DIRECTORATE NUTRITION

CLUSTER: MATERNAL, CHILD AND WOMEN’S HEALTH

DEPARTMENT OF HEALTH

2000/01 BUDGET HEARINGS

UPDATE ON INTEGRATED NUTRITION STRATEGY

  1. The Integrated Nutrition Strategy was adopted in the Department of Health’s White Paper for the Transformation of the Health System in South Africa, 1994
  2. Since 1994, the Directorate Nutrition has been involved in a consultative process to develop the Integrated Nutrition Programme (INP) that is based on the Integrated Nutrition Strategy.
  3. The Broad Guidelines for the Implementation of the INP were distributed in 1998.
  4. Since then, significant progress has been made with the implementation of the INP. This can briefly be summarised as follows:

Policy Development and Guidelines

The following guidelines have been developed during 1999:

Capacity Building, Training and Technical Support

The Provincial Technical Support and Liaison Programme is fully operational and takes the form of provincial visits by the national focal persons for the various provinces and three meetings per annum with the provincial subdirectorates for nutrition.

The visits focus on monitoring and support of provincial projects and activities such as parasite control projects, community-based nutrition development projects, school feeding projects, projects and activities to address malnutrition, etc. The visits are structured around the provincial INP Business Plans.

The National Training and Capacity Building Project started in 1997. The project is aimed at building human resource capacity around the implementation of the INP. The project takes the form of Training of Trainers, Advocacy Workshops for programme managers and field support for TOTs. The project has been completed in all the provinces with the exception of North West, which has been placed on hold due to provincial restructuring processes. In total 155 TOTs were trained and 162 people attended the advocacy workshops.

Following the training of 206 health professionals in lactation management during 1996/97 and the evaluation of the training from October to December 1998, the following activities were undertaken during 1999 regarding the BFHI:

Between April and November 1999, a total of 212 staff members from provincial and district levels were trained in the INP Monitoring Framework and reporting formats.

During May 1999, a workshop was held for the Directorate Nutrition and provincial representatives to develop an implementation framework for community-based nutrition. Specific areas were identified that needed attention to ensure the successful implementation of community-based nutrition projects. These included a mechanism to ensure that resources are targeted at the most vulnerable communities and capacity building at district level. The process to develop a system that would enable provincial subdirectorates for nutrition to identify the most vulnerable districts has commenced with the Free State Province as the starting point.

Food Fortification and Micronutrient Deficiency Control

The following progress can be reported:

Information, Education and Communication

The following surveys, the results of which will be taken forward during 2000, have been completed:

The following nutrition information and promotion activities have been completed:

 

Financial Management and Administration

Since 1994, when the concepts of project management and business planning were first introduced for RDP Lead Projects, capacity has been built to such an extent that project proposals (at community level) and business plans (at national and provincial levels) are requirements for funding in terms of the INP.

The INP Conditional Grant Allocation augments the normal budget allocations for the INP. The scope of funding for the Conditional Grant Allocation, which replaced the RDP Allocation for the PSNP in the 1998/99 financial year, provides for all the focus areas of the INP and are not restricted to school feeding. In addition, the Department of State Expenditure has approved the use of the INP Conditional Grant Allocation by provincial subdirectorates for nutrition to fund recurrent expenditure such as personnel and running costs. These provisions have enabled the department to actively initiate processes that will lead to a fully operational INP.

The following table reflects the use of the INP Conditional Grant Allocation in the 1999/2000 financial year:

FOCUS AREA/KPA/SUPPORT SYSTEM

PERCENTAGE OF CONDITIONAL GRANT ALLOCATION

Management

4.14%

Community-based Nutrition

3.69%

Prevention and Treatment of Malnutrition

4.23%

Micronutrient Deficiency Control/Food Fortification

.48%

School Nutrition

83.08%

Food Service Management

.09%

Parasite Control

1.13%

INP Models/Pilots

1.04%

Capacity Building and Training

.85%

Information, Education and Communication

.7%

Nutrition Information System/Surveillance

.57%

The auditing of nutrition programmes, which started in 1995, was completed at the end of 1999.

DIRECTORATE NUTRITION

Cluster: Maternal, Child and Women’s Health

Budget Hearings: 2000/01

Performance Targets for 1999/2000 Financial Year.

1 KPA: POLICY DEVELOPMENT AND GUIDELINES

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

1.1 Develop nutrition guidelines for different groups who are HIV/AIDS affected

-Tender specifications have been developed

-Advertised during Aug 99

-Vetting on the tender took place during Dec 99

-AFRICON was the successful tenderer

-Inter-directorate meeting with the tenderer Mar 00

Yes

Ongoing

Due to delays with tender process, the tender awarded in Dec 99. Implementation carried over to 2000/01

Very high

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

1.2 Develop guidelines for food services management and administration

-Interviews conducted on 3 June 1999

-Mr A Rasekhala was the successful candidate and resumed duty on 1 Sep 99

-Work has been conducted in Gauteng, Free State, Northern Province, North West Province, Eastern Cape, Mpumalanga and KwaZulu/Natal

-Progress report submitted Jan 2000

 

Second stage: Writing of final report

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

1.3 Therapeutic dietary guidelines developed

 

Yes

Ongoing

Suitable consultant could not be appointed. Function to be performed by Dir. And sub-dir’s for Nutrition in 2000/01 financial year

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

1.4 Maintain and distribute broad guidelines for the implementation of the INP

-Draft Guidelines finalised in Jan 98 for 99/00.

-Health Facility-based Nutrition Intervention (HFBNI) guidelines were edited into the INP format

-

Ongoing

-

High

1.5 Contribute to the implementation of the guidelines on micronutrient supplementation

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

1.5.1 Iodine Deficiency Disorder (IDD) survey

-second draft submitted Apr 99

-Presented at Quarterly meeting 1-3 Feb 00

-Final report available Feb 00

-

Ongoing

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

1.5.2 Develop an integrated micro-nutrient strategy

 

-workshop on development of micro-nutrient control strategy was held Feb 00

- results and recommendations of the IDD Survey and the Food Consumption Survey were presented

-broad action plan for micro-nutrient proposed

-interventions are being developed

-

Second stage: Interventions are being developed

-

High

 

 

 

 

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

1.6 National Breastfeeding Guidelines for health workers and health facilities and Policy guidelines and recommendation for the feeding of infants of HIV positive mothers

-Guidelines were presented to MINMEC Dec 99

-Approved by MINMEC and recommended that two documents be merged

-Documents were merged in Jan 00

- Document printed with the assistance from UNICEF

-

Yes

 

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

1.7 Guidelines for health facility-based nutrition interventions to prevent malnutrition.

-Guidelines for health facility-based nutrition interventions to prevent malnutrition compiled

-Guidelines are pending PHRC approval

-

Second stage: Pending approval

-

High

2 KPA: CAPACITY BUILDING, TRAINING AND TECHNICAL SUPPORT

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

2.1 Conduct regular provincial technical support and liaison visits

-Dates for the above programmes for the 1999/ 2000 financial year

-Visits have commenced and reports are produced

-Business Plans for the 99/2000 year approved

-Eight provinces have already submitted 2000/01 draft business plans.

-

Ongoing

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

2.2 Hold annual (3) meetings, linked to workshops, with provincial sub-directorates for nutrition

-Meetings held during May 99, 28-30 Sep 99 and 1-3 Feb 2000

-

Ongoing

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

2.3 Implement the National Nutrition Capacity Building Project

-curriculum developed and implemented

-Resource and training manuals developed

- provincial training conducted for 305 delegates

-

Ongoing

-

Very high

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

2.4 Manage BFHI assessments

-10 training-of-trainer courses in lactation management were presented

-15 health facilities were assessed for the BFHI during Oct 99

-eight health facilities were awarded the BFHI status

-four facilities were awarded the Certificate of Commitment

three facilities were acknowledged for the initiation of BFHI activities

-

Yes

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

2.5 Training of provincial staff on growth monitoring and promotion

-April-May 99 revised and updated the content as and graphics of the RtHC

-Jul-Aug 99 compiled, guidelines for health workers on growth monitoring

-

Ongoing

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

2.6 Contribute to student training

- 1 week student programme was conducted to 6 dietetic students from MEDUNSA from 10-14 Aug 99

-Workshop on the structuring of a business plan was facilitated at the University of Pretoria for final year dietetic students in community nutrition on 24 Apr 99

-

Ongoing

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

2.7 Contribute to the Integrated Management of Childhood Illnesses (IMCI)

-Training courses conducted in Mpumalanga, KwaZulu/Natal, Northern Cape and the Northern Province

-

Ongoing

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

2.8 Contribute to the development of minimum requirements and competencies for entry level dietitians

-Three expert committees in the fields of therapeutic nutrition, community nutrition and food service management were formed

-Compiled competency statements regarding each of these practice areas

-Recommendation concerning each of the competencies were formulated

-Results of the survey and recommendations were distributed to various departments/institutions for comments

-

Ongoing

-

High

3 KPA: FOOD FORTIFICATION

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

3.1 Develop Food Fortification Guidelines

A Fortification Technology feasibility assessment and a Industry Situation Analysis were conducted Information was used to compile a draft food fortification profile

The profile proposes maize meal and wheat flour as potential food vehicles and that sugar

may also be considered

-

Ongoing

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

3.2 Food Consumption Survey

-Provincial coordinators were trained in Jan 99 and field workers were trained in Feb 99

-Findings of the Food Consumption Survey were reported at the Management Committee Nov 99.

-Findings of the survey were presented during Feb 2000 quarterly meeting.

-Final report will be available by 10 April 2000.

-

Ongoing

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

3.3 Develop and implement IEC plan and packages for target groups

-Discussion document "A Broad framework for nutrition education in South Africa"is developed

-Consultancy for the development of an IEC plan for the Fortification Programme will commence at the end of Feb 2000 for 10 months.

-

Ongoing

-

Very high

4 KPA: COMMUNITY-BASED NUTRITION

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

4.1 Support and facilitate the transformation, expansion and establishment of community-based nutrition projects

In the 98/99 financial year an amount of R28 million was made available for poverty projects. The amount of R7,845 million was rolled over to the 1999/2000 financial year and a further R23 million was allocated for poverty projects, to make a total of R30,845 million.

263 projects were implemented for amount of R24,9 million

-

Ongoing

-

Very high

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

4.2 Coordinate the development of parasite control projects

In KwaZulu/Natal the first two rounds of treatment have taken place. The 2nd round took place. A further R2,5 million was made available by the Finnish government to the KwaZulu/Natal Department of Health

The project has gained momentum with the survey on parasite control becoming available. The project is set to start the first round of treatment, as soon as the district teams have been trained with the assistance of the WHO.

The Mpumalanga Province has also received an allocation of R2,5 million from the Finnish government.

-

Yes

-After the 1st round some resistance from communities was experienced

-In the Mpumalanga Province the parasite control project slowed down due to administrative problems.

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

4.3 Evaluation of Certain Aspects of School Feeding

-A meeting was held on 23 Jun 99 to review the specifications of the 1998/99 tender

-Specifications were submitted to the Director-General: Health and approved on 28 Sep 99

-The FMC has approved that the tender could be called in the 1999/2000 financial year and that the expenditure could be incurred in the 2000/01 financial year

- The tender was called on 11 Feb 2000 and will close on 31 Mar 2000.

An information session for prospective tenderers was held on 25 Feb 2000.

Yes

Ongoing

Tender amount exceeded project amount.. Tender revised and approval obtained to implement in 2000/01 financial year

Very high

5 KPA: NUTRITION INFORMATION, EDUCATION AND COMMUNICATION / PROMOTION

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

5.1 Manage the Adaption of Primary School Nutrition Education package

 

 

 

Department of Health, in partnership with the Department of Education, embarked on a programme to develop a Nutrition Education Package to support Curriculum 2005.

The Department of Education has been requested in Jul 99 to present the nutrition education package to HEDCOM and inform the Department of Health accordingly.

-

Ongoing

-

Very high

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

5.2 Develop and distribute booklets on IDD

 

 

Ongoing

-The IDD Report has not yet being finalised

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

5.3 Develop and distribute booklets on Food Consumption

.

 

Ongoing

-The Food Consumption Survey Report is not yet available

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

5.4 Organise 12th National Breastfeeding Week

-The 12th National Breastfeeding Week was held from

1-7 Aug 99.

-Media coverage was obtained and reports were published in the Star as well as the Sowetan

-A telephonic radio interview was also conducted and broadcasted

-

Ongoing

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

5.10 Compile a Nutrition Research Agenda

-Members from academic and research institutions as well as the Directorate HSR, RC & E participated in a task team on 21 Oct 99

-The assessment of completed, present and ongoing nutrition research areas will commence during 2000/01

-

Ongoing

-

High

6 KPA: FINANCIAL MANAGEMENT

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

6.1 Conduct external audits

-Audits of the PSNP, NNSDP & PEM have been conducted in all Provinces

-Extended audits of the NNSDP in Gauteng and of the PSNP in KwaZulu/Natal have also taken place

-

Yes

-

High

Performance Area

Achieved

Not achieved

Target stage and Policy reached

Reasons target not reached

Priority of target

6.2 Conduct external assessment of the INP

-The evaluation will commence during the 2000/01 financial year

The Terms of Reference have been drafted.

 

Ongoing

-Due to administrative delays, the evaluation of the PMT has become irrelevant. On 28 Sep 99 it was therefore decided to propose a tender for the evaluation of the financial and administrative procedures of the INP

High

DIRECTORATE NUTRITION

CLUSTER: MATERNAL, CHILD AND WOMEN’S HEALTH

DEPARTMENT OF HEALTH

2000/01 BUDGET HEARINGS

PERFORMANCE TARGETS FOR 2000/01 FINANCIAL YEAR

OBJECTIVE

TARGET

PRIORITY

TIME FRAME

LEGISLATION

CONSTRAINTS

SOLUTIONS

To provide policy and implementation guidelines for the INP and its focus areas

Policy and implementation guidelines for the INP and its focus areas developed/reviewed/

updated/maintained/

implemented

  • INP policy and implementation guidelines
  • Integrated micronutrient control strategy
  • BFHI
  • Primary school nutrition
  • Food service management
  • Capacity building and training

H

March 2001

No

Delays with the submission of the Food Consumption Survey Report by the Consultants and with the approval of the vitamin A policy have a cascading delaying effect on the development of the micronutrient control strategy and other policies and guidelines. For example, the food fortification guidelines can not be finalised. In addition, the vitamin A policy and guidelines were not approved when anticipated.

 

  • Continuos follow up through appropriate channels
  • Written commitment was obtained from the consultants that the Food Consumption Survey Report will be submitted in April 2000
  • The vitamin A policy and guidelines have reached the Minister of Health whose approval is now awaited

Voluntary Code of Ethics for the Marketing of Breast Milk Substitutes reviewed

VH

June 2000

Yes

Resistance from Baby Food Industry on legislating the Code

  • Will be addressed by bringing them into the process from the start

To develop and implement nutrition promotion, education, communication and marketing activities for the INP

Nutrition education framework completed

H

July 2000

No

None

N/a

Nutrition education activities completed

  • Nutrition and lifestyle guidelines for people living with HIV/AIDS
  • Phase 1: Therapeutic dietary guidelines
  • Food consumption
  • IDD
  • Food fortification
  • Breastfeeding

VH

March 2001

No

Due to delays with the tender process, the tender for the development of nutrition and lifestyle guidelines for people living with HIV/AIDS was only awarded in December 1999. The implementation, therefore, has to be carried over to the 2000/01 financial year

A suitable consultant could not be found for the development of therapeutic dietary guidelines during 1999/00 with the result that this important activity also has to be carried over to the 2000/01 financial year

The national Directorate Nutrition, in conjunction with the provincial subdirectorates for nutrition, will perform this activity in the 2000/01 financial year. Given the limited capacity in terms of human resources the project will be completed in phases with phase 1 scheduled for the 2000/01 financial year

INP marketing activities completed

  • INP newsletter
  • INP magazine
  • INP pamphlets
  • INP poster

H

March 2001

No

None

N/a

Legislative framework for food fortification developed

VH

December 2000

Yes

None

N/a

To develop, implement and maintain a National Nutrition Information System for the INP which would include monitoring, information reporting, evaluation and research

Minimum data set for INP Management Information System developed

H

April 2000

No

There is a lack of data.

Will start from a minimum data set and develop further as more data become available.

Monitoring systems for the following in place

  • INP
  • Capacity building and training
  • Provincial technical support and liaison visits
  • IDD and salt iodation
  • Distribution and use of vitamin A brochure

VH

March 2001

No

None

N/a

Provincial subdirectorates for nutrition provided with GIS maps for targeting of resources and services

H

March 2001

No

None

N/a

BFHI assessments completed

H

September 2000

No

None

N/a

Evaluation of certain aspects of school feeding completed

VH

November 2000

No

None

N/a

Nutrition research register in place

H

November 2000

No

None

N/a

Surveys and studies for food fortification programme completed

  • Organoleptic and consumer acceptability study
  • National aneamia survey

VH

 

 

 

 

June 2000

March 2001

No

None

N/a

Nutrition surveillance manual and guidelines completed

H

March 2001

No

None

N/a

To plan, coordinate and implement capacity building and training activities for the INP

Induction courses for health workers involved in the INP completed

VH

March 2001

No

None

N/a

In-service training for 2000/01 financial year for INP personnel completed

H

March 2001

No

None

N/a

Competency-based in-service training programme developed for implementation in 2001/02 financial year

H

March 2001

No

None

N/a

District Resource Manual on INP completed

VH

March 2001

No

None

N/a

Human resource policy and implementation plan for INP developed

VH

June 2000

No

To avoid delays, approaches will be adapted to be in line with broad DoH Human resource Plan and decentralisation process

N/a

Training plan for industry on food fortification facilitated

H

October 2000

No

Success depend on collaboration from the industry

Collaboration with industry would be obtained through a communication and social marketing campaign

To ensure the implementation of the INP in all provinces through technical support visits and regular meetings

  • Three meetings with provincial subdirectorates for nutrition held
  • All technical support visits completed

H

March 2001

No

None

N/a

To implement an effective administration, financial and personnel management system for the INP

Assessment of financial and administrative procedures of INP at implementation levels completed

VH

October 2000

No

None

N/a

100% expenditure of normal budget allocation, conditional grant allocation and poverty alleviation allocation

VH

March 2001

No

Delays with the establishments of projects due to capacity problems at provincial level will be addressed by forming a partnership with the IDT in terms of Poverty Alleviation Fund

N/a

Methodology for distribution of resources (Conditional grant allocation and poverty alleviation allocation) to provinces reviewed

H

September 2000

No

None

N/a

Planning completed in line with planning cycle

  • Operational plan for 2001/02 completed
  • MTEF estimations for 2001/02, 2002/03 and 2003/04 completed
  • MTEF 2001/02, 2002/03 and 2003/04 finalised
  • Individual work plans and job descriptions for 2000/01 completed

VH

 

 

March 2001

May 2000

 

December 2000

April 2000

No

None

N/a