MOST Country Programs

D.R. Congo
MOST’s initiative in the Democratic Republic of the Congo consists primarily of technical assistance and support for vitamin A supplementation conducted by the National Micronutrient Program in the Ministry of Health. MOST works as a collaborating partner with the MOH in these efforts, along with UNICEF, SANRU (Projet de Soins de Santé Primaires en Milieu Rural/Rural Primary Health Care Project), and Catholic Relief Services. MOST will also focus its technical assistance efforts on anemia reduction through a review of anemia components in the current national nutrition policy for vulnerable populations and the formulation of recommendations for specific interventions to address demonstrated needs throughout the country.

MOST is providing technical and implementation support to the Ministry of Health in the development of a national micronutrient program. The program is a cooperative effort between the MOH, USAID/Ethiopia, MOST, and UNICEF. Program components include strengthening of the newly formed nutrition division at the MOH and the micronutrient committee; development of a locally designed vitamin A supplementation strategy and its pilot test; support for initial trials of vitamin A sugar fortification in one of the country's four sugar factories; and support for information, education, and communication activities.

MOST provides technical and financial assistance to the Nutrition Unit of the Ministry of Health to strengthen the national vitamin A deficiency control program, especially efforts to scale up the vitamin A capsule distribution program to be national in scope. This assistance addresses the promotion component of the program, program monitoring and evaluation, and development of training materials for the regional and district levels. Activities have focused on vitamin A capsule supplementation, including vitamin A capsule distributions as part of NIDs and as stand-alone distributions. MOST is also assisting in the development of an anemia control strategy and food-based approaches to the reduction of micronutrient deficiencies.

MOST is providing assistance to the Ministry of Health in the development of a national vitamin A program. MOST supported a national vitamin A deficiency and anemia prevalence survey carried out in October 2000. A series of workshops were conducted in collaboration with the World Bank’s SECALINE project, UNICEF, and USAID/Madagascar in 2001 to disseminate the data and results from this and other recent surveys to government health managers in the provinces. MOST provided technical assistance and funding to develop, translate, and air vitamin A-related radio spots on national and local radio stations throughout the country prior to the vitamin A capsule distribution that took place in the fall of 2001.

South Africa
MOST is working with counterparts at the University of the Western Cape (UWC) to support and strengthen a new vitamin A supplementation program being started by the Department of Health in Eastern Cape province. MOST is also supporting a pilot initiative by UWC that aims to incorporate micronutrient interventions into the Eastern Cape Integrated Nutrition Program.

MOST provides technical assistance in vitamin A supplementation, food-based activities, and anemia prevention and control. In collaboration with the USAID DISH project, MOST has provided assistance in IEC and training workshops for semiannual vitamin A capsule distributions. MOST and the Department of Food Science and Technology, Makerere University, are developing an inventory of local manufacturers of cereal, oil, sugar, and diary products to determine the feasibility of food fortification. MOST, NARO (National Agricultural Research Organization), and VEDCO (Volunteer Efforts for Development Concerns) are implementing a project that promotes the growth and utilization of the vitamin A-rich, orange-fleshed sweet potato. The aim of the project is to improve the nutritional status of children and women, household food security, and income. MOST is working with the MOH to develop an anemia prevention and control advocacy plan.

In Zambia, MOST provides assistance in vitamin A supplementation and sugar fortification activities. The micronutrient program in Zambia utilizes a Child Health Week strategy, which allows for routine periodic (twice-yearly) provision of vitamin A capsules and provides the opportunity to include other child survival interventions that require scheduled or routine provision to be effective (deworming, immunizations, anemia screening, etc.). MOST has provided assistance in the development of IEC and training materials for vitamin A supplementation and in the design and implementation of observations of capsule providers and exit interviews with caregivers during vitamin A capsule distributions and household-based mini-surveys after distributions. MOST is currently assisting in the establishment of an evaluation and monitoring system for the country's sugar fortification program and continues to provide assistance to the MOH in the enforcement of the legislation mandating sugar fortification.

MOST is collaborating with others in the design and implementation of a pilot program that will feed 19,000 families vitamin A- and iron-fortified atta (wheat flour) for six months. The program will use World Food Programme wheat from the Vulnerable Group Development program under the Ministry of Women of the Government of Bangladesh. The Institute of Food and Nutrition, Dhaka University, will monitor the quality of atta.

MOST is working in collaboration with state governments, CARE, and UNICEF to support vitamin A supplementation activities in the states of Uttar Pradesh and Jharkhand. In Uttar Pradesh, MOST is supporting CARE in a vitamin A/measles immunization program that will expand to cover 11 districts. In Jharkhand, MOST and UNICEF are joint partners with the Government of Jharkhand in the implementation of vitamin A supplementation as an entry point for strengthening immunization activities.

In Morocco, MOST supports the Ministry of Health’s micronutrient program through three main activities: supplementation, food fortification, and the enlisting of health workers in community education. MOST provided assistance for the development of an aggressive training plan with new educational materials and strategies to train health workers throughout the nation on the benefits of micronutrients, particularly vitamin A, and in interpersonal communication techniques. This training began in the fall of 2001 and will continue until all health personnel involved are trained throughout the country. MOST also provided assistance in the preparation of a technical dossier on wheat flour fortification that was submitted to and approved by the government. MOST is funding one of the major universities to conduct stability studies to determine the optimum conditions for fortifying cooking oil with vitamin A.

MOST supports the work of NTAG, a local technical assistance group that implements a successful vitamin A capsule distribution program covering most districts of the country. This program has female community health volunteers distribute supplements on the same four days every year (two days for the first distribution and two for the second). The success of the program is largely attributed to the pride of ownership in the program established by this cadre of female community health volunteers. In addition, mini-surveys are used to measure coverage and provide feedback to managers and the volunteers.

MOST provides technical and implementation assistance for the Department of Health's food fortification strategy, whose goal is to meet 50 percent of the dietary requirements of iron, iodine, and vitamin A for women and preschool-aged children. Public-private partnership plays a central role in the strategy. MOST support focuses on strengthening the managerial and monitoring capacity of the DOH Bureau of Food and Drugs for more efficient program implementation and quality assurance; provision of technical assistance to private and government factories for the fortification of flour, sugar, and oil with vitamin A and rice with iron; development and implementation of a comprehensive communications plan to facilitate marketing and increase consumption of fortified foods; and the development of legislative and surveillance systems to secure enforcement at all levels. Institutional partners include the Food and Nutrition Research Institute, the Nutrition Center of the Philippines, the National Food Authority-Food Development Center, and Helen Keller International.

El Salvador
El Salvador has successfully reduced vitamin A and iodine deficiencies and will continue to maintain high coverage rates of sugar fortification with vitamin A, wheat flour fortification with iron and B-vitamins and salt iodization, and strengthening micronutrient (vitamin A, iron/folate) supplementation activities. Corn flour fortification with iron and B-vitamins is also contemplated. The Government of El Salvador has now assigned a high priority to anemia prevention and control and MOST is providing technical assistance in this effort. Activities focus on improving the iron/folate supplement supply and distribution system and expanding the existing nutrition education program to address iron deficiency anemia. A specific person-to-person education component is being developed that will focus on anemia prevention and control, which will be implemented in the context of ongoing health system reform, decentralization and expansion of Integrated Management of Child Illness and Integrated Child Care services.

In Nicaragua, MOST has provided technical assistance to the sugar industry and the Ministry of Health in universal sugar fortification with vitamin A, including training of both industry and MOH staff in the establishment and laboratory methods of quality assurance and control and monitoring systems for sugar fortification. MOST has provided assistance in micronutrient training courses for health personnel and support for the integration of micronutrient education into the training curricula for health and medical staff. MOST also provided technical and financial assistance to carry out a national micronutrient survey in 2000. Results of the survey are used for policy decisions and formulation of the second five-year micronutrient plan.

Work in collaboration with others includes the following:
With UNICEF, MOST has supported the design and implementation of two national informational campaigns to the consumer about the benefits of vitamin A fortification.
--With CDC, MI, and INCAP, MOST is providing assistance in the development of a micronutrient monitoring and evaluation and surveillance system.