence able agriculture”), but also SDGs goal # 3, calls to
of anaemia is above 20% in women of reproductive age ensure healthy lives and to promote wellbeing for all,
(WRA), and in areas where there are weak fortification at all ages.
programmes of staple foods with iron and folic acid.
In May 2016, the World Health Assembly recom-
In 2010, the World Health Assembly endorsed resolu- mended member states implement measures that would
tion WHA 63.23 which urges governments, inter alia, prevent the inappropriate promotion of foods for infants
to scale up interventions to improve infant and young and young children.25
child nutrition in an integrated manner with the pro-
tection, promotion, and support of breastfeeding and More than 30 years after endorsing the International
timely, safe, and appropriate complementary feeding Code, along with the Innocenti Declaration, BFHI, the
as core interventions. GIYCF Strategy, other relevant recommendations, and
20 World Health Assembly Resolutions, maternal nutri-
In 2012, the World Health Assembly (WHA 65.6) tion, breastfeeding, and complementary feeding prac-
endorsed the Comprehensive Implementation Plan for tices remain less than optimal and countries continue
Maternal, Infant, and Young Child Nutrition (CIP).8 It to struggle to improve the situation.
has six (6) goals that all countries have to contribute
to by year 2025: The Republic of South Sudan as a member state of the
1. Forty percent (40%) reduction of the global number of World Health Assembly, has taken important steps
children under five who are stunted towards the realization of international commitments.
The newly issued Health Policy 2016-2015 calls for

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 19

 GLOBAL RECOMMENDATIONS ON MATERNAL, INFANT AND YOUNG CHILD NUTRITION INTERVENTIONS

responsive intersectoral collaboration that targets indi- THE POLICY CALLS ON THE MINISTRY OF
viduals, families and communities to take responsibility HEALTH TO:
for the determinants of health; food security, nutrition, Ensure improved health determinants and address
education, poverty, water, sanitation, environmental health inequities through intersectoral collabora-
and climatic conditions, housing, socio-cultural and tion and developing community health structures, to
gender related barriers to access to health services, all effectively deliver health promotion services and com-
forms of violence, traffic and urban planning, in addi- munity participation.
tion to sustained behaviour changing campaigns.
Ensure reduction of mortality and morbidity due to
Among its objectives, the policy envisions that all non-communicable diseases through the establish-
efforts and programmes work to strengthen health ser- ment of health promotion, treatment and rehabilitation
vice organization and infrastructure development to interventions.
effectively and equitably deliver of the Basic Package
of Health and Nutrition Services.26

CHAPTER 4

The maternal, infant and

young child situation in
South Sudan
South Sudan has a total estimated population of 11,296,000 and a total of 406,000
annual births.27 Based on the most recent report from UNHCR, there are around
230,000 refugees in the country.28 As the newest country in the world, the South
Sudanese Ministry of Health, with the support of other stakeholders, has initiated a
process to establish a policy and legal environment that will help improve the nutrition
situation in the country.
TABLE 2 Basic maternal and child mortal-
Between 1990 and 2010, there has been success in ity indicators
curbing maternal and child mortality. Table 2 shows INDICATORS 1990 2000 2010
that maternal mortality decreased from 1,730 to 789 Maternal mortality ratio (/100,000 1730 1310 789
(/100,000 live births) during this period. A similar trend births)
has been recorded for child mortality, in which under Under five mortality rate (/1000 253 182 99
births)
five mortality rates decreased from 253 to 99 (/1000
Infant mortality rate (/1000 births)30 150 110 64
livebirths), infant and neonatal mortality decreased
Neonatal mortality rate (/1000 65 55 39
from 150 to 64 and 65 to 39 respectively (/1000 live- births)30
births). (Table 2) Source: WHO, Global Health Observatory repository of data, Ministry
of Health and UNICEF/WHO/World Bank/UN Population Division levels
and trends in child mortality, report 2014.

20 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 THE MATERNAL, INFANT AND YOUNG CHILD SITUATION IN SOUTH SUDAN

Based on the SSHHS 2010 survey less than 20% of The pre-crisis nutrition situation was already challeng-
pregnant women were able to have at least one ante- ing. Based on the 2010 survey, both acute and chronic
natal care visit (ANC) by a skilled attendant and just malnutrition were serious with stunting above 30% and
around 11% delivered in health facilities. At the same wasting above 20% (Table 6).
time, Mother to child transmission of HIV reached
worrisome levels and lacked appropriate interventions TABLE 6 Basic nutritional status indicators 30
to support the nutritional status of the mother and the
INDICATORS 2010
child. No data on anaemia is available, posing some
Underweight 27.6%
limitations in the effectiveness of the programming.
Stunting 31.1%
Therefore, we need to make an immediate effort to Wasting 22.7%
measure anaemia in the population. (Table 3) Overweight 6%
Source: Ministry of Health, South Sudan. Household and Health Survey,
2010
TABLE 3 Basic maternal and child health
indicators 31 Table 7 show the progress made in relation to increas-
ing access to iodized salt consumption and Vitamin A
INDICATORS 2010
supplementation. This table highlights the urgent need to
Pregnant women with at least 1 ANC visit 40.3%
step up interventions and drastically help increase cur-
Pregnant women with a skilled attendant 17.3%
Deliveries attended by a skilled attendant 19.4%
rent coverage.
Institutional deliveries 11.5%
Anaemia in pregnant women No data TABLE 7 Salt Iodization and Micronutri-
Anaemia in pre-school age children) No data ents 30
Source: Ministry of Health, South Sudan. Household and Health Survey,
INDICATORS 2010
2010
Adequate iodized salt consumption (%) 45%
Vitamin A supplementation, full coverage (%) 18%
The HIV/AIDS situation is alarming in the country, as Source: Ministry of Health, South Sudan. Household and Health Survey,
indicated by a recent report from the South Sudan HIV/ 2010

AIDS Commission (Table 4)

At the end of December 2015, the Integrated Food
TABLE 4 Mother to child transmission Security Phase Classification (IPC) estimated that
(women living with HIV) 32
2.8 million people or 23% of the population of South
INDICATORS 2013
Sudan would face acute food and nutrition insecurity
Mother-to-child-transmission (women living with HIV) 135,000
between January and March 2016.33
Children living with HIV 18,000
Source: Ministry of Health. South Sudan, Global AIDS Response, Prog-
ress Report 2013 Furthermore, the January 2016 FSNM report, refer-
ring to the 2015 situation, stated that the Global Acute
The relationship between undernutrition and access to Malnutrition (GAM) rate was 13.0%. The same report
WASH facilities is well established. Table 5 show some showed that the percentage of wasting in women was
key WASH indicators, and surface serious concerns more than 20%.34
related to sanitation and access to safe drinking water.
Poor infant and young child Feeding practices are one of
TABLE 5 Basic WASH indicators the key causes of child malnutrition. During the pre-cri-
sis, sub-optimal feeding practices of infants and young
INDICATORS 2010
children were also prevalent, with a national rate of
Access to improved source of drinking water 72%
exclusive breastfeeding under six months at 45.1%, and
Use of open defecation 64%
a national rate of continual breastfeeding at two years of
Children 0-2 years of age that had their stool disposed 16%
safely age, at 38% (Figure 1).35
Source: Ministry of Health, South Sudan. Household and Health Survey,
2010

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 21

 THE MATERNAL, INFANT AND YOUNG CHILD SITUATION IN SOUTH SUDAN

FIGURE 1 IYCF pt pre-crisis

100
2006
90
2010
80
70
60
PERCENT

50
40
30
20
10
0
Early Exclusive Continued BF Continued Introduction of Bottle
Initiation of Breastfeeding at 1 year BF at complementary Feeding
Breastfeeding of age 2 years feeding at
6-8 months
Source: Ministry of Health, South Sudan. Household and Health Survey, 2006 and 2010

The January 2016 FSNM report (referring to the 2015 sit- The composite indicator of quality and quantity of com-
uation) indicated that poor complementary feeding prac- plementary feeds provided (Minimum Acceptable Diet
tices and morbidity predisposed children to malnutrition. or MAD) to children six to 23 month’s shows a dis-
It was found that among families reached, only 59.7% of turbing situation: only 6.1% of children aged six to 23
children aged between zero and six months were exclu- months received the MAD.29
sively breastfed, while only 16% of children aged six to
eight months were fed solid or semi-solid foods.29

CHAPTER 5

Strengths, challenges
and barriers
The Ministry of Health and stakeholders identified several strengths of the nutri-
tion programme, in line with the relevant efforts and investment made in recent
years.36

One is the continuous effort to build the capacity of the The Second National Health Policy 2015–2026, fol-
Ministry of Health, both at the national and state levels, lowed by the launch of the Boma Health Initiative,
to offer quality infant and young child feeding services is expected to consolidate all the different efforts
and to provide support for pregnant or lactating moth- in making communities the key actors for improv-
ers and their children. At the same time, development ing their health and nutritional status. Moreover, the
partners under the leadership of the Ministry of Health implementation of the Integrated Case Management
have been increasing support and investment in nutri- Programme (ICCM) has allowed community-based
tion activities and interventions for infant and young distributors to treat additional childhood illnesses at
child feeding. the household level including: pneumonia, diarrhea,
and severe acute malnutrition.

22 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 STRENGTHS, CHALLENGES AND BARRIERS

The ongoing development of the national CMAM which creates exacerbating challenges for mothers
guidelines and the MIYCN strategy and guidelines trying to provide adequate nutrition to their infants. It
will strengthen the policy environment and help ensure also contributes to food insecurity, population move-
harmonized efforts in improving nutrition across the ment, climate change, and limited infrastructures like
country. roads or health facilities. Inadequate and inappropri-
ate access to food, an unstable economy (i.e. rising
Mainly through in-service training, major efforts food prices and unemployment), poverty, and limited
have been supported to create a cadre of specialists livelihood opportunities are also notable concerns.
and trained staff with MIYCN skills and knowledge. In some areas, inappropriate feeding practices were
There is also an unfinished nutrition policy, initially related to cultural beliefs (for example, the disposal of
drafted in 2009, that aims to provide guidance to all colostrum as it is considered ‘dirty’) and influences
nutrition stakeholders.37 While these are recognized from the elderly and in-laws. An example of this is
strengths among government and non-governmen- encouraging the new mother to follow family and/or
tal actors, challenges and barriers still remain and village traditions (introducing local liquids at birth,
urgently need to be addressed. throwing of colostrum, etc.) that may be harmful to
the mother and the child. It is also observed that the
Some local practices and beliefs interfere with the current limited capacity of the health care system, (i.e.
healthy growth of children. These practices include lack of IEC materials) and service providers aggravate
poor nutrition during pre-conception, early marriage the existing situation and limit the access of women
(child marriages), pregnancy and lactation, and inade- and children to services.
quate breastfeeding practices (delayed early initiation
due to lack of knowledge communities and traditional South Sudan’s Ministry of Health and the other stake-
rights, non-exclusive breastfeeding, and early cessa- holders recognize that there is still inadequate nutri-
tion of breastfeeding). In addition, inappropriate and tion capacity at every level. The absence of a nutrition
inadequate complementary feeding for various rea- policy/legal framework is a major gap that needs
sons, often related to food insecurity, lack of infor- immediate attention. There is a recognized inadequate
mation and lack of access to a diversified diet, are investment by all stakeholders for nutrition interven-
significant factors. Furthermore, poor access to health tions, particularly for preventative measures. Poor
services, high disease burden, and limited access to surveillance systems, a lack of monitoring, limited
WASH services and facilities contribute to the poor coordination among different government and non-
nutritional status of women and children. governmental partners, the lack of consistent support-
ive supervision and evaluation frameworks, and the
Experiences from the field show that low education, absence of nationwide nutrition assessments and sur-
early marriage (child mothers), and low levels of lit- veys are factors that limit the understanding and better
eracy among mothers affect complementary feeding comprehension of the situation.
practices. Health-seeking behavior is still very much
confined to accessing curative services with minimal
recognition of preventative services like growth pro-
motion, monitoring, and counselling. Based on differ-
ent assessments undertaken at the state level, it was
noted that each behavior may have context-specific set
of barriers, thus in regards to changing behaviours,
it can be difficult to make a ‘one package fits all’
recommendation.

Among the key factors affecting maternal, infant, and

young child nutrition is political instability. Some of
South Sudan’s states suffer from ongoing conflict,

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 23

 CHAPTER 6

Current efforts
The director general for primary health care of the Ministry of Health heads the
nutrition department in South Sudan. A director also heads the nutrition section,
which receives funding from the national budget and development partners.

At a state level, a nutrition focal person is in charge concentrated on creating a cadre (doctor, nurses and
of overseeing and guiding the implementation of the nutritionists) of trainers at the state level to build the
nutrition programme. Since 2013 major efforts have infant and young child feeding knowledge and capac-
been put in place to improve the nutrition of mothers, ity. The effort has been solely through in-service train-
infants and young children in South Sudan. In 2014 ing. Master Trainers and Training of Trainers (ToT) on
there was increased attention and resources invested IYCF Counselling were conducted, and six were doc-
towards preventive and curative measures. The num- umented. Based on the available reports, around 205
ber of Outpatient Therapeutic Programmes (OTP) and health workers and NGO staff attended a ToT between
Targeted Supplementary Feeding Programme (TSFP) June and September 2015. No documentation is avail-
were increased by 30% and 27% respectively, with a able on the effects or results of such initiatives so far.
higher concentration in conflict affected areas and high
burden states. Notably, preventive interventions were In 2015, a total of 22 NGOs were implementing IYCF-
stepped up with 109% of targeted beneficiaries reached related activities and projects, with more than 30,000 sets
with the Blanket Supplementary Feeding Programme of counselling cards printed and distributed nationwide.
(BSFP), and 111% with Vitamin A supplementation;
further 15% for deworming and 98% with Infant and According to interviews and discussions with govern-
Young Child Feeding (IYCF) messaging. ment and NGO partners, the following key strategies
have been implemented to improve IYCF practices
Between January 2015 and December 2015 over 60 among the population:
SMART surveys were conducted; nutrition indicators
were integrated in the Food Security and Nutrition 1. Creating capacity at the state level (rolling out ToTs
Monitoring System (FSNMS), and a nutrition situation from national to state level);
analysis and mapping was included in the Integrated 2. Establishing mother support groups to help facilitate
Food Security Phase Classification (IPC).38 peer-to-peer counselling and improving feeding
behaviors among mothers and the community; and
As of 2015 the focus has been on establishing Outpatient
and In-Patient services for SAM and MAM cases, as 3. Supporting the community-based volunteers who
well as on strengthening target and blanket food supple- disseminate IYCF messages and where possible,
mentation programmes. In the same year, the Ministry provide counselling services.
of Health established the IYCF Technical Working
Group which is responsible for all IYCF issues, the The recently concluded regional capacity mapping,
national guidelines, and supporting the MOH in devel- jointly facilitated by UNICEF and Save the Children
opment of the IYCF training package. at the end of 2015, confirmed that South Sudan
has started important efforts to improve coordina-
Most if not all the nutritionists in South Sudan were tion around IYCF, and build capacities (Training of
trained in Khartoum from Ahfad University for Trainers). The report detailed the need to increase the
Women, or they graduated in Kenya or Uganda. number of trained health workers and the ratio of health
Between June and October 2015, efforts have been workers to target population. The same report iden-

24 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 CURRENT EFFORTS

tified the need to increase the availability of trained midwives (CM), maternal and child health workers
health workers across the country, with the support (MCHWs), and home health promoters (HHPs), so to
of additional human resources like community health reach out to rural populations with basic health and
workers (CHWs), mid-level health cadres, community services.39

CHAPTER 7

Purpose and justification

In 2015, the Ministry of Health identified the need to develop a common set of strate-
gies, interventions, and actions that would guide the implementation of a concerted
set of activities by all stakeholders. The development process of the MIYCN strategy
has been characterized by consensus on the pillars and the phases of the develop-
ment process by all the stakeholders.
The key pillars of the development process are as follow (Table 8):

TABLE 8 Key pillars of the MIYCN development process

# PILLARS
1 Mothers and their children have the right to adequate nutrition and access to safe, quality and nutritious food, as both are essential for fulfilling their
right to the highest attainable standards of health.
2 Mothers and their children form a biological and social unit and improved MIYCN begins with ensuring the health and nutritional status of women.
3 Almost every woman can breast feed, provided she has accurate information and support from her family, community, media, and responsible health
and non-health related institutions.
4 National and local governments, development partners, non-government organizations, business sectors, trade unions, professional groups,
religious organizations, academia, and other stakeholders acknowledge their responsibilities to form alliances and partnerships for improving MIYCN
practices with no conflict of interest.
5 Strengthened communication approaches focusing on behavioral and social change is essential for demand generation and community
empowerment.

The development process has been characterized by The MIYCN strategy consolidates global and
key phases agreed upon by all key stakeholders (Fig. national guidelines with good practices to ensure
2). The aim of the process has been to ensure partici- that the population of South Sudan can develop to
pation and buy-in from all the relevant national and its full potential. This shall serve as a strategy for
sub-national government agencies, as well as from the government and all other stakeholders involved
other stakeholders working in the area of nutrition, in the conceptualization, planning, implementation,
maternal and child health, health and nutrition, child supportive supervision, and monitoring of related
protection, psychosocial support (PSS), food secu- programmes for preventative interventions to pre-
rity, and WASH-related/relevant concerns. vent malnutrition, and reduce morbidity and mortal-
ity in women and children.

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 25

 PURPOSE AND JUSTIFICATION

FIGURE 2 Key phases of the MIYCN development process

Setting the goals

Monitoring and other objectives
and evaluation of the strategy

9 1
Roll out of the Situational
strategy and analysis
guidelines 2
8

MINISTRY OF HEALTH
(NATIONAL AND STATE LEVEL) Consensus
AND building on
Advocacy and 7 DEVELOPMENT PARTNERS 3 key priorities,
dissemination strategies and
interventions

6 4
Submission for 5 Drafting
approval and process
endorsement
Review and
finalization

CHAPTER 8

Target users
The following are the primary users of the strategy:

1. Ministry of Health 9. Schools, academia (i.e. universities), research

2. Government ministries institutes and other training institutions
3. Parliamentarians 10. Non-governmental organizations (international and
4. Commissions national)
5. Sub-national government 11. United Nation agencies
6. Nutrition cluster 12. Donor community
7. Other sector clusters 13. Other civil society and community based
organizations and faith based groups
8. Health and nutrition workers including doctors,
social workers, community leaders and mobilizers, 14. Private sector (industries/enterprises)
community health, and nutrition volunteers 15. Media
16. Any other relevant actor

26 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

CHAPTER 9

Goal, objectives and

expected outcomes
Goal: To strengthen the health status of the population The main objective: To reduce the burden of malnutrition
by improving the health, nutritional status, and well- in pregnant and lactating mothers by 20%, and stunting in
being of mothers, infants, and young children through children under five years of age by 10% by the year 2025.
an effective delivery of the basic package of health and
nutrition services (BPHNS). The specific objectives are (Table 9):

TABLE 9 MIYCN specific objectives

OBJECTIVE I: POLICIES AND SYSTEM STRENGTHENING

Output 1 Policies to protect, promote, and support optimal Output 4 Programming at the national and sub-national
maternal, infant and young child nutrition level, all international and national organizations,
Output 2 MIYCN is a key development agenda supported by all civil society organizations, religious groups, and
levels of Government others are guided by the strategy when planning
interventions related to MIYCN
Output 2.1 MIYCN related interventions, resource allocations,
and compliance with the strategy are increased Output 5 MIYCN indicators are integrated in national health and
nutrition assessments, and surveys
Output 3 MIYCN related services in key health, nutrition, and
non-health programme for example CMAM, HIV, Output 6 The MIYCN monitoring, supportive supervision and
WASH etc., are integrated evaluation system for field based implementation is
established
Output 7 MIYCN topics are integrated in the curriculum in all
colleges and universities that educate health workers

OBJECTIVE II: MATERNAL, INFANT AND YOUNG CHILD NUTRITION

Output 1 At least two (2) functional MIYCN mother support Output 4.5 At least two (2) health workers trained in MIYCN in every
groups per village (1 every 2000 people) are county hospital department in key relevant departments
established (ANC, maternity, OBGYN, pediatrics, OPD, and IPD)
Output 2 All Boma Health Teams are trained on MIYCN40 Output 5 At least two (2) health workers trained in MIYCN In all
health and nutrition outreach activities
Output 3 All home health promoters (HHP) trained on MIYCN
messages41 Output 6 At least 95% of the existing health facilities providing
quality maternal health services (PHCCs and
Output 4 Health workers at every level of the health system hospitals) practice the ten steps for successful
(i.e. doctors, nurses, mid-wives, and other health breastfeeding (BFHI)
workers) are trained on MIYCN
Output 7 At least one (1) functional mother-baby friendly space
Output 4.1 At least three (3) health workers trained in MIYCN in with psychosocial support services (1: in every block) is
every Primary Health Care Unit (PHCU) set up in all sectors (blocks) in (IDPs/Refugees) camps
Output 4.2 At least six (6) health workers trained in MIYCN in Output 8 At least two (2) trained staff to support MIYCN
every Primary Health Care Centers (PHCC) services in all camps (IDPs/Refugees)
Output 4.3 At least five (5) health workers trained in MIYCN in Output 9 At least 50% of infants and young children in difficult
every national hospital department in key relevant circumstances (Low birth weight, HIV positive
departments (ANC, maternity, OBGYN, pediatrics, mothers, with medical conditions, malformations,
OPD, and IPD) abandoned, nodding) receive support to achieve
Output 4.4 At least three (3) health workers trained in MIYCN optimal infant and young child feeding practices.
in every state hospital department in key relevant Output 10 100% of pregnant and lactating mothers access to
departments (ANC, maternity, OBGYN, pediatrics, nutrition support and counselling services through
OPD, and IPD) the community, health promoters, mother support
groups and health facilities, and any other group

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 27

 GOAL, OBJECTIVES AND EXPECTED OUTCOMES

TABLE 9 MIYCN specific objectives (continued)

OBJECTIVE III: MICRONUTRIENT SUPPLEMENTATION

Output 1 At least 25% of the total number of adolescent girls, Output 4 All children, aged six to 59 months , in the high-
pregnant and lactating women receives fortified burden areas reecive micronutrient supplementation
food (MNPs)
Output 2 All children aged six to 59 months receive the Output 5 All pregnant women receive Iron/Folic Acid
recommended dosage of Vitamin A every six months supplementation for the duration of pregnancy
Output 3 All children aged 12 to 59 months receive at least two Output 6 National fortification and importation regulations of
doses of deworming medication every six months fortified staple products are developed

Expected outcomes
The full and sustained implementation of the MIYCN strategy will contribute to the achievement of the
following outcomes. (Table 10)

TABLE 10 MIYCN strategy expected outcome

1 Increase the rate of early initiation of 5 Increase the Minimum Dietary Diversity 10 Reduce anaemia five percent from
breastfeeding within the first hour of life (children six to 23 months) from 18% to baseline*, in women of reproductive age
from 48% to 75% at least 40% (There is no current baseline for anaemia in
women)
2 Increase the rate of exclusive 6 Decrease the low birth weight from 5% to
breastfeeding in the first six months from 2% from baseline
45% to at least 70%
11 Twenty percent reduction in the
Proportion of women aged 15 to 49 years
7 Reduce childhood stunting by 10% (from
with low body mass index (<18.5 kg/m2) (Less
Increase continued breastfeeding up to 31% to 21%)
3 than 2 SD below the mean body mass index for
two years from 38% to at least 60% age in women aged 15 to 18 years.)**
8 Reduce childhood wasting to less than
13% (currently 23%)
4 Increase the timely introduction of *Baseline to be determined by the overall baseline
complementary foods from 21% to at survey that will be conducted as a part of the MIYCN
least 50% Zero percent increase in childhood strategy implementation.
9 **MIYCN should be part of smart survey and FSNMS
obesity in urban areas
(later for assessment component)

28 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

CHAPTER 10

Beneficiaries
The MIYCN strategy will focus on reaching the following populations:
DIRECT: f. Infants with cleft palates/cleft lips
1. Adolescent girls g. Orphans
2. Pregnant and lactating women42
h. Children in emergencies
3. Primary caretakers of children (zero to 59 months)43
i. Others
4. Fathers of children (zero to 59 months)
5. Infants (zero to less than six months) INDIRECT:
6. Children (zero to 23 months) 1. Other caretakers and family members that care for
7. Children (24 to 59 months) infants and young children (i.e. babysitters, orphanage
8. Children with special needs: staff, grandparents)
2. Community (i.e. women’s and men’s groups,
a. Premature and low-birth weight
community leaders, religious leaders, etc.)
b. Acutely malnourished children 3. Health department staff (state, county, payam, and
c. Non-breastfed children boma)
d. Children exposed to HIV, children living with HIV and 4. Health practitioners, health and nutrition workers (at
other communicable diseases (TB, Hep B, visceral nutrition facilities, PHCUs, PHCCs, hospitals and
partner run sites, camps/PoCs) and other groups
leishmaniasis (Kalazar), measles others)
5. Community (boma health team, home health
e. Sick children (pneumonia. diarrhoea and malaria) promoters, and other groups

CHAPTER 11

Delivery platform(s)
The MIYCN strategy will focus on the following setting and groups(s):
1. Communities 6. Health facilities
a. Easy to reach / stable areas (urban and rural) a. Primary health care units (PHCUs)
b. Hard to reach areas (conflict areas and b. Primary health care centres (PHCCs)
geographically difficult to reach) c. Hospitals
¡ Rapid response mechanisms for conflict d. Faith based/run health and nutrition centres
affected areas and areas with low security 7. Prisons, orphanages and special institutions
2. Camps 8. School(s), universities, vocational, and research
a. Internally displaced population (IDPs) institutions
¡ Formal (POCs) 9. Private sector (industries/enterprises)
¡ Informal settings 10. Market(s)
b. Refugee 11. Media
3. Transit areas/centres a. TV/radio/print materials/online
4. Emergency related operations 12. Ministries (health and other line ministries)
5. Mobile and outreach services for health and nutrition 13. Religious institutions; churches and mosques

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 29

 CHAPTER 12

MIYCN: The lifecycle

approach and interventions
The MIYCN strategy is developed using the lifecycle approach (Fig.3). The following
key reasons are why the life cycle approach will ensure greater success in the imple-
mentation of this strategy:
• It recognized that good/bad health and nutrition is
cumulative 12.1 Nutrition interventions around
the maternal and child cycle
• The maximum benefit in one age group may be The WHO Comprehensive Implementation Plan for
derived from intervention in an earlier age-group MIYCN45 and the UNICEF scaling up nutrition plan46
• The interventions at one or a few points may not be recognize that the developmental impact of stunting
enough for sustainable improvements in health and and other forms of undernutrition happens early in life,
nutrition outcomes and the prevalence is greater than previously thought.
In particular, UNICEF’s scaling up plan suggests “The
• There is evidence of inter-generational benefits
1,000 days between the start of a woman’s pregnancy
• It will ensure a more efficient use of the scarce and the child’s second birthday offer an extraordinary
resources window of opportunity for preventing undernutrition

FIGURE 3 Main stages in the life cycle 44 Neonatal

period
Pregnancy
Infancy

Birth

28 days

Death
Ageing 1 year

Adulthood Childhood

20 years 5 years Preschool

years
10 years

Reproductive
years

Adolescence School-age

Adolescence & Pregnancy Birth Postnatal Maternal health

Pre-pregnancy (mother)

Postnatal
(newborn) Infancy Childhood

30 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 MIYCN: THE LIFECYCLE APPROACH AND INTERVENTIONS

and its consequences.” Figure 4 (below) shows how trition, like inadequate dietary intake, as well as some
nutrition interventions (specific and sensitive), at of the underlying causes like feeding practices and
different phases of the lifecycle, can significantly access to food. On the other hand, nutrition-sensitive
reduce stunting, micronutrient deficiencies, and interventions (supportive agricultural interventions)
wasting, as well as the risk of children becoming can address some of the underlying and basic causes
overweight and obese. of malnutrition by incorporating nutrition goals and
actions from a wide range of sectors (fig.4). They can
Nutrition-specific interventions (e.g. supporting IYCF also serve as delivery platforms for nutrition-specific
practices) address the immediate causes of undernu- interventions.47

FIGURE 4 Lifecycle and nutrition interventions around the maternal and child cycle

OUTCOMES

MICRONUTRIENT OVERWEIGHT &

CHILD STUNTING WASTING
DEFICIENCIES OBESITY

• Infant & young

• Infant & young • Infant & young child feeding
child feeding child feeding • Micronutrient
supplements & • Infant & young
• Nutritional support • Nutritional support
fortification child feeding
for those with for those with
• Nutritional support • Early childhood
Infant & infectious diseases* infectious diseases
for those with development
Young • Early childhood • Prevention &
infectious diseases • Food security
Children development treatment of SAM
• Early childhood approaches
Food security • Early childhood
development • Health
approaches development
• Food security • Social protection
• Health • Health
approaches • WASH
• Social protection • Social protection
WASH • WASH • Health
• WASH

• Energy & protein • Micronutrient

supplementation • Nutritional support for supplementation &
• Micronutrient those with infectious fortification • Food security
Pregnant & supplements*** diseases • Nutritional support approaches
Lactating • Nutritional support • Treatment of SAM for those with • Health
for those with • Health infectious diseases • Social protection
Women** infectious diseases • Food security
• Social protection • WASH
• Health • WASH approaches
• Social protection • Health
• WASH • WASH

• Micronutrient
supplementation &
• Nutritional support • Nutritional support fortification • Education
for those with for those with • Nutritional support • Food security
Adolescent infectious diseases infectious diseases for those with approaches
Girls • Education • Education infectious diseases • Health
• Health • Health • Education • Social protection
• Social protection • WASH • Food security • WASH
• WASH approaches
• Health

Nutrition sensitive approaches are denoted in blue italics.

*Infectious diseases include diseases such as HIV, TB, Malaria, NTDs, and pathogens associated with diarrhea and enteropathy.
The nutritional response to treating these diseases may be different depending on the context and the pathology of the disease.
**Maternal care linked to prevention of childhood stunting & obesity prevention.
***Prevention of LBW and SGA of children.

Source: UNICEF Nutrition strategy, 2015.

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 31
 CHAPTER 13

Key strategic actions of the

MIYCN strategy
The MIYCN strategy proposes evidence-based and cost-effective strategic actions
that shall have to be supported and enabled across the country (Table 11). Most of
the proposed interventions will focus on nutrition, while others on nutrition-sensitive
interventions, which may not be implemented directly by stakeholders in other sectors.
Their up-taking will be advocated by the relevant and concerned government and non-
government agencies.
RECOMMENDED ACTIVITIES:
13.1 Strategic Action 1: Endorse
and disseminate key policies and 13.1.1 DEVELOP A NATIONAL NUTRITION
regulations POLICY
The MIYCN strategy will focus on ensuring cost The Ministry of Health will lead the development of
effective and integrated approaches by creating sup- a new national policy. It is recommended to develop
port systems at the community and health care sys- and endorse a national nutrition policy that will inte-
tem level, and establishing cadre of specialists at all grate MIYCN as one of the key components. The policy
levels. The following is a set of critical recommenda- should provide guidance on decision-making processes,
tions and actions. as well as in identifying the roles and responsibili-
ties of each level of the health and nutrition systems.
PROBLEM STATEMENT: (Guideline 1.1)
Key MIYCN related policies, legislations, and regula-
tions are not yet in place (e.g. national policy, adaptation 13.1.2 ADOPTION OF THE INTERNATIONAL
of the International Code of Marketing of Breast-Milk CODE OF MARKETING OF BREAST-MILK
Substitutes, etc.). The MOH, with the support of other SUBSTITUTES AND RELATED RELEVANT
stakeholders, has initiated the process for the develop- WORLD HEALTH ASSEMBLY RESOLUTIONS
ment of relevant and critical policies and regulations (WHA) (THE CODE)
that will guide and contribute to the improvement of The International Code of Marketing of Breast-Milk
the health, nutrition, and wellbeing of the population. Substitutes and the relevant subsequent World Health
As of today, there are no or limited policies and regu- Assembly Resolutions should be adopted into a national
lations related to nutrition, especially to maternal and legislation. The Ministry of Health and its partners will
young child nutrition. draft the legislation, and eventually engage the relevant
agencies and bodies of government in line with national
SPECIFIC OBJECTIVE(S): legislature policies. This national legislation will ensure
1. To endorse and enforce policies and legislations that the protection, promotion, and support of the appropri-
protect, promote, and support optimal maternal, infant, and ate and optimal maternal, infant, and young child nutri-
young child nutrition. tion practices. In addition, the inappropriate promotion
or advertising, and provision of commercial products for
feeding infants and young children will be prohibited.
An independent monitoring and law enforcement system
will be established. (Guideline 1.2)

32 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

TABLE 11: MIYCN strategic actions cies to issue and enforce regulations and standards
MATERNAL, INFANT AND YOUNG CHILD NUTRITION STRATEGIC to ensure that all imported staple foods are forti-
ACTIONS fied according to the national approved standards.
(Guideline 1.6 and 1.7)
1 Endorse and disseminate key policies and regulations

13.1.6 ISSUE OTHER FOOD REGULATIONS

2 Improve maternal nutrition AND STANDARDS
Issue regulations to improve the nutritional quality of
3
Protect, promote, and support optimal infant and young child foods will focus on guidelines and standards for the
feeding practices
reduction of salt, fat, and sugar content, and the elim-
ination of trans-fatty acids, in line with the Codex.
Support optimal infant and young child feeding in difficult
4 (Guideline 1.8)
circumstances

13.2 Strategic Action 2: Improve

5 Ensure intra-sectoral integration (Health and Nutrition)
maternal nutrition
Improve intersectoral integration (food security and livelihood,
6 WASH, protection, education and shelter) PROBLEM:
There is limited information and data available on the
7 Support capacity building and service strengthening nutritional status of adolescent girls, pregnant and lac-
tating mothers. Low levels of access to antenatal care
8 Initiate advocacy and social behavioural change communication
and the low prevalence of institutional deliveries speak
to the limited access mothers have to appropriate nutri-
tional support. It is safe to assume that the current high
9 Sustain research, information, monitoring and evaluation
level of malnutrition in the country (chronic and acute)
may also be related to the poor nutritional status of
10 Mobilise resources and support
pregnant and lactating women.

13.1.3 ISSUE PROTOCOLS AND SPECIFIC OBJECTIVES:

GUIDELINES FOR ALL HEALTH FACILITIES To ensure that 25% of the total number of adolescent
OFFERING MATERNITY SERVICES girls, pregnant and lactating women have access to for-
Develop, disseminate and enforce health facil- tified foods.
ity protocols to ensure the ten steps for successful
breastfeeding (Baby Friendly Hospital Initiative) are To provide all pregnant women with iron/folic acid sup-
implemented.48 (Guideline 1.3) plementation for the duration of their pregnancy.

13.1.4 ADAPTATION OF THE ILO To allow 100% of pregnant and lactating mothers
CONVENTION 183 access to nutrition support and counselling services,
Review the status and conditions of women in the either through the community or local health facilities
workplace and advocate for the implementation
of the ILO Convention on Maternity Protection RECOMMENDED ACTIVITIES TARGETING
Convention, 2000 (No. 183) and Recommendation PREGNANT AND LACTATING WOMEN:
(No. 191) aimed at “promoting the equality of all
women in the workforce, health and safety of the 13.2.1 PROVIDE COUNSELLING AND SUPPORT
mother and the child…” (Guideline 1.5) FOR APPROPRIATE NUTRITION
Nutrition education and counselling is a widely used
13.1.5 FORTIFICATION OF STAPLE FOODS strategy to improve the nutritional status of adolescent
AND OIL, SALT IODIZATION girls, pregnant and lactating mothers. Community
Cooperate with relevant ministries and agen- health workers and the home health promoters, as well

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 33

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

as health workers in health facilities, have to provide SPECIFIC OBJECTIVES:

nutrition counselling and support to pregnant and lac- 1. To establish at least two (2) functional MIYCN mother
tating women. (Guideline 2.1.1 and 2.2.3) support groups per village (1 for every 2000 people)

2. To train all boma health teams in MIYCN50

13.2.2 DAILY SUPPLEMENTATION WITH IRON
AND FOLIC ACID FOR WOMEN DURING 3. To have all home health promoters (HHP) trained in
PREGNANCY AND POST-PARTUM49 MIYCN messages51 in the boma health teams;52
All pregnant and post-partum women should receive 4. To train health workers at every level of the health system
the required daily dosage amount of iron folic acid on MIYCN (i.e. doctors, nurses, midwives, and other health
(IFA) supplement to reduce the risk of low birth workers)
weight, maternal anaemia, and iron deficiency. Refer
to national guidelines for dosage and frequency of 5. To have at least two (2) health workers trained in MIYCN
supplementation and guidance on IFA in malaria in all health and nutrition outreach activities
endemic areas, guidance on how to take IFA, and how 6. To have at least 95% of the existing health facilities
to deal and mitigate possible side effects. (Guideline providing quality maternal health services (PHCCs, and
2.1.4 and 2.2.1) hospitals) practice the ten steps for successful breastfeeding
(BFHI)
13.2.3 NUTRITION CARE AND SUPPORT
7. To integrate MIYCN related services in key health,
FOR ADOLESCENT GIRLS, PREGNANT AND
nutrition, and non-health programmes for example
LACTATING WOMEN DURING EMERGENCIES
CMAM, WASH, HIV/AIDS and TB management, etc.
Adolescent girls, pregnant and lactating women
require additional nutritional support. One way to 8. To have at least one (1) functional mother-baby friendly
meet the recommended daily intake of micronutrients space with psychosocial support services (1: in every block)
is for MOH, in collaboration with other ministries and in all sectors (blocks) in (IDPs/refugees) camps
partners, to provide foods fortified with micronutri-
9. To have at least two (2) trained staff to support MIYCN
ents. (Guideline 2.1.2, 2.1.3 and 2.2.2 and 2.2.3)
services in all camps (IDPs/refugees)

13.2.4 REACHING OPTIMAL IODINE NUTRITION 10. To provide all children aged six to 59 months with the
IN PREGNANT AND LACTATING WOMEN recommended dosage of Vitamin A, twice a year53
To increase access and coverage of iodised salt, South 11. To provide all children aged 12 to 59 months with at least
Sudan needs to step up its national salt iodization one dose of deworming medication twice a year
programme, and also ensure that imported salt com-
plies with the standards presented in the national salt 12. To provide all children, aged six to 59 months, in the high
iodization guidelines. Available salt, either at home or burden areas with micronutrient supplementation (MNPs),
sold in markets, is to be tested regularly to verify its and MNTs for PLWs
iodine content. (Guideline 2.1.6 and 2.2.6) 13. To integrate key MIYCN topics in the curriculum at all
universities, colleges and vocational training institutes that
13.3 Strategic Action 3: Protect, educate health workers/practitioners.
promote and support optimal infant
and young child feeding practices RECOMMENDED ACTIVITIES TARGETING
CHILDREN 0 TO LESS THAN 2 YEARS OF AGE:
PROBLEM:
Sub-optimal breastfeeding and complementary feed- 13.3.1 NUTRITION SCREENING, GROWTH
ing practices are widespread in South Sudan due to MONITORING AND COUNSELLING
the several previously discussed factors. Key issues
that urgently need to be addressed are dangerously All children zero to 23 months should undergo nutri-
low early initiation and exclusive breastfeeding rates, tion screening. In community, camp-based, and mobile
with poor complementary feeding diet and practices. clinics, it is recommended to use the Mid-Upper Arm

34 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

Circumference (MUAC) measures for nutrition screen- capacity to mentor and support others, and successful
ing. MUAC is a rapid and effective predictor of risk of experiences during her pregnancy and her breastfeed-
death in children aged six to 59 months with low mid- ing period. These women also support each other as they
upper arm circumference (MUAC < 115 mm), and/or care for children ages zero to five years. A mother leader
bilateral pitting edema. is usually identified and trained on MIYCN, as well as
on basic group facilitation techniques. This person will
It is important to equip health workers in health facili- be responsible for engaging group members in discus-
ties with the skills and necessary equipment to provide sion about MIYCN and for providing counselling ser-
growth monitoring services using weight-for-height vices. Mobilization efforts should focus on identifying
(WFH). Both WHO and UNICEF recommend the use of and recruiting existing community groups with women
a cut-off for weight-for-height of below 3 standard devia- members instead of forming entirely new groups. At the
tions (SD) of the WHO growth monitoring standards to same time it is important to identify mechanisms and
identify infants and children severely malnourished and schemes that would help sustain and scale up the initia-
WFH <-2 SD for moderately acute malnutrition. After tive to reach more women in an effective way.
growth monitoring, the health workers in the health
facilities will have the opportunity to offer one-on-one 13.3.3 SETTING MOTHER-BABY FRIENDLY
counselling to the mother and the child. (Guideline 3.1.3 SPACES IN CAMP SETTINGS
and 3.2.9) Mother-baby friendly spaces, in particular, those in evac-
uation areas (centres/camps/shelters), help foster familiar
13.3.2 ESTABLISHMENT OF MOTHER-TO- social support, and facilitate the provision of 1-1 coun-
MOTHER SUPPORT GROUPS selling services for delivering key MIYCN messages.
With limited access and reach, the health facilities In South Sudan privacy does not hinder breastfeeding,
in the country are mainly rural in nature. Mother- as a mother can openly breastfeed her child anywhere.
to-mother support groups are a key strategy to pro- However there is a need to have a support structure, espe-
vide concrete support to breastfeeding mothers. A cially within the refugee/IDP settings. Hence, adequate
Cochrane review of 52 studies from 21 countries show access to private, quiet and safe mother-baby friendly
that together all forms of extra support had a positive spaces should be an initial priority. The location of these
effect on the duration of exclusive breastfeeding (RR at spaces should also be carefully considered to maximize
six months 0.86, 95% CI 0.82 to 0.91). Support by both accessibility. (Guideline 3.2.11)
lay and professionals had a positive impact on breast-
feeding outcomes.54 Anecdotal evidence shows that in 13.3.4 IYCF COUNSELLING SERVICES AT THE
5 years, since the creation of mother-to-mother sup- COMMUNITY AND HEALTH FACILITY LEVELS
port groups in Mumbai India, the percentage of moth- Mothers whom received three peer counselling vis-
ers initiating BF in first hour of birth has more than its decreased their use of formula seven-fold (P < .001)
doubled and the number of mothers, giving pre-lacteal and mixed-feeding by 37% (P < .001). 57 A study in
feeds, has reduced by half.55 In Kenya the initial imple- Bangladesh shows that well-trained and supervised com-
mentation of the mother to mother support group strat- munity-based peer counsellors could assist in encour-
egy has shown promising results, like the increase of aging and helping mothers of both normal birth weight
early initiation of breastfeeding from 45.3% (2011) to and LBW infants, to initiate breastfeeding within one
67.3% (2013), as well as exclusive breastfeeding during hour of birth, and then to continue exclusively breast
the first six months of life from 21.1% (2011) to 53.7% feeding their child until it is 6 months of age.58 There is
(2013).56 (Guideline 3.2.9 and 3.2.10) need to provide infant and young child feeding (IYCF)
counselling and support to mothers. This can be done in
Mother-to-mother support groups (MtMSG) are groups relatively comfortable places, such as the mother-baby
of pregnant and lactating women, of any age, who come friendly spaces, in the household, and at the health facil-
together to learn about and discuss issues of maternal, ity when the mother and the child are accessing nutrition
infant, and young child nutrition (MIYCN). A mother services (growth monitoring) or other maternal and child
leader should be identified and selected based on her health services. (Guideline 3.2.3 and 3.2.9)

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 35

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

13.3.5 IYCF MESSAGES DISSEMINATION AT In emergencies situations, or a situation where there is

THE COMMUNITY AND HEALTH FACILITY limited access to food and food commodities, it may
LEVEL be needed to consider the provision of the following:
Context, age, and situation for appropriate IYCF
messages should be given by the boma health teams 1. Micronutrient fortified blended foods (as part of general
and health workers in their health facilities or when ration, blanket, or supplementary feeding);
carrying out their community, or health facility 2. Basic food-aid commodities from general rations with
based, initiatives and public health services. When supplements of inexpensive locally available foods; and
providing other public health services (e.g. immu-
nization, child weighing) IYCF messages will help 3. Complementary fresh food vouchers.
remind the mother of the optimal feeding practices.
The messages should be short, and tested as effective 13.3.7 VITAMIN A SUPPLEMENTATION
and acceptable to the target population and possibly Vitamin A supplementation is a critical public health inter-
based on formative research. In this regard, all health vention that saves children’s lives. Vitamin A supplements
facilities should have some IEC/BCC materials (i.e. should be administered to children six to 59 months of age,
pictorial posters, leaf let, garlands, ribbons etc.) twice a year (every 6 months), at different service delivery
available and displayed prominently in the health points. It is highly recommended that where appropriate,
facilities. Messages are not replacing actual one-on- supplements should be integrated into other public health
one or group counselling sessions. (Guideline 3.2.9, programmes aimed at improving child survival, such as
3.2.10 and 3.2.11) polio or measles immunization days, or biannual child
health days delivering a package of interventions, like
13.3.6 SUPPORT AND ENCOURAGE OPTIMAL deworming, distribution of insecticide-treated mosquito
COMPLEMENTARY FEEDING PRACTICES nets, and immunizations. (Guideline 3.2.4)
To improve the minimum dietary diversity (meal
frequency and acceptable diet) in children 6 to 23 13.3.8 MICRONUTRIENT SUPPLEMENTATION:
months, it is imperative to support actions and inter- COMPLEMENTARY FOOD SUPPLEMENTS
ventions that improve the complementary feeding for One of the recommended complementary food supple-
older infants (over six months) and young children ments is micronutrient powders (MNPs). MNPs are gen-
(12-<24 months). The actions will consist of the fol- erally recommended for children six to 23 months where
lowing (Guideline 3.2.1): the rate of anaemia and other micro-nutrient deficiencies
are very high or when the variety, quality and/or quantity
1. Provide sustained MIYCN counselling and support of foods provided to young children may not meet the
services; nutrient density or the adequacy for this period of rapid
2. Encourage the use of locally available and diverse growth and development.
nutritious food for appropriate complementary feeding,
along with continued breastfeeding for at least the first 2 Studies have proven MNPs to be a cost effective interven-
years of life; tion that reduce anaemia in children by as much as 45%.
(Guideline 3.2.5)
3. Support, sustain and scale up nutrition sensitive kitchen
gardens and other similar interventions; 13.3.9 OPTIMAL IODINE NUTRITION IN YOUNG
4. Provide additional nutrient-rich foods in supplementary CHILDREN
feeding programmes; Children less than two years of age are most sus-
ceptible to iodine deficiency. The focus should be
5. Provide micronutrient supplementation for Home
on increasing access and household consumption of
fortification; and
iodised salt. Imported salt should comply with the
6. Increase access to fortified staple foods (imported and minimum standards set by the programme, and salt
locally produced) through integration and partnerships sold in markets and shops must be tested regularly to
with other sectors. verify its iodine content. Behavioral change messages

36 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

and strategies are needed to ensure increased avail- represented as a last resort. The Ministry of Health
ability and uptake. (Guideline 3.2.7) will oversee the procurement and management of the
BMS. Provision of BMS to infants (priority 0 to less
13.3.10 DEWORMING ADMINISTRATION than 6 months) should follow international procure-
It is recommended that children over 12 months of age, ment and distribution guidelines, and protocols should
and all at-risk people living in endemic areas without only be executed when (Guideline 4.1.1, 4.1.2, 4.1.3,
previous individual diagnosis,59 periodically be admin- 4.1.4 and 4.1.6):
istered with anthelminthic (deworming) medicines.
(Guideline 3.2.8) a. A full assessment of a mother and child pair has verified
their needs (e.g. child never breastfed before) ; and
13.4 Strategic Action 4: Support b. This assessment is supported by data submitted by qualified
optimal infant and young child people in the field (i.e. MIYCN point person/qualified
feeding with special needs healthcare personnel) (e.g. appropriate rapid assessment
conducted).
PROBLEM STATEMENT:
Children with special needs are those that have spe- 13.4.2 PREVENTING AND HANDLING BMS
cific medical conditions that may warrant specific DONATIONS
feeding recommendations, or those children that are All agencies (government and non-government)
left with no mother/parents. There is no specific data are encouraged to monitor and report donations of
available to determine the number of infants and young breastmilk substitutes, bottles, and teats, in line
children who suffer or are affected by rare medical with the International Code of Marketing of Breast-
conditions, or how many children experience other milk Substitutes and the Operational Guidance for
conditions that may prevent them from breastfeeding IYCF-E. Civil society organizations and individuals
or being breastfed. On the other hand at least 3.5% of must NEVER solicit nor accept unsolicited donations
children in South Sudan have lost both parents.60 of ANY product covered by the International Code
of Marketing and subsequent relevant World Health
SPECIFIC OBJECTIVE: Assembly Resolutions. State level Ministry of Health
1. Fifty percent (50%) of infants and young children in offices should be vigilant in receiving reports from
difficult circumstances (Low birth weight, HIV positive the different levels (county, payams, boma, and vil-
mothers, with medical conditions, not breastfed, with lage) and ensure that donations of breast-milk substi-
malformations, abandoned, with nodding disease) are tutes, bottles, and teats are surrendered to them and
provided with support to achieve optimal infant and young managed as per recommended guidelines (MIYCN
child feeding practices. guidelines). (Guideline 4.1.1)

RECOMMENDED ACTIVITIES: 13.4.3 ADDRESSING HIV AND INFANT AND

All the previous recommended activities (section 13.3.1 to YOUNG CHILD FEEDING
13.3.9) are generally applicable to these categories as well An HIV-infected mother can pass the infection to
(excluding children that have rare metabolic conditions that her infant during pregnancy, delivery, or through
prevent them from having breast milk). Additional specific breastfeeding in the absence of any intervention.
activities are hereby recommended: Antiretroviral (ARV) drugs are given to either the
mother, or HIV-exposed infant, to reduce the risk of
13.4.1 PROVISION OF APPROPRIATE FEEDING transmission. Together, breastfeeding and ARVs have
FOR ELIGIBLE INFANTS WITH NO POSSIBILITY the potential to significantly improve infants’ chances
OF BREASTFEEDING of surviving, while remaining HIV uninfected. WHO
Only after ALL options (wet nursing, donor’s breast recommends that when HIV-infected mothers breast-
milk for example) for breast milk feeding have been feed, they should receive ARVs and follow WHO
exhausted; provision and/or recommendation of an guidance for infant feeding.61,62
appropriate breast milk substitutes for infants will be

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 37

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

In 2014, the Ministry of Health endorsed the National programmatic integration.

Consolidated Guidelines on the use of antiretroviral
drugs for HIV treatment and prevention.63 SPECIFIC OBJECTIVES:
1. To integrate MIYCN related services in key health,
The national guidelines noted that HIV transmission nutrition, and non-health programmes
through breastfeeding can be significantly reduced if a
2. To have at least two (2) health workers trained in MIYCN
mother breastfeeds her child exclusively and if the mother
during outreach activities and in all health and nutrition at
and the baby receives ARV drugs at the same time, but
the primary health facilities
recommends breastfeeding only up to 12 months, and
encourage to stop if the child is tested negative. 3. To integrate MIYCN indicators in national nutrition
assessments, surveys, and health information system
The recently released 2016 WHO recommendations on
HIV and infant feeding recommends that “Mothers liv- RECOMMENDED ACTIVITIES:
ing with HIV should breastfeed for at least 12 months and
may continue breastfeeding for up to 24 months or longer 13.5.1 HEALTH INFORMATION SYSTEMS
(similar to the general population) while being fully sup- • Collaborate with the monitoring and evaluation directorate
ported for ART adherence”.64 in the MOH to capture key MIYCN Indicators in the
routine data recording and reporting of the health care
The national HIV guidelines will have to be revised as to system (PHCU, PHCC, Hospitals)
align with the recently released WHO 2016 on HIV and
infant feeding recommendations. At the same time there 13.5.2 REPRODUCTIVE HEALTH/MATERNAL
is a need to ensure that MIYCN counselling services are AND CHILD HEALTH
available in the PMTC sites, and the ARVs are available and All maternal and child health related services provide
distribution meets these requirements. HIV testing will be an opportunity for engaging the mothers and the care-
provided during the lactation period for women who tested givers on the importance of MIYCN (Guideline 5.1).
HIV negative during pregnancy. (Guideline 4.1.2)
• Include relevant nutrition interventions in national and state
13.4.4 COMPLEMENTARY FEEDING DURING level reproductive health, maternal, and child health plans
EMERGENCIES • Conduct integrated health and nutrition monitoring and
The operational guidance for infant and young child supportive supervisory visits
feeding during emergencies is being updated, and one
of the areas of major review is the area of complemen- • Include MIYCN relevant messages and counselling as
tary feeding during emergency situations. As soon as part of family planning. For example; use of lactation
the new guide is published and its information dissemi- amenorrhea method (LAM)
nated, South Sudan will review it and adapt the guid- • Standardize the inclusion of MIYCN-relevant messages
ance according to context and needs. and counselling as part of the ANC protocol

• Health facilities offering maternity care services are to

13.5 Strategic Action 5: Intra-
ensure that all normal and cesarean delivery practices
sectoral integration
follow the ten steps for successful breastfeeding (i.e.
skin-to-skin contact, early initiation of breastfeeding,
PROBLEM STATEMENT:
breastfeeding education, no bottles, and teats,
The health and nutrition programme aims to pro-
breastfeeding education to newly delivered mothers)
vide preventative and curative services that will,
in a comprehensive and concerted way, prevent, • When midwives conduct home visits to PLW to verify the
reduce, and treat malnutrition. Often times, verti- conditions of the mother and the newborn baby, ensure that
cal and independent programmatic efforts may limit the importance of breastfeeding, practical help, support and
the cost-effectiveness and efficacy of approaches, counselling are provided
which might be strengthened through intra-sectoral

38 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

• Standardize the inclusion of MIYCN relevant messages 2. All children aged six to 59 months should undergo
and counselling as part of ANC/PNC/PMTCT services nutrition screenings, and their mothers or caregivers must
receive health and MIYCN counselling support.
• Immunization services (routine, campaign and outreaches)
should be used to deliver key MIYCN services, to ensure 3. All MAM/SAM cases in TSFP/OTP as well as infants
systematic nutritional screening and growth monitoring, as admitted in the SC, detected, and under treatment
needed. should be receiving regular and sustained MIYCN
counselling and follow up services (focusing on ages
• Integration of standardized messages in maternal and child
zero to 23 months).
health and nutrition services (outreaches, EPI, sick child
clinics, child days, immunization campaigns, and national a. Targeted intervention for SAM cases discharge should
immunization days, and family planning/birth spacing consist of
promotion, SC/OTP/TSFP)
i. MIYCN counselling focusing on infant and
• Outreach services provided or offered by boma health young child feeding
teams and home health promoters/mother support groups
ii. Provision of targeted baskets of foods
and community health workers and health workers should
include services such as: iii. Provision of micronutrient supplementation
for complementary feeding
i. Nutrition screening and growth monitoring
iv. Livelihood opportunities for the mother/
ii. Nutrition and MIYCN counselling and support
caregiver/father
iii. Provision of micronutrients for pregnant women i.e.
4. Community health workers need to follow infant and
iron folic acid, other micronutrients, and Vitamin A for
young children both in terms of compliance with the
children 6 to 59 (in areas where NID was not conducted
treatment, and to help and support the mother or caregiver
or there has been a limited coverage)65
in improving feeding practices.
• Health promotion initiatives should emphasize the key
5. To address the causes of malnutrition and prevent children
health and nutrition practices that may prevent maternal
from relapsing community and/or home health promoters
and child morbidity
and/or mother support groups need to follow up on all
i. Several nutrition interventions have direct implications cases discharged from CMAM programmes; with special
on the health of the mother and the child (e.g. early emphasis on the children who were/are defaulters, non-
initiation of breastfeeding, IFA supplementation) recovered, and have frequent relapses with nutrition and
counselling services (MIYCN).
ii. Several health interventions have direct implication on
the nutritional status of the mother and the child. (e.g.
delayed cord clamping, birth spacing)
(Guideline 5.2 and 5.2.1)

Collaboration with and among other sectors is recom- 13.5.4 INCLUSION OF ESSENTIAL MIYCN
mended, also the following are suggested activities and INDICATORS IN THE HEALTH AND NUTRITION
interventions that will need to be explored and dis- SURVEY, SURVEILLANCE AND MONITORING
cussed with the relevant line ministries, departments, SYSTEM
and clusters. In order to strengthen the existing health and nutri-
tion information systems, it is important to monitor
13.5.3 INTEGRATION IN THE COMMUNITY the implementation of the MIYCN strategy and ana-
BASED MANAGEMENT OF ACUTE lyze key nutritional outcomes. Generally, health and
MALNUTRITION PROGRAMME nutrition surveys and surveillance systems are used to
1. Nutrition screening (oedema and MUAC, WFH) must gather, review, analyze, and interpret data about the
be conducted jointly with MIYCN (IYCF rapid/full nutritional status of the population, and to a certain
assessment of practices (refer to the national CMAM extent, understand its determinants so that populations
guidelines)). at risk can be identified.

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 39

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

Ongoing efforts to establish a national nutrition sur- RECOMMENDED ACTIVITIES:

veillance system will have to integrate the minimum The Ministry of Health and the other ministries and
set of MIYCN indicators with KAP, or other qualita- sectors have several opportunities and venues for col-
tive surveys, aligned with the global MIYCN monitor- laboration and integration in South Sudan. There is a
ing system. strong recognition that nutrition sensitive interventions
have a major role in the minimum dietary diversity for
Inclusion of priority MIYCN indicators/questions and women and children. The following is a set of inter-
qualitative information through focus group discussions sectoral collaborations and integrated initiatives that
(FGD) or key informant interviews (KII) in the rapid the Ministry of Health will explore with each relevant
nutrition assessments (RNA/IRNA) are needed to inform sector of interest:
rapid response missions (where conducted) about the nec-
essary MIYCN actions to be prioritized in the community. 13.6.1 WATER, SANITATION AND HYGIENE
(WASH)
For monitoring and evaluation purposes, it is recom- • Encourage the implementation of nutrition services
mended that MIYCN indicators be included in assess- together with WASH services (convergence): (Guideline 6.1
ments (i.e. post distribution monitoring (PDM) as well and 6.1.1)
as in the national information management systems, like
a. Implement hand-washing and hygiene promotion
HMIS or DHIS-2). (Guideline 9.1 to 9.8)
b. Ensure caregivers of artificially fed infants have access
13.6 Strategic Action 6: Improve to a safe water supply, and in the provision of portable
intersectoral integration (food water, prioritize breastfeeding (lactating) mothers
security and livelihood, WASH, c. Support sanitation measures to prevent
protection, education and shelter) communicable diseases among women, infants and
young children
PROBLEM STATEMENT:
Nutrition-specific interventions are not sufficient to pre- d. Integrate open defecation free (ODF) and community led
vent and eventually eliminate the burden of malnutrition. total sanitation (CLTS) packages with nutrition advocacy
The lack of systematic and sustained nutrition sensitive and promotion services
interventions can hamper progress and jeopardize the
initiatives already in place to improve maternal, infant 13.6.2 FOOD SECURITY AND LIVELIHOOD
and young child nutrition in South Sudan. To improve (AGRICULTURE, INDUSTRY, TRADE AND
the minimum dietary diversity of children and women COMMERCE)
it is critical to enable interventions that will increase the For emergency and short term solutions the following
access to local, diverse, and nutritionally adequate foods will be implemented
in a sustainable way.
• Provide food baskets and rations sensitive to MIYCN
SPECIFIC OBJECTIVE(S): priority groups (PLW, children six to 59 months)
1. To integrate MIYCN-related services in key health and non- • Explore using food voucher schemes that would target/
health programmes prioritize PLW and caregivers of children six to 59
2. To integrate key MIYCN topics in the curriculum of all months, where in the appropriate context, would help
universities, colleges, and vocational training institutes underprivileged populations access fresh foods (where
that educate health workers (doctors, nurses, midwives feasible) and other nutrient-rich foods available in the
and nutritionists) local markets.

3. To strengthen the development and enforcement of For long term and sustainable solutions the following
national fortification or importation of fortified staple are needed
products by working with the relevant ministries, clusters,
and private sectors • Production of nutrient-rich foods and staple foods through

40 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

home gardening and large-scale fruit and vegetable infant feeding difficulties and malnutrition
production, including micronutrient-rich crop varieties
¡¡ Provide concrete MIYCN counselling and support
• Ensure salt iodization, provision of vitamin-A fortified oil
¡¡ Provide child protection staff with training that allows
and sugar
them to undertake MUAC measurements and related
• Support the livelihood of agricultural or fishery referrals in remote communities
interventions with capital investment, technology transfer,
• Assess and coordinate appropriate nutrition support for
coaching, and capacity building
separated and orphaned infant and children
• Micronutrient fortification of staple foods (e.g. rice, oil,
• Place child friendly spaces67,68 near mother-baby friendly
cereals)
spaces (guideline 3.2.11)
• Bio-fortification of different crops i.e. zinc bio-fortified
• When appropriate to the context, provide special stipend
rice, Vitamin-A bio-fortified potato/maize etc.
or incentives to the PLWs to protect, support, and promote
MIYCN practices
13.6.3 EDUCATION
• Integrate MIYCN messages and relevant topics into the • Provide special protection and services under the social
curricula of primary and secondary level education or involve welfare ministry for abandoned infants
the local nutrition partner/MOH to support in providing this
education 13.6.5 SHELTER
• In the shelter vulnerability criteria, advocate for
a. Integrate key messages and topics related to good
prioritization of PLW and children under five years of age
nutrition and hygienic practices
• Coordinate with shelter agencies to respond to community/
b. Promote school-based nutrition activities
beneficiaries needs of MIYCN the while ensuring its
c. Develop gardening programs at schools that help visibility (standard set of messages)
develop practical skills as well as general knowledge of
• Advocate for the construction of bother-baby and child
nutrition practices
friendly spaces (refer to the guidelines/chapter)
d. Ensure WASH messaging used in schools is tied in to
• Advocate strategic positioning of shelter for PLW/children
messages about health and nutrition, particularly relating
under 5, and their families, that enables access to mother
to hygiene practices
and child safe spaces and WASH facilities
• Engage universities and colleges who train midwives,
nurses, doctors, and nutritionist or public health 13.7 Strategic Action 7: Support
professionals to: capacity building and service
strengthening
¡¡ Integrate key MIYCN topics and competencies in the
curriculum of midwives, nurses, and doctors66
PROBLEM:
e. Review and explore the possibility to start a new Major efforts and investments have been made to
nutrition department in the universities to build a increase MIYCN capacity both at the community and
cadre of nutrition specialists within the country health facility levels. Despite this, there are recognized
limitations in the capacity of service providers in offer-
(Guideline 6.2 and 6.3) ing quality MIYCN related services.

13.6.4 SOCIAL PROTECTION AND WELFARE SPECIFIC OBJECTIVES:

• Psychosocial interventions and support integrated with the 1. To have all boma health teams trained in MIYCN69
mother-baby friendly spaces as well as within the mother
2. To have all home health promoters (HHP) in boma health
support groups
teams trained on MIYCN messages70
• Train child protection staff (social workers) to:
3. To train health workers on MIYCN at every level of the
¡¡ Identify, detect danger signs, and refer mothers with health system (i.e. doctors, nurses, mid-wives, and other

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 41

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

health workers)
for use of a formal or informal venue wherein a specific
4. To have at least two (2) health workers trained in MIYCN topic will be presented, shared, discussed, and if neces-
in all health and nutrition outreach activities sary, practicum and demonstrations may be facilitated.
The usual duration of these activities can be from a few
RECOMMENDED ACTIVITIES: hours to two or three days, consecutively or on a staggered
basis. These activities have less logistical requirements,
13.7.1 IDENTIFYING AND PRIORITIZING thus, will not need a formal curriculum and may rely on
TARGET GROUPS FOR CAPACITY BUILDING a limited number of resource persons.
ACTIVITIES
Capacity building is a core cross-cutting component [Link] Trainings (pre-service and in-service)
of the MIYCN strategy. The capacity building efforts
will have to focus on improving and strengthening the Pre-service training
stakeholder’s ability to meet objectives and achieve rel- While the main goal is to ensure integration of MIYCN
evant goals. The following are the target(s) of capacity relevant topics in the curriculum (13.6.3) Specific pre-
building effort(s) (Guideline 7.1): service courses on MIYCN relevant topics will be
offered to undergraduate and graduate students to pro-
1. Programme managers vide them with the competencies needed to perform their
2. Hospitals - doctors, nurses, nutritionists, midwives etc. services at the health facility. Pre-service programmes
will support the creation of nutrition programme man-
3. Lead mothers in mother-to-mother support groups agers that will help the strengthening of nutrition pro-
4. Community health workers (CHWs). grammes in the country.

5. Home health promoters

In-service training
6. Health workers (HWs) at every level of the health system Formal training programme(s) for priority target groups
(PHCUs, PHCCs, Mobile Clinics). will be necessary to build skills and knowledge and to
shape the required attitudes towards the services and
7. Mothers and caregivers (the person who is directly involved
support needed. Trainings will require a full compre-
in the care and the feeding practices of the child).
hensive curriculum with session plans and competencies
8. Fathers and men. to be achieved. Directors, trainers, and trainee materials
9. Communities (leaders, religious leaders, school teachers, will also be necessary. (Guideline 7.2 and 7.3)
local government officials)
The strategy proposes that the MIYCN training pack-
13.7.2 IMPLEMENT A DIVERSIFIED SET OF age will prioritize the following target groups:
CAPACITY BUILDING STRATEGIES
Four key strategies are recommended to support the a. Community health workers
capacity building process (Guideline 7.2): b. Home health promoters

1. Information dissemination, seminars and orientations c. Health staff at the health facility level

2. Training(s) (in-service and pre-service)

At the community level, trainings should be conducted tar-
3. Supportive supervision and mentoring geting mothers, fathers, caregivers, and relevant and influ-
4. Sharing of best practices ential family members. Well-prepared community workers
and the home health promoters (boma health committees)
[Link] Information dissemination, seminars will conduct these trainings.
and orientation
These activities are meant to share updates, review current Training priorities will have the objective of creating a
knowledge, and provide additional relevant information cadre of specialists in the areas of MIYCN in all states,
to the concerned targets. The recommended approach is starting with the training of high risks areas with GAM

42 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

rates of 15% and above, as well as in areas where cov- tives of the strategy. At the national and state lev-
erage and practices related to MIYCN are dangerously els, program managers, nutrition focal persons, and
low. A roll out plan71 for training activities is being sug- selected staff will be oriented on supportive supervi-
gested in three phases as following: sion in line with the provided guidelines.

The supportive supervisory visit aims to:

Phase 1:
• Conduct a master training (MT) at national level to 1. Monitor and promote quality and standardized services
support state level training of trainers
2. Assess performance in relation to quantity (i.e. reach =
• Training of trainers (ToT), training state level trainers who coverage, volume, & service utilization).
in turn will train the MIYCN facilitators
All CHWS, HHP, and the health workers should ben-
efit from regular supportive supervision. UNICEF
recommends that the first visit should be within six
Phase 2: weeks to two months following training.67 This initial
• Training of facilitators (ToF), mainly in-charges of health
facilities with maternity services and ANC/PNC clinics, health follow-up supervision will provide an opportunity to
workers, and NGO field staff doing direct implementation determine whether the newly-trained MIYCN trained
and facilitating training for community level IYCF volunteers personnel and staff are:
• Training (ToC) of health and nutrition volunteers
(counsellors) community based home health promoters 1. Using their knowledge and skills to facilitate group
or community volunteers work, and counsel mothers/caregivers with accurate
information
• Training for mother-to-mother support groups,
community leaders, religious groups using effective audio 2. Confident about what they are doing
visual materials
3. If they are experiencing difficulties, to help them solve
the issue(s).

Phase 3: Supportive supervision and mentoring should be part

• Regular on the job training and supportive supervision of routine health and nutrition monitoring activities.
for in-charges, health workers, HHP, health and nutrition
Central level will provide quarterly monitoring and
volunteers, and community based groups etc.
supportive supervision. At the state level, monthly
• Standby trainings for new staff before they are deployed
supportive supervision for the counties is being rec-
to their assigned health facility
ommended. The monitors will be using the tool pro-
posed in the guidelines.
As described above, refresher training at all levels will
be conducted every one to two years to update and revi- [Link] Sharing of best practices, experiences
talize their knowledge and skills. and lessons learned
A low-cost and high-impact capacity building strat-
[Link] Supportive supervision and egy is the “sharing of best practices, experiences
mentoring72 and lesson learned”. Government section meetings,
Supportive supervision is an important aspect of man- donor’s partner meetings, nutrition clusters, IYCF
aging performance, making it an essential feature of TWG meetings, health and nutrition-related meetings,
the quality driven MIYCN support services. The main and forums provide opportunities for government
objective of the supportive supervision is to motivate and partners to share experiences, developments, les-
and support field implementers at different levels, sons learned, and innovations that generated positive
improve performance, and deliver quality and timely results. Time should be allocated for such sharing as
services to contribute to the overall goal and objec- this benefits all participants.

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 43

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

iv. Health and nutrition workers and volunteers, social

13.8 Strategic Action 8: Roll-out
workers, and other involved in the provision of MIYCN
advocacy and social and behavioral
related services and activities.
change (SBCC) activities
v. Mothers, families and communities
PROBLEM STATEMENT:
The lack of a consolidated advocacy and an SBCC 13.8.2 DEVELOPMENT AND IMPLEMENTATION
strategy limits the effect of current behavioral change OF A COMPREHENSIVE ADVOCACY AND
interventions implemented for the mothers and care- SBCC STRATEGY
givers (e.g. counselling and group sessions), and do Like KAP surveys and/or barrier analysis, a national
not support concrete advocacy efforts to increase advocacy and SBCC strategy based on the best avail-
support from different decision makers and inf lu- able results from formative research is needed. The
encers. (Guideline 8) aim of the advocacy and communication plan is to
spell out the key advocacy actions, messages, and
SPECIFIC OBJECTIVES: channels to be used to reach the desired audience.
1. To advocate to position and maintain MIYCN as a The following are recommended actions that should
key development agenda supported by all levels of the be included in the advocacy and communication plan:
government of the Republic of South Sudan
1. Development of key messages for government decision
a. To increase MIYCN related interventions, resource
makers and donors regarding nutrition funding priorities
allocations and compliance with the strategy
developed and signed off for use.
2. To inform programming at the national and sub-national
2. Development of a database of members’ success stories
level, as well as guiding all international and national
and examples of best practices related to nutrition
organizations, civil society organizations, religious
programming and MIYCN activities specifically.
groups and others when planning interventions related
to MIYCN 3. Development of a MIYCN fact sheet and policy brief
for use with donors and partners to demonstrate what

RECOMMENDED ACTIVITIES: members have highlighted as working on the ground.

4. Support members to develop and disseminate success

13.8.1 IDENTIFICATION OF THE TARGET stories from their programmes, with a focus on
AUDIENCES successful partnership approaches between government,
For the advocacy and SBCC efforts to be more effec- NGOs and communities.
tive, initial audience segmentation is required. The
5. Development of messaging regarding the need for
audiences are listed in relation to their role in ensuring
more mentoring and partnership opportunities as well
change and the realization of the MIYCN goal. The
as capacity building funds needed to fill the gap of
following audiences are suggested:
trained cadre with health and nutrition workers and
volunteers.
NATIONAL AND STATE LEVELS:
i. The whole government, donors, UN agencies, clusters, 6. Use of appropriate social media and mobile platform
international and national NGOs, media (both electronic (mHealth) to disseminate the key messages of MIYCN
and print), private sectors as part of the IYCF communication plan of action.

ii. Civil society organizations, religious groups, and other 7. Need for all humanitarian actors take the nutrition
social organizations needs of vulnerable groups into consideration during
distributions. This includes conducting awareness
COMMUNITY LEVEL:
sessions alongside the distribution of nutrition
iii. Civil society organizations, religious groups and other
items. At the same time, it is important to tailor the
social groups or and organizations, community leaders,
complementary items (i.e. fresh food baskets) to the
local governments, camp managers, emergency response
specific needs of the vulnerable groups.
actors, school teachers and others.

44 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

The MIYCN survey can be a stand-alone (the cost

13.9 Strategic Action 9: effectiveness and efficiency will need to be consid-
Sustain research, information, ered) or be integrated in existing or planned national
monitoring and evaluation systems surveys (DHS and MICS surveys recommended).
Both DHS and MICS provide for IYCF modules and
PROBLEM: contain relevant maternal nutrition questions and
Lack of a standardized programme data, no national indicators. The lack of data on current micronutri-
nutrition assessment, no surveys conducted since 2010, ent deficiencies also suggests that such survey should
and limited information on beliefs and traditions affect- include a component on micronutrient deficiencies,
ing and/or influencing the MIYCN practices at the fam- with biochemical assessment of blood samples (or
ily level other techniques accepted for population based sur-
veys) from children aged six to 59 months and PLWs
SPECIFIC OBJECTIVES: as a priority.
1. To integrate MIYCN indicators in surveys and national
health and nutrition assessments (HMIS) After five years, the baseline survey will be fol-
lowed by another survey that would provide insights
2. To establish a MIYCN monitoring, supportive supervision,
and information on the progress made in regressing
and evaluation system for field based implementation
nutritional related problems. It is envisioned that the
RECOMMENDED ACTIVITIES: MIYCN related survey would eventually become a rou-
tine effort of the national government (every three to
13.9.1 INSTITUTIONALIZING MIYCN AND IYCF five years), which will inform all government agencies
STANDARD INDICATORS FOR COUNTRY and partners on the nutritional status of the country.
ASSESSMENT (Guideline 9.1, 9.2, 9.3 and 9.4)
It is recommended that the Global Monitoring
Framework for Maternal, Infant, and Young Child 13.9.3 SUPPORTING FORMATIVE RESEARCH
Nutrition be reviewed and adapted.73 Member states The differences and cultural variations in South Sudan
will be requested to provide information on the status make it imperative to conduct formative research that
of the MIYCN situation in the country. A technical draw out specific family practices, food taboos, and
review team will be appointed to review the frame- preferences. The Ministry of Health and its partners
work of the strategy during the first year of its imple- should ensure that conducted formative research helps
mentation, checking adaptability, consistency with the surface practices that are influenced by the family,
context, and the priorities of the country. At the same food security, or access to appropriate food.
time, the technical review team will review the pos-
sible/potential sources of data, and see where the gaps The implementation plan for the MIYCN strategy
are in terms of indicators and source of the information. should address the range of issues, challenges, and
(Guideline 9.1 and 9.2) barriers that stand between the mother/primary care-
giver, her children, and appropriate nutrition prac-
13.9.2 CONDUCT REGULAR NATIONAL tices. To do this, three (3) methods are recommended
NUTRITION ASSESSMENTS AND SURVEYS that focus on MIYCN-related issues or are integrated
The MIYCN strategy advocates conducting national or with other crosscutting concerns (WASH, Health,
state surveys every five years (depending on resources) FSL, etc.). (Guideline 9.2)
that would cover the following, among others:
[Link] Knowledge, attitudes, and practices
1. Maternal nutrition indicators surveys (KAP surveys) on MIYCN
2. Child nutrition indicators Knowledge, attitude, and practices (KAP) surveys
reveal beliefs and understandings that contribute to
3. IYCF indicators good feeding practices, along with misconceptions
or misunderstandings that may be potential barriers

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 45

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

2. Activity planning for resolving bottlenecks and tracking

to behavior change74 and represent obstacles to the
corrective actions
activities that aim to be implemented. The same guid-
ance suggests that a KAP survey essentially records an 3. Monitoring of bottlenecks to determine whether the actions
“opinion” and is based on the “statements provided by are effective and to support service providers to adjust
the respondents.” action as needed

KAP surveys are generally used to a) measure the extent of 13.9.4 ASSESSMENT OF INFANT AND YOUNG
a known situation; b) enhance the knowledge, attitude, and CHILD FEEDING PRACTICE(S)
practices of specific themes and c) establish the baseline All CHWs and the Home Health Promoters should
(reference value) for use in future assessments and help conduct an IYCF rapid assessment of mother with
measure the effectiveness of being able to change health- children zero to 23 months. At registration, the
related behaviors through health education activities. CHWs and the HHPs should secure or collect data
on the demographic breakdown of children under
[Link] Barrier analysis two years, then use it to identify vulnerable groups
“Barrier Analysis is a rapid assessment tool used in and report them to the boma health supervisor that
community health and other community development will coordinate and inform the relevant health facili-
projects to identify behavioral determinants associated ties. (Guideline 9.7)
with a particular behavior. These behavioral determi-
nants are identified so that more effective behavior 13.9.5 MONITORING AND TRACKING
change communication messages, strategies and sup- PROGRESS DURING IMPLEMENTATION
porting activities (e.g., creating support groups) can be Measuring progress and tracking results is a criti-
developed. It focuses on eight determinants: perceived cal element of the MIYCN strategy. During imple-
susceptibility, perceived severity, perceived action effi- mentation, to measure and track progress at the field
cacy, perceived social acceptability, perceived self-effi- level, a standard set of indicators is proposed to help
cacy, cues for action, perception of divine will, and assess the effectiveness and reach of the interventions.
positive and negative attributes of the action (i.e., the The primary users of the data collected are the field
behavior).”75 implementers, this will guide them on identifying
what “goes well” and what “does not go well” when
[Link] Bottleneck analysis76 they review their efforts. Reported data and progress
The proposed tools and surveys will help understand information will then be used to inform the state and
the MIYCN nutritional situation, service delivery national level stakeholders to determine and review
performance, behaviors, practices, and barriers to the status of implementation, as well as support the
optimal practices. These information and data are decision making process (bottleneck analysis). The
not sufficient to identify the bottlenecks to effective feedback loop established will help the whole system
service delivery in a systematic way. The MOH will at each level optimize and improve the quality of ser-
conduct a bottle-neck analysis on an annual basis vices provided. (Guideline 9.6)
during the nutrition programme review. This will help
in determining the root cause of service delivery issues, [Link] Monitoring a minimum package of
as well as firm up its solutions, and monitoring the indicators for field level implementation
corrective actions. Table 12 presents a minimum list of indicators that the
government and implementing partners will have to
Current experiences show that a bottle-neck analysis collect and report on, according to the type of activ-
should focus on ities and settings where they are operating and/or
implementing. The data collected will be reported on
1. Identification of bottlenecks to service delivery, root causes a monthly basis to the respective agencies (by imple-
and solutions related to the delivery of MIYCN related mentation agency). Consolidation at the agency level
services and programmes. should be facilitated.

46 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

13.10 Strategic Action 10: Mobilizing 13.10.2 SOCIAL MOBILIZATION: FACILITATING

resources and support STAKEHOLDERS’ AGREEMENT AND
CONSOLIDATING PARTNERSHIPS
PROBLEM: Engaging and advocating for the strategy’s implemen-
Limited financial and human resources, as well as polit- tation is a priority action. The strategy will need to be
ical will and support for MIYCN related programmes supported by the government, partners, and donors, UN
and interventions have been identified as critical prob- agencies, communities, and families. The advocacy strat-
lems that affect the implementation and scaling up of egy recommended in section 13.8.2 will contribute to this.
the different initiatives.
The strategy’s goals, aims, and objectives have to be com-
SPECIFIC OBJECTIVE(S): municated and adapted by all concerned stakeholders.
1. Advocate to position and maintain MIYCN as a key
development agenda supported by all levels of government, Facilitating stakeholder’s agreement around the strat-
implementing partners and communities. egy, building consensus, and then mobilizing resources
to implement the strategy is a priority effort. Existing
2. To increase MIYCN related interventions, resource
coordination mechanisms and forum at the international,
allocations, and compliance with the strategy
national, and government levels should be utilized to gain
RECOMMENDED ACTIVITIES: traction and support for the implementation of the strategy.

13.10.1 COSTING THE IMPLEMENTATION OF Mobilization should not only be confined at the higher
THE MIYCN STRATEGY (national levels), engagement also has to target local
Budgeting each component of the strategy is neces- authorities, local governments, communities, and civil
sary. It will help prioritize and pace the key strategies society organizations down to the family/household level.
and interventions that will need to be implemented. A Local authority forums, presentations, community-based
budgeting exercise will follow the development of the discussions and exchanges on relevant topics should be
initial roll out plan of the strategy. organized and facilitated. (Guideline 10.1)

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 47

 KEY STRATEGIC ACTIONS OF THE MIYCN STRATEGY

TABLE 12 MIYCN Indicators for health facilities and community based interventions
+1
# Indicators 1ST
TIME
A. Health Facility

1 # (%) of pregnant women counselled on MIYCN (1 on 1)

2 # (%) of caregivers of children < 6 months counselled on MIYCN (1 on 1)

3 # (%) of caregivers of children 6 to 23 months counselled on MIYCN (1 on 1)

4 # (%) of children < 6 months exclusively breastfed (male/female)

# (%) of women who have received MIYCN information session (not 1 on 1)

5 # (%) of children < 6 months with special needs receiving breast milk substitute (male/female)

6 # (%) of children 6 to 23 months receiving micronutrient supplementation (MNP) (male/female)

7 # (%) of children 6 to 59 months receiving supplementary foods (MNP) (male/female)

8 # (%) of mothers of children (0 to <6 months) receiving supplementary foods (BSFP)

9 # (%) of pregnant women receiving micronutrient supplementation (iron-folic acid)

10 # (%) of pregnant women receiving supplementary foods (BSFP)

11 # (%) of health workers trained on MIYCN

12 # of support supervision visits to community volunteers on MIYCN

B Community

1 # (%) of pregnant women counselled on MIYCN

2 # (%) of caregivers of children (0 to < 6 months) counselled on MIYCN

3 # (%) of caregivers of children (6 to 23 months) counselled on MIYCN

4 # (%) of caregivers of children (0 to 23 months) attending mother support groups

5 # of Fathers/males counselled with MIYCN

6 # of other women- grandmothers, adolescent girls, attending mother support groups

6 # mother-to-mother support groups established

7 # of home health promoters trained on MIYCN

8 # of community health workers trained on MIYCN

9 # of health and nutrition volunteers trained on MIYCN

10 # of mother-baby friendly spaces set up in POCs/IDPs/refugee camps

48 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 CHAPTER 14

Gaps, needs analyses and

mapping of resources
A gaps analysis and mapping of resources is a critical step that will help determine
what is needs to be done so that the MIYCN strategy recommendations can be speci-
fied and fully and successfully implemented. The gap analysis coupled with the results
of the bottleneck analysis will help the MOH and the other stakeholders to verify cur-
rent capacities, but most importantly, what remains to be done is to step up the whole
implementation. The following sections propose a basic set of steps to be followed
when conducting a gaps analysis.
TABLE 13 Template for gaps analysis
Where are you now? Where would you like Are there any gaps Describe the What are the key What are the solutions
Current situation? to be? Your target between current and gaps (qualitative reasons for the gap? and remedies
future targets? (Y/N) or quantitative
differences)

9. # of health facilities practicing the 10 steps for successful

14.1 Identifying the gaps to breastfeeding
implement MIYCN related actions at
10. # of children six to 23 months receiving complementary
the national and sub-national level
food supplementation
A rapid needs analysis exercise is recommended, focus-
ing on the program aspects related to implementing STEP 2:
activities and achieving the stated objectives. The second step is to agree on what would be the ideal
or acceptable conditions so that one can actually imple-
STEP 1: ment, meet objectives, and achieve goals (Table 13).
The first step in the gaps analysis is to list down the
current status on each of the different programmatic 14.2 SWOT analysis for the MIYCN
aspects. programme
A tool that is commonly used for gaps analysis is the
EXAMPLE: SWOT analysis. The recommendation is for the national
1. # of community health workers (CHWs) and sub-national level mechanisms (MOH, cluster, part-
ners, states, counties etc.) to work together towards
2. # of health home promoter(s)
understanding the actual strengths and opportunities
3. # of other community health and nutrition volunteers per available in implementing the MIYCN strategy, as well
village (CHNVs) as to review areas that will need support and additional
4. # of health workers resources (weaknesses) and point out the risks and
threats of its implementation. The Ministry of Health
5. # CHWs trained on MIYCN (IYCF) should facilitate and lead regular SWOT analysis (every
6. # of CHWs trained on MIYCN (IYCF) 3 to 5 years) in line with the MIYCN strategy review.

7. # of health home promoter(s) trained on MIYCN messages

The SWOT analysis itself is a two-step process
8. # of health workers trained on MIYCN (IYCF) (Table 14):

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 49

 GAPS, NEEDS ANALYSES AND MAPPING OF RESOURCES

TABLE 14 template for SWOT analysis 3. The aim is to agree on the immediate next steps, building
STRENGTHS on the available resources, and transforming your oppor-
What do you do well? What unique resources can you draw on? What do tunities in strengths.
others see as your strengths?

14.3 MIYCN implementation

coverage and activities
OPPORTUNITIES The MIYCN strategy calls for regular mapping exer-
What opportunities are open to you? What trends could you take cises that will help monitor and track the progress of
advantage of? How can you turn your strengths into opportunities? interventions being implemented with consideration to
their timeframes, the type of activities supported, the
agency and the cadres leading the implementation, its
location, and intended beneficiaries. Important infor-
WEAKNESSES mation that will aid in mapping the MIYCN work
What could you improve (where are the areas where you are lagging being conducted will be drawn from asking why cer-
behind)? Where do you have fewer resources than others (human and tain activities are being conducted, that is, the basis
financial)? What are others likely to see as weaknesses?
or rationale for such activities (Table 15). This map-
ping exercise will guide implementation by providing
answers on relevant programming questions, such as:
THREATS
What threats could harm you (competing priorities, no political and or a. Are priority areas covered by the relevant activities?
technical support)
What is your competition doing (dissemination of wrong information and b. What kind of activities are being implemented?
misconceptions)? What threats do your weaknesses expose you to? c. Is there overlapping or potential overlap?
d. Are the activities responding to the actual/evolving needs
of the areas?

1. The first step is to identify the core themes that fall into each e. How long/what is the timeframe of the activities? It helps
SWOT category. The SWOT themes will be, for example, to start thinking of replacements and augmentation to
the key actions recommended by the MIYCN Strategy. avoid stopping or slowing down the process.
f. Are there underserved areas where no MIYCN work is
2. The second step involves the actual analysis (strengths- being implemented?
opportunities [S-O], weaknesses-opportunities [W-O],
strengths-threats [S-T], and weak-nesses-threats [W-T]) for
each of the recommended action.

TABLE 15 Mapping MIYCN interventions

WHEN WHAT WHY WHO HOW WHERE FOR WHOM

50 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 CHAPTER 15

Institutional framework:
management and
coordination structure
The MIYCN strategy has been developed to align with South Sudan’s national public
health priorities and policies, particularly with the National Health Policy 2015-2026
and the Boma Health Initiative 2016.
It is envisioned that the MIYCN strategy will be MIYCN (IYCF) coordinator has been appointed, sup-
implemented as a key public health programme, along porting the nutrition department, the MIYCN (IYCF)
with the different levels of the public health system in and CMAM technical working groups provide ven-
the country. Figure 5 represents the different layers of ues for government and non-governmental partners to
the national and sub-national public health and nutri- participate in the reviewing, planning, and overseeing
tion system. The MIYCN strategy has been developed of the implementation and operationalization of the
and harmonized in line with the vision of government, strategy.
in which primary health care remains the main vehicle
to arrest communicable and non-communicable dis- It is recommended that at the local level, (state, county,
eases. The MIYCN strategy provides the opportunity payam and boma*) the local health authority have to iden-
to enhance the basic package of health and nutrition tify focal persons (working on maternal and child health
services (BPHNS), so to ensure that the standards and and nutrition programmes), who will be tasked to oversee,
services recommended in the strategy would be part manage, and support the implementation of the MIYCN
of the package of high impact health and nutrition strategy at each level.
services that need to be accessible to the population.
Suggested criteria for the identification and tasking of
The MIYCN strategy aligns with the aim of the the focal person is as following:
National Health Policy 2015-2026, that is, to
strengthen the effective delivery of the BPHNS, and 1. employee of the state Ministry of Health
to recognize the importance of delivering cost-effec- 2. training (college/university level) in public health and/or
tive health and nutrition services to the population. In nutrition
addition, the recently launched Boma Health Initiative
(2016) provides an effective and sustainable platform ¡¡ at the boma level the boma health team will have this
to ensure that the basic nutrition services are offered responsibility.
at the community level, and that the integration with
other public health interventions is achieved through Each focal person (according to the respective level)
boma health teams. will be given the task to generate relevant reports and
updates on the status of implementation of the strat-
In terms of infrastructure, the MIYCN strategy aims egy, among others. boma health teams, with selected
to contribute to the strengthening of the current pub- home health promoters, will remain the structure clos-
lic health system. Each level of the health system has est to the community, and will ensure the delivery of
to ensure the localization, adaptation, implementation, the basic health and MIYCN services to the populations
monitoring, and evaluation of the MIYCN strategy. with which they work.
At the national level (Ministry of Health), a national

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 51

 INSTITUTIONAL FRAMEWORK: MANAGEMENT AND COORDINATION STRUCTURE

Figure 5, shows the different layers of the health system the appropriate health facility. Community based data
and how they interrelate and coordinate their activi- will flow from the boma health team to the respective
ties. The boma health team will help promote basic county, where it will be consolidated with the health
health and MIYCN relevant messages to their popula- facility based reports.
tions, and refer the cases that need further assistance to

FIGURE 5 Republic of South Sudan Public health system and level of responsibilities

Political & Admin Technical Healthcare Levels

President, Parliment,
Minister of Health, Ministry of Health Teaching Hospitals
Under Secretary

State Ministry of Health State Hospital

Governor, State Assembly,
SMOH, DG

Country Health Department Country Hospital

County Council, Paramount
Chief, Commissioner,
Executive D,

Payam Health Department Primary Health Care Centre

Payam council/ Executive
chiefs, Payam Admin,

Boma Health Teams

Boma Chief/ Boma Admin,

Boma Health Committees
Individual, household &
community Primary Health Care Unit

Home Health Promoters

Source: Ministry of Health South Sudan, Boma Health Initiative document, 2016.

52 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 CHAPTER 16

Strategy implementation
The MIYCN strategy will require prioritizing interventions, identifying the timeframe
and responsibilities of carrying out and leading the actual implementation process. It
is recommended that two concrete steps will be supported to ensure a sustained and
successful implementation of the strategy, namely a) the development of an implemen-
tation plan, and b) the costing and identification of resources needed.
16.1 Development of an 16.2 Budgeting and financing
implementation plan A costing exercise will assist the Ministry of Health
The MIYCN strategy requires an implementation plan and the stakeholders to:
that will prioritize, pace, and indicate how to rollout
the set of strategic actions and activities at the national 1. Identify available resources (human and financial) that can be
and sub-national levels. The Ministry of Health, with allocated to support the implementation of the MIYCN plan;
the support of its stakeholders, will lead a planning, 2. Estimate the resources that need to be requested and/or
costing and resource mobilization exercise. advocated for at national and/or sub-national levels;

The implementation plan should indicate the key 3. Review related systems and plans in order to ensure their
responsible agencies, the resources needed, and among sustainability and efficiency.
others the target results. The implementation plan will
also indicate measures to prevent any risks for failure The following is a list of costs (one time and recurrent
and ensure the assumptions linked with the implemen- costs) that need to be estimated:
tation are supported.
1. Training (pre- and in-services)
An initial implementation plan as being developed, 2. Development of plans and tools
with the aim of achieving all the key objectives and
produce the desired outcomes (Annex 1). The plan 3. Adaptation and finalization of recording and reporting tools:
provides concrete recommendations for immediate, 4. Dissemination, forums, workshops of guidelines and tools
medium and long term implementation that will help (annual/multi-annual):
roll out the implementation of the strategy. It is impor-
5. Printing and dissemination of relevant materials.
tant to note that is an initial plan that will need regular
review and updating. 6. Regular meetings of the management structures (operation
costs, per diem, logistical costs).
In addition to the full implementation plan, a contin-
7. Reports, monitoring and evaluation
gency plan should ensure that a minimum set of activi-
ties are implemented, monitored, and sustained at all 8. Advocacy, SBCC and promotion
levels with the available resources. The contingency 9. Monitoring and evaluation
plan should be drawn from the implementation plan,
short-term, and focused on a basic set of activities. After the development of the implementation plan, the
Among the priority activities to be included in the con- same was costed, following the indications and sugges-
tingency plan is the high level advocacy to increase tions above (Annex 1). The costing is an initial forecast
government and donors’ contributions to the implemen- of the financial resources needed to fully implement
tation of the MIYCN strategy. the proposed strategy and will need regular review and
updating.

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 53

 CHAPTER 17

Strategy review and

improvement
A midterm review (three years - 2020) during the implementation of the MIYCN
strategy will be conducted. The Ministry of Health will call on key stakeholders and
implementers to review the progress made, challenges and issues encountered, as
well as the recommendations for the next steps.

A national strategy review exercise, facilitated by the Based on planned outcomes (three or four year mile-
Ministry of Health and supported by its partners, should stones), there should be a general logical framework
be organized to revisit the progress made after seven for measuring the achievements during the review
years of the strategy being implemented. This will exercise.
inform the development of a second MIYCN strategy
for the following five years.

BI BLIOGR A PH Y
1. Operational guidelines for the implementation of integrated 11. Health Sector Development Plan 2011-2015. Government of South
deworming activities. PAHO/WHO. Washington D.C.,2015 Sudan, Ministry of Health (final draft), 2011.
2. Preventing Chemotherapy in Human Helminthiasis. Coordinated 12. A Guide to resource mobilization. Promoting Partnership with FAO.
use of anthelminthic drugs in control interventions: a manual for FAO, 2012.
health professionals and programme managers. World Health 13. Indicators for the Global Monitoring Framework on Maternal, Infant
Organization, 2006. and Young Child Nutrition (24 November, 2014). WHO, 2014.
3. Guidelines: Updates on the Management of Severe Acute 14. Mother to Mother Support Group. Facilitator’s Manual with
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Praziquantel during Pregnancy/Lactation and Albendazole/
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2006. Organization, 2002.

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[Link]/gho/data/[Link].1710?lang=en. Accessed July,2016 33 IPC. Republic of South Sudan: UPDATE Acute Food Insecurity Situa-
tion - December 2015
6 Victora G et al. Breastfeeding in the 21st century: epidemiology,
mechanisms, and lifelong effect. The Lancet Breastfeeding Series 34 Food Security and Nutrition Monitoring System South Sudan, Janu-
Group*, January 29, 2016. ary [Link] OOD Security and Nutrition Monitoring System South
Sudan – January 2016.
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LANCET • Vol 362 • July 5, 2003 35 The Republic of South Sudan Household Health Survey, 2010
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tality risk among newborns in southern Nepal. J Nutr. 2008
Mar;138(3):599-603. 39 UNICEF and Save the Children- East and Southern Africa Regional Of-
fices. Infant and Young Child Feeding During Emergencies. Capacity
10 WHO. Long term effects of breastfeeding. Geneva, 2013. Mapping, March 2016
11 Ip et al. A summary of the Agency for Healthcare Research and Qual- 40 Boma Health teams are composed by at least 3 community health
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41 Home Health promoters: Home Health Promoters shall be selected
12 Kathryn G. Dewey and Sandra L. Huffman . Maternal, infant, and at the ratio of 1HHP per 30-40 households in densely populated
young child nutrition: Combining efforts to maximise impacts on areas (urban), or two HHPs (one woman and one man per village)
child growth and micronutrient status. Food and Nutrition Bulletin, in sparsely populated areas (rural). They will work together with the
vol. 30, no. 2 © 2009 (supplement), The United Nations University Boma. Health Teams on voluntary basis with a defined basic incen-
13 Onyango, A. W. (2013), Promoting healthy growth and preventing tive mechanisms
childhood stunting: a global challenge. Maternal & Child Nutrition, 9: 42 Lactating mothers defined as mothers of children 0 to 23 months)
1–5. doi: 10.1111/mcn.12092
43 i.e. mothers, fathers, step parents, in-laws, grandparents)
14 WHO. Comprehensive implementation plan on maternal, infant and
young child nutrition, Annex 2. 2012 44 Kate J Kerber et al. Continuum of care for maternal, newborn, and
child health: from slogan to service delivery. Lancet 2007; 370:
15 WHO. World Wide Prevalence of Anemia, 1993-2005. WHO Global 1358–69
Database of Anemia. Geneva, 2008.
45 WHO MIYCN CIP, Geneva, 2012
16 World Health Assembly, Comprehensive Implementation Plan,2012
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18 UNICEF/WFP. Annual Report 2015-2016. eu/files/101322_000_Unicef_Brief_NutritionOverview_A4_v1r15.pdf
19 South Sudan. Updated Nutrition Cluster, Response Plan, 2014 48 The 10 steps for successful breastfeeding are currently under review,
20 WHO Philippines, Position Paper, for Congress Hearing, Manila 2006 and a new guidance will be issued in 2017. The Ministry of Health will
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21 WHO. Guiding Principles for feeding infants and young children dur- tion process.
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nutrition/publications/emergencies/9241546069/en/ accessed last 49 Ministry of Health South Sudan. Health Sector Development Plan,
March 2014. 2011-2015. [Link]
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22 Operational Guidance on Infant and Young Child Feeding in Emergen-
cies, v2.1. Oxford, Emergency Nutrition Network, February 2007 50 Boma Health teams are composed by at least 3 community health
workers
23 Second International Nutrition Conference, ICN2. Rome declaration,
2014 51 Home Health promoters: Home Health Promoters shall be selected
at the ratio of 1HHP per 30-40households in densely populated ar-
24 [Link] eas (urban), or two HHPs (one woman and one man per village) in
accessed January 10,2016 sparsely populated areas (rural). They will work together with the
25 World Health Assembly. World Health Assembly Resolution WHA Boma Health Teams on voluntary basis with a defined basic incentive
69.9. Geneva, May 2016. mechanisms
26 Ministry of Health, South Sudan. Health Policy 2016 to 2026. 52 Home Health promoters: Home Health Promoters shall be selected

56 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 ENDNOTES AND APPENDICES

at the ratio of 1HHP per 30-40 households in densely populated 64 The WHO GUIDELINE Updates on HIV and infant feeding The duration
areas (urban), or two HHPs (one woman and one man per village) of breastfeeding and support from health services to improve feeding
in sparsely populated areas (rural). They will work together with the practices among mothers living with HIV. Geneva 2016.
Boma Health Teams on voluntary basis with a defined basic incentive 65 The country will explore the possibility to shift from a campaign
mechanisms based approach to a routine administrative of Vitamin A at the health
53 Except malnourished who are receiving RUTF/RUSF from the nu- facility level.
trition center. So should ask the mother before providing blanket 66 Model Chapter for textbooks for medical students and al-
supplementation lied health professionals [Link]
54 Renfrew MJ, McCormick FM, Wade A, Quinn B, Dowswell T. Sup- am/10665/44117/1/9789241597494_eng.pdf?ua=1, accessed May
port for healthy breastfeeding mothers with healthy term babies. 2,2016
Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: 67 CFS can be defined as places designed and operated in a participa-
CD001141. DOI: 10.1002/[Link] tory manner, where children affected by natural disasters or armed
55 Impact of Mother Support Group In An Institutional Set-up In a De- conflict can be provided with a safe environment, where integrated
veloping Country [Link] programming including play, recreation, education, health, and
conference-news/item/185-impact-of-mother-support-group-in- psychosocial support can be delivered and/or information about
an-institutional-set-up-in-a-developing-country. Accessed August services/supports provided. Source: UNICEF. A Practical Guide
15,2016. for Developing Child Friendly Spaces. [Link]
56 Charles Muruka, Hellen Ekisa. A Case Study on the Impact of Mother- protection/A_Practical_Guide_to_Developing_Child_Friendly_Spac-
to-Mother Support Groups on Maternal, Infant and Young Child Nutri- es_-_UNICEF_(1).pdf. Accessed November 2016
tion and Care Practices in Habaswein and Wajir South Districts of North 68 UNICEF. Guidelines for Child Friendly Spaces in Emergencies. Janu-
Eastern Kenya. Food and Nutrition Sciences, 2013, 4, 31-35 [Link] ary 2011. [Link]
org/10.4236/fns.2013.410A006 Published Online October 2013 (http:// spaces_in_emergencies.pdf. Accessed November 2016.
[Link]/journal/fns) 69 Boma Health teams are composed of at least 3 community health
57 Salud et al. People’s Initiative to Counteract Misinformation and Mar- workers
keting Practices: The Pembo, Philippines, Breastfeeding Experience, 70 Home Health promoters: Home Health Promoters shall be selected
2006. J Hum Lact Online First, published on April 21, 2009 at the ratio of 1HHP per 30-40 households in densely populated
58 Haider R, Saha KK. Breastfeeding and infant growth outcomes in the areas (urban), or two HHPs (one woman and one man per village)
context of intensive peer counselling support in two communities in in sparsely populated areas (rural). They will work together with the
Bangladesh. Int Breastfeed J. 2016 Jul 7;11:18. doi: 10.1186/s13006- Boma Health Teams on voluntary basis with a defined basic incentive
016-0077-6. eCollection 2016. mechanisms
59 WHO recommends that Treatment should be given once a year when 71 UNICEF South Sudan, recommendations for the training roll out plan
the prevalence of soil-transmitted helminth infections in the commu- for MIYCN (IYCF), 2016
nity is over 20%, and twice a year when the prevalence of soil-trans- 72 UNICEF HQ. Supportive Supervision/Mentoring and Monitoring for
mitted helminth infections in the community exceeds 50%.[Link] community Infant and Young Child Feeding
[Link]/elena/titles/deworming/en/. Accessed November,2016
73 Indicators for the Global Monitoring Framework on Maternal, Infant
60 South Sudan Household Survey (SSHS) 2010. and Young Child Nutrition [Link]
61 WHO. Guidelines on HIV and infant feeding 2010 Principles and rec- posed_indicators_framework/en/. November 2014
ommendations for infant feeding in the context of HIV and a sum- 74 [Link]
mary of evidence [Link] kap-survey-model-knowledge-attitudes-and-practices
documents/9789241599535/en/
75 Food for the Hungry: Barriers Analysis Facilitator’s Guide. 2010
62 WHO. Consolidated guidelines on the use of antiretroviral drugs for
treating and preventing HIV infection. [Link] 76 UNICEF, ACF. What is the bottleneck analysis approach for the man-
guidelines/arv2013/download/en/ agement of severe acute malnutrition? [Link]
[Link]/wp-content/uploads/2015/12/[Link] accessed
63 Consolidated Clinical Guidelines on Use of Antiretroviral Drugs for November 2016
Hiv Treatment and Prevention, Ministry of Health, Republic of South
Sudan, 2014

A PPEN DICES
Ministry of Health, Republic of South Sudan. Maternal, Infant and Young Child Nutrition. Guidelines. December 2016

The Maternal, Infant, and Young Child Nutrition (MIYCN) strategy (2017 to 2025)
and guidelines provide the government and its partners a broad menu of strategic
actions and interventions, that once implemented, will contribute to
the prevention of malnutrition and the reduction of maternal and child mortality and
morbidity in the country.

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy 57

58
A N N EX 1
POLICY AND SYSTEMS
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025

Objectives Outcomes Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Verification
GOAL: To strengthen the health sta- Early Initiation of 48 51 54 57 60 63 66 69 72 75
tus of the population by improving the Breastfeeding
health and nutritional status of moth- Exclusive Breastfeeding 45.0 47.8 50.6 53.3 56.1 58.9 61.7 64.4 67.2 70.0
ers, infants, and young children and (from 0 to less than 6
their wellbeing through an effective months)
delivery of the basic package of healthContinued breastfeeding 38.0 40.4 42.9 45.3 47.8 50.2 52.7 55.1 57.6 60.0
and nutrition services (BPHNS). up to 2 years of age
Timely introduction of 21.0 24.2 27.4 30.7 33.9 37.1 40.3 43.6 46.8 50.0 1. Country stability
complementary foods allows for the full
implementation
Minimum Dietary 18.0 20.4 22.9 25.3 27.8 30.2 32.7 35.1 37.6 40.0 1. National Health 2. Resources (fi-
Diversity (6 to 23 and Nutrition
nancial and human) 1. MOH and part-
months) Survey
are available to ner agencies
MAIN OBJECTIVE: To reduce the bur- Low Birth Weight 5.0 4.7 4.3 4.0 3.7 3.3 3.0 2.7 2.3 2.0 2. SMART surveys meet requirements
den of malnutrition in pregnant and 3. KAP surveys
Childhood Stunting 31.0 29.9 28.8 27.7 26.6 25.4 24.3 23.2 22.1 21.0 3. MIYCN remains

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

lactating mothers by 20%, and stunting Childhood wasting 23.0 21.9 20.8 19.7 18.6 17.4 16.3 15.2 14.1 13.0 a Government
in children under five years of age by priority
10% by year 2025 Childhood obesity -
Anemia in women of re- -
productive age
Body Mass Index for -
women
Objective 1: To support policies, regula- Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
tions, actions and interventions aiming Verification
at creating a coherent legal and policy
framework for maternal, infant and
young child nutrition
Output 1: Policies to protect, promote, All MICYN policies, 1 Validated copy of Available donor MoH
and support optimal maternal, infant regulations, and legisla- the policies, regula- resources, govern-
and young child nutrition. tion are endorsed and tions, and legisla- ment prioritization,
implemented tion documents and support of the
legislative body
Output 1.1: National Nutrition Policy Endorse the National 1 1 Validated copy MoH
(NNP) and strategy Nutrition Policy of the NNP and
strategy
Output 1.2: Adopt the International Code “The Code” is fully en- 1 1 1 Validated copy of MoH
of Marketing of Breast-Milk Substitutes acted in to law “The Code”
and Related Relevant WHA Resolutions
(“The Code”)
Output 1.3: Adopt the ILO Convention The ILO convention is 1 1 1 Validated copy of MoH with rel-
on Maternity Protection Convention fully enacted into law the ILO convention evant ministries
ANNEX 1
 POLICY AND SYSTEMS
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Output 1.4: Issue protocols and guide- Protocols and guidelines 1 1 Validated copy of MoH
lines for all health facilities offering ma- are issued the protocols and
ternity services guidelines
Output 1.5: Fortification of staple foods Staple foods are fortified 1 1 1 1 1 Copy of the official MoH with rel-
and oils, salt ionization documentation of evant ministries
the biochemical
tests indicating for-
tification of foods
Output 1.6: Issuance of other food Regulations/legislation 1 1 1 Validated copy of MoH
regulations and standards enacted as per the Codex the regulations/
recommendations legislation
Activities Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
1.1.1 Meet with high level key develop- Venue, logistics/trans- 1 $3,741.84
ment partners to build a framework for portation, and focal
the development of a national nutrition points/consultant from
policy (NNP) and strategy UNICEF (MEETINGS: 6
meetings /PAX: 10 + 1
int’l consultant)
1.1.2 All relevant partners should meet Venue, logistics/trans- 1 1 $9,236.40
with MoH to review and comment on portation, and focal
the progress of the NNP and strategy points/consultant from
on a monthly basis (for the 1st year) UNICEF (MEETINGS: 10
and make changes during a 1-2 day meetings /PAX: 20 + 1
workshop int’l consultant)
1.1.3 Finalize NNP and strategy en- Venue, logistics/trans- 1 $9,236.40
suring MIYCN is one of the key portation, and focal
components points/consultant from
UNICEF (MEETINGS: 10
meetings /PAX: 20 + 1
int’l consultant)
1.2.1 Drafting the recommendation for Venue, logistics/trans- 1 $1,847.28
the legislative body to incorporates “the portation, and focal
code” into law points/consultant from
UNICEF (MEETINGS: 2
meetings /PAX: 10 + 1
int’l consultant)
1.2.1 Submission of recommendations Printing 1 $5.00
to the legislative body
1.2.2 Review of the proposed law to Venue, logistics/trans- 1 $6,636.40
ensure that “the code” is properly em- portation, and focal
bodied in the law points/consultant from
UNICEF (MEETINGS: 10
meetings /PAX: 20 + 1
int’l consultant)

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

ANNEX 1

59
60
A N N EX 1
POLICY AND SYSTEMS
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
1.2.3 Run a media campaign promoting Venue, equipment, 1 1 1 1 1 1 1 $3,523.64
and explaining the new law with con- Involve PR from
tinuous media promotion Government, and other
agency involved. Launch
of the media campaign
(through radio and other
sources) (T-shirts for the
first 250 participants + 1
int’l consultant)
1.3.1 MoH to advocate for the drafting Venue, logistics/trans- 1 $4,120.90
of legislation that incorporates the ILO portation, and focal
Convention (#183) to the MoL points/consultant from
UNICEF (meetings 3 PAX:
10 + 1 int’l consultant)
1.3.2 Review of the proposed law by Venue, logistics/trans- 1 $4,420.00
UN agencies and nutrition partners to portation, and focal
ensure that the ILO Convention (#183) points/consultant from
is properly embodied in the law UNICEF (MEETINGS: 3

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

meetings /PAX: 20 + 1
int’l consultant)
1.3.3 Run a media campaign promoting Involve PR from 1 1 1 1 1 1 1 1 $120,000.00
and explaining the new law with con- Government, and other
tinuous media promotion agency involved. Launch
of the media campaign
(through radio spots
(15,000/yr)
1.4.1 Development of health facility Venue, logistics/trans- 1 $4,268.20
protocols (“10 Steps for Successful portation, and focal
Breastfeeding”) on the national and points/consultant from
state levels UNICEF (MEETINGS: 5
meetings /PAX: 30 + 1
int’l consultant)
Hospital/PHCC level orientation of the Venue, logistics/trans- $9,518.20
BFHI protocols portation, and focal
points/consultant from
UNICEF (MEETINGS: 5
meetings /PAX: 135 + 1
int’l consultant)
1.4.2 Dissemination of health facility Posters, documents, 1 1 1 1 1 1 1 1 1 $30,465.00
protocols (“10 Steps for Successful and other media (radio)
Breastfeeding”) incorporating the “10
Steps for Successful
Breastfeeding” (post-
ers and 1 pg. fact sheets
for 1404 hospitals and
health facilities)
ANNEX 1
 POLICY AND SYSTEMS
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
1.5.1 Preparing a proposal with MoA Venue, logistics/trans- 1 1 1 $4,268.20
and relevant partners to develop portation, and focal
“Regulation and Standards” guidelines points/consultant from
for imported foods UNICEF (MEETINGS: 5
meetings /PAX: 30 + 1
int’l consultant)
1.5.2 Development of “Regulation and Venue, logistics/trans- 1 $4,018.20
Standards” guidelines for imported portation, and focal
foods points/consultant from
UNICEF (MEETINGS: 5
meetings /PAX: 25 + 1
int’l consultant)
1.5.3 Importation of staple foods that Trade agreements be- 1 $0.00
are fortified according to the na- tween those exporting
tional approved regulations and stan- these foods
dards, as well as including compliance
monitoring
1.6.1 Development of the document to Venue, logistics/trans- 1 $3,394.56
guide the regulations to improve the portation, and focal
nutritional quality of foods in line with points/consultant from
“Codex Alimentarius” UNICEF (MEETINGS: 4
meetings /PAX: 25 + 1
int’l consultant)
1.6.2 Finalization of the document to Venue, logistics/trans- 1 $2,147.28
guide the regulations to improve the portation, and focal
nutritional quality of foods in line with points/consultant from
“Codex Alimentarius” UNICEF (MEETINGS: 2
meetings /PAX: 25 + 1
int’l consultant)
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 2: MIYCN is a key develop- # of government de- 1 Validated copy of Available donor
ment agenda supported by all levels of velopment documents documents reflect- resources, govern-
Government reflecting MIYCN ing MIYCN ment prioritization
and validation
Output 2.1: All government ministries Government develop- 1 Validated copy of
relevant to nutrition are to incorporate ment plans integrate government de-
MIYCN as one of the health and nutri- MIYCN relevant topics velopment plans
tion priorities into their development including MIYCN
plan
Output 2.2: Government officials to Have a complete list of 1 Validated copy of
champion the MICYN strategy all key government of- list of “champions”
ficials that will act as the
“champions”

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

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POLICY AND SYSTEMS
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Activities Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
2.1.1 Produce a development plan Venue, logistics/trans- 1 $4,268.20
portation, and focal
points/consultant from
UNICEF (MEETINGS: 5
meetings /PAX: 30 + 1
int’l consultant)
2.1.2 Allow for stakeholders to review Venue, logistics/trans- 1 $4,268.20
the plan so that they may build consen- portation, and focal
sus and make changes accordingly points/consultant from
UNICEF (MEETINGS: 5
meetings /PAX: 30 + 1
int’l consultant)
2.2.1 Hold advocacy workshops on the Select motivated indi- 1 1 1 1 1 1 1 1 1 $14,825.52
national, state level to allow for proper viduals from various
identification of the “champions”. Once relevant government
individuals from are identified, they departments and agen-
should advocate for the integration and cies and organizations

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

implementation of the MIYCN guide- (MEETINGS: 2 meet-
lines in their respective organization/ ings /PAX: 40 + 1 int’l
ministry/agency consultant)
2.2.2 The “champions” to attend and Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $7,862.76
meeting associated with MIYCN so that portation, and focal
they may be involved in any updates or points/consultant from
changes in the guidelines UNICEF (MEETINGS: 1
meetings /PAX: 40 + 1
int’l consultant)
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 2.1: To increase MIYCN related Annual fund allocation 1 1 1 1 1 1 1 1 1 Annual budget with Available donor
interventions, resource allocations, and for MICYN fund allocations for resources, govern-
compliance with the strategy MIYCN ment prioritization
and budget approval
Output 2.1.1: MIYCN related interven- Completed/approved do- 1 Validated copy of
tions, resource allocations, and compli- nors development plan donors develop-
ance with the strategy are increased ment plan
Output 2.1.2: MOH Health Budget has MoH contains a specific 1 MOH Health budget
specific amount dedicated to MIYCN line item for MICYN dedi-
cated funds
ANNEX 1
 POLICY AND SYSTEMS
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Activities Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
[Link] High Level advocacy with key Venue, logistics/trans- 1 $2,047.28
development partners and donors (do- portation, and focal
nor’s meeting) points/consultant from
UNICEF (MEETINGS: 3
meetings /PAX: 20 + 1
int’l consultant)
[Link] Government to facilitate donor’s Venue, logistics/trans- 1 1 $3,070.92
meeting to launch the MIYCN strategy portation, and focal
as a priority points/consultant from
UNICEF (MEETINGS: 2
meetings /PAX: 20 + 1
int’l consultant)
[Link] Orientation with the all rel- Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $1,847.28
evant ministries (Senior Management portation, and focal
Committee) points/consultant from
UNICEF (MEETINGS: 2
meetings /PAX: 10 + 1
int’l consultant)
[Link] Propose budget line for MIYCN Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $1,373.64
to Ministry of Health Planning and portation, and focal
Budget Department points/consultant from
UNICEF (MEETINGS: 1
meetings /PAX: 10 + 1
int’l consultant)
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 3: MIYCN related services in Document outlining 1 Validated copy of Available donor
key health, nutrition, and non-health MIYCN integration into document outlining resources, govern-
programme for example CMAM, nutrition and non-nutri- MIYCN integration ment prioritization
HIV,WASH etc., are integrated . tion programs and involvement
from other sectors
Output 3.1: Key MIYCN guidelines are Reporting from other 1 Report from other
used by the different sectors sectors (from their re- sectors show-
spective cluster meet- ing use of MIYCN
ings) indicate use of guidelines
MIYCN guidelines
Output 3.2: the plan of the differ- MIYCN activities reflect- 1 Other sectors’ work
ent sectors reflects relevant MIYCN ed in the other sectors’ plans
intervention work plan
Activities Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
3.1.1 Dissemination forums with all Venue, logistics/trans- 1 $4,268.20
key sectors of the MIYCN strategy and portation, and focal
guidelines points/consultant from
UNICEF (MEETINGS: 5
meetings /PAX: 30 + 1

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

int’l consultant)
ANNEX 1

63
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REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
3.1.2 Permanent participation of Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $4,268.20
Nutrition focal person in relevant sec- portation, and focal
tors discussions (interdepartmental points/consultant from
meetings, clusters meeting) UNICEF (MEETINGS: 5
meetings X year)
3.2.1 Participate in different planning Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $4,268.00
and strategy development initiatives portation, and focal
points/consultant from
UNICEF (MEETINGS: 5
meetings x year)
3.2.1 Identify and develop key MIYCN Venue, logistics/trans- 1 1 1 1 $11,683.00
messages for each relevant sector portation, and focal
points/consultant from
UNICEF (MEETINGS: 3
meetings /PAX: 30 + 1
int’l consultant)
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

Output 4: Programming at the national Number of meetings/ 1 1 1 1 1 1 1 1 1 Copy of attendance Available donor
and sub-national level, all international presentations/workshops sheets from all resources, govern-
and national organizations, civil society used to inform all rel- meetings ment prioritization
organizations, religious groups, and evant partners and involvement
others are guided by the strategy when from all other rel-
planning interventions related to MIYCN evant partners
Output 4.1: The annual health and nutri- Nutritional operational 1 1 1 1 1 1 1 1 1 Copy of health and
tion operational plans at the national plan contains relevant nutrition plans
and sub-national government levels MIYCN activities
support MIYCN relevant activities (by
state/county)
Output 4.2: Annual/Bi-annual health Health and nutrition 1 1 1 1 1 1 1 1 1 Health and nutrition
and nutrition plans for INGOs/NGOs plans supports MIYCN plans
and civil society supports MIYCN interventions
interventions
Activities Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
4.1.1 High level forum with national and Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $201,969.00
state level to advocate for MIYCN inclu- portation, and fo-
sion in their annual budget and plan cal points/consultant
(MEETINGS: 1 meet-
ings /PAX: 40 + 1 int’l
consultant)
ANNEX 1
 POLICY AND SYSTEMS
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
4.1.2 Key annual priorities and interven- Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $201,969.00
tions included in a planning guide portation, and fo-
cal points/consultant
(MEETINGS: 1 meet-
ings /PAX: 40 + 1 int’l
consultant)
4.1.3 Facilitate national and state Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $201,969.00
level annual reviews and planning and portation, and fo-
costing cal points/consultant
(MEETINGS: 1 meet-
ings /PAX: 40 + 1 int’l
consultant)
4.2.1 Orientation/Consultation with Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $201,969.00
team leaders to review annual MIYCN portation, and focal
priorities and targets to be (by county) points/consultant from
UNICEF (MEETINGS: 1
meetings /PAX: 40 + 1
int’l consultant)
4.2.2 Present the annual/bi annual Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $201,969.00
plans to identify MIYCN support for portation, and focal
the year points/consultant from
UNICEF (MEETINGS: 1
meetings /PAX: 40 + 1
int’l consultant)
4.2.3 Mapping of MIYCN related inter- Printouts, focal persons 1 1 1 1 1 1 1 1 1 $201,969.00
ventions supported by INGOs/NGOs (MEETINGS: 1 meet-
ings /PAX: 20 + 1 int’l
consultant)
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 5: MIYCN indicators are inte- 1) MIYCN indicators inte- 1)Validated copy of Governmental (pri-
grated in national health and nutrition grated into assessments the assessments 2) oritization) and do-
assessments, and surveys 2) MIYCN indicators inte- Validated copy of nor (funding), and
grated into surveys surveys NIWG (technical)
support
Output 5.1: DHIS captures MIYCN MIYCN indicators includ- 1 Validated copy of
indicators ed in the DHIS DHIS
Output 5.2: National Health and MIYCN indicators includ- 1 1 1 Validated copy of
Nutrition surveys includes MIYCN ed in the National Health National Health and
Indicators and Nutrition surveys Nutrition surveys
Activities Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
5.1.1 Consultations and building con- Venue, logistics/trans- 1 $3,268.20
sensus with DHIS focal persons and portation, and focal
the Nutrition Information Working points/consultant from
Group (NIWG) UNICEF (MEETINGS: 5
meetings /PAX: 10 + 1

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

int’l consultant)
ANNEX 1

65
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A N N EX 1
POLICY AND SYSTEMS
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
5.1.2 Review and finalization of the Venue, logistics/trans- 1 $3,268.20
MIYCN indicators (definitions, method portation, and focal
of collection) points/consultant from
UNICEF (MEETINGS: 5
meetings /PAX: 10 + 1
int’l consultant)
5.2.1 Provide complete list of MIYCN Venue, logistics/trans- 1 $3,268.20
indicators with recommended portation, and focal
questionnaires points/consultant from
UNICEF (MEETINGS: 5
meetings /PAX: 10 + 1
int’l consultant)
5.2.2 Consultation and consen- Venue, logistics/trans- 1 $3,268.20
sus building with focal persons and portation, and focal
the Nutrition Information Working points/consultant from
Group(NIWG) UNICEF (MEETINGS: 5
meetings /PAX: 10 + 1
int’l consultant)

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

5.2.3 Review and finalization of ques- Venue, logistics/trans- 1 $3,268.20
tionnaires and indicators portation, and focal
points/consultant from
UNICEF (MEETINGS: 5
meetings /PAX: 10 + 1
int’l consultant)
5.2.4 Conduct of a National Health and Financial support for the 1 1 1 $600,000.00
Nutrition Survey with MIYCN indicators nutrition component
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 6: The MIYCN monitoring, M&E tools and su- 1 Use of M&E tools Governmental (pri-
supportive supervision and evaluation pervisory checklists and supervisory oritization) and do-
system for field based implementation indicate positive out- checklists nor (funding), and
is established come for field-based NIWG (technical)
implementation support
Output 6.1: MIYCN monitoring MIYCN monitoring 1 Approved MIYCN
framework framework has been en- monitoring
dorsed and implemented framework
Output 6.2: Cadre of supervisors in Number of supervisors 1 List of supervisors
place
Activities Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
6.1.1 Review and agree of key MIYCN Venue, logistics/trans- 1 $2,620.92
process indicators for health facility portation, and focal
and community interventions points/consultant from
UNICEF (MEETINGS: 3
meetings /PAX: 20 + 1
int’l consultant)
ANNEX 1
 POLICY AND SYSTEMS
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
6.1.2 Review and finalize basic tools Venue, logistics/trans- 1 $2,620.92
(recording and reporting) based on the portation, and focal
MIYCN guidelines points/consultant from
UNICEF (MEETINGS:
3 /PAX: 20 + 1 int’l
consultant)
6.1.3 Disseminate the MIYCN monitor- Venue, logistics/trans- 1 1 1 $43,800.00
ing framework and tools at the different portation, and focal
levels (national and state) at workshops points/consultant from
UNICEF (MEETINGS:
15 /PAX: 30 + 1 int’l
consultant)
6.2.1 Finalization the supervisory tool Venue, logistics/trans- 1 $3,768.20
portation, and focal
points/consultant from
UNICEF (MEETINGS: 5
meetings /PAX: 20 + 1
int’l consultant)
6.2.2 Identify the potential supervisors Logs, consultant/focal 1 1 $2,047.28
(nutrition focal persons, others) persons (MEETINGS: 2
meetings /PAX: 20 + 1
int’l consultant)
6.2.3 Capacity assessment (gaps, Logs, consultant/focal 1 1 $2,920.92
strengths etc) persons (MEETINGS: 3
meetings /PAX: 30 + 1
int’l consultant)
6.2.4 Training on supervisory skills Venue, logistics/trans- 1 1 1 $8,762.76
and tools portation, and focal
points/consultant from
UNICEF (MEETINGS: 3
meetings /PAX: 30 + 1
int’l consultant)
6.2.5 Quarterly based feedback discus- Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $28,661.00
sions with the supervisors (state level) portation, and focal
points/consultant from
UNICEF (MEETINGS:
4 /PAX: 20 + 1 int’l
consultant)
6.2.6 Annual reviews with nutrition fo- Venue, logistics/trans- 1 1 1 1 1 1 1 1 1 $25,625.00
cal person (national level) portation, and focal
points/consultant from
UNICEF (MEETINGS:
1 /PAX: 30 + 1 int’l
consultant)

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

ANNEX 1

67
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A N N EX 1
POLICY AND SYSTEMS
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 7: MIYCN topics are integrat- MIYCN topics in all 1 1 1 Approved copy of Cooperation with
ed in the curriculum in all colleges health-related curriculum curriculum being MoE and other rel-
and universities that educate health implemented in all evant institutions
workers key institutions and organizations
Output 7.1: Development curriculum for MIYCF topics incorporat- 1 1 1 Approved copy of
doctors, nurses and midwives includes ed into curriculum curriculum being
relevant MIYCN topics implemented in all
key institutions
Output 7.2: Develop curricula for mid- MIYCF topics incorporat- 1 1 1 Approved copy of
level cadres (teaching hospitals) pro- ed into curriculum curriculum being
grammes/curriculum include MIYCN implemented in all
relevant topics key institutions
Activities Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
7.1.1 Meetings with MoE to advocate for Send emails, provide 1 1 1 $5,841.00
the development of a proposed set of print outs to all rel-

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

topics and materials (to be suggested evant stakeholders
by the MoE) for relevant colleges and (MEETINGS: 2 /PAX: 15 +
universities 1 int’l consultant)
7.1.2 Forums and consultations with Venue, logistics/trans- 1 1 1 $11,304.00
relevant colleges and universities on portation, and focal
the integration process points/consultant from
UNICEF (MEETINGS:
5/PAX: 20 + 1 int’l
consultant)
7.1.3 Support the integration MIYCN Venue, logistics/trans- 1 1 1 $7,860.00
process (meetings) portation, and focal
points/consultant from
UNICEF (MEETINGS:
3 /PAX: 20 + 1 int’l
consultant)
7.2.1 Development of Curriculum Venue, logistics/trans- 1 1 1 $11,304.00
portation, and focal
points/consultant from
UNICEF (MEETINGS:
5 /PAX: 20 + 1 int’l
consultant)
7.2.2 Finalize the curriculum for the Venue, logistics/trans- 1 $3,768.20
mid-level cadre (doctor, nurses and portation, and focal
midwives) points/consultant from
UNICEF (MEETINGS:
5 /PAX: 20 + 1 int’l
consultant)
ANNEX 1
 POLICY AND SYSTEMS
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
7.2.3 Launch the curriculum for each of Venue, logistics/trans- 1 $3,768.20
the category portation, and focal
points/consultant from
UNICEF (MEETINGS:
5 /PAX: 20 + 1 int’l
consultant)
7.2.4 Dissemination to all relevant col- Send emails, provide 1 1 $7,536.00
leges and universities print outs to all rel-
evant stakeholders
(MEETINGS: 5 /PAX: 20
+ 1 int’l consultant)
7.2.5 Training of resources persons on Venue, logistics/trans- 1 1 $7,536.00
MIYCN of colleges and universities portation, and focal
points/consultant from
UNICEF and send emails,
provide print outs to all
relevant stakeholders
(MEETINGS: 5 /PAX: 20
+ 1 int’l consultant)

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

ANNEX 1

69
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A N N EX 1
MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025

Objectives Outcomes Baseline 2017 (%) 2018 (%) 2019 (%) 2020 (%) 2021 (%) 2022 (%) 2023 (%) 2024 (%) 2025 (%) Means of Assumptions Lead Agency
(%) Verification
GOAL: To strengthen the Early Initiation of 48 51 54 57 60 63 66 69 72 75
health status of the popula- Breastfeeding
tion by improving the health Exclusive 45.0 47.8 50.6 53.3 56.1 58.9 61.7 64.4 67.2 70.0
and nutritional status of Breastfeeding (from 0
mothers, infants, and young to less than 6 months)
children and their wellbeing Continued breast- 38.0 40.4 42.9 45.3 47.8 50.2 52.7 55.1 57.6 60.0 1. Country
through an effective deliv- feeding up to 2 years stability al-
ery of the basic package of of age lows for the
health and nutrition services full imple-
(BPHNS). Timely introduction of 21.0 24.2 27.4 30.7 33.9 37.1 40.3 43.6 46.8 50.0 1. National
complementary foods mentation
Health and
2. Resources
Minimum Dietary 18.0 20.4 22.9 25.3 27.8 30.2 32.7 35.1 37.6 40.0 Nutrition (financial 1. MOH
Diversity (6 to 23 Survey
and human) and partner
months) 2. SMART
are avail- agencies
MAIN OBJECTIVE: To reduce Low Birth Weight 5.0 4.7 4.3 4.0 3.7 3.3 3.0 2.7 2.3 2.0 surveys able to meet

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

3. KAP
the burden of malnutrition in Childhood Stunting 31.0 29.9 28.8 27.7 26.6 25.4 24.3 23.2 22.1 21.0 surveys requirements
pregnant and lactating moth- Childhood wasting 23.0 21.9 20.8 19.7 18.6 17.4 16.3 15.2 14.1 13.0 3. MIYCN
ers by 20%, and stunting in remains a
children under five years of Childhood obesity - Government
age by 10% by year 2025 Anemia in women of - priority
reproductive age
Body Mass Index for -
women
Objective 1: To create a Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
health and nutrition system Verification
with the minimum capacity to
offer quality maternal, infant
and young child nutrition
services
Output 1: At least two (2) 1173 MIYCN support 0 200 300 300 300 73 Reports, at- Funding avail-
functional MIYCN mother groups established tendant list. able, Security
support groups per village and trained stable
(1 every 2000 people). are
established).
Output 1.1: MIYCN advocacy Number of sessions 0 2400 6000 9600 13200 14076 14076 14076 14076 14076 Monthly Funding avail-
sessions attended by mem- conducted for stake- reports able, Security
bers of the support groups holders on the impor- from the stable, po-
tance of MIYCN to communities litical will-
supports the activities ingness to
implemented by the participate
establishes groups (at
1 session per group
per month)
ANNEX 1
 MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Output 1.2: MIYCN support At least 60% of the 120 300 480 660 704 704 704 704 704
groups MEMBERS are groups are meeting
ACTIVE involved IN THE every month
MIYCN ACTIVITIES IN THE
COMMUNITY
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
1.1.1 Community sensitiza- Funds, Human/log 8368 1195 1267 1343 1423 1509 1599 $416,800.0
tion on MIYCN resources, safety (50 sessions
USD per meeting at
the Boma Level)
1.1.2 identification of the mem- Funds, Human/log 17595 1955 1955 1955 1955 1955 1955 1955 1955 1955 $0.0
bers of the support group resources, safety
1.1.3 Supportive monitoring Funds, Human/log 2346 261 261 261 261 261 261 261 261 261 $160,210.7
Supervision by county and resources, safety
Boma health teams
1.2.1 Conduct Refresher Venue, Resource 1174 200 300 300 300 73 $360,000.0
training speakers, Resource Community
materials members
1.2.2 Provision of the visibil- Funds (1 kit per 2092 2092 2092 $313,800.0
ity materials Boma) *50 USD
per kit
1.2.3 Provide incentives to In kind support (10 17595 1955 1955 1955 1955 1955 1955 1955 1955 1955 $175,950.0
the members of the support USD per member)
group
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 2: All Boma Health Number of boma 6276 1702905 1255 1256 1255 1255 Training Security,
Teams are trained on MIYCN health teams trained reports with funding &
on MIYCN pre & post HR, BHI pol-
test results icy remained
permissive
Output 2.1: Trained personnel 70% of boma health 879 879 879 879 879 Activities Security,
carrying out MIYCN activities teams trained ap- report funding,
plying correctly the BHI policy
MIYCN guideline remained
permissive
Output 2.2: Deliver key Number of individuals 99733316 11081480 11081480 11081480 11081480 11081480 11081480 11081480 11081480 11081480 Activities
MIYCN Messages in group reached with MIYCN report
and individual sessions in the key messages.
community.
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
2.1.2 Training of boma health Funds, Human& Log 6276 1255 1255 1256 1255 1255 $1,722,059.00
teams on MIYCN and Safety
2.1.3 Conduct supportive su- Funds, Human& Log 4184 465 465 465 465 465 465 465 465 465 $285,006.06
pervision visits and Safety

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

2.2.1 Refresher Training Funds, Human & Log 42464 1883 3108 4363 5618 6873 6873 6873 6873 $1,937,652.00
ANNEX 1

and Safety

71
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A N N EX 1
MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 3: All home health Number of HHPs 67008 13402 13402 13402 13402 13402 Training re- Funding &
promoters (HHP) trained on trained on MIYCN ports, atten- HR avail-
MIYCN messages dance sheets able, Security
stable
Output 3.1: HHPs are trained Number of HHPs 67008 13402 13402 13402 13402 13402 Training re- Funding &
on MIYCN trained on MIYCN ports, atten- HR avail-
dance sheets able, Security
stable
Output 3.2: HHPs are imple- 90% of the HHPs are 60307 12061 12061 12061 12061 12061 Supervision Funding &
menting the MIYCN proto- applying the correct checklist & HR avail-
cols correctly. MIYCN protocol reports able, Security
stable
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
3.1.1 Train of HHP on MIYCN Funds, HR & Log and 67008 13402 13402 13402 13402 13402 $4,387,015.00
messaging Safety

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

3.1.2 Supportive supervi- Funds, HR & Log and 4184 465 465 465 465 465 465 465 465 465 $285,066.06
sion Visits Safety
3.1.3 Refresher training Funds, HR & Log and 455668 20103 33505 46907 60309 73711 73711 73711 73711 $4,988,369.00
Safety
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 4: Health workers Number of health 5192 1029 1229 1317 1189 600 0 0 0 0 Training re- Funding &
at every level of the health workers who have ports, atten- HR avail-
system (i.e. doctors, nurses, successfully com- dance sheets able, Security
mid-wives, and other health pleted the MIYCN stable
workers) are trained on training.
MIYCN
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 4.1: At least three Number of health 3078 300 650 828 700 600 Training re- Funding &
(3) health workers trained workers in PHCUs ports, atten- HR avail-
in MIYCN in every Primary dance sheets able, Security
Health Care Unit (PHCU); stable
Output 4.1.1: health workers Number of health 3078 300 650 828 700 600 Training re- Funding &
on MIYCN in PHCUs trained workers trained ports, atten- HR avail-
dance sheets able, Security
stable
Output 4.1.2:Health workers 90% of the trained 2770 270 585 745 630 540 Supervision Funding &
are implementing the MIYCN staffs are applying checklist & HR avail-
protocols correctly. the correct MIYCN reports able, Security
protocol stable
ANNEX 1
 MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
[Link] conduct training for Funds, HR and logs, Baseline 300 650 828 700 600 $853,902.00
health workers at the PHCU safety
level
[Link] conduct supportive Funds, HR and logs, 18468 2052 2052 2052 2052 2052 2052 2052 2052 2052 $558,225.14
supervision visits (ON THE safety
JOB) at the PHCU Level
[Link] refresher training Funds, HR and logs, 19207 625 1364 2128 2778 3078 3078 3078 3078 $961,827.00
safety
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 4.2: At least six (6) No. PHCC staffs 1956 489 489 489 489 Training re- Funding &
health workers trained in trained on MIYCN ports, atten- HR avail-
MIYCN in every Primary (1956) dance sheets able, Security
Health Care Centers (PHCC) stable
Output 4.2.1: 2 health work- Number of health 2608 652 652 652 652 Training re- Funding &
ers from different depart- workers trained on ports, atten- HR avail-
ments (OPD, ANC, IPD, EPI) MIYCN at PHCC dance sheets able, Security
on MIYCN in PHCCs trained stable
Output 4.2.2: Health workers 90% of the trained 2347 587 587 587 587 Supervision Funding &
are implementing the MIYCN staffs are applying the checklist and HR available,
protocols correctly. correct MIYCN protocol reports Security stable
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
[Link] Training of the PHHCC Fund, HR & Log, and 2608 652 652 652 652 $1,300,972.00
health staffs on MIYCN Safety
[Link] Conduct Supportive Fund, HR & Log, and 5868 652 652 652 652 652 652 652 652 652 $442,614.35
Supervision Visits (ON THE JOB) Safety
[Link] Refresher Training Fund, HR & Log, and 13449 980 1632 2284 2936 2936 2936 2936 2936 $1,949,757.00
Safety
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 4.3: At least five (5) Health staff from 5 150 150 Training re- Funding &
health workers trained in national hospitals are ports, atten- HR avail-
MIYCN in every national trained on MIYCN dance sheets able, Security
hospital department in key stable
relevant departments (ANC,
maternity, OBGYN, pediat-
rics, OPD, and IPD)
Output 4.3.1: 5 Health staff Number of staff 150 150 Training re- Funding &
per departments on MIYCN trained at National ports, atten- HR avail-
in national hospitals are hospital on MIYCN dance sheets able, Security
trained stable
Output 4.3.2: Health staff are 90% of the trained 135 135 Supervision Funding &
implementing the MIYCN staffs are applying checklist and HR avail-
protocols correctly. the correct MIYCN reports able, Security

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

protocol stable
ANNEX 1

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A N N EX 1
MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
[Link] Training of the Fund, HR & Log, and 150 150 $69,393.00
National hospital staffs on Safety
MIYCN
[Link] Conduct Supportive Fund, HR & Log, and 90 10 10 10 10 10 10 10 10 10 $41,661.84
Supervision Visits Safety
[Link] Refresher Training Fund, HR & Log, and 1200 150 150 150 150 150 150 150 150 $325,493.00
Safety
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 4.4: At least three Health staff from 10 180 90 90 Training re- Funding &
(3) health workers trained in state hospitals are ports, atten- HR avail-
MIYCN in every state hospital trained on MIYCN dance sheets able, Security
department in key relevant stable
departments (ANC, mater-
nity, OBGYN, pediatrics, OPD,
and IPD)

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

Output 4.4.1 : 3 Health staff Number of staff 180 90 90 Training re- Funding &
per departments on MIYCN trained at State hos- ports, atten- HR avail-
in state hospitals are trained pital on MIYCN dance sheets able, Security
stable
Output 4.4.2: Health staff are 80% of the trained 162 81 81 0 0 0 0 0 0 0 Supervision Funding &
implementing the MIYCN staffs are applying checklist and HR avail-
protocols correctly. the correct MIYCN reports able, Security
protocol stable
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
[Link] Training of the state Fund, HR & Log, and 180 90 90 $88,770.00
hospital staffs on MIYCN Safety
[Link] Conduct Supportive Fund, HR & Log, and 180 20 20 20 20 20 20 20 20 20 $82,400.27
Supervision Visits Safety
[Link] Refresher Training Fund, HR & Log, and 1395 135 180 180 180 180 180 180 180 $197,319.00
Safety
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 4.5: At least two Health staff from 37 444 148 148 148 Training re- Funding &
(2) health workers trained county hospitals are ports, atten- HR avail-
in MIYCN in every county trained on MIYCN dance sheets able, Security
hospital department in key stable
relevant departments (ANC,
maternity, OBGYN, pediat-
rics, OPD, and IPD)
ANNEX 1
 MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Output 4.5.1 : 2 Health staff Number of staff 444 148 148 148 Training re- Funding &
per departments on MIYCN trained at county hos- ports, atten- HR avail-
in state hospitals are trained pitals on MIYCN dance sheets able, Security
stable
Output 4.5.2: Health staff are 90% of the trained 400 133 133 133 Supervision Funding &
implementing the MIYCN staffs are applying checklist and HR avail-
protocols correctly. the correct MIYCN reports able, Security
protocol stable
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
[Link] Training of the county- Fund, HR & Log, and 444 148 148 148 $201,336.00
hospital staffs on MIYCN Safety
[Link] Conduct Supportive Fund, HR & Log, and 486 54 54 54 54 54 54 54 54 54 $302,387.79
Supervision Visits Safety
[Link] Refresher Training Fund, HR & Log, and 3256 222 370 444 444 444 444 444 444 $417,554.00
Safety
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 5: At least two (2) # of health workers 0 300 300 300 300 300 300 300 300 300 1. Training 1. Security MOH/UNICEF
health workers trained in implementing out- reports situation is
MIYCN In all health and nutri- reach activities trained 2. Training stable
tion outreach activities attendance 2. Funding is
sheets” available
3. Staff
turnover is
minimal”
Output 5.1: All health # of health workers of 0 300 300 300 300 300 300 300 300 300 1. Training 1. Security MOH/UNICEF
workers(CHW, EPI, MW, HWs trained reports situation is
nurses) implementing health 2. Training stable
and nutrition outreach facili- attendance 2. Funding is
ties trained sheets” available
3. Staff
turnover is
minimal”

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

ANNEX 1

75
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A N N EX 1
MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
5.1.1 Mobilise resources for 1. Technical staff 9 propos- 1 1 1 1 1 1 1 1 1 $217,000.00 1. Security MOH/
training health workers (pro- 2. Laptop als written situation is UNICEF
posals for donors) 3. Communication every year stable
costs 2. Funding is
4. Transport and available
logistics” 3. Staff
turnover is
minimal”
5.1.2 Prepare training materi- 1. Development of 90 10 10 10 10 10 10 10 10 10 $202,500.00 1. Security
als, allocate master trainers training guides costs situation is
to states stable
3. Communication 2. Funding is
costs available
3. Staff
turnover is
minimal”

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

5.1.3 Train health workers 1. Accommodation 2700 300 300 300 300 300 300 300 300 300 $7,665,300.00 1. Security MOH/
2. Allowances situation is UNICEF
3. Transport costs, stable
4. Venue costs” 2. Funding is
available
3. Staff
turnover is
minimal”
5.1.4 Compilation of training 1. Laptops 90 10 10 10 10 10 10 10 10 10 $0.00 1. Security MOH/
reports and dissemination 2. Human situation is UNICEF
Resources(central stable
coordinator focal 2. Funding is
person for reports). available
(charge to 5.1)” 3. Staff
turnover is
minimal”
2. Funding is available
3. Staff turnover is minimal” MOH/ UNICEF
5.1.5 Follow up and support 1. Supervision check- 25% of 75 75 75 75 75 75 75 75 75 $181,800.00 1. Security MOH/
supervision and mentorship lists development trained situation is UNICEF
to the trained health workers costs health stable
2. Accommodation workers 2. Funding is
3. Allowances followed available
up(1818) 3. Staff
4. Transport costs
5. Communication turnover is
costs” minimal”
ANNEX 1
 MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 6: At least 95% of the # of PHCC and 0 54 54 36 36 36 36 36 36 36 Supervision 1. Security MOH/
existing health facilities pro- Hospital practising the reports, situation is UNICEF
viding quality maternal health optimal BFHI Monthly stable
services (PHCCs and hos- reports 2. Funding is
pitals) practice the ten steps available
for successful breastfeeding 3. Staff
(BFHI) turnover is
minimal”
Output 6.1: PHCCs and # of PHCC and hos- 0 1111 1111 740 740 740 740 740 740 740 Training 1. Security MOH/
Hospital staff trained and pital trained and ac- reports situation is UNICEF
accredited in BFHI credited in BFHI(All stable
staff in the target 2. Funding is
facilities to receive available
training depend- 3. Staff
ing on roles and turnover is
responsibilities) minimal”
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
6.1.1 Mobilization of resourc- 1. Laptops 9 propos- 1 1 1 1 1 1 1 1 1 $0.00 1. Security MOH/
es for training PHCC and 2. Human Resources als written situation is UNICEF
Hospital staff on BFHI 3. Logistics and trans- every year stable
port costs 2. Funding is
4. Communication/ad- available
vocacy costs (charge 3. Staff
to 5.1)” turnover is
minimal”
6.1.2 Development and fi- 1. Laptops 1 Guideline 1 1 $47,176.18
nalization of standards and 2. Human Resources specifying
requirements) that is in line 3. Logistics and trans- accredita-
with SSD situation port costs tion stan-
dards for
4. Communication/ad- BFHI in SS
vocacy costs
6.1.2 Assessment of PHCC 1. Laptops 360 54 54 36 36 36 36 36 36 36 $1,800,000.00 1. Security MOH/
and hospitals as BFHI 2. Human Resources situation is UNICEF
3. Logistics and trans- stable
port costs 2. Funding is
4. Allowances” available
3. Staff
turnover is
minimal”

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

ANNEX 1

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A N N EX 1
MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
6.1.3 Preparation of train- 1. Training guides 7402 cop- 1111 1111 740 740 740 740 740 740 740 $148,040.00 1. Security MOH/
ing materials and solicit for 2. Transport costs ies guides situation is UNICEF
trainers 3. Communication devel- stable
costs” oped and 2. Funding is
printed available
3. Staff
turnover is
minimal”
6.1.4 Advocacy and orienta- 1. Human resources 360 54 54 36 36 36 36 36 36 36 $36,000.00 1. Security MOH/
tion of senior hospital and to liaise with PHCC situation is UNICEF
PHCC staff and hospital senior stable
staff 2. Funding is
2. Communication available
costs 3. Staff
3. Logistics and trans- turnover is
port costs” minimal”
6.1.5 Follow up and monitor- 1. Laptops 25% of 275 275 185 185 185 185 185 185 185 $184,500.00 1. Security MOH/

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

ing and mentorships at HFs 2. Human Resources trained situation is UNICEF
3. Logistics and trans- health stable
port costs” workers 2. Funding is
followed available
up(1845) 3. Staff
turnover is
minimal”
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 7: At least one (1) # of functional baby 10 200 200 200 200 200 200 200 200 200 Donor 1. There are 1. Nutrition
functional mother-baby friendly spaces in reports still popula- Cluster
friendly space with psycho- IDP camps per every tions residing 2. IOM
social support services (1: in block in IDP camps 3. NGOs
every block) is set up in all 2. Funding
sectors (blocks) in (IDPs/ 4. UNICEF”
is available
Refugees) camps to support
baby friendly
spaces
Output 7.1: All blocks have # of functional baby 10 200 200 200 200 200 200 200 200 200 Donor 1. There are 1. Nutrition
baby friendly spaces friendly spaces in IDP reports still popula- Cluster
camps per block tions residing 2. IOM
in IDP camps 3. NGOs
2. Funding 4. UNICEF”
is available
to support
baby friendly
spaces
ANNEX 1
 MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
7.1.1 Mobilise and secure 1. Human Resources 45 pro- 5 5 5 5 5 5 5 5 5 $0.00 1. There are 1. Nutrition
funds 2. Laptops posals(5 still popula- Cluster
3. Communication camps for tions residing 2. IOM
costs 9 years) in IDP camps 3. NGOs
4. Transport and lo- 2. Funding 4. UNICEF”
gistical costs (charge is available
to 5.1.1)” to support
baby friendly
spaces
7.1.2 Recruit and train staff 1. Salaries 50 staff 50 50 50 50 50 50 50 50 50 $90,000.00 1. There are 1. Nutrition
who will work in the baby 2. Training costs per year still popula- Cluster
friendly spaces tions residing 2. IOM
in IDP camps 3. NGOs
2. Funding 4. UNICEF”
is available
to support
baby friendly
spaces
7.1.3 Conduct situational as- 1. Human Resources 5 5 1. There are 1. Nutrition
sessments in IDP camps to 2. Laptops still popula- Cluster
come up with specific baby 3. Communication tions residing 2. IOM
friendly curricula for each costs in IDP camps 3. NGOs
region 2. Funding
4. Transport and lo- 4. UNICEF”
gistical costs (charge is available
to 6.1.2)” to support
baby friendly
spaces
7.1.4 Develop curricula for 1. Human Resources 1 5 $33,750.00 1. There are 1. Nutrition
guiding activities in the baby 2. Laptops curriculum still popula- Cluster
friendly spaces 3. Communication tions residing 2. IOM
costs in IDP camps 3. NGOs
4. Transport and lo- 2. Funding 4. UNICEF”
gistical costs is available
to support
baby friendly
spaces
7.1.5 Advocacy with block 1. Communication 200 200 200 200 $60,000.00 1. There are 1. Nutrition
leaders’ committees on es- costs Committees still popula- Cluster
tablishment of baby friendly 2. Transport and lo- tions residing 2. IOM
spaces gistics costs in IDP camps 3. NGOs
3. Human resourc- 2. Funding 4. UNICEF”
es to conduct the is available
advocacy” to support
baby friendly
spaces

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

ANNEX 1

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A N N EX 1
MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
7.1.6 Establish Baby friendly 1. Building supplies 200 baby 200 $1,200,000.00 1. There are 1. Nutrition
spaces and services friendly still popula- Cluster
2. Furniture spaces tions residing 2. IOM
3. Running in IDP camps 3. NGOs
expenses(toys, sta- 2. Funding 4. UNICEF”
tionery, IEC materials, is available
counselling cards etc) to support
baby friendly
spaces
7.1.7 Supportive monitor- Supervision checklist, 12 12 12 12 12 12 12 12 12 12 $2,160,000.00 1. There are 1. Nutrition
ing and supervision of baby logistics, allowance still popula- Cluster
friendly spaces and refreshment tions residing 2. IOM
in IDP camps 3. NGOs
2. Funding 4. UNICEF”
is available
to support
baby friendly
spaces

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 8: At least two (2) # of health workers 0 50 50 50 50 50 50 50 50 50 1. Training 1. There are 1. Nutrition
trained staff to support trained in each IDP reports still popula- Cluster
MIYCN services in all camps Camps 2. Training tions residing 2. IOM
(IDPs/Refugees) attendance in IDP camps 3. NGOs
sheets” 2. Funding 4. UNICEF”
is available
to support
baby friendly
spaces
Output 8.1:50 HF staff trained # of health workers 0 50 50 50 50 50 50 50 50 50 1. Training
in MIYCN every year in IDP trained in each IDP reports
camps Camps 2. Training
attendance
sheets”
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
8.1.1: Preparation for train- 1. Training guides 50 every 50 50 50 50 50 50 50 50 50 $0.00 1. There are 1. Nutrition
ing on MIYCN for HWs in IDP 2. Transport costs year still popula- Cluster
Camps 3. Communication tions residing 2. IOM
costs (same as in IDP camps 3. NGOs
7.4.1)” 2. Funding 4. UNICEF”
is available
to support
baby friendly
spaces
ANNEX 1
 MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
8.1.2 Training of HWs in IDPs 1. Training guides 50 every 50 50 50 50 50 50 50 50 50 $0.00 1. There are 1. Nutrition
on MIYCN 2. Accommodation year still popula- Cluster
3. Allowances tions residing 2. IOM
in IDP camps 3. NGOs
4. Transport costs
(same as 7.1.2) 2. Funding 4. UNICEF”
is available
to support
baby friendly
spaces
8.1.3: Conduct mentorship 1. Laptops 12 12 12 12 12 12 12 12 12 12 $0.00 1. There are 1. Nutrition
and follow up the IDP facili- 2. Human Resources still popula- Cluster
ties on MIYCN 3. Logistics and trans- tions residing 2. IOM
port costs (same as in IDP camps 3. NGOs
7.1.7)” 2. Funding 4. UNICEF”
is available
to support
baby friendly
spaces
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency
Verification
Output 9: At least 50% of # of infant and Young 0 2,606 2,606 2,606 2,606 2,606 2,606 2,606 2,606 2,606 Monthly 1. Security
infants and young children child in difficult cir- reports situation is
in difficult circumstances cumstances provided stable
(Low birth weight, HIV posi- with MIYCN services 2. Funding is
tive mothers, with medical and support in all the available
conditions, malformations, 10 greater states 3. Staff
abandoned, nodding) receive turnover is
support to achieve optimal minimal”
infant and young child feed-
ing practices.
Output 9.1: Infant and young # of infant and Young 0 2,606 2,606 2,606 2,606 2,606 2,606 2,606 2,606 2,606 Monthly 1. Security
children with MIYCN difficul- child in difficult cir- reports situation is
ties received supports for cumstances provided stable
optimal infant and young with MIYCN services 2. Funding is
child feeding practices and supports available
3. Staff
turnover is
minimal”
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
9.1.1 Advocate that hospi- 1. Human Resources 360 54 54 36 36 36 36 36 36 36 $0.00 1. Security
tals, PHCC and communi- 2. Logistical and situation is
ties are BFHI accredited(SS transport resources stable
standards) (charged to 6.1.4) 2. Funding is
available
3. Staff

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

turnover is
minimal”
ANNEX 1

81
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A N N EX 1
MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
9.1.2 Equip and train health 1. Human Resources 10102 1411 1411 1040 1040 1040 1040 1040 1040 1040 $0.00 1. Security
workers to be able to support 2. Logistical and situation is
children with difficulties transport resources stable
3. Accommodation 2. Funding is
4. Training guides available
(charged to 5.1.3 and 3. Staff
6.1.5) turnover is
minimal”
9.1.3 Community health 1. Human resources 67008.00 7,445 7,445 7,445 7,445 7,445 7,445 7,445 7,445 7,445 $0.00 1. Security
workers trained to be able to 2. Training costs situation is
counsel and refer mothers (charge to MIYCN stable
of babies with difficulties to trainings in objec- 2. Funding is
PHCU/PHCC/Hospital tive 4) available
3. Staff
turnover is
minimal”
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead Agency

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

Verification
Output 10: 100% of pregnant % of PLW access- 0 100% 100% 100% 100% 100% 100% 100% 100% 100% 1. Counselling 1. Security MOH
and lactating mothers ac- ing counselling and reports situation is
cess to nutrition support and support through 2. Donor favourable
counselling services through community health reports
the community, health pro- promoters, mother
moters, mother support support groups,
groups and health facilities, health facilities
and any other group.
Output 10.1: All PLW access % of PLW access- 0 100% 100% 100% 100% 100% 100% 100% 100% 100% 1. Counselling 1. Security MOH
support and counselling ing counselling and reports situation is
services through community support through 2. Donor favourable
health promoters, mother community health reports
support groups, health promoters, mother
facilities support groups,
health facilities
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of
Verification
10.1.1 Train health facility 1. Human Resources 10102 1411 1411 1040 1040 1040 1040 1040 1040 1040 $0.00 1. Security MOH
workers how to counsel and 2. Logistical and situation is
support all PLW transport resources favourable
3. Accommodation
4. Training
guides(charged to
5.1.3 and 6.1.5)
ANNEX 1
 MIYCN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
10.1.1 Train community 1. Human resources 67,008 7,445 7,445 7,445 7,445 7,445 7,445 7,445 7,445 7,445 $0.00 1. Security MOH
health promoters on how to to conduct trainings situation is
counsel and support mothers 2. Training allow- favourable
ances for commu-
nity health workers
(charged to 9.1.3)
10.1.2 Develop IEC materials 1. Human resources Media 1 1 1 1 1 1 1 1 1 $34,300,000.00 1. Security MOH
to be used for advocacy to to develop IEC materi- campaign situation is
promote and support optimal als and media cam- (1 media favourable
MIYCN paigns materials campaign
(Radio, TV, etc) every
2. Trials, pretesting year)
costs
3. Printing and pub-
lishing IEC materials”
10.1.3 Distribute IEC 1. Human resources 6,939,900 771,100 771,100 771,100 771,100 771,100 771,100 771,100 771,100 771,100 0 1. Security MOH
materials (charge to 9.1.3) situation is
favourable
10.1.4 Commemorate World 1. WBW IEC materials 720 80 80 80 80 80 80 80 80 80 $7,200,000.00 1. Security MOH
breastfeeding week in each 2. Communication situation is
80 counties of the greater costs for WBW favourable
10 states 3. Costs for
campaigns”
10.2.1 Procure counselling 1. Printing counsel- 77,110 8,562 8,562 8,562 8,562 8,562 8,562 8,562 8,562 8,562 $377,839.00 1. Security MOH
cards and other job aids for ling cards and job aids situation is
community health workers for community health favourable
workers

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

ANNEX 1

83
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A N N EX 1
MICRONUTRIENT
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025

Objectives Outcomes Baseline 2017 (%) 2018 (%) 2019 (%) 2020 (%) 2021 (%) 2022 (%) 2023 (%) 2024 (%) 2025 (%) Means of Assumptions Lead
(%) Verification Agency
GOAL: To strengthen the Early Initiation of 48 51 54 57 60 63 66 69 72 75
health status of the popula- Breastfeeding
tion by improving the health Exclusive 45.0 47.8 50.6 53.3 56.1 58.9 61.7 64.4 67.2 70.0
and nutritional status of Breastfeeding
mothers, infants, and young (from 0 to less
children and their wellbeing than 6 months)
through an effective deliv- Continued breast- 38.0 40.4 42.9 45.3 47.8 50.2 52.7 55.1 57.6 60.0
ery of the basic package of feeding up to 2
health and nutrition services years of age 1. Country sta-
(BPHNS). bility allows for
Timely introduc- 21.0 24.2 27.4 30.7 33.9 37.1 40.3 43.6 46.8 50.0
tion of comple- the full imple-
mentary foods 1. National mentation 2.
Health and Resources
Minimum Dietary 18.0 20.4 22.9 25.3 27.8 30.2 32.7 35.1 37.6 40.0 1. MOH
Nutrition (financial and
Diversity (6 to 23 and
Survey 2. human) are

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

months) partner
SMART available to
MAIN OBJECTIVE: To reduce Low Birth Weight 5.0 4.7 4.3 4.0 3.7 3.3 3.0 2.7 2.3 2.0 agencies
surveys meet require-
the burden of malnutrition in Childhood 31.0 29.9 28.8 27.7 26.6 25.4 24.3 23.2 22.1 21.0 3. KAP surveys ments 3.
pregnant and lactating moth- Stunting MIYCN remains
ers by 20%, and stunting in Childhood wasting 23.0 21.9 20.8 19.7 18.6 17.4 16.3 15.2 14.1 13.0 a Government
children under five years of priority
age by 10% by year 2025 Childhood obesity -
Anemia in women -
of reproductive
age
Body Mass Index -
for women
Objective 3: To provide es- Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead
sential micronutrient supple- Verification Agency
mentation support to the
population at risks
Output 1: At least 25% of the Number of ado- 62,540 64,418 66,296 68,174 70,052 71,930 73,808 75,686 77,564 Monthly nutri- Security is okay WFP
total number of adolescent lescent girls and tion reports to allow ac-
girls, pregnant and lactat- PLW received tivities to take
ing women receives forti- fortified food . place
fied food
Output 1.1 Community and Advocacy meet- 0 160 160 160 160 160 160 160 160 160 Bi-annual Security is okay IPS
local leaders enlightened ings held with MIYCN meeting to allow ac-
about services for PLWs community and reports tivities to take
local leaders place
ANNEX 1
 MICRONUTRIENT
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Output 1.2: Capacity of Number of health/ 0 160 ToTs 2610 2106 2106 160 2610 2610 2106 2106 Training report
community health workers Nutrition work- then roll
enhanced to provided quality ers trained on to coun-
services to PLWs micronutrient ty= 2610
supplementa- Doctors,
tion for PLWs and nurses,
adolescents midwives
and CO)
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
1.1.1 Mobilization communi- Cash/HR/Logistic 720 80 80 80 80 80 80 80 80 80 $720,000.00
ties and hold advocacy meet- support
ings on MIYCN (1 meeting
each with local leaders the
county level)
1.1.3 Procurement and distri- Cash/HR/Logistic 28371.06 2814.3 2898.81 2983.32 3067.83 3152.34 3236.85 3321.36 3405.87 3490.38 WFP
bution of CSB++ support
1.1.4 Monitoring and Data collection 54= 378 52 378 378 378 378 378 378 378 378 $0.00
reporting and reporting hospital
tools (charge to and PHCC
supportive super-
vision for health
facilities in the
MIYCN sections)
1.2.1 Training of health care Cash and HR 4212 468 468 468 468 468 468 468 468 468 $0.00
providers on CSB++ distribu- (charge to MIYCN,
tion we recommend package objective 4)
it in MIYCN
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead
Verification Agency
Output 2: All children aged No of children 179,415 184,797 190,341 196,052 201,933 207,991 214,231 220,658 227,278 NID reports
six to 59 months receive the 6-59 months sup-
recommended dosage of plemented with
Vitamin A every six months vitamin A twice
a year
Output 2.1:Children 6-59 No of children 179,415 184,797 190,341 196,052 201,933 207,991 214,231 220,658 227,278 NID reports
months received vitamin A 6-59 months sup-
supplementation twice a year plemented with
vitamin A twice
a year
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
2.1.1 Procurement of vitamin Cash/Logistics 4665 518 518 518 518 518 518 518 518 518 $39,745.00
A capsules (tins) for 6 to 11
months
2.1.2 Procurement of vitamin Cash/Logistics 63324 7036 7036 7036 7036 7036 7036 7036 7036 7036 $663,002.00
A capsules (12 to 59 months)

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

2.1.3 community mobilization Cash/HR (charge 1440 160 160 160 160 160 160 160 160 160 $0.00
(2 per county) to MIYCN section)
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A N N EX 1
MICRONUTRIENT
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
2.1.3 Training of community Cash/HR (charge 43398 4272 4400 4532 4668 4808 4952 5101 5254 5411 $0.00
health volunteers of vitamin to MIYCN section)
A supplementation
2.1.3 Transportation and dis- Cash 90 10 10 10 10 10 10 10 10 10 $90,000.00
tribution of vitamin A cap-
sules (per state/year)
2.2.1 Monitoring and sup- Cash/HR (charge 18 2 2 2 2 2 2 2 2 2 $0.00
portive supervision during to MIYCN section)
implementation
2.2.2 Reporting on vitamin A Cash/HR (charge 18 2 2 2 2 2 2 2 2 2 $0.00
to MIYCN section)
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead
Verification Agency
Output 3: All children aged # of children 12 1,583,069 1,630,561 1,679,478 1,729,862 1,781,758 1,835,211 1,890,267 1,946,975 2,005,385
12 to 59 months receive at to 59 months who
least two doses of deworm- received deworm-
ing medication every six ing tablets

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

months
Output 3.1:Children 12-59 # of children 12 1,583,069 1,630,561 1,679,478 1,729,862 1,781,758 1,835,211 1,890,267 1,946,975 2,005,385 NID reports
months received deworm- to 59 months who
ing tablets twice a year six received deworm-
months apart ing tablets
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
3.1.1 Procurement Cash 321,651 31,661 32,611 33,590 34,597 35,635 36,704 37,805 38,940 40,108 $800,910.00
of deworming
tablets(Albendazole)
3.1.2 Training of community Cash (charge to 69,924 6,883 7,089 7,302 7,521 7,747 7,979 8,219 8,465 8,719 $0.00
health workers MIYCN section)
3.1.3 Transportation and dis- Cash 90 10 10 10 10 10 10 10 10 10 $9,000.00
tribution of the tablets
3.2.1 Community mobiliza- 18 2 2 2 2 2 2 2 2 2
tion and advocacy
3.2.2 Reporting and moni- 18 2 2 2 2 2 2 2 2 2
toring and supportive
supervision
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead
Verification Agency
Output 4: All children, aged Number of chil- 4064405 422152 434816 435196 447872 448632 461331 462472 475205 476728
six to 59 months , in the dren 6-59 months
high-burden areas receive that received
micronutrient supplementa- MNPs
tion (MNPs)
ANNEX 1
 MICRONUTRIENT
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Output 4.1: Children living inNumber of 1 1 1 1
high burden areas receive baseline survey
MNPs conducted on
MIYCN- national
wide (Integrated
in the national
health and nutri-
tion survey)
Output 4.2: All children (60% No of children 4064405 422152 434816 435196 447872 448632 461331 462472 475205 476728
of Children 6-23 )months in 6-23 months
high burden states received supplemented
MNPS with MNPs
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
4.1.1 Conduct a baseline Cash, HR, 1 1 $0.00
survey for micronutrients Logistics (charge
deficiency to policies and
systems line for
surveys)
4.1.2 Advocacy and commu- Cash, HR, 18 2 2 2 2 2 2 2 2 2 $0.00
nity mobilization meetings Logistics (charge
to MIYCN section)
4.1.3 Training of commu- Cash, HR, 4,212 468 468 468 468 468 468 468 468 468 $0.00
nity Health workers on MNP Logistics (charge
supplementation to MIYCN section,
objective 4)
4.1.4 Monitoring and supervi- 18 2 2 2 2 2 2 2 2 2 $0.00
sion (what is 2?)
4.1.5 Procurement of MNPs Cash and logistic 16257620 1688606 1739265 1740784 1791488 1794529 1845324 1849889 1900821 1906913 $11,542,000.00
4.1.6 Distribution of MNPs Trained staff, 16257620 1688606 1739265 1740784 1791488 1794529 1845324 1849889 1900821 1906913 $0.00
(distribution by pack? Or by cash, logistics
state? By county?)
4.1.6 Develop IEC materials Technical team, 45 5 5 5 5 5 5 5 5 5 $0.00
cash (charge to
MIYCN section
on development
of IEC)
4.3.2 Micronutrient survey to Cash, HR, 1 1 $0.00
establish impact of MNPs Logistics (charge
to policies and
systems line for
surveys)

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MICRONUTRIENT
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead
Verification Agency
Output 5: All pregnant Number of PLWs 0 562869 562869 562869 562869 562869 562869 562869 562869 562869
women receive Iron/Folic received MNTs
Acid supplementation for the
duration of pregnancy
Output 5.1:At least 60% PLW Number of PLWs 0 562869 562869 562869 562869 562869 562869 562869 562869 562869
are supplemented with MNTs received MNTs
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
5.1.1 Supplement PLW with MNTs, 562,869 562,869 562,869 562,869 562,869 562,869 562,869 562,869 562,869 $0.00
MNT cash,logistics
5.1.2 Procurement of Iron/ Cash and logistics 455,924 50,658 50,658 50,658 50,658 50,658 50,658 50,658 50,658 50,658 $5,927,000.00
Folic/MNTS
5.1.3 Distribution of MNT to Cash and logistics 90 10 10 10 10 10 10 10 10 10 $90,000.00
the state
5.1.4 Training of Community Trainers, Cash, 4,212 468 468 468 468 468 468 468 468 468 $0.00
health workers on MNT Logistics (charge

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

to MIYCN section,
objective 4)
5.1.5 Monitoring and Supervision 36 4 4 4 4 4 4 4 4 4 $0.00
supervision forms, HR, cash
and logistics
(charge it to
MIYCN section)
5.1.6 Develop IEC materials Technical team 45 5 5 5 5 5 5 5 5 5 $0.00
& cash, logis-
tics (charge it to
MIYCN section
4 under devel-
opment of IEC
materials)
5.1.7 Micronutrient survey Cash, trained 3 1 1 1 $0.00
to establish impact of MNT team, logistics
supplementation (charge it to poli-
cies and systems)
integrated in the
national health
and nutrition
survey
ANNEX 1
 MICRONUTRIENT
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
Indicators Baseline 2017 2018 2019 2020 2021 2022 2023 2024 2025 Means of Assumptions Lead
Verification Agency
Output 6: National fortifica- Number of forti-
tion and importation regu- fied food checked
lations of fortified staple and satisfied
products are developed by Bureau of
standards
Output 6.1: staple products # of sample prod- 0 0 0 0 0 10 10 10 10 1 Report from
fortified ucts fortified survey
Output 6.2:90% Household % of HHs utilizing 0
in south Sudan utilise io- iodised salt
dized salt
Activities: Inputs/resources Target 2017 2018 2019 2020 2021 2022 2023 2024 2025 Cost
6.1.1 see activities under poli-
cies and systems
6.2.1 train each state in con- Cash, resource 90 10 10 10 10 10 10 10 10 10 $450,000.00
ducting salt iodization test persons, logistics,
(10 inspectors per state)
6.2.2 Produce IEC materials Charge to MIYCN $0.00
and other campaign materi- section under
als to sensitize people on the the development
use of iodized salt of IEC materials
and campaign
materials
6.2.3 inspections in markets Cash, 8640 960 960 960 960 960 960 960 960 960 $864,000.00
and store (12 inspections per logistics,tools
year per county)
6.2.3 Annual review and plan- Cash, 90 10 10 10 10 10 10 10 10 10 $180,000.00
ning at the state level with the logistics,tools,
inspectors venue

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

ANNEX 1

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A N N EX 1
SUMMARY OF IMPLEMENTATION PLAN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025

COMPONENT AVERAGE COST BY YEAR (USD) TOTAL COST (USD)

2017 2018 2019 2020 2021 2022 2023 2024 2025
Objective 1:POLICY AND SYSTEMS
Output 1 $24,539 $24,539 $24,539 $24,539 $24,539 $24,539 $24,539 $24,539 $24,539 $220,848
Output 2 $3,469 $3,469 $3,469 $3,469 $3,469 $3,469 $3,469 $3,469 $3,469 $31,225
Output 2.1 $927 $927 $927 $927 $927 $927 $927 $927 $927 $8,339
Output 3 $2,721 $2,721 $2,721 $2,721 $2,721 $2,721 $2,721 $2,721 $2,721 $24,487
Output 4 $134,646 $134,646 $134,646 $134,646 $134,646 $134,646 $134,646 $134,646 $134,646 $1,211,814
Output 5 $68,482 $68,482 $68,482 $68,482 $68,482 $68,482 $68,482 $68,482 $68,482 $616,341
Output 6 $13,425 $13,425 $13,425 $13,425 $13,425 $13,425 $13,425 $13,425 $13,425 $120,827
Output 7 $6,546 $6,546 $6,546 $6,546 $6,546 $6,546 $6,546 $6,546 $6,546 $58,917

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

SUBTOTAL $248,209 $248,209 $248,209 $248,209 $248,209 $248,209 $248,209 $248,209 $248,209 $2,233,881

COMPONENT AVERAGE COST BY YEAR (USD) TOTAL COST (USD)

2017 2018 2019 2020 2021 2022 2023 2024 2025
Objective 2: MIYCN
Output 1 $158,529 $158,529 $158,529 $158,529 $158,529 $158,529 $158,529 $158,529 $158,529 $1,426,761
Output 2 $438,302 $438,302 $438,302 $438,302 $438,302 $438,302 $438,302 $438,302 $438,302 $3,944,717
Output 3 $1,073,383 $1,073,383 $1,073,383 $1,073,383 $1,073,383 $1,073,383 $1,073,383 $1,073,383 $1,073,383 $9,660,450
Output 4 $0 $0 $0 $0 $0 $0 $0 $0 $0
Output 4.1 $263,773 $263,773 $263,773 $263,773 $263,773 $263,773 $263,773 $263,773 $263,773 $2,373,954
Output 4.2 $410,371 $410,371 $410,371 $410,371 $410,371 $410,371 $410,371 $410,371 $410,371 $3,693,343
Output 4.3 $48,505 $48,505 $48,505 $48,505 $48,505 $48,505 $48,505 $48,505 $48,505 $436,548
Output 4.4 $40,943 $40,943 $40,943 $40,943 $40,943 $40,943 $40,943 $40,943 $40,943 $368,489
Output 4.5 $102,364 $102,364 $102,364 $102,364 $102,364 $102,364 $102,364 $102,364 $102,364 $921,278
Output 5 $918,511 $918,511 $918,511 $918,511 $918,511 $918,511 $918,511 $918,511 $918,511 $8,266,600
Output 6 $246,191 $246,191 $246,191 $246,191 $246,191 $246,191 $246,191 $246,191 $246,191 $2,215,716
Output 7 $393,750 $393,750 $393,750 $393,750 $393,750 $393,750 $393,750 $393,750 $393,750 $3,543,750
Output 8 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0
Output 9 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0
Output 10 $4,653,093 $4,653,093 $4,653,093 $4,653,093 $4,653,093 $4,653,093 $4,653,093 $4,653,093 $4,653,093 $41,877,839
ANNEX 1
 SUMMARY OF IMPLEMENTATION PLAN
REPUBLIC OF SOUTH SUDAN - MATERNAL, INFANT AND YOUNG CHILD NUTRITION - COSTED IMPLEMENTATION PLAN 2017-2025
SUBTOTAL $8,747,716 $8,747,716 $8,747,716 $8,747,716 $8,747,716 $8,747,716 $8,747,716 $8,747,716 $8,747,716 $78,729,445

COMPONENT AVERAGE COST BY YEAR (USD) TOTAL COST (USD)

2017 2018 2019 2020 2021 2022 2023 2024 2025
Objective 3: MICRONUTRIENTS
Output 1 $80,000 $80,000 $80,000 $80,000 $80,000 $80,000 $80,000 $80,000 $80,000 $720,000
Output 2 $88,083 $88,083 $88,083 $88,083 $88,083 $88,083 $88,083 $88,083 $88,083 $792,747
Output 3 $89,990 $89,990 $89,990 $89,990 $89,990 $89,990 $89,990 $89,990 $89,990 $809,910
Output 4 $1,282,444 $1,282,444 $1,282,444 $1,282,444 $1,282,444 $1,282,444 $1,282,444 $1,282,444 $1,282,444 $11,542,000
Output 5 $668,556 $668,556 $668,556 $668,556 $668,556 $668,556 $668,556 $668,556 $668,556 $6,017,000
Output 6 $166,000 $166,000 $166,000 $166,000 $166,000 $166,000 $166,000 $166,000 $166,000 $1,494,000
SUBTOTAL $2,375,073 $2,375,073 $2,375,073 $2,375,073 $2,375,073 $2,375,073 $2,375,073 $2,375,073 $2,375,073 $21,375,657

Total for the 9 years $102,338,983

Annual requirement $11,370,998

Cost person per person/year (ToT Population) $0.97

Investment per Pregnant woman, mother of infant less than 6 months and child less than 5/year (27 % of the Total Population) $3.59

Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

ANNEX 1

91
 NOT ES

92 Maternal, Infant and Young Child Nutrition (MIYCN) Strategy

 Big Yellow Taxi was
responsible for art
direction and design.
[Link]