Table 2 Summary of policy documents

Multisectoral considerations

Both recognise multi-causal nature of malnutrition and need for MoPH collaboration with other ministries

MoPH policy acknowledges need for broad-based interventions to tackle malnutrition, specifically for nutritious foods and education/awareness but largely remains health sector focused

MoPH policies similar to previous years; ANDS is multisector by design and guides overall development strategy

MoPH BPHS guidelines are health service delivery specific; WASH Policy, AFSANA and NAF address multisectoral approaches for improving nutrition outcomes with WASH and food security

Public Nutrition Policy and FSN have extensive linkages to food security and safety strategies and their effect on nutrition; Hygiene Promotion Strategy covers sanitation, personal hygiene and food hygiene messages

MoPH National Health Strategy has a strong health sector focus; AFSeN was developed across multiple line ministries, including nutrition and food security

Main nutrition objectives

Ensure prevalence of acute malnutrition or wasting remains <5% for children under 5 years old; access to iodised salt; control micronutrient deficiency disease outbreaks; increase EBF; increase public nutrition capacity and skills

Increase service coverage and quality to prevent and treat communicable diseases and malnutrition among children and adults

New content includes increasing appropriate IYCF practices; reduce major micronutrient deficiency disorder prevalence; ANDS outlines government-wide efforts to recognise nutrition as development foundation, establish nutrition target responsibility across sectors and identify feasible actions to achieve targets

Deliver BPHS/EPHS nutrition component; improve access to safe drinking water, make communities ODF, increase hygiene awareness and practices; improve availability, access to and use of healthy foods

Largely a continuation of earlier objectives

Greater political and social commitment to improve food security and nutrition through increased financial resources; advocate for involvement of private and public sectors and communities in food security and nutrition activities

Key nutrition strategies

National food security and nutrition surveillance system; nutrition surveys with standardised indicators; household food security interventions; adequate nutritious food aid; emergency SFPs; universal salt iodisation; integrated micronutrient education, treatment, supplementation and food fortification; appropriate IYCF support and promotion; establish appropriate services for SAM diagnosis and treatment; nutrition education, communication and advocacy; integrated IMCI

In addition to previous strategies, collaborate with other line ministries to address environmental health consequences of poor water supplies and lack of adequate sanitation facilities

In addition to previous strategies, adopt public nutrition approach involving multi-sectoral interventions (food insecurity, poor social environment and inadequate health service access); focus on quality salt iodisation, flour fortification, diarrhoeal interventions and therapeutic feeding of hospitalised malnourished children; application of IYCF policy and strategy supported by advocacy, technical guidance and law enforcement; IYCF promotion and counselling implemented within BPHS and EPHS in all health facilities; public–private partnerships with food industry and local markets

In addition to previous strategies, hygiene education in schools, community groups and women’s groups; establish and maintain community water systems, community-led household latrine promotion and construction; increase food availability through production and dietary diversification, food storage and preservation, market availability; improve food access through food transfers, food for work or assets, poverty alleviation programmes and community-based income generation; National Solidarity Program/Citizen's Charter Program

In addition to previous strategies, multipronged approach to address micronutrient deficiency problems, with special focus on anaemia and iron deficiency among women of reproductive age and children 6–59 months of age

Advocacy to prioritise audiences through meetings, workshops and seminars, with nutrition advocacy materials package for each target audience to build a critical mass of food security and nutrition advocates and promote a national coordinated effort to improve food security and nutrition; CLTS

Changes over time

Baseline nutrition policy and strategy

Language more specific to environmental factors and linkages beyond health sector, nutrition IEC, service provision and training; no nutrition indicators included in M&E plan for national policy/strategy

Identified target groups: women, adolescent girls and children; expanded target micronutrient deficiencies; mapping nutrition indicators by source; more comprehensive list of strategies linked to each objective

Emphasis on nutritious food programming and community-led WASH (with separate implementation from nutrition programmes)

No significant changes from previous years, rather continuation of identified key strategies

Prioritise advocacy audiences of multisectoral government ministries and authorities, private sector (e.g. food producers, importers and retailers), religious leaders, development partners, donors, civil society organisations, and media

Programmatic responses

Established Consultative Group for Health and Nutrition to coordinate work across ministries and donors; implemented public nutrition component within BPHS, including micronutrient supplementation, clinical malnutrition treatment, measles and vitamin A campaigns (coverage targets >95% and >85%, respectively); 25 iodised salt factories established through partnerships with private sector and MoM; small-scale flour fortification

Implemented nutrition services within EPHS with BPHS; 47 TFUs established within provincial hospitals; Piloted CMAM; SFP added in 2009 to CMAM pilot; Food and Drug Quality Control Department established in MoPH; Quality Control department in MAIL developed legislation, regulatory frameworks, standards, etc. on certification systems and laboratory testing for food quality and safety; Nutrition Cluster activated

IYCF public awareness campaigns; Baby Friendly Hospital Initiative, complementary feeding (recipes and participatory cooking sessions); passage of Maternity Protection Act; Code of Marketing of Breast Milk Substitutes adopted by government; application of the Positive Deviance-Hearth model; and piloting C-GMP; formative research on infant and young child feeding practices, including TIPS and recipes; developed breastfeeding counselling tools and trained 80 breastfeeding master trainers and 3000 counsellors in health facilities; Celebration of World Breastfeeding Week annually, launched National Breastfeeding Communication Campaign in 2009; introduction of re-lactation support as part of TFUs; refurbished MoPH equipment and labs; Afghan National Standards Authority established

Established Food and Nutrition Secretariat and high-level steering committee; efforts to implement nutrition-sensitive programmes increasing with improved HED capacity in MAIL and agriculture projects are designed to be more nutrition sensitive

Promotion of home-based food processing, storage and conservation, particularly for women; IEC on food and nutrition issues;

food safety standards and control; expansion of nutrition sensitive products (vegetables, fruits) in home gardens and on agricultural land

CLTS aimed at supporting communities to be open defecation-free through hygiene education, community mobilisation and behaviour change