Reducing Persistent Chronic Malnutrition in Children in Mongolia :
Mongolia
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Summary
Reducing Persistent Chronic Malnutrition in Children in Mongolia :
Mongolia
Timetable
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Financing Plan and Loan Utilization
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Project Outcome
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Implementation Progress
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Status of Covenants
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Grant Name
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Reducing Persistent Chronic Malnutrition in Children in Mongolia |
| Country |
Mongolia |
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Grant Number
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9131 |
| Project Number |
42155- 01 |
| Sector/Subsector |
/ Multisector
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| Gender Mainstreaming Category |
Some gender benefits
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| Linkage to Country/Regional Strategy |
The project is in line with the development agenda for inclusive economic growth of ADB's long-term strategic framework 2008–2020 (Strategy 2020) and supports the Mongolia country partnership strategy pillar of inclusive social development. The proposed Project is consistent with the health, nutrition, and social protection priority sector of the country operations business plan 2008–2010. The CPS update for Mongolia (2007-2009) confirmed a priority focus on poverty reduction and MDGs. The health road map of the CPS (2009–2013), in preparation, identifies persistent chronic malnutrition among children (stunting) and disparities in nutritional status between urban and rural areas as important issues in Mongolia. The Government Health Sector Master Plan (2006-2015) identifies nutrition as a priority issue and makes the improvement of the nutritional status of the population, particularly micronutrient status among children and women, part of the overall outcomes to be attained until 2015. |
| Project Outcome |
| Outcome |
Progress Toward Outcome |
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Availability, awareness and demand for micronutrients increased in project areas.
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19 trainings on Community Based Integrated Management of Child Illness (C-IMCI) were conducted in the project target areas between July-August 2012 covering 559 primary health care workers particularly the bag feldshers, nurses at family health centers, and soum health centers (SHCs). As a result, 79.6 percent of the target group has received the C-IMC training.
In accordance with WHO recommendation, C-IMCI training has 2 parts such as providing knowledge and skill and evaluation of C-IMCI or follow up training. The follow up training wil be conducted in late October 2012. Follow up Training of Community Based Integrated Management of Child Illness handbook for facilitators has been developed by the C-IMCI team.
Targeted bag and soum feldshers were provided with standard child growth measuring equipments such as 224 scales for children and mother, 340 hanging scales, 340 children weigthing pants, 262 wooden height measurement, and 472 bedding height measurement in accordance with distribution schedule approved by decree of Minister of Health on 2 July 2012.
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| Implementation Progress |
| Outputs and Timeframe |
Status of Implementation
Progress (Outputs, Activities and Issues) |
Component A: Analysis of obstacles in addressing chronic child malnutrition, and policy recommendations
Component B: Approaches (methods, products and services) to reduce chronic malnutrition in mothers and children
Subcomponent B.1: Delivery of nutrition improvement approaches by primary health care workers in all project areas
Subcomponent B.2: Informed, tailor-made IEC/BCC methods, materials and activities for improved mother and child nutrition, developed and implemented
Subcomponent B.3: Pilot approaches for increased access to mother and child nutrition generated and supported, and delivered through MOH partners in selected project areas, and tested
Component C: Development and institutionalization of formal undergraduate and graduate PHN training
Component D: Project management and health policy development
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Additional 19 C-IMCI training was conducted to reach 70% of target health workers in project areas. The guidelines for conducting follow-up on the job C-IMCI training was developed by the C-IMCI team and approved by MOH. The C-IMCI team conducted the training for trainers on 24-28 November 2012 for 28 participants from the project target areas. The follow-up on the job training has started in the project target areas. The first training was conducted on 21-29 December 2012 in Gobi-Altai aimag. The rest of the training will be conducted in January 2013.
The EA distributed the second batch of micronutrients for children and women to the target areas. The project technical working group recommended procuring additional MMPs in 2013 using the remaining funds of the project. The MOH submitted to ADB a request to procure 3.3 million sachets of MMPs for children.
As of end 2012, totally 48900 children with duplicated number received the MMP (22,400 in 2011, and 26,500 in 2012).
The community based IMCI training was organized in the project areas covering 79.6 % of target health care workers.
Follow-up on-the-job training aims to reach at least 300 out of 1159 health workers of the project target areas, who have attended the C-IMCI training.
The New Public Health Association was recruited by the MOH to carry out the campaign. The campaign strategy was developed and approved by MOH. The 1st campaign has been carried out in the project target areas. The 2nd campaign has started in the target areas since December 2012.
Eleven pilot approaches were identified by MOH, from which 8 are on the final stage of their implementation. One pilot approach implementation has been completed.
The draft curriculum was developed by the HSU team with technical support from WHO expert.
The project team started to work on the draft policy recommendations based on the outcome of the pilot approaches which have been completed.
M&E system was developed in the first year of the project, adnt he M&E specialist keeps it updated.
The project team started to prepare summary documentation of the pilot approaches which have been completed.
The project team started to work on draft guidelines and policies based on the outcome of the pilot approaches which have been completed.
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| Geographical Location |
Arkhangai, Dundgov, Gobi ALtai, Sukhbaatar and Tuv aimags, and Chingeltei and Songinokhairkhan districts of Ulaanbaatar city |
Safeguard Categories
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| Environment |
C |
| Resettlement |
C |
| Indigenous People |
C |
| Summary of Environmental and Social Issues |
Four percent and 27.3% of the population in the project aimags and districts are poor respectively. 51.4% of target population are women and 28.7% are children under 16. In addition to the resident population, primary health care service providers in the project locations will benefit greatly from the Project. It is estimated that about 1,200 doctors and mid-level health personnel in the project aimags will benefit directly.
Key social issues related to improved nutrition outcomes identified in the social analysis include: The need for extensive public information campaigns: To modify negative beliefs and attitudes (low quality and for the poor) among the population about primary health services and to counter the perception that good services are only provided by specialists in hospitals, extensive outreach is needed. The need for public health and health education programs: To improve community and local government involvement. Importance of and need for preventive health services: FGPs must provide preventive services rather than curative services including health promotion and protection. Clients expressed greater need for preventive health services. They agree that receiving preventive services will prevent them from illness and from medical conditions before they become serious.
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| Stakeholder Communication, Participation and Consultation |
The Project was designed with inputs from Ministry of Health, Ministry of Agriculture, Nutrition Research Center, World Vision Mongolia, School of Public Health faculty, Action Contre la Faim, Health Sciences University faculty, Consumer Rights Association, and representatives of United Nations agencies and NGOs working on food and nutrition issues. Specific social analysis and perspectives of communities was generated during the comprehensive social assessments carried out for the JFPR-MON: Access to Health Services for the Poor and Vulnerable Groups In Ulaanbaatar and for the Third Health Sector Development Project. MOH has set up a multisectoral working group to prepare the project since January 2008. In April 2008, consultation meetings with MOH and key stakeholders (FAO, WHO, Unicef, universities, NGO) were held to discuss the proposed project. The Japanese Embassy in Ulaanbaatar and the MOH are both very supportive of ADB's initiatives.
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| Responsible ADB Officer |
Itgel Lonjid
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| Responsible ADB Department |
East Asia Department
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| Responsible ADB Division |
Urban and Social Sectors Division, EARD
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| Concept Clearance |
05 Jun 2008 |
| Fact-finding |
17 Jul 2008 to
12 Aug 2008 |
| Board Approval |
16 Mar 2009 |
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CLOSING |
| Grant No. |
Approval |
Signing |
Effectivity |
Original |
Revised |
Actual |
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TOTAL (
Amount in US$ million) |
| Project Cost |
2.00
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| ADB |
0.00
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| Counterpart |
0.00
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| Cofinancing |
2.00
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| Date |
ADB |
OTHERS |
Net Percentage |
| Cumulative Contract
Awards |
| 19 Jun 2013 |
1.834
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92%
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| Cumulative
Disbursements |
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19 Jun 2013 |
1.728
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86%
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| Category |
Sector |
Social |
Financial |
Economic |
Others |
Safe |
| Rating |
Satisfactory
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Satisfactory
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Satisfactory
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Satisfactory
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Satisfactory
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Satisfactory
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